Browsing by Author "Kaba, Alyshah"

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    An experimental study on the impact of clinical interruptions on simulated trainee performances of central venous catheterization
    (2017-02-14) Jones, Jessica; Wilkins, Matthew; Caird, Jeff; Kaba, Alyshah; Cheng, Adam; Ma, Irene W Y
    Abstract Background Interruptions are common in the healthcare setting. This experimental study compares the effects of interruptions on simulated performances of central venous catheterization during a highly versus minimally complex portion of the task. Methods Twenty-six residents were assigned to interruptions during tasks that are (1) highly complex: establishing ultrasound-guided venous access (experimental group, n = 15) or (2) minimally complex: skin cleansing (control group, n = 11). Primary outcomes were (a) performance scores at three time points measured with a validated checklist, (b) time spent on the respective tasks, and (c) number of attempts to establish venous access. Results Repeated measure analyses of variances of performance scores over time indicated no main effect of time or group. The interaction between time and group was significant: F (2, 44) = 4.28, p = 0.02, and partial eta2 = 0.16, indicating a large effect size. The experimental group scores decreased steadily over time, while the control group scores increased with time. The experimental group required longer to access the vein (148 s; interquartile range (IQR) 60 to 361 vs. 44 s; IQR 27 to 133 s; p = 0.034). Median number of attempts to establish venous access was higher in the experimental group (2, IQR 1–7 vs. 1, IQR 1–2; p = 0.03). Conclusions Interruptions during a highly complex task resulted in a consistent decrement in performance scores, longer time required to perform the task, and a higher number of venous access attempts than interruptions during a minimally complex tasks. We recommend avoiding interrupting trainees performing bedside procedures.
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    Building impactful systems-focused simulations: integrating change and project management frameworks into the pre-work phase
    (2021-04-29) Dubé, Mirette; Posner, Glenn; Stone, Kimberly; White, Marjorie; Kaba, Alyshah; Bajaj, Komal; Cheng, Adam; Grant, Vincent; Huang, Simon; Reid, Jennifer
    Abstract Healthcare organizations strive to deliver safe, high-quality, efficient care. These complex systems frequently harbor gaps, which if unmitigated, could result in harm. Systems-focused simulation (SFS) projects, which include systems-focused debriefing (SFD), if well designed and executed, can proactively and comprehensively identify gaps and test and improve systems, enabling institutions to improve safety and quality before patients and staff are placed at risk. The previously published systems-focused debriefing framework, Promoting Excellence and Reflective Learning in Simulation (PEARLS) for Systems Integration (PSI), describes a systematic approach to SFD. It includes an essential “pre-work” phase, encompassing evidence-informed steps that lead up to a SFD. Despite inclusion in the PSI framework, a detailed description of the pre-work phase, and how each component facilitates change management, was limited. The goal of this paper is to elucidate the PSI “Pre-work” phase, everything leading up to the systems-focused simulation and debriefing. It describes how the integration of project and change management principles ensures that a comprehensive collection of safety and quality issues are reliably identified and captured.
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    Commissioning simulations to test new healthcare facilities: a proactive and innovative approach to healthcare system safety
    (2019-07-16) Kaba, Alyshah; Barnes, Sue
    Abstract Development and reconstruction of new healthcare facilities and spaces has the potential for latent safety threats to emerge, specifically unintentional harm that could affect actual patients once the facility opens, such as missing equipment, inefficient setup, or insufficient space for procedures. Process-orientated simulation and testing is a novel innovation in healthcare. The aim of process-orientated simulations and debriefing is to examine the process of care, rather than the outcome of care. These simulations, which take place in actual patient care settings and environments prior to occupancy, are an emerging strategy that can be used to test new environments and new healthcare facilities to ensure that the spaces created match the needs of the staff and administration, while proactively identifying latent safety threats prior to delivering patient care. In turn, these simulations can be also be used as part of the new site orientation and training plan. The aim of this paper is to examine a case study describing the use of the novel innovation of process-orientated simulations to test the opening of a new 300-bed healthcare facility.
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    Correction to: COVID-19 pandemic preparation: using simulation for systems-based learning to prepare the largest healthcare workforce and system in Canada
    (2021-04-20) Dubé, Mirette; Kaba, Alyshah; Cronin, Theresa; Barnes, Sue; Fuselli, Tara; Grant, Vincent
    An amendment to this paper has been published and can be accessed via the original article.
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    COVID-19 pandemic preparation: using simulation for systems-based learning to prepare the largest healthcare workforce and system in Canada
    (2020-08-18) Dubé, Mirette; Kaba, Alyshah; Cronin, Theresa; Barnes, Sue; Fuselli, Tara; Grant, Vincent
    Abstract Healthcare resources have been strained to previously unforeseeable limits as a result of the COVID-19 pandemic of 2020. This has prompted the emergence of critical just-in-time COVID-19 education, including rapid simulation preparedness, evaluation and training across all healthcare sectors. Simulation has been proven to be pivotal for both healthcare provider learning and systems integration in the context of testing and integrating new processes, workflows, and rapid changes to practice (e.g., new cognitive aids, checklists, protocols) and changes to the delivery of clinical care. The individual, team, and systems learnings generated from proactive simulation training is occurring at unprecedented volume and speed in our healthcare system. Establishing a clear process to collect and report simulation outcomes has never been more important for staff and patient safety to reduce preventable harm. Our provincial simulation program in the province of Alberta, Canada (population = 4.37 million; geographic area = 661,848 km2), has rapidly responded to this need by leading the intake, design, development, planning, and co-facilitation of over 400 acute care simulations across our province in both urban and rural Emergency Departments, Intensive Care Units, Operating Rooms, Labor and Delivery Units, Urgent Care Centers, Diagnostic Imaging and In-patient Units over a 5-week period to an estimated 30,000 learners of real frontline team members. Unfortunately, the speed at which the COVID-19 pandemic has emerged in Canada may prevent healthcare sectors in both urban and rural settings to have an opportunity for healthcare teams to participate in just-in-time in situ simulation-based learning prior to a potential surge of COVID-19 patients. Our coordinated approach and infrastructure have enabled organizational learnings and the ability to theme and categorize a mass volume of simulation outcome data, primarily from acute care settings to help all sectors further anticipate and plan. The goal of this paper is to share the unique features and advantages of using a centralized provincial simulation response team, preparedness using learning and systems integration methods, and to share the highest risk and highest frequency outcomes from analyzing a mass volume of COVID-19 simulation data across the largest health authority in Canada.
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    An experimental study on the impact of clinical interruptions on simulated trainee performances of central venous catheterization
    (BioMed Central, 2017-02) Jones, Jessica; Wilkins, Matthew; Caird, Jeff; Kaba, Alyshah; Cheng, Adam; Ma, Irene
    Background: Interruptions are common in the healthcare setting. This experimental study compares the effects of interruptions on simulated performances of central venous catheterization during a highly versus minimally complex portion of the task. Methods: Twenty-six residents were assigned to interruptions during tasks that are (1) highly complex: establishing ultrasound-guided venous access (experimental group, n = 15) or (2) minimally complex: skin cleansing (control group, n = 11). Primary outcomes were (a) performance scores at three time points measured with a validated checklist, (b) time spent on the respective tasks, and (c) number of attempts to establish venous access. Results: Repeated measure analyses of variances of performance scores over time indicated no main effect of time or group. The interaction between time and group was significant: F (2, 44) = 4.28, p = 0.02, and partial eta2 = 0.16, indicating a large effect size. The experimental group scores decreased steadily over time, while the control group scores increased with time. The experimental group required longer to access the vein (148 s; interquartile range (IQR) 60 to 361 vs. 44 s; IQR 27 to 133 s; p = 0.034). Median number of attempts to establish venous access was higher in the experimental group (2, IQR 1–7 vs. 1, IQR 1–2; p = 0.03). Conclusions: Interruptions during a highly complex task resulted in a consistent decrement in performance scores, longer time required to perform the task, and a higher number of venous access attempts than interruptions during a minimally complex tasks. We recommend avoiding interrupting trainees performing bedside procedures.
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    Group Conformity in Interprofessional Teams
    (2016) Kaba, Alyshah; Beran, Tanya; White, Deborah; McLaughlin, Kevin
    Within the multidisciplinary team environment, professionals bring varying levels of experience, authority, and responsibility: examining how team members interact is critical to ensure the highest standard of patient care. One type of influence in this environment is peer pressure, whereby an individual changes his or her own behavior to match the responses of others in a group. Known as conformity, this body of research, which spans 60 years since Asch’s (1951) seminal work, has only recently been examined in medical education (Beran et al., 2012). When the individual conforms to an incorrect diagnosis or plan for treatment, the safety of the patient may be compromised, contributing to the burden of adverse events. Given the ubiquity of collaborative practice in healthcare, the research presented in this dissertation is about succumbing to peer pressure - and the greater pressures experienced by nursing as compared to medical students to conform to a procedural task. This thesis is divided into four papers. The first paper is a narrative review, the second paper is a methods paper, the third paper compares the difference between medical and nursing students’ rate of conformity on a vital sign skill task, and the fourth paper examines whether conforming on the vital signs task is related to their clinical interpretations. The study is an adaption of the original Asch design to recreate conformity within an interprofessional simulated environment. The findings from the four papers presented in this dissertation, suggest that social pressure may prevent nursing and medical students from questioning incorrect information within interprofessional environments. If health professional students are making clinical decisions based on the consensus of the group, this is a critical issue for patient safety, as we cannot negate the fact that these students will one day be future doctors and nurses and will be working with real patients. To improve teamwork and collaboration amongst medicine and nursing in practice, Interprofessional Education (IPE) curriculum needs to teach students how to overcome barriers within the medical hierarchy, by encouraging students to question and politely challenge what seems to be incorrect information.