Inter-professional clinical handover in post-anaesthetic care units: tools to improve quality and safety

OBJECTIVES: To examine quality and safety in inter-professional clinical handovers in Post Anaesthetic Care Units (PACUs) and make recommendations for tools to standardize handover processes.
DESIGN: Mixed methods combining data from observations and focus groups.
SETTING: Three PACUs, one public tertiary hospital and two private hospitals.
PARTICIPANTS: Observations were made of 185 patient handovers from anaesthetists to nurses. Eight focus groups were conducted with 62 staff (15 anaesthetists and 47 nurses) across the study sites.
INTERVENTION: Inter-professional clinical handovers in PACU's.
MAIN OUTCOME MEASURES: Characteristics of the structure and processes that support safe inter-professional PACU handover practice.
RESULTS: Characteristics of the process, content, activities and risks during anaesthetist to nurse patient handover into the PACU were integrated into four steps in the PACU handover process summarized by the acronym COLD (Connect, Observe, Listen and Delegate), a verbal communication tool (ISoBAR), a checklist of critical information for safe patient transfer into PACU and a matrix of factors perceived to increase handover risk.
CONCLUSIONS: The standard structure and checklists for optimal content of patient handovers were derived from existing practices and consensus, hence, expected to provide ecologically valid and practical resources to improve quality and safety during clinical handovers in the PACU.

Medical burden, body mass index and the outcome of psychosocial interventions for bipolar depression

Objective: Individuals with bipolar disorder experience a disproportionately high incidence of medical co-morbidity and obesity. These health-related problems are a barrier to recovery from mood episodes and have been linked with unfavorable responses to pharmacological treatment. However, little is known about whether and how these characteristics affect responses to adjunctive psychotherapy. Method: Embedded in the Systematic Treatment Enhancement Program for Bipolar Disorder was a randomized controlled trial of psychotherapy for bipolar depression comparing the efficacy of intensive psychotherapy plus pharmacotherapy with collaborative care (a three-session psycho-educational intervention) plus pharmacotherapy. We conducted a post-hoc analysis to evaluate whether medical burden and body mass index predicted and/or moderated the likelihood of recovery and time until recovery from a depressive episode among patients in the two treatments. Results: Participants who had medical co-morbidity and body mass index data constituted 199 of the 293 patients in the original Systematic Treatment Enhancement Program for Bipolar Disorder trial. Higher medical burden predicted a lower likelihood of recovery from depression in both treatment conditions (odds ratio = 0.89), but did not moderate responses to intensive psychotherapy vs collaborative care. Intensive psychotherapy yielded superior recovery rates for individuals of normal body mass index (odds ratio= 2.39) compared with collaborative care, but not among individuals who were overweight or obese. Conclusion: Medical co-morbidity and body weight impacts symptom improvement and attention to this co-morbidity may inform the development of more personalized treatments for bipolar disorder.

Post-crisis: rebuilding a company, a reputation, a community

It is well recognised that when an organisation experiences a crisis caused by a natural disaster,publics are less likely to apportion responsibility to that organisation. This contrasts with crisesinvolving events such as product tampering, accidents or management transgressions where thelevel of organisational control is perceived or judged to be greater (Coombs, 2000, p. 86). In 2012,biomedical company Gambro’s manufacturing plant, based in Medolla, a small town of 6000 in theModena region of Italy, was hit by a devastating series of earthquakes. Damage to the plant hadsignificant and immediate impact for employees, customers and other key stakeholders, as operationsceased in the wake of the earthquakes.This chapter will reflect on Gambro’s crisis management response and their crisis communicationstrategies in response to the earthquakes and the ensuing rumours. An analysis ofGambro’s crisis response shows they acted to counteract stakeholder concerns and leveragewell-established stakeholder relationships. As Coombs (2000, 2006, 2007a, 2007b) makes clear,relationships are central to effective crisis management, and, although stakeholders often view anatural disaster as being removed from the organisation’s responsibility, this concession may not exist in a prolonged recovery period or where the stakeholders face a life or death outcome. Thesewere the very conditions Gambro faced. So, a relational approach can add depth to the attributionalanalysis of such a crisis (Coombs 2000, p. 86). To extend the analysis of crises caused bynatural disaster and Gambro’s crisis response, the chapter will also examine crisis communicationstrategies of similar disaster case studies.The international medical-technical company Gambro, headquartered in Sweden, has 13 productionfacilities in more than 90 countries, and employs more than 8000 people worldwide. Gambrohas operated in the Medolla region of Emilia-Romagna since the early 1960s.