Redefining the clinical gaze

Lachman, Peter

doi:10.1136/bmjqs-2013-002322

Cited by 13 publications

(12 citation statements)

References 17 publications

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“…Originally a military concept, it has become a core aspect of safety in the aviation industry6 and has recently been translated into healthcare 78 In healthcare, situation awareness involves redirecting the ‘clinical gaze’9 to encompass a range of prospective indicators of risk or deterioration, including clinical indicators and staff and parent concerns, so that healthcare professionals can review relevant information and act on it as required. It takes the position that any person involved in the care of the patient could have a piece of information that is critical for understanding the future state of the child.…”

Section: Introductionmentioning

confidence: 99%

Realistic evaluation of Situation Awareness for Everyone (SAFE) on paediatric wards: study protocol

et al. 2016

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IntroductionEvidence suggests that health outcomes for hospitalised children in the UK are worse than other countries in Europe, with an estimated 1500 preventable deaths in hospital each year. It is presumed that some of these deaths are due to unanticipated deterioration, which could have been prevented by earlier intervention, for example, sepsis. The Situation Awareness For Everyone (SAFE) intervention aims to redirect the ‘clinical gaze’ to encompass a range of prospective indicators of risk or deterioration, including clinical indicators and staff concerns, so that professionals can review relevant information for any given situation. Implementing the routine use of huddles is central to increasing situation awareness in SAFE.Methods and analysisIn this article, we describe the realistic evaluation framework within which we are evaluating the SAFE programme. Multiple methods and data sources are used to help provide a comprehensive understanding of what mechanisms for change are triggered by an intervention and how they have an impact on the existing social processes sustaining the behaviour or circumstances that are being targeted for change.Ethics and disseminationEthics approval was obtained from London—Dulwich Research Ethics Committee (14/LO/0875). It is anticipated that the findings will enable us to understand what the important elements of SAFE and the huddle are, the processes by which they might be effective and—given the short timeframes of the project—initial effects of the intervention on outcomes. The present research will add to the extant literature by providing the first evidence of implementation of SAFE and huddles in paediatric wards in the UK.

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Section: Introductionmentioning

confidence: 99%

Realistic evaluation of Situation Awareness for Everyone (SAFE) on paediatric wards: study protocol

et al. 2016

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“…The safety huddle is a brief, multidisciplinary team ward meeting that aims to establish situational awareness and redirect clinical teams towards a proactive approach to assessment and intervention. 10 Situational Awareness for Everyone (SAFE) is a framework that promotes the safety huddle as an intervention by drawing on both quantitative and qualitative data. 11 It empowers any member of the team to contribute meaningful information towards the perioperative care of the surgical patient.…”

Section: Designmentioning

confidence: 99%

The Surgical Safety Huddle: Novel Quality Improvement Patient Safety Initiative

et al. 2021

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Background: Acutely deteriorating patients are entitled to the best possible care which includes early recognition and timely appropriate intervention to reduce adverse events, unnecessary admissions to intensive care and/or cardiac arrest. Aim: To reduce the number of poor outcomes for surgical patients with a National Early Warning Score (NEWS) score ≥7 in our institution by 50%. A poor outcome was defined as: 1. Cardiac arrest 2. NEWS >7 not improving after 72 hours 3. Transfer to ICU >6 hours Methods: Surgical inpatients from a variety of surgical specialties (general, vascular, breast, colorectal, hepatobiliary, and plastic surgery) in a large university teaching hospital were included. Quality improvement tools were used to generate regular dialogue with the clinical teams, resulting in the concept of the surgical safety huddle being proposed. Deteriorating patients were highlighted at the daily huddle and a plan of early intervention was implemented. An incremental approach with continuous PDSA [Plan- Do-Study-Act] cycles and subsequent feedback was adopted on the surgical ward to develop the huddle. Poor patient outcomes were analysed prospectively via chart reviews. Results: Prior to the introduction of the “surgical huddle” 110 patients with NEWS >7 were audited. Twenty-eight of these patients had a poor outcome at 72 hours (25%). Following the introduction of the surgical huddle supported by the deteriorating patient team, 64 patients with NEWS >7 were reviewed. Three of these patients had a poor outcome at 72 hours (4.7%). The introduction of the surgical huddle increased the interval between cardiac arrests more than sixfold on the surgical ward. Discussion: The introduction of the surgical safety huddle supported by the deteriorating patient response team reduced the number of cardiac arrests and poor outcomes in a surgical inpatient cohort.

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“…I subsequently visited him at his family home, after he had consented to participate in this study, with his family members present and his mother joined the discussion. The complexity of interactions between a person with TBI and family members (who may be taking carer roles) requires consideration within the context of family life, rather than in the clinical gaze of the healthcare or research setting that prioritise clinical perspectives (Lachman, 2013). The interview was conducted more in line with a conversation rather than following structured topic guide, thereby integrating social interactions within the research (Medved, 2007).…”

Section: A Narrative Case Studymentioning

confidence: 99%