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Article ; Online: The trauma laparotomy-A key procedure that lacks global data.

Bath, Michael F / Bashford, Tom

2024 Volume 48, Issue 5, Page(s) 1001–1003

MeSH term(s)	Humans ; Laparotomy/methods ; Abdominal Injuries/surgery ; Global Health ; Wounds and Injuries/surgery
Language	English
Publishing date	2024-04-17
Publishing country	United States
Document type	Journal Article ; Editorial
ZDB-ID	224043-9
ISSN	1432-2323 ; 0364-2313
ISSN (online)	1432-2323
ISSN	0364-2313
DOI	10.1002/wjs.12168
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Zs.A 1336: Show issues

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Jg. 1995 - 2021: Lesesall (1.OG)
ab Jg. 2022: Lesesaal (EG)

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Article: Design as a quality improvement strategy: The case for design expertise.

Lamé, Guillaume / Komashie, Alexander / Sinnott, Carol / Bashford, Tom

Future healthcare journal

2024 Volume 11, Issue 1, Page(s) 100008

Abstract: Bad design in safety-critical environments like healthcare can lead to users being frustrated, excluded or injured. In contrast, good design can make it easier to use a service correctly, with impacts on both the safety and efficiency of healthcare ... ...

Abstract	Bad design in safety-critical environments like healthcare can lead to users being frustrated, excluded or injured. In contrast, good design can make it easier to use a service correctly, with impacts on both the safety and efficiency of healthcare delivery, as well as the experience of patients and staff. The participative dimension of design as an improvement strategy has recently gained traction in the healthcare quality improvement literature. However, the role of design expertise and professional design has been much less explored. Good design does not happen by accident: it takes expertise and the specific reasoning that expert designers develop through practical experience and training. Here, we define design, show why poor design can be disastrous and illustrate the benefits of good design. We argue for the recognition of distinctive design expertise and describe some of its characteristics. Finally, we discuss how design could be better promoted in healthcare improvement.
Language	English
Publishing date	2024-02-29
Publishing country	England
Document type	Journal Article
ZDB-ID	3016427-8
ISSN	2514-6653 ; 2514-6645
ISSN (online)	2514-6653
ISSN	2514-6645
DOI	10.1016/j.fhj.2024.100008
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Article ; Online: Perioperative management of adults with traumatic brain injury.

Okeke, Chinazo / Zhang, Jenny / Bashford, Tom / Seah, Matthew

Journal of perioperative practice

2023 Volume 34, Issue 4, Page(s) 122–128

Abstract: Despite advances in management strategy, traumatic brain injury remains strongly associated with neurological impairment and mortality. Management of traumatic brain injury requires careful and targeted management of the physiological consequences which ... ...

Abstract	Despite advances in management strategy, traumatic brain injury remains strongly associated with neurological impairment and mortality. Management of traumatic brain injury requires careful and targeted management of the physiological consequences which extend beyond the scope of the primary impact to the cranium. Here, we present a review of the principles of its acute management in adults. We outline the procedure which patients are assessed and the critical physiological variables which must be monitored to prevent further neurological damage. We describe current interventional strategies from the context of the underlying physiological mechanisms and recent clinical data and identify persisting challenges in traumatic brain injury management and potential avenues of future progress.
MeSH term(s)	Adult ; Humans ; Brain Injuries/surgery ; Brain Injuries/complications ; Intracranial Pressure/physiology ; Brain Injuries, Traumatic/surgery ; Brain Injuries, Traumatic/complications
Language	English
Publishing date	2023-08-31
Publishing country	England
Document type	Review ; Journal Article
ZDB-ID	2226186-2
ISSN	2515-7949 ; 1750-4589
ISSN (online)	2515-7949
ISSN	1750-4589
DOI	10.1177/17504589231187798
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Zs.A 4006: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (2.OG) ab Jg. 2022: Lesesaal (EG)
Zs.MG 83: Show issues

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Article ; Online: How can communication to GPs at hospital discharge be improved? A systems approach.

Boddy, Nicholas / Barclay, Stephen / Bashford, Tom / Clarkson, P John

BJGP open

2022 Volume 6, Issue 1

Abstract: Background: Poor communication to GPs at hospital discharge threatens patient safety and continuity of care, with reliance on discharge summaries that are commonly written by the most junior doctors. Previous quality improvement efforts have largely ... ...

Abstract	Background: Poor communication to GPs at hospital discharge threatens patient safety and continuity of care, with reliance on discharge summaries that are commonly written by the most junior doctors. Previous quality improvement efforts have largely focused on adherence to standardised templates, with limited success. A lack of understanding has been identified as a cause of the issue's resistance to decades of improvement work. Aim: To understand the system of communication to GPs at hospital discharge, with a view to identifying potential routes to improvement. Design & setting: A qualitative exploration of the secondary-to-primary care communication system surrounding a large UK hospital. Method: A systems approach, recently defined for the healthcare domain, was used to structure and thematically analyse interviews ( Results: The largely one-way communication system structure and the low level of hospital stakeholder insight into recipient GP needs emerged as consistent hindrances to system performance. More open lines of communication and shared records might enable greater collaboration to share feedback and resolve informational deficits. Teaching sessions and assessments for medical students and junior doctors led by GPs could help to instil the importance of detail and nuance when using standardised communication templates. Conclusion: Facilitating the sharing of performance insights between stakeholder groups emerged as the key theme of how communication might be improved. The empirical measures proposed have the potential to mitigate the safety risks of key barriers to performance such as patient complexity.
Language	English
Publishing date	2022-03-22
Publishing country	England
Document type	Journal Article
ISSN	2398-3795
ISSN (online)	2398-3795
DOI	10.3399/BJGPO.2021.0148
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Article: Quality improvement in low resource settings: an Ethiopian experience.

Bashford, Tom

British journal of hospital medicine (London, England : 2005)

2013 Volume 74, Issue 5, Page(s) 286–288

Abstract: Improving surgical and anaesthetic mortality in the developing world is a global health priority. Quality improvement processes have a role to play in addressing this need and are applicable to low-resource settings despite difficulties in their ... ...

Abstract	Improving surgical and anaesthetic mortality in the developing world is a global health priority. Quality improvement processes have a role to play in addressing this need and are applicable to low-resource settings despite difficulties in their implementation. International initiatives to reduce perioperative mortality can be focussed to support interventions at the level of individual departments, but this requires integration with existing local systems and an understanding of the specific needs of the institutions concerned. There is a small but growing evidence base for quality improvement in low resource settings, but this needs to be locally accessible to allow self-sustaining evidence-based quality improvement.
MeSH term(s)	Anesthesia/mortality ; Anesthesia/standards ; Cooperative Behavior ; Ethiopia ; Health Resources ; Humans ; Quality Improvement ; Surgical Procedures, Operative/mortality ; Surgical Procedures, Operative/standards
Language	English
Publishing date	2013-03-15
Publishing country	England
Document type	Journal Article
ISSN	1750-8460
ISSN	1750-8460
DOI	10.12968/hmed.2013.74.5.286
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Article ; Online: Anaesthesia in Ethiopia: providers' perspectives on the current state of the service.

Bashford, Tom

Tropical doctor

2013 Volume 44, Issue 1, Page(s) 6–13

Abstract: The improvement of surgical and anaesthetic safety in low-resource settings is hampered by a lack of reliable information on the current provision of these services. Ethiopia is one of the world's poorest countries and, despite large amounts of both ... ...

Abstract	The improvement of surgical and anaesthetic safety in low-resource settings is hampered by a lack of reliable information on the current provision of these services. Ethiopia is one of the world's poorest countries and, despite large amounts of both foreign and domestic investment, still reports some of the worst health outcomes. However, information on anaesthesia and surgical provision is sparse. This work reproduces a questionnaire study, first used in Uganda in 2006, to survey practising anaesthetists regarding the current state of anaesthesia services across Ethiopia. The results indicate that a large proportion of centres remain unable to provide safe general, spinal, paediatric and obstetric anaesthesia, at all levels of hospital and across almost all of the country's regions. In addition to a lack of equipment and pharmaceuticals, anaesthetists report problems with professional recognition and a lack of access to continuing professional development as key barriers to service development.
MeSH term(s)	Anesthesia/standards ; Anesthesia, General/standards ; Anesthesia, Obstetrical/standards ; Anesthesia, Spinal/standards ; Anesthesiology/education ; Anesthesiology/standards ; Anesthetics/supply & distribution ; Attitude of Health Personnel ; Child ; Delivery of Health Care/standards ; Education, Medical, Continuing ; Equipment and Supplies, Hospital/standards ; Equipment and Supplies, Hospital/supply & distribution ; Ethiopia ; Female ; Health Care Surveys/methods ; Humans ; Pregnancy ; Safety ; Surveys and Questionnaires
Chemical Substances	Anesthetics
Language	English
Publishing date	2013-11-15
Publishing country	England
Document type	Journal Article
ZDB-ID	193169-6
ISSN	1758-1133 ; 0049-4755
ISSN (online)	1758-1133
ISSN	0049-4755
DOI	10.1177/0049475513512642
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Zs.A 1056: Show issues

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Jg. 1995 - 2021: Lesesall (1.OG)
ab Jg. 2022: Lesesaal (EG)

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Article ; Online: The EyeVu Consortium for global neurosurgery.

Smith, Brandon G / Rambabu, Lekaashree / Kolias, Angelos G / Hutchinson, Peter J / Bashford, Tom

The Lancet. Neurology

2023 Volume 22, Issue 10, Page(s) 883–884

MeSH term(s)	Humans ; Neurosurgery ; Neurosurgical Procedures
Language	English
Publishing date	2023-09-20
Publishing country	England
Document type	Letter ; Research Support, Non-U.S. Gov't
ZDB-ID	2081241-3
ISSN	1474-4465 ; 1474-4422
ISSN (online)	1474-4465
ISSN	1474-4422
DOI	10.1016/S1474-4422(23)00328-9
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Zs.A 5955: Show issues

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ab Jg. 2022: Lesesaal (EG)

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Article ; Online: Using network analysis to model the effects of the SARS Cov2 pandemic on acute patient care within a healthcare system.

Kohler, Katharina / Jankowski, Matthew D / Bashford, Tom / Goyal, Deepi G / Habermann, Elizabeth B / Walker, Laura E

Scientific reports

2022 Volume 12, Issue 1, Page(s) 10050

Abstract: Consolidation of healthcare in the US has resulted in integrated organizations, encompassing large geographic areas, with varying services and complex patient flows. Profound changes in patient volumes and behavior have occurred during the SARS Cov2 ... ...

Abstract	Consolidation of healthcare in the US has resulted in integrated organizations, encompassing large geographic areas, with varying services and complex patient flows. Profound changes in patient volumes and behavior have occurred during the SARS Cov2 pandemic, but understanding these across organizations is challenging. Network analysis provides a novel approach to address this. We retrospectively evaluated hospital-based encounters with an index emergency department visit in a healthcare system comprising 18 hospitals, using patient transfer as a marker of unmet clinical need. We developed quantitative models of transfers using network analysis incorporating the level of care provided (ward, progressive care, intensive care) during pre-pandemic (May 25, 2018 to March 16, 2020) and mid-pandemic (March 17, 2020 to March 8, 2021) time periods. 829,455 encounters were evaluated. The system functioned as a non-small-world, non-scale-free, dissociative network. Our models reflected transfer destination diversification and variations in volume between the two time points - results of intentional efforts during the pandemic. Known hub-spoke architecture correlated with quantitative analysis. Applying network analysis in an integrated US healthcare organization demonstrates changing patterns of care and the emergence of bottlenecks in response to the SARS Cov2 pandemic, consistent with clinical experience, providing a degree of face validity. The modelling of multiple influences can identify susceptibility to stress and opportunities to strengthen the system where patient movement is common and voluminous. The technique provides a mechanism to analyze the effects of intentional and contextual changes on system behavior.
MeSH term(s)	COVID-19/epidemiology ; Critical Care ; Delivery of Health Care ; Humans ; Pandemics ; Retrospective Studies ; Severe Acute Respiratory Syndrome
Language	English
Publishing date	2022-06-16
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2615211-3
ISSN	2045-2322 ; 2045-2322
ISSN (online)	2045-2322
ISSN	2045-2322
DOI	10.1038/s41598-022-14261-3
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Article ; Online: Can process mapping and a multisite Delphi of perioperative professionals inform our understanding of system-wide factors that may impact operative risk?

Stubbs, Daniel / Bashford, Tom / Gilder, Fay / Nourallah, Basil / Ercole, Ari / Levy, Nicholas / Clarkson, John

BMJ open

2022 Volume 12, Issue 11, Page(s) e064105

Abstract: Objectives: To examine whether the use of process mapping and a multidisciplinary Delphi can identify potential contributors to perioperative risk. We hypothesised that this approach may identify factors not represented in common perioperative risk ... ...

Abstract	Objectives: To examine whether the use of process mapping and a multidisciplinary Delphi can identify potential contributors to perioperative risk. We hypothesised that this approach may identify factors not represented in common perioperative risk tools and give insights of use to future research in this area. Design: Multidisciplinary, modified Delphi study. Setting: Two centres (one tertiary, one secondary) in the UK during 2020 amidst coronavirus pressures. Participants: 91 stakeholders from 23 professional groups involved in the perioperative care of older patients. Key stakeholder groups were identified via process mapping of local perioperative care pathways. Results: Response rate ranged from 51% in round 1 to 19% in round 3. After round 1, free text suggestions from the panel were combined with variables identified from perioperative risk scores. This yielded a total of 410 variables that were voted on in subsequent rounds. Including new suggestions from round two, 468/519 (90%) of the statements presented to the panel reached a consensus decision by the end of round 3. Identified risk factors included patient-level factors (such as ethnicity and socioeconomic status), and organisational or process factors related to the individual hospital (such as policies, staffing and organisational culture). 66/160 (41%) of the new suggestions did not feature in systematic reviews of perioperative risk scores or key process indicators. No factor categorised as 'organisational' is currently present in any perioperative risk score. Conclusions: Through process mapping and a modified Delphi we gained insights into additional factors that may contribute to perioperative risk. Many were absent from currently used risk stratification scores. These results enable an appreciation of the contextual limitations of currently used risk tools and could support future research into the generation of more holistic data sets for the development of perioperative risk assessment tools.
MeSH term(s)	Humans ; Delphi Technique ; Systematic Reviews as Topic ; Consensus ; Perioperative Care/methods ; Hospitals
Language	English
Publishing date	2022-11-11
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2599832-8
ISSN	2044-6055 ; 2044-6055
ISSN (online)	2044-6055
ISSN	2044-6055
DOI	10.1136/bmjopen-2022-064105
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Article ; Online: Artificial intelligence-enabled ophthalmoscopy for papilledema: a systematic review protocol.

Rambabu, Lekaashree / Smith, Brandon G / Tumpa, Stasa / Kohler, Katharina / Kolias, Angelos G / Hutchinson, Peter J / Bashford, Tom

International journal of surgery protocols

2023 Volume 28, Issue 1, Page(s) 27–30

Abstract: Papilledema is a pathology delineated by the swelling of the optic disc secondary to raised intracranial pressure (ICP). Diagnosis by ophthalmoscopy can be useful in the timely stratification of further investigations, such as magnetic resonance imaging ... ...

Abstract	Papilledema is a pathology delineated by the swelling of the optic disc secondary to raised intracranial pressure (ICP). Diagnosis by ophthalmoscopy can be useful in the timely stratification of further investigations, such as magnetic resonance imaging or computed tomography to rule out pathologies associated with raised ICP. In resource-limited settings, in particular, access to trained specialists or radiological imaging may not always be readily available, and accurate fundoscopy-based identification of papilledema could be a useful tool for triage and escalation to tertiary care centres. Artificial intelligence (AI) has seen a rise in neuro-ophthalmology research in recent years, but there are many barriers to the translation of AI to clinical practice. The objective of this systematic review is to garner and present a comprehensive overview of the existing evidence on the application of AI in ophthalmoscopy for papilledema, and to provide a valuable perspective on this emerging field that sits at the intersection of clinical medicine and computer science, highlighting possible avenues for future research in this domain.
Language	English
Publishing date	2023-12-22
Publishing country	England
Document type	Journal Article
ISSN	2468-3574
ISSN (online)	2468-3574
DOI	10.1097/SP9.0000000000000016
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