H Higham - Academia.edu (original) (raw)

Papers by H Higham

Anaesthesia

SummaryClinical emergencies can be defined as unpredictable events that necessitate immediate int... more SummaryClinical emergencies can be defined as unpredictable events that necessitate immediate intervention. Safety critical industries have acknowledged the difficulties of responding to such crises. Strategies to improve human performance and mitigate its limitations include the provision and use of cognitive aids, a family of tools that includes algorithms, checklists and decision aids. This systematic review evaluates the usefulness of cognitive aids in clinical emergencies. Following a systematic search of the electronic databases, we included 13 randomised controlled trials, reported in 16 publications. Each compared cognitive aids with usual care in the context of an anaesthetic, medical, surgical or trauma emergency involving adults. Most trials used only clinicians in the development and testing of the cognitive aids, and only some trials provided familiarisation with the cognitive aids before they were deployed. The primary outcome was the completeness of care delivered to ...

Anaesthesia

Most surgical and anaesthetic mortality and morbidity occurs postoperatively, disproportionately ... more Most surgical and anaesthetic mortality and morbidity occurs postoperatively, disproportionately affecting lowand middle-income countries. Various short courses have been developed to improve patient outcomes in lowand middle-income countries, but none specifically to address postoperative care and complications. We aimed to identify key features of a proposed short-course addressing this topic using a Delphi process with lowand middle-income country anaesthesia providers trained as short-course facilitators. An initial questionnaire was co-developed from literature review and exploratory workshops to include 108 potential course features. Features included content; teaching method; appropriate participants; and appropriate faculty. Over three Delphi rounds (panellists numbered 86, 64 and 35 in successive cycles), panellists indicated which features they considered most important. Responses were analysed by geographical regions: Africa, the Americas, southeast Asia and Western Pacific. Ultimately, panellists identified 60, 40 and 54 core features for the proposed course in each region, respectively. There were high levels of consensus within regions on what constituted core course content, but not between regions. All panellists preferred the small group workshop teaching method irrespective of region. All regions considered anaesthetists to be key facilitators, while all agreed that both anaesthetists and operating theatre nurses were key participants. The African and Americas regional panels recommended more multidisciplinary healthcare professionals for participant roles. Faculty from high-income countries were not considered high priority. Our study highlights variability between geographical regions as to which course features were perceived as most locally relevant, supporting regional adaptation of short-course design rather than a one-size-fits-all model.

BMJ Simulation and Technology Enhanced Learning, 2020

This review will present developments in simulation-based education (SBE) over the past decade wi... more This review will present developments in simulation-based education (SBE) over the past decade with a focus on activity in the UK’s National Health Service and the role of the national society (the Association for Simulation Practice in Healthcare). The article covers the evolution of strategic changes for the use of SBE in the UK and the operational challenges faced by clinicians and other faculty in SBE. The expansion of the evidence base to support SBE in healthcare both in technical skills and, more broadly, in interprofessional team training is explored. Finally, the wider role of simulation in patient safety and healthcare systems, including testing pathways and the development of cognitive aids and involvement of patients in SBE is considered.

Peripheral nerve blocks, 2021

The duration of the blockade was assessed. Pain intensity was assessed at the 6th, 12th, 24th and... more The duration of the blockade was assessed. Pain intensity was assessed at the 6th, 12th, 24th and 36th h. after blockade. The amount of narcotic anesthetic were also recorded. In addition, patients underwent electromyography of the innervation area of the blocked nerve before the surgery and 24 and 36h after surgery. Results Duration of blockade in G2 was longer by 10h, intensity of pain was significantly higher after 24h (1.65 ± 1.35 in G2 and 5.3 ± 1.26 in G1). According to electromyography, 24h after blockade conductance in G1 was restored by 95-100%, unlike G2, where conductivity was restored by only 47-59%. Conclusions Proposed combination of local anesthetics and adjuvants provides both adequate anesthesia during surgery and prolonged post-operative analgesia.

BMJ Simulation and Technology Enhanced Learning, 2020

BMC Health Services Research, 2020

Background The Partners at Care Transitions Measure (PACT-M) is a patient-reported questionnaire ... more Background The Partners at Care Transitions Measure (PACT-M) is a patient-reported questionnaire for evaluation of the quality and safety of care transitions from hospital to home, as experienced by older adults. PACT-M has two components; PACT-M 1 to capture the immediate post discharge period and PACT-M 2 to assess the experience of managing care at home. In this study, we aim to examine the psychometric properties, factor structure, validity and reliability of the PACT-M. Methods We administered the PACT-M over the phone and by mail, within one week post discharge with 138 participants and one month after discharge with 110 participants. We performed principal components analysis and factors were assessed for internal consistency, reliability and construct validity. Results Reliability was assessed by calculating Cronbach’s alpha for the 9-item PACT-M 1 and 8-item PACT-M 2 and exploratory factor analysis was performed to evaluate dimensionality of the scales. Principal components...

British Journal of General Practice, 2020

International Journal of Surgery, 2018

Improving emergency surgical care for patients with right iliac fossa pain at a regional scale: a... more Improving emergency surgical care for patients with right iliac fossa pain at a regional scale: a Quality Improvement study using the Supported Champions implementation strategy,

BMJ Simulation and Technology Enhanced Learning, 2019

BMJ Simulation and Technology Enhanced Learning, 2019

BMC Health Services Research, 2019

Background: The transition of older patients (over 65 years of age) from hospital to their own ho... more Background: The transition of older patients (over 65 years of age) from hospital to their own home is a time when patients are at high risk. No measure currently exists to assess the experience, quality and safety of care transitions relevant to UK population. We aim to describe the development and initial testing of the Partners at Care Transitions Measure (PACT-M) as a patient-reported questionnaire for evaluation of the quality and safety of care transitions from hospital to home in older patients. Methods: We used an established measure development procedure which includes conceptualising the components of care transitions, item development, conducting a modified Delphi process and pilot-testing of the PACT-M with patients over 65 years old using telephone administration. Results: Pilot testing of the PACT-M suggests that the components identified cover the issues of most importance to patients. Face validity testing showed that the measure in its current form is acceptable to older patients. Conclusions: The measure developed in this study shows promise for use by those involved in planning, implementing and evaluating discharge care, and could be used to inform interventions to improve the transition from hospital to home for older patients.

BMJ Quality & Safety, 2019

BackgroundOver the past three decades multiple tools have been developed for the assessment of no... more BackgroundOver the past three decades multiple tools have been developed for the assessment of non-technical skills (NTS) in healthcare. This study was designed primarily to analyse how they have been designed and tested but also to consider guidance on how to select them.ObjectivesTo analyse the context of use, method of development, evidence of validity (including reliability) and usability of tools for the observer-based assessment of NTS in healthcare.DesignSystematic review.Data sourcesSearch of electronic resources, including PubMed, Embase, CINAHL, ERIC, PsycNet, Scopus, Google Scholar and Web of Science. Additional records identified through searching grey literature (OpenGrey, ProQuest, AHRQ, King’s Fund, Health Foundation).Study selectionStudies of observer-based tools for NTS assessment in healthcare professionals (or undergraduates) were included if they: were available in English; published between January 1990 and March 2018; assessed two or more NTS; were designed for...

British Journal of Anaesthesia, 2015

British Journal of Anaesthesia, 2016

British Journal of Anaesthesia, 2017

Human beings who work in complex, dynamic, and stressful situations make mistakes. This is as tru... more Human beings who work in complex, dynamic, and stressful situations make mistakes. This is as true for anaesthetists as for any other health-care professional, but we face unique challenges in the many roles and responsibilities we have in diverse clinical contexts. As a profession, we are well versed in the development and utilization of improvement techniques and technologies that prioritize high-quality, safe care for patients. This article focuses on one particular domain of patient safety in which anaesthetists have been pre-eminent, the use of simulation in training to improve both professional capabilities and patient safety in anaesthetic practice. This review considers the impact of error in health care; the role of anaesthetists in promoting simulation-based education for the development of clinical skills and improved teamwork; and their role in disseminating human factors and quality improvement science to enhance safety in the clinical workplace. Finally, we consider our position at the vanguard of developments in patient safety and how the profession should continue to pursue a leadership role in the application of simulation-based interventions to training and systems design across health care.

BMJ quality & safety, Jan 3, 2015

It is well recognised that a significant proportion of errors involving trainee doctors result fr... more It is well recognised that a significant proportion of errors involving trainee doctors result from failures of non-technical skills (NTS),1 which occur at least as frequently as knowledge and technical errors.2 Regardless of background, all trainees need generic skills of leadership, decision-making, team-working and resource management.3 It might, therefore, be expected that curricula for different specialties would use similar definitions and teaching methods to specify NTS standards. We have performed an analysis of medical training curricula to determine the extent to which different medical specialties set training objectives in NTS, and to seek trends in the prominence with which these skills feature. All hospital-based medical, surgical and critical-care specialties were obtained in mid-2013, along with each curriculum's immediate predecessor (where available). The curricula were initially searched for the core keywords ‘non-technical skills’, ‘situational awareness’ and ‘human factors’, as well as a list of secondary keywords (generated by a modified Delphi process) grouped under headings ‘task management’, ‘team working’, ‘situational awareness’ and ‘decision making’. The list was refined over two generations before consensus was reached. Each curriculum …

Anaesthesia

SummaryClinical emergencies can be defined as unpredictable events that necessitate immediate int... more SummaryClinical emergencies can be defined as unpredictable events that necessitate immediate intervention. Safety critical industries have acknowledged the difficulties of responding to such crises. Strategies to improve human performance and mitigate its limitations include the provision and use of cognitive aids, a family of tools that includes algorithms, checklists and decision aids. This systematic review evaluates the usefulness of cognitive aids in clinical emergencies. Following a systematic search of the electronic databases, we included 13 randomised controlled trials, reported in 16 publications. Each compared cognitive aids with usual care in the context of an anaesthetic, medical, surgical or trauma emergency involving adults. Most trials used only clinicians in the development and testing of the cognitive aids, and only some trials provided familiarisation with the cognitive aids before they were deployed. The primary outcome was the completeness of care delivered to ...

Anaesthesia

Most surgical and anaesthetic mortality and morbidity occurs postoperatively, disproportionately ... more Most surgical and anaesthetic mortality and morbidity occurs postoperatively, disproportionately affecting lowand middle-income countries. Various short courses have been developed to improve patient outcomes in lowand middle-income countries, but none specifically to address postoperative care and complications. We aimed to identify key features of a proposed short-course addressing this topic using a Delphi process with lowand middle-income country anaesthesia providers trained as short-course facilitators. An initial questionnaire was co-developed from literature review and exploratory workshops to include 108 potential course features. Features included content; teaching method; appropriate participants; and appropriate faculty. Over three Delphi rounds (panellists numbered 86, 64 and 35 in successive cycles), panellists indicated which features they considered most important. Responses were analysed by geographical regions: Africa, the Americas, southeast Asia and Western Pacific. Ultimately, panellists identified 60, 40 and 54 core features for the proposed course in each region, respectively. There were high levels of consensus within regions on what constituted core course content, but not between regions. All panellists preferred the small group workshop teaching method irrespective of region. All regions considered anaesthetists to be key facilitators, while all agreed that both anaesthetists and operating theatre nurses were key participants. The African and Americas regional panels recommended more multidisciplinary healthcare professionals for participant roles. Faculty from high-income countries were not considered high priority. Our study highlights variability between geographical regions as to which course features were perceived as most locally relevant, supporting regional adaptation of short-course design rather than a one-size-fits-all model.

BMJ Simulation and Technology Enhanced Learning, 2020

This review will present developments in simulation-based education (SBE) over the past decade wi... more This review will present developments in simulation-based education (SBE) over the past decade with a focus on activity in the UK’s National Health Service and the role of the national society (the Association for Simulation Practice in Healthcare). The article covers the evolution of strategic changes for the use of SBE in the UK and the operational challenges faced by clinicians and other faculty in SBE. The expansion of the evidence base to support SBE in healthcare both in technical skills and, more broadly, in interprofessional team training is explored. Finally, the wider role of simulation in patient safety and healthcare systems, including testing pathways and the development of cognitive aids and involvement of patients in SBE is considered.

Peripheral nerve blocks, 2021

The duration of the blockade was assessed. Pain intensity was assessed at the 6th, 12th, 24th and... more The duration of the blockade was assessed. Pain intensity was assessed at the 6th, 12th, 24th and 36th h. after blockade. The amount of narcotic anesthetic were also recorded. In addition, patients underwent electromyography of the innervation area of the blocked nerve before the surgery and 24 and 36h after surgery. Results Duration of blockade in G2 was longer by 10h, intensity of pain was significantly higher after 24h (1.65 ± 1.35 in G2 and 5.3 ± 1.26 in G1). According to electromyography, 24h after blockade conductance in G1 was restored by 95-100%, unlike G2, where conductivity was restored by only 47-59%. Conclusions Proposed combination of local anesthetics and adjuvants provides both adequate anesthesia during surgery and prolonged post-operative analgesia.

BMJ Simulation and Technology Enhanced Learning, 2020

BMC Health Services Research, 2020

Background The Partners at Care Transitions Measure (PACT-M) is a patient-reported questionnaire ... more Background The Partners at Care Transitions Measure (PACT-M) is a patient-reported questionnaire for evaluation of the quality and safety of care transitions from hospital to home, as experienced by older adults. PACT-M has two components; PACT-M 1 to capture the immediate post discharge period and PACT-M 2 to assess the experience of managing care at home. In this study, we aim to examine the psychometric properties, factor structure, validity and reliability of the PACT-M. Methods We administered the PACT-M over the phone and by mail, within one week post discharge with 138 participants and one month after discharge with 110 participants. We performed principal components analysis and factors were assessed for internal consistency, reliability and construct validity. Results Reliability was assessed by calculating Cronbach’s alpha for the 9-item PACT-M 1 and 8-item PACT-M 2 and exploratory factor analysis was performed to evaluate dimensionality of the scales. Principal components...

British Journal of General Practice, 2020

International Journal of Surgery, 2018

Improving emergency surgical care for patients with right iliac fossa pain at a regional scale: a... more Improving emergency surgical care for patients with right iliac fossa pain at a regional scale: a Quality Improvement study using the Supported Champions implementation strategy,

BMJ Simulation and Technology Enhanced Learning, 2019

BMJ Simulation and Technology Enhanced Learning, 2019

BMC Health Services Research, 2019

Background: The transition of older patients (over 65 years of age) from hospital to their own ho... more Background: The transition of older patients (over 65 years of age) from hospital to their own home is a time when patients are at high risk. No measure currently exists to assess the experience, quality and safety of care transitions relevant to UK population. We aim to describe the development and initial testing of the Partners at Care Transitions Measure (PACT-M) as a patient-reported questionnaire for evaluation of the quality and safety of care transitions from hospital to home in older patients. Methods: We used an established measure development procedure which includes conceptualising the components of care transitions, item development, conducting a modified Delphi process and pilot-testing of the PACT-M with patients over 65 years old using telephone administration. Results: Pilot testing of the PACT-M suggests that the components identified cover the issues of most importance to patients. Face validity testing showed that the measure in its current form is acceptable to older patients. Conclusions: The measure developed in this study shows promise for use by those involved in planning, implementing and evaluating discharge care, and could be used to inform interventions to improve the transition from hospital to home for older patients.

BMJ Quality & Safety, 2019

BackgroundOver the past three decades multiple tools have been developed for the assessment of no... more BackgroundOver the past three decades multiple tools have been developed for the assessment of non-technical skills (NTS) in healthcare. This study was designed primarily to analyse how they have been designed and tested but also to consider guidance on how to select them.ObjectivesTo analyse the context of use, method of development, evidence of validity (including reliability) and usability of tools for the observer-based assessment of NTS in healthcare.DesignSystematic review.Data sourcesSearch of electronic resources, including PubMed, Embase, CINAHL, ERIC, PsycNet, Scopus, Google Scholar and Web of Science. Additional records identified through searching grey literature (OpenGrey, ProQuest, AHRQ, King’s Fund, Health Foundation).Study selectionStudies of observer-based tools for NTS assessment in healthcare professionals (or undergraduates) were included if they: were available in English; published between January 1990 and March 2018; assessed two or more NTS; were designed for...

British Journal of Anaesthesia, 2015

British Journal of Anaesthesia, 2016

British Journal of Anaesthesia, 2017

Human beings who work in complex, dynamic, and stressful situations make mistakes. This is as tru... more Human beings who work in complex, dynamic, and stressful situations make mistakes. This is as true for anaesthetists as for any other health-care professional, but we face unique challenges in the many roles and responsibilities we have in diverse clinical contexts. As a profession, we are well versed in the development and utilization of improvement techniques and technologies that prioritize high-quality, safe care for patients. This article focuses on one particular domain of patient safety in which anaesthetists have been pre-eminent, the use of simulation in training to improve both professional capabilities and patient safety in anaesthetic practice. This review considers the impact of error in health care; the role of anaesthetists in promoting simulation-based education for the development of clinical skills and improved teamwork; and their role in disseminating human factors and quality improvement science to enhance safety in the clinical workplace. Finally, we consider our position at the vanguard of developments in patient safety and how the profession should continue to pursue a leadership role in the application of simulation-based interventions to training and systems design across health care.

BMJ quality & safety, Jan 3, 2015

It is well recognised that a significant proportion of errors involving trainee doctors result fr... more It is well recognised that a significant proportion of errors involving trainee doctors result from failures of non-technical skills (NTS),1 which occur at least as frequently as knowledge and technical errors.2 Regardless of background, all trainees need generic skills of leadership, decision-making, team-working and resource management.3 It might, therefore, be expected that curricula for different specialties would use similar definitions and teaching methods to specify NTS standards. We have performed an analysis of medical training curricula to determine the extent to which different medical specialties set training objectives in NTS, and to seek trends in the prominence with which these skills feature. All hospital-based medical, surgical and critical-care specialties were obtained in mid-2013, along with each curriculum's immediate predecessor (where available). The curricula were initially searched for the core keywords ‘non-technical skills’, ‘situational awareness’ and ‘human factors’, as well as a list of secondary keywords (generated by a modified Delphi process) grouped under headings ‘task management’, ‘team working’, ‘situational awareness’ and ‘decision making’. The list was refined over two generations before consensus was reached. Each curriculum …