Mina Azimirad

Objectives: : Real-time automated alert and trigger systems that notify clinical staff beyond the patient’s assigned bedside nurse are increasingly used to improve the recognition and response to clinical deterioration in hospital wards. This review evaluated their effects on clinical outcomes in adult general ward patients. Data Sources: : Seven electronic databases were searched from inception to April 1, 2024, supplemented with citation tracking. Study Selection: : Two sets of reviewers independently screened for comparative studies assessing automated clinical deterioration alert and trigger systems vs. conventional manual escalation processes. Data Extraction: : Two sets of reviewers extracted data. Primary outcomes were hospital mortality and in-hospital cardiac arrest. Secondary outcomes included unplanned ICU transfers, and hospital and ICU length of stay. Data were pooled using random-effects meta-analysis. Data Synthesis: : Eighteen studies ( n = 349,818) were included: two randomized controlled trials (RCTs), 15 before-and-after designs, and one quasi-experimental study. All studies had at least moderate risk of bias. The main meta-analysis included nine studies ( n = 58,632) involving alert-eligible cohorts (i.e., patients meeting alert thresholds). Based on two before-and-after studies, automated alert and trigger systems were associated with a significant reduction in-hospital cardiac arrests (risk ratio [RR], 0.60; 95% CI, 0.43–0.85; p = 0.004). No significant reduction in hospital mortality was observed (RR, 0.80; 95% CI, 0.62–1.05; p = 0.09), based on pooled data from RCTs and before-and-after studies. ICU length of stay was also significantly reduced, based on one RCT and one before-and-after study. No significant effects were found for hospital length of stay or unplanned ICU transfers in either alert-eligible or all-admission cohorts. Conclusions: : Real-time clinical deterioration automated alert and trigger systems are associated with reduced in-hospital cardiac arrests and may offer mortality benefits when integrated into structured escalation pathways. Further high-quality trials are needed to confirm these findings and optimize system design.

Digitalization in healthcare education has shifted simulation learning methods to distanced implementations. Successful transition to distance education requires effective communication and the teacher’s good ability to use digital learning methods, as well as students’ active interaction and motivation throughout the entire educational process. This study explores participants’ experiences of online large group simulations as an approach for learning about interprofessional collaboration. A mixed method design was used in this study. Data from health and social care students and qualified professionals were collected using a questionnaire which contained statements presented on a five-point Likert scale and open-ended questions. The questionnaire was filled online by 100 students and professionals. The quantitative data were analyzed using descriptive statistical methods, and the open-ended questions were analyzed with inductive content analysis. As a result, the participants were satisfied with the large group simulation intended for learning interprofessional collaboration (mean = 4.42, SD = 0.759). The majority viewed it as a good learning method (95%) that is suitable for interprofessional collaboration learning (90%) and for promoting working together (82%). Digitally activated communication tools promoted interactive discussion and activated joint learning. However, only one activation tool was preferred instead of using two methods simultaneously. In conclusion, distanced large group simulations were evaluated to be a good method for learning interprofessional collaboration. This study was not registered.

Background: Patient safety is a global concern. Learning to provide safe, high-quality care is core to nursing education. Problem: Students are exposed to diverse clinical practices, and experiences may vary between placements and across countries. Student experience is seldom used as an educational resource. Approach: An international, European Union-funded project, Sharing Learning from Practice for Patient Safety (SLIPPs), aimed to develop an innovative online educational package to assist patient safety learning. Based on student reported data and educational theory, multiple elements were iteratively developed by a multicountry, multidisciplinary group. Outcomes: The educational package is freely available on the SLIPPs Web site. Materials include a student reporting and reflection tool, virtual seminars, student reports data set, pedagogical game, high-fidelity simulation scenarios, scenario development and use guidelines, debriefing session model, and videos of simulations already performed. Conclusions: E-learning enables removal of physical barriers, allowing educators, professionals, and students from all over the world to collaborate, interact, and learn from each other.

Background: The role of medical emergency team (MET) in managing deteriorating patients and enhancing patient safety is greatly affected by teamwork.Aims: To identify teamwork‐related needs of the MET from MET nurses' perspectives. To assess the associations between MET nurses' perceptions of teamwork and their work experience and education.Study design: A quantitative, descriptive correlational design.Methods: Registered intensive care unit (ICU) nurses (n = 50) who were members of the MET in an acute tertiary care hospital answered a modified version of the team assessment questionnaire in 2017. Data were analysed using descriptive statistics, the Kruskal‐Wallis test, and the univariate analysis of variance method. The reporting of this study adheres to the strengthening the reporting of observational studies (STROBE) guidelines.Results: Participants showed least agreement with the items presenting leadership skills (mean = 2.6, SD = 0.68). Approximately 50% nurses disagreed that the MET had adequate resources, training, and skills. The majority of nurses (80%) felt that their responsibilities as a MET member interfered with taking care of their own ICU patients. Many nurses (64%) felt that they did not have a voice in MET's decision‐making process. Approximately 50% nurses felt that they were not recognized for their individual contribution, and they were uncertain regarding MET's policies for dealing with conflicts. The amounts of MET nurses' work experience and education were associated with MET skills and function, respectively.Conclusion: Key teamwork elements of the MET that need improvements include decision‐making and conflict resolution skills, valuing team members, and team leadership. Practicing shared mental models, implementing the TeamSTEPPS curricula at hospitals for training ICU nurses, and simulation‐based team‐training programmes may be beneficial in improving teamwork of MET members.Relevance to clinical practice: This study revealed key teamwork elements of the MET that need improvements. Our findings may contribute to improve teamwork, thereby optimizing MET function, and enhancing patient outcomes.

While technical and profession‐specific competencies are paramount in the delivery of healthcare services, the cross‐cutting core competencies of healthcare professionals play an important role in healthcare transformation, innovation, and the integration of roles. This systematic review describes the characteristics and psychometric properties of existing instruments for assessing healthcare professionals' core competencies in clinical settings. It was guided by the JBI methodology and used the COSMIN checklist (Mokkink et al., User manual, 2018, 78, 1) to evaluate the methodological quality of the included studies. A database search (CINAHL, Scopus, and PubMed) and additional manual search were undertaken for peer‐reviewed papers with abstracts, published in English between 2008 and 2019. The search identified nine studies that were included in the synthesis demonstrating core competencies in professionalism, ethical and legal issues, research and evidence‐based practice, personal and professional development, teamwork and collaboration, leadership and management, and patient‐centered care. Few instruments addressed competencies in quality improvement, safety, communication, or health information technology. The findings demonstrate the reviewed tools' validity and reliability and pave the way for a comprehensive evaluation and assessment of core competencies into clinical practice.