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Correlation between medical performance and teamwork in multidisciplinary high fidelity obstetrics simulations [Meeting Abstract]

Detlefs, S E; Buttle, R; Goffman, D; Foley, M; Deering, S
Objective: Teamwork and communication gaps are consistently cited as contributors to adverse outcomes in Obstetrics. The Critical Care in Obstetrics Course provides an innovative experience by combining brief interactive didactics with hands-on simulation. Most participants have never worked together, which creates a unique environment to evaluate the importance of teamwork and communication. The objective of this study is to evaluate the association between teamwork and medical performance in high-fidelity critical care simulations.
Study Design: Participants were separated into multidisciplinary teams and taken through simulations including placental abruption, eclampsia, sepsis, cardiac arrest, venous thromboembolism, diabetic ketoacidosis (DKA) and thyroid storm. Facilitators completed a validated checklist assessment for each group's performance in medical care and teamwork. Each element was rated on a scale from 1 to 5, with 1 being unacceptable and 5 being perfect. We evaluated 5 communication measures, including use of closed-loop communication and orientation of new team members A spearman correlation was used to evaluate the relationship between total medical performance and total teamwork scores as well as specific measures of team communication. ROC curves were created for total teamwork score as a predictor of good or perfect medical performance.
Result(s): A total of 354 multidisciplinary teams participated in 1,564 high-fidelity simulations. There was a significant correlation between medical performance and teamwork/communication scores for all scenarios (Table 1). The strongest correlation was for total teamwork score for all simulations. Teamwork scores were highly predictive of medical performance with an AUC of at least 0.88 for all simulations, although this was not significant for DKA (Fig.1).
Conclusion(s): The quality of teamwork and communication correlated with the quality of clinical performance in newly formed multidisciplinary teams. This demonstrates the importance of teamwork training among medical providers to optimize management of complex and emergent obstetric conditions. [Formula presented] [Formula presented]
Copyright
EMBASE:2016042789
ISSN: 0002-9378
CID: 5098982

Emergencies in renal failure and dialysis patients

Chapter by: Spektor, Mark; Sinert, Richard; Foley, Mathew
in: Tintinalli's emergency medicine : a comprehensive study guide by Tintinalli, Judith E; Stapczynski, J; Ma, O; Yealy, Donald M; Meckler, Garth D; Cline, David [Eds]
New York : McGraw-Hill Education, [2016]
pp. ?-?
ISBN: 007179476x
CID: 2477602

Financial impact of emergency department crowding

Foley, Mathew; Kifaieh, Nizar; Mallon, William K
OBJECTIVE: The economic benefits of reducing emergency department (ED) crowding are potentially substantial as they may decrease hospital length of stay. Hospital administrators and public officials may therefore be motivated to implement crowding protocols. We sought to identify a potential cost of ED crowding by evaluating the contribution of excess ED length of stay (LOS) to overall hospital length of stay. METHODS: We performed a retrospective review of administrative data of adult patients from two urban hospitals (one county and one university) in Brooklyn, New York from 2006-2007. Data was provided by each facility. Extrapolating from prior research (Krochmal and Riley, 2005), we determined the increase in total hospital LOS due to extended ED lengths of stay, and applied cost and charge analyses for the two separate facilities. RESULTS: We determined that 6,205 (5.0%) admitted adult patients from the county facility and 3,017 (3.4%) patients from the university facility were held in the ED greater than one day over a one-year period. From prior research, it has been estimated that each of these patient's total hospital length of stay was increased on average by 11.7% (0.61 days at the county facility, and 0.71 days at the university facility). The increased charges over one year at the county facility due to the extended ED LOS was therefore approximately $9.8 million, while the increased costs at the university facility were approximately $3.9 million. CONCLUSION: Based on extrapolations from Krochmal and Riley applied to two New York urban hospitals, the county hospital could potentially save $9.8 million in charges and the university hospital $3.9 million in costs per year if they eliminate ED boarding of adult admitted patients by improving movement to the inpatient setting.
PMCID:3099606
PMID: 21691525
ISSN: 1936-9018
CID: 2285552

The Turning Point Model State Public Health Act-Emergency Public Health Law versus Civil Liberties

Foley, Mathew
PMID: 23186881
ISSN: 1937-7010
CID: 2285562

Clinical assessment of the patient with a suspected pulmonary embolism

Sinert, Richard; Foley, Matthew
PMID: 18584772
ISSN: 1097-6760
CID: 2473522

Nerve growth factor stimulates coupling of beta1 integrin to distinct transport mechanisms in the filopodia of growth cones

Grabham, P W; Foley, M; Umeojiako, A; Goldberg, D J
The cycling of membrane receptors for substrate-bound proteins via their interaction with the actin cytoskeleton at the leading edge of growth cones and other motile cells is important for neurite outgrowth and cell migration. Receptor delivered to the leading edge binds to its ligand, which induces coupling of the receptor to a rearward flowing network of actin filaments. This coupling is thought to facilitate advance. We show here that a soluble growth factor stimulates this cycling. We have used single particle tracking to monitor the effects of nerve growth factor (NGF) on the movements of beta1 integrin in the plane of the plasma membrane of the filopodia of growth cones. Beta1 integrin was visualized by its binding of 0.2 microm beads coated with a monoclonal Ab directed against an extracellular epitope distant from the binding site for extracellular matrix ligands. The beads were observed by video microscopy. Beads coated with a low concentration of antibody, and therefore bound to unliganded receptor with little cross-linking, showed an increase in both diffusion and directed forward transport in response to NGF. Transport had a net velocity of 37 microm/minute and was characterized by brief periods of sustained forward excursions with a velocity of 75-150 microm/minute. There was a 2-fold increase in the number of beads accumulated at the tips of filopodia after 10 minutes, indicating that NGF enhanced the delivery of beta1 integrin to the periphery. Forward transport was dependent on an intact actin cytoskeleton and myosin ATPase, since treatment with cytochalasin D or the myosin ATPase inhibitor butanedione monoxime inhibited the transport but not the diffusion of receptors. NGF also greatly increased the steady rearward migration of beads coated with a high density of (&bgr;)1 integrin antibody, indicating that coupling of cross-linked receptor to the retrograde flow of actin is also enhanced. The rate of the retrograde flow of actin was unaffected by NGF. These studies show that a soluble factor can stimulate the coupling of a receptor for substrate-bound factor to two actomyosin-based transport mechanisms and thus facilitate the response of the growth cone to the substrate-bound factor by increasing cycling of the receptor at the periphery.
PMID: 10934039
ISSN: 0021-9533
CID: 2473532

Recruitment of the Arp2/3 complex and mena for the stimulation of actin polymerization in growth cones by nerve growth factor

Goldberg, D J; Foley, M S; Tang, D; Grabham, P W
The growth of axons and dendrites during development and regeneration is regulated by cues in the environment. Many of these cues regulate the actin cytoskeleton of the protrusive structures (like filopodia) of the growth cone that are essential for detecting and responding to cues. Nerve growth factor, which promotes the formation of protrusive structures, stimulated actin polymerization in rat sympathetic growth cones, resulting within 1-2 min in accumulations of F-actin at the distal edge and in splotches of F-actin farther back. We examined the potential involvement of a protein machinery important in at least certain types of actin polymerization in non-neuronal cells. Members of the Arp2/3 complex, p34-Arc and p21-Arc, heavily concentrated in the early accumulations of F-actin, as did one member of the Ena/VASP family (Mena) but not another (VASP). Retention of Arc proteins at preferred sites of actin polymerization did not require polymerization itself. Growth cones of differentiated PC12 cells were similar to sympathetic growth cones in their response to NGF. Introduction into these cells of a peptide that should block the binding of Ena/VASP family proteins to the protein complex at sites of actin polymerization reduced the formation of splotches and filopodia in response to NGF. These results point to the early involvement of the Arp2/3 complex and the Ena/VASP family in growth factor-stimulated actin polymerization that gives rise to protrusive structures at the growth cone.
PMID: 10797548
ISSN: 0360-4012
CID: 2473542