Guests

Improving Patient Care (QI)

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In this episode I am joined by my friends and colleagues, Stacey Davidson and Ru Clements of VetLed, to discuss the role of Quality Improvement (QI) in improving patient care. We discuss what QI is and why you should be engaged with it. We also talk about the role of human factors and workplace culture in QI.

VetLed website
VetLed Facebook page
Veterinary Human Factors private Facebook group started by VetLed

Some terms used in the episode:

Quality Improvement:

A number of definitions describe quality improvement as a formal approach that uses specific techniques to improve quality. The RCVS definition is ‘supporting effective, patient and client-centred treatment by implementing systematic, measurable approaches to advance high-quality care’

Clinical Governance:

Essentially a framework through which organisations are accountable for continuously improving the quality of their services and safeguarding high standards of care by creating an environment in which excellence in care will improve. The RCVS definition is ‘a continuing process of reflection, analysis and improvement in professional practice for the benefit of the animal patient and the client owner’.

Clinical Audit:

The systematic critical analysis of the quality of veterinary care, including the procedures used for diagnosis and treatment, the use of resources and the resulting outcome and quality of life for the patient. This is considered a major component of clinical governance and QI.

Human Factors:

This has become a common way of referring to Human Performance in the working environment. It is scientific knowledge about the human body, mind and behaviour, specifically to understand human capabilities and limitations so that there is the best possible fit between people and the systems in which they operate.

In healthcare, clinical human factors have been described as enhancing clinical performance through an understanding of the effects of elements such as teamwork, tasks, equipment, workspace, culture and organisation on human behaviour and abilities, and application of that knowledge in clinical settings.

Non-technical skills:

Social, cognitive and personal elements of behaviour which combined with role-specific (technical) skills contribute towards successful outcomes. Examples include identifying and communicating anticipated complications prior to a procedure and awareness of cognitive bias’ during decision making.

Workplace culture:

The character and personality of your organisation. It's what makes your workplace unique and is the sum of its values, traditions, beliefs, interactions, behaviours, and attitudes. It is the unique social and psychological environment. Put simply it's measured by 'the way people do things' in any given environment and has a huge influence on the way people in that environment are likely to do things subsequently.

CRM:

Crew Resource Management is the name given to the field of human factors within aviation. It is commonly defined as the effective utilisation of all available resources (people, equipment, checklists, procedures etc.) to achieve a safe and efficient operation and passenger well-being.

Blame culture:

A culture where blame is apportioned to individuals based primarily on the severity of outcome without a willingness to understand underlying causational factors.

Growth vs. fixed mindset:

A growth mindset is a fundamental belief that you can grow, learn and change for the better – through failure and success alike. This mindset motivates you to try, to reflect, to get back up, to ask for help and to learn. 

A fixed mindset is seated in the opposite and is a belief that your qualities are not able to develop or change. It assumes that our character, intelligence, ability, talent and so on are static and that we are unable to change them in any meaningful way.

[This podcast is closely aligned with the MedEdLIFE Research Collaborative's Quality Checklist for Podcasts.]

Tweet: Check out FREE audio podcasts from @VetEmCC http://ctt.ec/UqL8b+ Also available in iTunes/Stitcher. #veterinary #podcast

Dog and Cat Amputees: 'Tripods'

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On this episode of the podcast I am joined by Rene Agredano and Jim Nelson of TRIPAWDS, “the world's largest support community for animal amputees”, to discuss how we as veterinary staff can be better prepared to help clients with dogs and cats that are either facing or have had a limb amputation.

After some background discussion of the Tripawds resource, we discuss:

  • Ethical and moral considerations carers may have around amputation
  • Steps carers can take to prepare for their amputee dog or cat returning home for the first time
  • Client concerns about when their pet will be normal again, pain management, and the surgical incision

The following links were mentioned in the episode:

Tripawds - Help For Three Legged Dogs And Cats

The Tripawds charitable foundation

Tripawds on YouTube

Tripawds Downloads

The PBS Show that Rene mentions, “Why we love dogs and cats”

The Tripawds blog by an ECC vet: Hank the Tank
(backstory for Hank the Tank)

[This podcast is closely aligned with the MedEdLIFE Research Collaborative's Quality Checklist for Podcasts.]

Tweet: Check out FREE audio podcasts from @VetEmCC http://ctt.ec/UqL8b+ Also available in iTunes/Stitcher. #veterinary #podcast

Emotional Well-being in Veterinary Practice

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In this episode of the podcast I am joined by Enid Traisman M.S.W., CT, CFS to discuss issues around emotional well-being in veterinary practice. Enid is the Director of Pet Loss Support Services at Dove Lewis, a non-profit emergency animal hospital in Portland, Oregon in the USA.

Topics that we discuss in this episode include the following; where appropriate we talk about prevention, recognition and coping strategies:

  • Pet loss grief
  • When veterinary staff have to deal with loss of their own companion animals
  • Compassion fatigue and burnout
  • Workplace stress and emotional challenges of the veterinary profession

During the episode Enid mentions creating a memorial table at work when a staff member loses a pet. Here are a couple of examples of beautiful memorial tables created by Enid:
 

 

You can also find Enid’s overview of the pet memorial table concept here.

 

SOME USEFUL RESOURCES

Provided by Enid:

OTHERS

Vetlife (UK)
Intensive Care for Intensivists
Managing Exposure: A Grounded Theory of Burnout and Resilience in Critical Care Nurses

Find contact details for Enid here at the Dove Lewis website.

Please do get in touch if you have any comments or questions using the contact form, via email at shailenjasani@gmail.com, via Twitter @VetEmCC or via Facebook at the Veterinary ECC Small Talk page.

[This podcast is closely aligned with the MedEdLIFE Research Collaborative's Quality Checklist for Podcasts.]

I mention my Small Animal Emergency Medicine App for iPhone/iPad in this episode which you can find HERE. An Android version is in development.

 
 
Tweet: Check out FREE audio podcasts from @VetEmCC http://ctt.ec/UqL8b+ Also available in iTunes/Stitcher. #veterinary #podcast



Managing Dog Bite Injuries

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In this episode I am joined by my good friend and European Specialist in Small Animal Surgery, Nicola Kulendra.

Apologies for the sound quality of this episode which is poorer than usual and not produced in stereo sound! Ooops.

I mention my Small Animal Emergency Medicine App for iPhone/iPad in this episode which you can find HERE. An Android version is in development.

[This podcast is closely aligned with the MedEdLIFE Research Collaborative's Quality Checklist for Podcasts.]

Tweet: Check out FREE audio podcasts from @VetEmCC http://ctt.ec/UqL8b+ Also available in iTunes/Stitcher. #veterinary #podcast

Patient Handovers/Rounds

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This episode is the first in this series to feature guests! In today's episode I am joined by Liz Hughston and Charlotte Rosenthal, two specialist ECC nurses from the USA.

Liz mentions "The Checklist Manifesto" by Atul Guwande and during the podcast we also refer to my ECC In-Patient Checklist.

This is a great human medicine blog post relating to handoffs in the Emergency Department that clearly has relevance to veterinary settings too. "ED HANDOFFS – THE PROBLEM AND WHAT WE CAN DO TO IMPROVE"

January 2016: something else that we did not discuss during this podcast episode was the I-PASS handoff system ("I-PASS this patient to you"!) reported in human medicine. See more here and here.

Tweet: Check out FREE audio podcasts from @VetEmCC http://ctt.ec/UqL8b+ Also available in iTunes/Stitcher. #veterinary #podcast