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Historically simulation was used as an education and training technique in healthcare, but now has an emerging role in improving quality and safety. Simulation-based techniques can be applied to help understand healthcare settings and the practices and behaviours of those who work in them. Simulation-based interventions can help to improve care and outcomes – for example, by improving readiness of teams to respond effectively to situations or to improve skill and speed. Simulation can also help test planned interventions and infrastructural changes, allowing possible vulnerabilities and risks to be identified and addressed. Challenges include cost, resources, training, and evaluation, and the lack of connection between the simulation and improvement fields, both in practice and in scholarship. The business case for simulation as an improvement technique remains to be established. This Element concludes by offering a way forward for simulation in practice and for future scholarly directions to improve the approach. This title is also available as Open Access on Cambridge Core.
Simulation is often employed to test mass casualty and disaster response planning within hospitals, but it is resource intensive and needs to achieve high-quality recreation of scenarios to be effective. The delivery of large-scale interdisciplinary team and system simulation requires consideration of physical safety, system integrity for real patients, simulation team communication, and effective dissemination of outcomes.
To describe challenges and potential solutions for effective delivery of disaster simulations, drawn from simulation service experience at Gold Coast Hospital and Health Service (GCHHS).
This case study reviews strategies used to deliver a large-scale multi-team in-hospital disaster and trauma simulation, involving more than 75 participants drawn from paramedic/ambulance, emergency, trauma service, anesthetics, perioperative, surgical, and hospital administrative teams.
Issues reviewed include simulation delivery team composition and briefing, safety strategies, matching simulation methodology to exercise objectives, the use of real-time communications technologies and apps for real-time communication and performance tracking, and leveraging the simulation experience for observers by narrated Facetime stream. Following the simulation, a debriefing was conducted with participants to address performance, communication and interfaces, strengths and weaknesses, and overall opportunity for improvement. Facility-wide dissemination of messages through standardized reporting, infographics, and video vignettes were also reviewed.
Simulation is an engaging way to assess protocols and practices for disaster response within a tertiary hospital, and effectiveness can be enhanced through the strategic use of contemporary techniques and technologies.
Constipation may be defined as either stool frequency of less than three per week or, more generally, as difficulty in passing stool. In either case it should be recognized that constipation is a symptom, not a medical diagnosis.
It has been estimated that the prevalence of constipation in the adult population of industrialized nations is as high as 20%. There are approximately 2.5 million physician visits per year in the US for this symptom, and at least 20% of the population habitually use over-the-counter laxative preparations.
Constipation is a surprisingly frequent chief presenting complaint in the emergency department (ED) despite the medical community's attitude of it being a “minor” problem. It is particularly common in the elderly and those with multiple medical problems, complicating both their assessment and treatment for other conditions.
It is important to recognize constipation as a preventable adverse outcome of an ED visit, and to consider selecting discharge medications with this in mind.
Normal bowel function has two components – colonic transit and defecation.
Colonic transit is maintained by smooth muscle function via bowel wall myenteric plexuses regulating motility and submucosal plexuses regulating absorption, with overall control by the parasympathetic nervous system. Transit time is also affected by bowel contents, specifically fiber and water.
Defecation is a complex series of events in which rectal distension triggers a series of reflexes to relax sphincters and pelvic floor muscles.
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