References of "GHUYSEN, Alexandre"
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See detailComparaison de l'impact de deux méthodes d'apprentissage sur la sécurité d'administration des médicaments : stages cliniques versus simulation
Servotte, Jean-Christophe ULiege; Galerin, Catherine ULiege; Ghuysen, Alexandre ULiege et al

Conference (2017, September 12)

Introduction Drug administration is the act nurses most frequently do. However, 50% of errors occur during administration. The damage these errors causes to patients, results in excess mortality rates and ... [more ▼]

Introduction Drug administration is the act nurses most frequently do. However, 50% of errors occur during administration. The damage these errors causes to patients, results in excess mortality rates and health care costs, hence leading to a major public health problem. Therefore, it is advisable to consider the training of future nurses on the practice of this delicate act. The objective of this study is to evaluate the impact of teaching by simulation combined with the internship on the safety administration of intravenous drugs by nursing students, compared to just the internship alone. Material and method A selection of 99 students from the bachelors’ block two of the Namur-Liege-Luxembourg Higher Institute of Nursing met the inclusion criteria under consideration. They were divided into two groups, one experimental group which participated in a simulation session and a control group, the latter did not participate in the simulation session. At the start of the research, all students were assessed by an objective structured clinical examination (OSCE) with the theme of modifying infusion and syringe flow rates. They were also asked to complete a questionnaire concerning their knowledge and self-efficacy feeling related to drug administration. The experimental group then participated in the simulation sessions. The experimental group and the control group also went into four weeks of training in medical or surgical services before participating in the second stage of the study. The latter consisted of the same tests and questionnaires as stage one of the study. The evolution of the results of the two groups was first observed separately before being compared. Results The majority of the results shows that the simulation improves, in a way significantly more important than the clinical course, the acquisition of skills and knowledge, as well as the feeling of self-efficacy in drug administration. On the other hand, the assessment of the level of stress linked to drug administration and the professional attitude evaluated during the OSCE were not significantly more improved by the simulation than by the training alone (stress: p-value = 0.8269, professional attitude = 0.9857). Conclusions For the students in the experimental group, the simulation showed a positive impact on the skills, knowledge and feeling of self-efficacy associated with drug administration. Changes and continuation of the study would make it possible to go further in the generalization of results, in the evaluation of learning outcomes, and to attest to their sustainability. [less ▲]

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See detailEmergency Medical Services: When Fatigue Becomes The Norm.
Berastegui, Pierre ULiege; Jaspar, Mathieu ULiege; GHUYSEN, Alexandre ULiege

Conference (2017, June 27)

BACKROUND: Emergency Medical Services (EMS) routinely work at the very limit of their capacity due to growing emergency rooms visits and residents’ shortage. In this context, EMS workers are regularly ... [more ▼]

BACKROUND: Emergency Medical Services (EMS) routinely work at the very limit of their capacity due to growing emergency rooms visits and residents’ shortage. In this context, EMS workers are regularly asked to work more than 10 hours a day, on varying shifts and with short recuperation breaks. Two approaches can be used to reduce fatigue-related risk: reducing the likelihood a fatigued operator is working (i.e. fatigue reduction), or reducing the likelihood a fatigued operator will make an error (i.e. fatigue proofing). In Emergency Medical Services, formal risk control mainly focuses on reduction strategies such as reducing work hours while proofing strategies develops as an implicit element of the safety system. OBJECTIVE: Our purpose is to identify individual proofing and reduction strategies used by emergency residents and to investigate how they relate to fatigue, performance and patient safety indicators. METHODS: First, we conducted 4 focus-group sessions with a total of 25 EMS residents to elicit perceived consequences of fatigue and strategies used to cope with them. Focus group results were used to design a questionnaire assessing how often EMS residents personally used any of the strategies reported during sessions. Second, we administered the questionnaire to a larger sample and conducted a prospective observational study with a repeated within-subjects component. A total of 45 EMS residents participated in the study for a total of 400 shifts analyzed. We gathered sleep diaries, subjective sleepiness, reaction time, self-reported medical errors and performance ratings at different time point during both day and night shift using an android-based application. Sleep time and activity levels were confirmed using wrist actigraphy. DISCUSSION: We will discuss what can be drawn from our results in terms of individual and collective resilience processes with a focus on the potential for implementation of more formal processes at a system level.  [less ▲]

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See detailPrehospital identification of trauma patients requiring transfusion: results of a retrospective study evaluating the use of the trauma induced coagulopathy clinical score (TICCS) in 33,385 patients from the TraumaRegister DGU®
TONGLET, Martin ULiege; Lefering, Rolf; Minon, Jean Marc et al

in Acta Chirurgica Belgica (2017)

Background: Identifying trauma patients that need emergent blood product transfusion is crucial. The Trauma Induced Coagulopathy Clinical Score (TICCS) is an easy-to-measure score developed to meet this ... [more ▼]

Background: Identifying trauma patients that need emergent blood product transfusion is crucial. The Trauma Induced Coagulopathy Clinical Score (TICCS) is an easy-to-measure score developed to meet this medical need. We hypothesized that TICCS would assist in identifying patients that need a transfusion in a large cohort of severe trauma patients from the TraumaRegister DGUVR (TR-DGU). Materials and methods: A total of 33,385 severe trauma patients were extracted from the TR-DGU for retrospective analysis. The TICCS was adapted for the registry structure. Blood transfusion was defined as the use of at least one unit of red blood cells (RBC) during acute hospital treatment. Results: With an area under the receiving operating curve (AUC) of 0.700 (95% CI: 0.691–0.709), the TICCS appeared to be moderately discriminant for determining the need for RBC transfusion in the trauma population of the TR-DGU. A TICCS cut-off value of 12 yielded the best trade-off between true positives and false positives. The corresponding positive predictive value and negative predictive values were 48.4% and 89.1%, respectively. Conclusion: This retrospective study confirms that the TICCS is a useful and simple score for discriminating between trauma patients with and without the need for emergent blood product transfusion. [less ▲]

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See detailHi-Fi simulation and teamwork training: what is it good for?
CARDOS, Benoît ULiege; GILLET, Aline ULiege; Ghuysen, Alexandre ULiege et al

Poster (2017, June 15)

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See detailLe cas clinique du mois. Embolie pulmonaire compliquée d’un œdème laryngé angioneurotique.
LOPEZ IGLESIAS, Raphaelle ULiege; CUPPENS, Benoit ULiege; ROBINET, Sébastien ULiege et al

in Revue Médicale de Liège (2017), 72(6), 275-280

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See detailBreaking Bad News: the TAKE five program
VAN CAUWENBERGE, Isabelle ULiege; GILLET, Aline ULiege; Bragard, Isabelle ULiege et al

Conference (2017, January 14)

Introduction For years, bad news delivery’s impact on patients or their relatives, as well as physicians’ stress has been a major concern. Based on studies claiming the efficacy of training courses to ... [more ▼]

Introduction For years, bad news delivery’s impact on patients or their relatives, as well as physicians’ stress has been a major concern. Based on studies claiming the efficacy of training courses to help physicians delivering such news, many protocols, like SPIKES, BREAKS or SHARE, have emerged worldwide. However, training to such protocol might be time-consuming and not suitable with junior doctors or trainees’ turnover. We hypothesised that a standardized 5-hours training program could improve bad news delivery practice. Participants and methods This preliminary study was conducted in the ED of a tertiary care academic hospital accounting for 90000 ED census per year, 16 attending physicians, 10 junior residents, and 5 trainees per month. Data were collected between November 2015 and April 2016. The study included 3 phases over 4 weeks. Video recorded single role-playing sessions happened the 1st (T1) and the 4th (T3) weeks. A 3-hour theory lesson happened the second week (T2), introducing the basics of therapeutic communication and delivering bad news. Each role-playing session lasted almost 1 hour (10 minutes briefing and medical case reading, 10 minutes role-plays and 40 minutes group debriefing). Bad news delivery performance was evaluated by a 14-points retrospective assessment tool (1). We collected data about the status and impact of a stressful event at 3-days using the French version of the IES-R scale (2). We applied Student t-tests for statistical analysis. Results 14 volunteers (10 trainees and 4 junior emergency physicians) were included in the study. On average, bad-news delivery process took 9’45’’ at T1 and 10’20’’ at T3. From T1 to T3, bad-news delivery performance increased significantly for both junior emergency physicians and trainees (p=0.0003 and p=0.0006, respectively). Further analysis revealed that most relevant increases involved the “situation” (p<0.001), “presentation” (p=0.009), “knowledge” (p=0.037), “emotions” (p=0.01) and “summary” (p=0.001) steps. We also found a significant decrease of the impact of bad-news delivery on trainee physicians’ stress (p=0.006). Discussion and conclusion These preliminary results indicate some potential for this new standardized course of bad news delivery. Apart from allowing physicians increase their communications skills, we believe that this simple 5-hour simulation-training program could alleviate physicians’ stress when they happen to break bad news. References 1. Brunet, A. et al. (2003). Validation of a French version of the Impact of Event Scale-Revised. Can J Psychiatry, 48(1), 56-61. 2. Park, I. et al. (2010). Breaking bad news education for emergency medicine residents: A novel training module using simulation with the SPIKES protocol. J Emerg Trauma Shock, 3(4), 385-388. [less ▲]

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See detailImpact psychologique de la réanimation cardio-pulmonaire extra-hospitalier (ACREH) chez le témoin pratiquant les gestes de survie.
Stassart, Céline ULiege; STIPULANTE, Samuel ULiege; Zandona, Régine ULiege et al

in Revue Médicale de Liège (2017), 72(5), 236-240

The occurrence of an unexpected death puts the witnesses of this event in a situation of high emotional impact. The benefit to allow the families of victims to dispense the first resuscitation techniques ... [more ▼]

The occurrence of an unexpected death puts the witnesses of this event in a situation of high emotional impact. The benefit to allow the families of victims to dispense the first resuscitation techniques has been emphasized. However, little data exist on the emotional impact of a cardio-respiratory arrest outside the hospital on the witness, who is often a close family member. Recently, we investigated the presence of psychological distress and the factors influencing it, in the active practice of basic resuscitation gestures by the witnesses guided by the operator 112. Resuscitation by a person not belonging to the medical corps seems not to be devoid of impact. Indeed, the presence of psychological distress is observed for most of witnesses questioned 6 to 10 days after the call but also 3 months later. This work highlights therefore the importance of identifying the coping strategies involved, in order to promote potentially beneficial strategies and limit the trauma associated with this type of event. [less ▲]

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See detailBreaking Bad News: the TAKE five program.
GILLET, Aline ULiege; VAN CAUWENBERGE, Isabelle ULiege; TUBES, Rebecca ULiege et al

Poster (2016, October)

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See detailProofing & Reduction Strategies Used by Emergency Residents to Manage Fatigue-related Risk
Berastegui, Pierre ULiege; Ghuysen, Alexandre ULiege; Nyssen, Anne-Sophie ULiege

Poster (2016, July 29)

Fatigue and sleep loss are typically associated with psychomotor and cognitive impairment resulting in poorer task performance. Most of these studies are conducted in controlled settings and involve the ... [more ▼]

Fatigue and sleep loss are typically associated with psychomotor and cognitive impairment resulting in poorer task performance. Most of these studies are conducted in controlled settings and involve the completion of experimental tasks. Only a few field studies involving exhausted residents have been conducted over the past decade, and they yielded to contradictory results (Ellman et al., 2004). One of the key factors that could be involved in the non-linear relationship between fatigue and performance in specific work context reside in the mobilization of Fatigue Proofing Strategies. FPS are adaptive and protective risk-reduction behaviors that improve the resilience of a system of work (Dawson et al., 2012). In this study, we aimed to identify and classify proofing strategies mobilized by EMS residents using an inductive content analysis approach. EMS residents reported a range of strategies for reducing subjective level of sleepiness (reduction strategies, n=15) or managing its consequences (proofing strategies, n=17). Content analysis yielded to three sub-categories of proofing strategies: Behavioral Compensation (n=8), Error’s Opportunity Reduction (n=5) and Error’s Consequences Mitigation (n=4). Our results show that EMS residents use both types of strategies although none of the proofing strategies were part of their training program. Despite the current informal use, there is significant potential for implementation of more formal processes. [less ▲]

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See detailGestion des flux patients et surpopulation des urgences : Heurs et malheurs de la fonction de « Bed Manager ».
GILLET, Aline ULiege; Minder, Anaïs ULiege; Nyssen, Anne-Sophie ULiege et al

Conference (2016, July 11)

For many years, emergency departments (ED) overcrowding has become a major issue in Public Health. Many studies have demonstrated the efficiency of flow management coordination on this recurrent problem ... [more ▼]

For many years, emergency departments (ED) overcrowding has become a major issue in Public Health. Many studies have demonstrated the efficiency of flow management coordination on this recurrent problem, by offering an interface between the ED, the hospital and out-of-hospital structures and by coordinating patients’ movements towards hospital care units. This was the basis for the implementation of "bed management" coordination program in the ED of the University Hospital of Liège in January 2014. The present study evaluates the adequacy of the Bed Manager (BM) activity with actual ED and hospital workload. Our results describe the rate of intra-hospital patients’ transfers according to the adequacy of the destination unit and time delays for these transfers. Head nurses from specific care units were interrogated about their perceptions of BM activity. We are now convinced by the importance of a participative approach in the development of ED bed management and working procedures, as well as the usefulness of further studies to explore this complex activity. [less ▲]

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See detailWhy is this urine turning blue? A uncommon alarm but a common disease.
LU, Marie Anh-Dao ULiege; GENSBURGER, Mathieu ULiege; TONGLET, Martin ULiege et al

Poster (2016, January 30)

Turning purple-blue urine is an alarming phenomenon uncommonly seen in patients with chronic urinary catheterization. Such discoloration, often misdiagnosed as haematuria, frequently causes concerns for ... [more ▼]

Turning purple-blue urine is an alarming phenomenon uncommonly seen in patients with chronic urinary catheterization. Such discoloration, often misdiagnosed as haematuria, frequently causes concerns for the nurses, the doctor, the patient and his family. [less ▲]

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See detailEmergency department bed coordination: burden and pitfalls.
GILLET, Aline ULiege; Minder, Anaïs ULiege; Nyssen, Anne-Sophie ULiege et al

Conference (2016, January 30)

Introduction Improving patient flow from emergency department (ED) to in-hospital bed admission has become an everyday challenge. Implementation of an ED bed manager (BM) who monitors hospital beds ... [more ▼]

Introduction Improving patient flow from emergency department (ED) to in-hospital bed admission has become an everyday challenge. Implementation of an ED bed manager (BM) who monitors hospital beds availability daily has been advocated to reduce boarding time for admitted patient. However, little is known on the actual burden and pitfalls of ED bed coordination. Indeed, overcrowded hospitals often lead to inappropriate transfer from ED to less adapted hospital unit or unit with lower level of care. We design the present study to evaluate the occurrence of such step-down units transfer. Methods This prospective study was conducted in a tertiary care academic hospital accounting for 622 licensed beds and an ED census of 45000/year. In 2014, a BM was implemented as a result of a quality improvement program. Focus was made solely on facilitating and improving patient movements form ED to the hospital wards. The investigators extracted data from a 20-days random observation period in February and March 2015, or a total of 231 patients administered by the BM. Results During this period, mean ED census was 131 (±12) patients /day, of which mean hospital admission rate was 20,6 %. BM administered 12 (±3) of these patients daily. Most of these patients were transferred to an appropriate unit (47.6 %) or a short stay unit (32.1%), while 17.7 % were referred to under adapted units and 2.6 % to step down units. Patients’ average length of stay (LOS) was 32 hours. LOS for patients immediately admitted in the ED short stay unit (n=74) was 26.5 (±22) hours, while it took 35.8 (±26) hours to reach an appropriate unit (n=110) and 35.6 (±27.4) to reach a less-appropriate unit (n=41). Interestingly, patients transferred to a non-appropriate unit (n=6) stayed 29.5 (±15.7) hours in the ED. Communications means used by the BM was face-to-face talk almost half of the cases (n=93) and phone calls for the other half (n=115). Discussion and conclusion These results emphasize the complexity of ED flow coordination. Whether or not such coordination is effective on ED overcrowding or patients’ LOS, this preliminary study identifies the frequent use of short stay and under-adapted units instead of optimal bed location. Besides, further research should clarify the impact of these hospitalisations’ pathways on the quality of care. Finally, these observations indicate the urgent need for early determination of patients who could actually be safely transferred to such units. [less ▲]

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