10 Organisational culture
Box 10.1 Following an increase in the number of bacteraemias in a Trust, it is regulated that only doctors can take blood cultures. Subsequently, a patient is admitted to the…
9 Key elements in communication: briefing and debriefing
SBAR (courtesy of the NHS Institute for Innovation and Improvement) S Situation B Background A Assessment R Recommendation See the NHS Institute for Innovation and Improvement website at http://www.institute.nhs.uk/quality_and_service_improvement_tools/quality_and_service_improvement_tools/sbar_-_situation_-_background_-_assessment_-_recommendation.html. Briefing…
8 Fatigue and stress
Further discussion of the roles of each phase is outside the remit of this text. It is sufficient to note that all are needed for basic psychological well being. Interruptions,…
11 Guidelines, checklists and protocols
html xmlns=”http://www.w3.org/1999/xhtml”> CHAPTER 11 Guidelines, Checklists and Protocols Learning Outcomes By the end of this chapter you should be able to demonstrate an understanding of: why guidelines, checklists and protocols…
1 Introduction to human factors in medicine
Background to Clinical Error The United States was the first country to investigate clinical error systematically. In 1984, Brennan et al. looked at 30,121 admissions to New York hospitals and…
3 Situation awareness
Maintenance of SA demands vigilance and good monitoring at all times. It may easily be lost if agreed actions, protocols or guidelines are not followed or do not have the…
7 Decision making
Klein (1993, 1995, 1998) describes versions of recognition-primed decision making. At the basic level, the decision maker recognises the situation and knows an appropriate response. When the situation is more…
4 Leadership and teamworking
Box 4.1 A junior doctor was asked to examine a child with blunt chest trauma, and correctly identified that the chest movement was asymmetrical and that the percussion note was…
