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Using Clicker Training and Social Observation to Teach Rats to Voluntarily Change Cages
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Brief teaching sessions change behaviour in A&E.

Alexander Grant1,2, Matthew Stuttard3, Thomas Mitchell2

  • 1Weston General Hospital, Weston Area Health Trust, Weston-Super-Mare, Somerset, UK.

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Summary

Brief teaching interventions improved clinician behavior in managing cervical spine (c-spine) trauma in busy Accident and Emergency (A&E) departments. This led to more frequent c-spine CT scans without compromising quality or guideline adherence.

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Area of Science:

  • Emergency Medicine
  • Medical Education
  • Radiology

Background:

  • Accident and Emergency (A&E) departments are high-pressure environments demanding efficient teaching methods.
  • New doctors often lack experience in managing cervical spine (c-spine) trauma.
  • Effective, resource-light teaching strategies are crucial for improving clinical practice in A&E.

Purpose of the Study:

  • To evaluate the impact of brief, multimodal teaching interventions on clinician behavior in managing c-spine trauma within A&E.
  • To assess changes in the efficiency and appropriateness of c-spine computed tomography (CT) imaging following the teaching intervention.
  • To determine if the teaching improved the adherence to clinical guidelines for c-spine CT scans.

Main Methods:

  • A comparative study analyzing data from 482 patients undergoing c-spine CT in two A&E departments before and after a teaching intervention.
  • Manual recording of key data points including time to CT, scan indication, and presence of bony injury from patient management software.
  • Statistical analysis to compare outcomes pre- and post-intervention, focusing on scan frequency and timeliness.

Main Results:

  • While the proportion of CT scans completed within one hour did not significantly change (31% to 37.6%), the weekly volume of c-spine CT scans increased significantly (14.50 to 23.25).
  • The number of c-spine CT scans performed within one hour also rose significantly (4.50 to 8.75 per week).
  • Scan quality, indicated by the detection of bony injury, remained consistent, and there was no increase in scans performed outside National Institute for Health and Care Excellence guidelines.

Conclusions:

  • Brief, low-resource teaching interventions can effectively modify clinician behavior in A&E settings.
  • The implemented teaching strategy was simple to deploy and shows potential for transferability to other guideline-driven diagnostic processes.
  • Further research could explore outcomes in major trauma centers and analyze cases where CT scans were indicated but not performed.