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Tschan, Franziska

Nom
Tschan, Franziska
Affiliation principale
Fonction
Professeure ordinaire
Email
franziska.tschan@unine.ch
Identifiants
https://libra.unine.ch/handle/123456789/497

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  • Publication
    Métadonnées seulement
    Explicit Reasoning, Confirmation Bias, and Illusory Transactive Memory A Simulation Study of Group Medical Decision Making
    (2009)
    Tschan, Franziska 
    ;
    Semmer, Norbert
    ;
    Gurtner, Andrea
    ;
    Bizarri, Lara
    ;
    Spychiger, Martin
    ;
    Breuer, Marc
    ;
    Marsch, Stephan
    Teamwork is important in medicine, and this includes team-based diagnoses. The influence of communication on diagnostic accuracy in an ambiguous situation was investigated in an emergency medical simulation. The situation was ambiguous in that some of the patient's symptoms suggested a wrong diagnosis. Of 20 groups of physicians, 6 diagnosed the patient, 8 diagnosed with help, and 6 missed the diagnosis. Based on models of decision making, we hypothesized that accurate diagnosis is more likely if groups (a) consider more information, (b) display more explicit reasoning, and (c) talk to the room. The latter two hypotheses were supported. Additional analyses revealed that physicians often failed to report pivotal information after reading in the patient chart. This behavior suggested to the group that the chart contained no critical information. Corresponding to a transactive memory process, this process results in what we call illusory transactive memory. The plausible but incorrect diagnosis implied that the two lungs should sound differently. Despite objectively identical sounds, some physicians did hear a difference, indicating confirmation bias. Training physicians in explicit reasoning could enhance diagnostic accuracy.
  • Publication
    Métadonnées seulement
    Hands-on time during cardiopulmonary resuscitation is affected by the process of teambuilding: a prospective randomised simulator-based trial
    (2009)
    Hunziker, Sabina
    ;
    Tschan, Franziska 
    ;
    Semmer, Norbert
    ;
    Zobrist, Roger
    ;
    Spychiger, Martin
    ;
    Breuer, Marc
    ;
    Hunziker, Patrick
    ;
    Marsch, Stephan
  • Publication
    Métadonnées seulement
    How Accurate Is Information Transmitted to Medical Professionals Joining a Medical Emergency? A Simulator Study
    (2009)
    Bogenstätter, Yvonne
    ;
    Tschan, Franziska 
    ;
    Semmer, Norbert
    ;
    Spychiger, Martin
    ;
    Breuer, Marc
    ;
    Marsch, Stephan
    Objective: This study used a high-fidelity simulation to examine factors influencing the accuracy of 201 pieces of information transmitted to nurses and physicians joining a medical emergency situation. Background: Inaccurate or incomplete information transmission has been identified as a major problem in medicine. However, only a few studies have assessed possible causes of transmission errors. Method: Each of 20 groups was composed of two or three nurses (first responders), one resident joining the group later, and one senior doctor joining last. Groups treated a patient suffering a cardiac arrest. Results: Multilevel binomial analyses showed that 18% of the information given to newcomers was inaccurate. Quantitative information requiring repeated updating was particularly error prone. Information generated earlier (i.e., older information) was more likely to be transmitted inaccurately. Explicitly encoding information to be transmitted after the physicians arrived at the scene enhanced accuracy, supporting transfer-appropriate processing theory. Conclusion: Information transmitted to nurses and physicians who join an ongoing emergency is only partly reliable. Therefore, medical professionals should not take accuracy for granted and should be aware of the nature of transmission errors. Application: Medical professionals should be trained in adequate encoding of information and in standardized communication procedures with regard to error-prone information. In addition, technical devices should be implemented that reduce reliance on memory regarding information with error-prone characteristics.
  • Publication
    Métadonnées seulement
    Team process and diagnostic success in medical emergency driven teams: A simulator study
    (2008)
    Tschan, Franziska 
    ;
    Semmer, Norbert
    ;
    Gurtner, Andrea
    ;
    Bizarri, Lara
    ;
    Spychiger, Martin
    ;
    Marsch, Stephan
  • Publication
    Métadonnées seulement
    Leading to recovery: Group performance and coordinative activities in medical emergency driven groups
    (2006)
    Tschan, Franziska 
    ;
    Semmer, Norbert
    ;
    Gautschi, Dieter
    ;
    Hunziker, Patrick
    ;
    Spychiger, Martin
    ;
    Marsch, Stephan
    The influence of human factors on team performance was investigated in "medical emergency driven groups" composed of medical professionals treating a sudden cardiac arrest in a high fidelity simulator setting. The group composition is unique, but realistic, in that it is not constant. Three phases are distinguished: In Phase 1, 3 nurses are present; in Phase 2, a resident joins; and in Phase 3 a senior doctor joins. It was hypothesized that directive leadership behavior would enhance group performance. This was supported with regard to the directive leadership behavior of the nurse first on bedside in Phase 1, and for directive leadership of the resident in Phase 2-but only with regard to behavior occurring in the first 30 see after entering the group, which reflects the need for quick action in this time-sensitive task. For Phase 3, we expected not only directive leadership but also indirect guidance by "structuring inquiry" of the senior doctor to enhance performance. This was confirmed for structuring inquiry. Results indicate that to enhance group performance training should go beyond "technical" training that concentrates on medical necessities. Rather, it should include aspects of group coordination, emphasizing that coordinating behavior should be adapted (a) to the situation and (b) to professional role requirements.
  • Publication
    Métadonnées seulement
    Performance of first responders in simulated cardiac arrests
    (2005)
    Marsch, Stephan
    ;
    Tschan, Franziska 
    ;
    Semmer, Norbert
    ;
    Spychiger, Martin
    ;
    Breuer, Marc
    ;
    Hunziker, Patrick
    Objective. Survival of in-hospital cardiac arrests depends more on first responders than on cardiac arrest teams. The objective of this study was to determine the adherence to algorithms of cardiopulmonary resuscitation of first responders in simulated cardiac arrests in intensive care. A second objective was to assess the effect of the early vs. late availability of a physician on the performance of nurse-based teams acting as first responders. Design: Prospective study. Setting. Patient simulator in a tertiary level intensive care unit. Participants: A total of 20 teams consisting of three registered nurses and one resident each. Interventions: A simulated witnessed cardiac arrest due to ventricular fibrillation occurred in the presence of one nurse while the remaining two nurses could be called to help. Depending on the time of the residents' arrival, teams were classified as "early" (median arrival 50 secs after the onset of the arrest) or "late" (median arrival 150 secs after the onset of the arrest). Measurements and Main Results: In all teams, the recognition of the arrest and the calling for help occurred, in a timely fashion. However, a median of 85 secs (interquartile range [10], 130 secs) elapsed until the start of cardiac massage and 100 secs (IQ, 45 secs) to the first defibrillation. Once commenced, cardiac massage and mask ventilation were carried out during 61% (IQ, 33%) and 77% (IQ, 23%) of the possible time only. Delays and interruptions were generally not recalled by the participants. Compared with teams with late arriving residents, teams with early arriving residents administered more countershocks: 4.5 (IQ, 2) vs. 3.5 (IQ, 1.5; p =.026). Conclusions. First responders in intensive care often failed to build a team structure that ensured timely, effective, monitored, and ongoing team activity. The early availability of a physician increased the number of countershocks administered. Self-reporting is unsuitable to reliably assess the quality of cardiopulmonary resuscitation.
  • Publication
    Métadonnées seulement
    Unnecessary interruptions of cardiac massage during simulated cardiac arrests
    (2005)
    Marsch, Stephan
    ;
    Tschan, Franziska 
    ;
    Semmer, Norbert
    ;
    Spychiger, Martin
    ;
    Breuer, Marc
    ;
    Hunziker, Patrick
    Background and objective: Cardiopulmonary resuscitation should not be interrupted until the return of spontaneous circulation or the decision to withhold further treatment. There are no data on how consistent in-hospital cardiopulmonary resuscitation is performed. Accordingly, the aim of the present study was to identify length and type of unnecessary interruptions in simulated cardiac arrests. Methods: The study was carried out in a patient simulator. A scenario of cardiac arrest due to ventricular fibrillation was used. Resuscitation teams consisted of three nurses, a resident and a staff physician. Using videotapes recorded during simulations, the activities of the teams were coded in 5-s intervals. Unnecessary interruptions were defined as any interruptions in cardiac massage of 10s or more that were not caused by defibrillation or endotracheal intubation. Results: Twelve teams were studied. The total time of possible cardiac massage was 414 +/- 125 s. In each team at least one unnecessary interruption occurred (range 1-5). Interruptions mounted up to 65 +/- 40 s (range 20-155) or 16 +/- 10% (range 5-41) of the total time of possible cardiac massage. Failure to swiftly resume cardiac massage after an unsuccessful defibrillation accounted for 14 of 39 episodes and for 44 +/- 40% of the time of unnecessary interruptions. The debriefings revealed that participants had generally not noticed the unnecessary interruptions during the simulation. Conclusions: The present study identified a significant amount of unnecessary interruptions in cardiac massage. These interruptions were not noticed by the health-care workers involved.