Aviation has used a real-time observation method to advance anonymised feedback to the front-line and improve safe practice. Using an experiential learning method, this pilot study aimed to develop an observation-based real-time learning tool for final-year medical students with potential wider use in clinical practice. Using participatory action research, we collected data on medical students’ observations of real-time clinical practice. The observation data was analysed thematically and shared with a steering group of experts to agree a framework for recording observations. A sample of students (observers) and front-line clinical staff (observed) completed one-to-one interviews on their experiences. The interviews were analysed using thematic analysis. Thirty-seven medical students identified 917 issues in wards, theatres and clinics in an acute hospital trust. These issues were grouped into the themes of human influences, work environment and systems. Aviation approaches were adapted to develop an app capable of recording real-time positive and negative clinical incidents. Five students and eleven clinical staff were interviewed and shared their views on the value of a process that helped them learn and has the potential to advance the quality of practice. Concerns were shared about how the observational process is managed. The study developed an app (Healthcare Team Observations for Patient Safety—HTOPS), for recording good and poor clinical individual and team behaviour in acute-care practice. The process advanced medical student learning about patient safety. The tool can identify the totality of patient safety practice and illuminate strength and weakness. HTOPS offers the opportunity for collective ownership of safety concerns without blame and has been positively received by all stakeholders. The next steps will further refine the app for use in all clinical areas for capturing light noise.

中文翻译：

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开发医疗团队观察患者安全 (HTOPS)：高年级医学生捕捉日常临床时刻


航空业采用实时观察方法，向前线提供匿名反馈，并改善安全实践。这项试点研究采用体验式学习方法，旨在为最后一年的医学生开发一种基于观察的实时学习工具，并有可能在临床实践中更广泛地使用。通过参与性行动研究，我们收集了医学生对实时临床实践的观察数据。对观测数据进行了专题分析，并与专家指导小组共享，以商定记录观测的框架。学生（观察者）和一线临床工作人员（观察者）样本完成了一对一的访谈，了解他们的经历。使用主题分析对访谈进行分析。 37 名医学生在一家急症医院信托机构的病房、手术室和诊所中发现了 917 个问题。这些问题分为人类影响、工作环境和系统等主题。采用航空方法开发了一款能够记录实时正面和负面临床事件的应用程序。五名学生和十一名临床工作人员接受了采访，并分享了他们对帮助他们学习并有可能提高实践质量的过程的价值的看法。人们对如何管理观测过程表示担忧。该研究开发了一款应用程序（医疗团队患者安全观察 - HTOPS），用于记录急症护理实践中良好和不良的临床个人和团队行为。这个过程促进了医学生对患者安全的了解。该工具可以识别患者安全实践的整体并阐明其优势和劣势。 HTOPS 提供了集体承担安全问题而不受指责的机会，并得到了所有利益相关者的积极响应。下一步将进一步完善该应用程序，以用于所有临床领域捕获光噪声。