Scientific publications describing what we learned is one of the important outputs for SafePAT.
Here’s a list of published abstracts and articles describing what we have been working on.


Detecting Mistakes in CPR Training with Multimodal Data and Neural Networks

Di Mitri D, Schneider J, Specht M, Drachsler H


This study investigated to what extent multimodal data can be used to detect mistakes during Cardiopulmonary Resuscitation (CPR) training. We complemented the Laerdal QCPR ResusciAnne manikin with the Multimodal Tutor for CPR, a multi-sensor system consisting of a Microsoft Kinect for tracking body position and a Myo armband for collecting electromyogram information. We collected multimodal data from 11 medical students, each of them performing two sessions of two-minute chest compressions (CCs). We gathered in total 5254 CCs that were all labelled according to five performance indicators, corresponding to common CPR training mistakes. Three out of five indicators, CC rate, CC depth and CC release, were assessed automatically by the ReusciAnne manikin. The remaining two, related to arms and body position, were annotated manually by the research team. We trained five neural networks for classifying each of the five indicators. The results of the experiment show that multimodal data can provide accurate mistake detection as compared to the ResusciAnne manikin baseline. We also show that the Multimodal Tutor for CPR can detect additional CPR training mistakes such as the correct use of arms and body weight. Thus far, these mistakes were identified only by human instructors. Finally, to investigate user feedback in the future implementations of the Multimodal Tutor for CPR, we conducted a questionnaire to collect valuable feedback aspects of CPR training.


Prediction of outcome after acute stroke: comparison of CT-DRAGON score and a simplified score

Anouk Lesenne, Jef Grieten, Alain Wibail, Ludovic Ernon, Luc Stockx, Patrick Wouters, Leentje Dreesen, Elly Vandermeulen, Sam Van Boxstael, Pascal Vanelderen, Sven Van Poucke, Joris Vundelinckx, Sofie Van Cauter, Dieter Mesotten

Background – Acute ischaemic stroke is not only a major cause of mortality, it bears also a heavy burden of morbidity and healthcare-related costs. Accurate prognostication of long-term outcome in these patients may be useful in advising stroke patients and in the allocation of the right stroke treatment.
As for all prognostic stroke scores, the CT-DRAGON was developed to predict long-term functional outcome after acute stroke, at a time when only intravenous thrombolysis was available as treatment. Moreover, their implementation in clinical practice is hampered because of the many variables and by lack of validation in the context of all stroke treatments.
Relevance – This study therefore aims to investigate whether a simplified score, that incorporates less variables and is applicable independently of stroke treatment, may be as accurate and reliable as the CT-DRAGON Score in predicting both favourable and miserable long-term functional outcome in patients after acute ischaemic stroke.
Methods – This single-centre retrospective study analyses 564 patients admitted for stroke between January 2017 and February 2019, in the anterior and posterior cerebral circulation and receiving all stroke treatments (thrombolysis, thrombectomy, combination of thrombolysis and thrombectomy and conservative therapy). At 90 days, favourable (modified Rankin Scale (mRS): 0-2) and miserable outcome (mRS: 5-6) were predicted by CT-DRAGON. Selection of predictors from the CT-DRAGON to build a simplified score was done by machine learning techniques, suited for dimensionality reduction: logistic regression, bootstrap forest and decision tree analysis. Discrimination, calibration and misclassification of CT-DRAGON and its simplified score were tested.
Results – 13% (n=71) of patients had thrombectomy, 17% (n=96) received thrombolysis and 9% (n=53) underwent combination-therapy. 61% (n=344) was treated conservatively. AUC-ROC for CT-DRAGON was 0.78 (95%CI 0.74-0.81) for favourable and 0.78 (95%CI 0.72-0.83) for miserable outcome. NIHSS, pre-stroke mRS and age were the strongest contributors to outcome, and included in the simplified score. AUC-ROC was respectively 0.82 (95CI% 0.79-0.86) and 0.83 (95CI% 0.77-0.87) for the prediction of favourable and miserable outcome. Both scores had better misclassification rates and higher specificity for miserable outcome. The simplified score had better discrimination than CT-DRAGON for both outcomes (both p<0.005).
Conclusion – The CT-DRAGON score revealed acceptable discrimination in our cohort of both anterior and posterior circulation strokes, receiving all treatment modalities. The simplified score had a better discrimination, while maintaining comparable and good specificity and misclassification rate for miserable outcome. The simplified score needs further validation in a prospective, multi-centre study

Implémentation du SBAR à l’hôpital : au-delà d’un curriculum mixte.

CHR Citadelle, Liège (Belgique)

Contexte – Le Centre Hospitalier Régional (CHR) Citadelle (Liège, Belgique) est en phase d’accréditation par le Joint Commission International (JCI). En janvier 2018, une équipe de quatre référents a bénéficié d’une formation d’Instructeurs TeamSTEPPS. Notre institution a retenu l’optimalisation de la communication
professionnelle, pilier transversal du travail en équipe, comme le premier projet basé sur les outils proposés. Un programme mixte de formation n’est que la première étape pour améliorer les comportements visant la sécurité du patient. Les enjeux réels résident dans les stratégies pour une implémentation efficace et durable.
Objectifs – Le premier objectif de l’étude que nous menons (Cf. annexe) est d’évaluer l’impact perçu d’un programme mixte d’enseignement et de mise en oeuvre de l’outil SBAR au sein des départements infirmiers et (para)médicaux du CHR Citadelle Liège.
Intervention(s) réalisée(s) – Dans une phase test, nous avons formé et comparé des groupes équivalents issus du service des urgences, en gériatrie, dans deux salles de revalidation et en soins intensifs de gynécologie/obstétrique (n=136). Avant le déploiement institutionnel en février 2019 (n≈1200), des managers, des leaders, des formateurs, des coaches et des utilisateurs finaux seront formés (n=278).
Méthodes d’évaluation – La première phase de notre étude s’appuie sur une Handover Evaluation Scale (HES) adaptée. La deuxième phase s’appuiera sur la validation d’un indicateur qualité observationnel des transferts de charge.
Résultats – Les résultats seront présentés à l’occasion du Deuxième Forum Francophone TeamSTEPPS (7 mars 2019).
Leçons retenues – Nous proposons d’ores et déjà une stratégie à plusieurs niveaux ciblant en première intention des départements ou spécialités spécifiques. Il s’agit d’une approche pragmatique vers une nouvelle culture de la communication dans les établissements de santé. Il semble obligatoire de créer un processus de développement du leadership ayant une incidence sur tous les niveaux de l’organisation.


Out of sight, out of mind? International patient handover from a patient perspective.

Beuken JA, Bouwmans MEJ, Verstegen DML and Dolmans DHJM

Abstract in progress


Going the Extra Mile. Cross-border Patient Handover in a European Border Region from a Healthcare Professional Perspective.

Beuken, J.A., Verstegen D.M.L., Dolmans, D.H.J.M., Van Kersbergen, L.J.M., Losfeld, X. , Sopka, S. , Vogt, and Bouwmans, M.E.J.

Background Cross-border healthcare is complex, increasingly frequent and causes potential risks for patient safety. In this context, cross-border handovers or the transfer of patients from one country to another deserves particular attention. Although general handover has been the topic of extensive research, little is known about the challenges of handover across national borders, especially as perceived by stakeholders. In this study, we aimed to gain insight into healthcare professionals’ perspectives on cross-border handover and ways to support this.

Methods We conducted semistructured interviews with healthcare professionals (physicians, nurses, paramedics and administrative staff) in a European border region to investigate their perspectives on cross-border handover. The interviews were aimed to investigate settings of acute and planned handover. Informed by the theory of planned behaviour (TPB), interviews focused on participant perspectives. We summarised all interviews and inductively identified healthcare professionals’ perspectives. We used elements of the TPB as sensitising concepts.

Results Forty-three healthcare professionals participated. Although respondents had neutral to positive attitudes, they often did not know very well what was expected of them or what influence they could have on improving cross-border handover. Challenges covered five themes: information transferlanguage barrierstask division and educationpolicy and financial structures and cultural differences. To overcome these challenges, we proposed strategies such as providing tools and protocols, discussing and formalising collaboration, and organising opportunities to meet and get to know each other.

Conclusion Healthcare professionals involved in cross-border handovers face specific challenges. It is necessary to take measures to come to a shared understanding while paying special attention to the above-mentioned challenges. Meeting in person around meaningful activities (eg, training and case discussions) can facilitate sharing ideas and community building.

Full text available on:


Implementation of SBAR tools in hospital settings: beyond a

Emergency Department, Centre Hospitalier Régional (CHR) de la Citadelle – Liège, Belgium.

Abstract in progress