Patient safety in rehabilitation medicine: traumatic brain injury

Factors Affecting Patient Safety in Inpatient Rehabilitation Hospital: A Multidisciplinary Perspective

Patient safety (PS) is of special importance in Inpatient Rehabilitation Hospital (IRH). Few studies have assessed the factors affecting PS in IRH. Therefore, this study aimed to explore the factors affecting PS based on the experiences of the rehabilitation team in an IRH. This qualitative study was conducted using the conventional content analysis approach in 2020-2021. The participants were 16 members of the rehabilitation team. They were purposively selected from Rofaydeh rehabilitation hospital, Tehran, Iran. Data collection was performed through semi-structured interviews and was continued up to data saturation. The mean age of the participants was 37.31 ± 8.68 years and their mean work experience was 8.75 years. The factors affecting PS in IRH were classified into five main categories, namely shortage of organizational resources, inappropriate physical environment of the IRH, inappropriate PS culture, patients' and their caregivers' limited participation in safety programs, and poor fall prevention programs. The results of this study revealed the factors affecting PS in IRH. Accurate identification of the influential factors on PS can help healthcare providers, managers, and policymakers use multi-component interventions to improve PS culture and increase PS in IRHs. Action research studies are also recommended to determine the main components of such interventions.

The Safety Assessment Measure for persons with traumatic brain injury: Item pool development and content validity

BACKGROUND

Persons with moderate to severe TBI are at increased risk for unintentional injury or harm in the home and community; however, there is currently no standard measure of safety risk they face now and in the future.

OBJECTIVE

To develop comprehensive and content valid scales and item pools for assessing safety and risk for persons with moderate to severe traumatic brain injuries.

METHOD

Qualitative psychometric methods for developing scales and items were used including literature review, item development and revision, focus groups with interdisciplinary rehabilitation staff (n = 26) for rating content validity, and cognitive interviewing of TBI family members (n = 9) for assuring item clarity.

RESULTS

The Safety Assessment Measure is comprised of 6 primary scales - Cognitive Capacity, Visuomotor Capacity, Wheelchair Use, Risk Perception, Self-Regulation, and Compliance Failures with Safety Recommendations - in which family caregivers or clinicians rate the risk for unintentional injury or harm in adults who have sustained moderate or severe TBI. The scale item pools encompass a broad spectrum of everyday activities that pose risk in the home and community and were rated as having excellent levels of content validity.

CONCLUSIONS

The Safety Assessment Measure scales and items cover a broad range of instrumental activities of daily living that can increase the risk of unintentional injuries or harm. Empirical evidence suggests that the Safety Assessment Measure items have excellent content validity. Future research should use modern psychometric methods to examine each scale unidimensionality, model fit, and precision.

Preliminary evaluation of a measure for reliable assessment of need for constant visual observation in adults with traumatic brain injury

PRIMARY OBJECTIVE

To develop and provide initial validation of a measure for accurately determining the need for Constant Visual Observation (CVO) in patients with traumatic brain injury (TBI) admitted to inpatient rehabilitation.

RESEARCH DESIGN

Rating scale development and evaluation through Rasch analysis and assessment of concurrent validity.

METHODS AND PROCEDURES

One hundred and thirty-four individuals with moderate-severe TBI were studied in seven inpatient brain rehabilitation units associated with the National Institute for Disability, Independent Living and Rehabilitation Research (NIDILRR) TBI Model System. Participants were rated on the preliminary version of the CVO Needs Assessment scale (CVONA) and, by independent raters, on the Levels of Risk (LoR) and Supervision Rating Scale (SRS) at four time points during inpatient rehabilitation: admission, Days 2-3, Days 5-6 and Days 8-9.

OUTCOMES AND RESULTS

After pruning misfitting items, the CVONA showed satisfactory internal consistency (Person Reliability = 0.85-0.88) across time points. With reference to the LoR and SRS, low false negative rates (sensitivity > 90%) were associated with moderate-to-high false positive rates (29-56%).

CONCLUSIONS

The CVONA may be a useful objective metric to complement clinical judgement regarding the need for CVO; however, further prospective study is desirable to further assess its utility in identifying at-risk patients, reducing adverse events and decreasing CVO costs.