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Packendorff N, Magnusson C, Wibring K, Axelsson C, Hagiwara MA. Development of a trigger tool to identify harmful incidents, no harm incidents, and near misses in prehospital emergency care. Scand J Trauma Resusc Emerg Med 2024; 32:38. [PMID: 38685120 PMCID: PMC11059688 DOI: 10.1186/s13049-024-01209-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 04/21/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Emergency Medical Services (EMS) are a unique setting because care for the chief complaint is given across all ages in a complex and high-risk environment that may pose a threat to patient safety. Traditionally, a reporting system is commonly used to raise awareness of adverse events (AEs); however, it could fail to detect an AE. Several methods are needed to evaluate patient safety in EMS. In this light, this study was conducted to (1) develop a national ambulance trigger tool (ATT) with a guide containing descriptions of triggers, examples of use, and categorization of near misses (NMs), no harm incidents (NHIs), and harmful incidents (HIs) and (2) use the ATT on randomly selected ambulance records. METHODS The ambulance trigger tool was developed in a stepwise manner through (1) a literature review; (2) three sessions of structured group discussions with an expert panel having knowledge of emergency medical service, patient safety, and development of trigger tools; (3) a retrospective record review of 900 randomly selected journals with three review teams from different geographical locations; and (4) inter-rater reliability testing between reviewers. RESULTS From the literature review, 34 triggers were derived. After removing clinically irrelevant ones and combining others through three sessions of structured discussions, 19 remained. The most common triggers identified in the 900 randomly selected records were deviation from treatment guidelines (30.4%), the patient is non conveyed after EMS assessment (20.8%), and incomplete documentation (14.4%). The positive triggers were categorized as a near miss (40.9%), no harm (3.7%), and harmful incident (0.2%). Inter-rater reliability testing showed good agreement in both sessions. CONCLUSION This study shows that a trigger tool together with a retrospective record review can be used as a method to measure the frequency of harmful incidents, no harm incidents, and near misses in the EMS, thus complementing the traditional reporting system to realize increased patient safety.
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Affiliation(s)
- Niclas Packendorff
- Prehospen-Centre for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden.
- Department of Prehospital Emergency Care, Sahlgrenska University Hospital, Gothenburg, Sweden.
| | - Carl Magnusson
- Prehospen-Centre for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
- Department of Prehospital Emergency Care, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Kristoffer Wibring
- Department of Ambulance and Prehospital Care, Region Halland, Sweden
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Christer Axelsson
- Prehospen-Centre for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
- Department of Prehospital Emergency Care, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Magnus Andersson Hagiwara
- Prehospen-Centre for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
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McGrane N, Dunbar P, Keyes LM. Contributing Factors to Adverse Events in Long-Term Care Facilities in Ireland, a Content Analysis. J Am Med Dir Assoc 2024; 25:633-638.e3. [PMID: 38141662 DOI: 10.1016/j.jamda.2023.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 11/08/2023] [Accepted: 11/14/2023] [Indexed: 12/25/2023]
Abstract
OBJECTIVES There is substantial research on contributing factors to adverse events (AEs) in acute settings. Little is known about AEs in long-term care facilities (LTCFs). Our aim was to identify contributing factors to AEs from LTCFs for older persons and people with disability to inform quality improvement. DESIGN Content analysis of statutory notifications of AEs from LTCFs using a modified version of the Human Factors Analysis and Classifications System (HFACS) applied to health care. SETTING A sample of high risk-rated notifications of AEs received by the regulator in 2018 and 2019 was drawn from the Database of Statutory Notifications from Social Care in Ireland (n = 156). METHODS Two researchers independently analyzed notifications to identify contributing factors using our modified HFACS. The number of factors identified in each level, subcategory, and nanocode of the HFACS was calculated along with percentage representation of factors within notifications and percentage contribution of individual factors to the total number of factors identified. The number and percentage contributions of factors were also calculated, disaggregated by notification type. RESULTS Contributing factors from all levels of the HFACS were identified. The most common contributing factor was "Resident factors" followed by "Unsafe acts." No contributing factors were attributed to 68 notifications (43.6%). Multiple contributing factors were attributed to 45 notifications (28.8%). The largest percentage of factors was identified in notifications of serious injuries (27.4%). CONCLUSION AND IMPLICATIONS It is the responsibility of LTCFs to account for "Resident factors" in system design, risk management, and care plans. Developing systems and processes that identify where residents have higher risk of harm may reduce the occurrence of high-risk events and thus improve resident safety. The large proportion of notifications where no contributing factors were identified suggests the need for improved reflection and reporting from LTCFs and for more specific questions on notification forms.
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Affiliation(s)
- Niall McGrane
- Health Information and Quality Authority, Cork, Ireland
| | - Paul Dunbar
- Health Information and Quality Authority, Cork, Ireland
| | - Laura M Keyes
- Health Information and Quality Authority, Cork, Ireland.
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Khatatbeh H, Al‐Dwaikat T, Rababah J, Oláh A, Pakai A. Paediatric nurses' burnout, quality of life and perceived patient adverse events during the COVID-19 pandemic: Testing an integrated model using structural equation modelling. J Clin Nurs 2024; 33:255-264. [PMID: 34719846 PMCID: PMC8662054 DOI: 10.1111/jocn.16114] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 07/30/2021] [Accepted: 10/14/2021] [Indexed: 12/15/2022]
Abstract
PURPOSE A model was hypothesised by integrating two theoretical models: the compassion satisfaction-compassion fatigue and empowerment models. This study aimed to assess the extent to which this integrated model can explain the relationships between paediatric nurses' burnout quality of life, perceived patient safety and work-related variables during the COVID-19 pandemic. BACKGROUND Nurses' burnout is negatively associated with quality of life (QOL) and positively with patient safety. Several theoretical models were introduced to explain burnout determinants and outcomes such as Golembiewski, Munzenrider and Stevenson model, Leiter and Maslach's process model, and Lee and Ashforth's model. However, few models described burnout in relation to QOL or patient safety. METHODS A sample of 225 paediatric nurses responded to questionnaires about burnout, QOL, adverse events and work-related variables. Compassion satisfaction - compassion fatigue and empowerment models were integrated into a single model and tested using structural equation modelling analysis. This study was prepared and is reported according to the STROBE checklist. RESULTS The final model explained 65% of the variance of burnout and 37% of the variance of QOL. The work-related variables (co-workers' support, job satisfaction, satisfaction with the monthly salary, participation in continuous education and exposure to violence) are predicting paediatric nurses' burnout and quality of life. CONCLUSION The Compassion satisfaction - compassion fatigue -Empowerment integrated model allows for assessing the different paths in the relationship between work-related variables and burnout. RELEVANCE TO CLINICAL PRACTICE These results might be essential for nursing managers to develop strategies that improve nurses' work environment and minimise their burnout during COVID-19 pandemic. These strategies should focus on enhancing co-workers' support, job satisfaction and participation in continuous education. Furthermore, paediatric nurses should be protected from any violence.
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Affiliation(s)
- Haitham Khatatbeh
- Doctoral School of Health SciencesFaculty of Health SciencesUniversity of PécsPécsHungary
| | - Tariq Al‐Dwaikat
- Department of Community and Mental HealthFaculty of NursingJordan University of Science and TechnologyIrbidJordan
| | - Jehad Rababah
- Department of Adults HealthFaculty of NursingJordan University of Science and TechnologyIrbidJordan
| | - András Oláh
- Faculty of Health SciencesInstitute of Nursing SciencesBasic Health Sciences and Health VisitingUniversity of PécsPécsHungary
| | - Annamária Pakai
- Faculty of Health SciencesInstitute of Nursing SciencesBasic Health Sciences and Health VisitingUniversity of PécsPécsHungary
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Ring J, Maracle J, Zhang S, Methot M, Zevin B. Medication Prescribing Errors on a Surgery Service - Addressing the Gap with a Curriculum for Surgery Residents: A Prospective Observational Study. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2024; 11:23821205241226819. [PMID: 38268730 PMCID: PMC10807340 DOI: 10.1177/23821205241226819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 12/22/2023] [Indexed: 01/26/2024]
Abstract
OBJECTIVES Educational interventions with proven effectiveness to reduce medication prescribing errors are currently lacking. Our objective was to implement and assess the effectiveness of a curriculum to reduce medication prescribing errors on a surgery service. METHODS This was a prospective observational cohort study at a Canadian academic hospital without an electronic order entry system. A pharmacist-led medication prescribing curriculum for surgery residents was developed and implemented over 2 days (2 h/day) in July 2019. Thirteen (76%) out of 17 surgery residents contributed pre-implementation data, while 13 (81%) out of 16 surgery residents contributed post-implementation data. Medication prescribing errors were tracked for 12 months pre-implementation and 6 months post-implementation. Errors were classified as prescription writing (PW) or decision making (DM). RESULTS There were a total of 1050 medication prescribing errors made in the pre-implementation period with 615 (59%) PW errors and 435 (41%) DM. There were a mean of 87.5 (SD = 14.6) total medication prescribing errors per month in the pre-implementation period with 51.3 (11.9) PW and 36.3 (6.0) DM errors. There were a total of 472 medication prescribing errors made in the post-implementation period with 260 (55%) PW and 212 (45%) DM errors. There were a mean of 78.7 (10.3) total medication prescribing errors per month in the post-implementation period with 43.3 (9.5) PW and 35.3 (4.2) DM errors. In the first quarter of the academic year, there were significantly fewer mean total errors per month post-implementation versus pre-implementation (77.7(12.7) versus 107.3(8.1); P = .035), with significantly fewer PW errors per month (40.7(13.2) versus 68.7(9.3); P = .046) and no difference in DM errors per month (37.0(2.0) versus 38.7(5.7);P = .671). There were no differences noted in the second quarter of the academic year. CONCLUSION Medication prescribing errors occurred from PW and DM. Medication prescribing curriculum decreased PW errors; however, a continued education program is warranted as the effect diminished over time.
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Affiliation(s)
- Justine Ring
- Division of Plastic Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jesse Maracle
- School of Medicine, Queen’s University, Kingston, Ontario, Canada
| | - Shannon Zhang
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Boris Zevin
- Department of Surgery, Queen’s University, Kingston, Ontario, Canada
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Dube S, Mlambo M, Mapukata NOMO. Final-year medical students' reflections on types of significant events in primary care. Afr J Prim Health Care Fam Med 2023; 15:e1-e6. [PMID: 37916726 PMCID: PMC10696899 DOI: 10.4102/phcfm.v15i1.4099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 07/31/2023] [Accepted: 08/10/2023] [Indexed: 11/03/2023] Open
Abstract
BACKGROUND Adverse events are considered a universal challenge and a burden in the provision of healthcare. For that reason, significant event analysis (SEA) is a critical undertaking in primary health care (PHC), particularly in South Africa where 84% of the population relies on the public health system for their care. AIM The study aimed to describe the types of perceived significant events medical students experienced during an integrated primary care block placement. SETTING Eighteen PHC settings included clinics, community health centres and district hospitals across three provinces in Gauteng, Mpumalanga and the North West. METHODS Using a qualitative descriptive design with purposeful sampling and maximum variation, structured reflection reports were retrieved from logbooks of final-year medical students studying at a South African university in 2014. Conventional content analysis was used to record the relevant facets of secondary data from 124 logbooks that contained a recording of a significant event using MAXQDA software version 2020.4. RESULTS An iterative process revealed three major themes of significant events that were prevalent in PHC settings. These comprised medication and prescription errors, diagnostic errors and suboptimal patient management. CONCLUSION Significant event analysis became a critical quality improvement reflective learning tool. Logbooks offered an opportunity for medical students to explore significant events as a strategic way towards addressing quality and safe practices in PHC settings.Contribution: This study demonstrated medical students' ability to identify incidents in the care of patients using the SEA approach and their role in assessing patient safety issues in PHC settings.
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Affiliation(s)
- Samantha Dube
- Department of Family Medicine and Primary Care, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg.
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Passini L, Le Bouedec S, Dassieu G, Reynaud A, Jung C, Keller ML, Lefebvre A, Katty T, Baleyte JM, Layese R, Audureau E, Caeymaex L. Error disclosure in neonatal intensive care: a multicentre, prospective, observational study. BMJ Qual Saf 2023; 32:589-599. [PMID: 36918264 DOI: 10.1136/bmjqs-2022-015247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 11/08/2022] [Indexed: 03/16/2023]
Abstract
IMPORTANCE Surveys based on hypothetical situations suggest that health-care providers agree that disclosure of errors and adverse events to patients and families is a professional obligation but do not always disclose them. Disclosure rates and reasons for the choice have not previously been studied. OBJECTIVE To measure the proportion of errors disclosed by neonatal intensive care unit (NICU) professionals to parents and identify motives for and barriers to disclosure. DESIGN Prospective, observational study nested in a randomised controlled trial (Study on Preventing Adverse Events in Neonates (SEPREVEN); ClinicalTrials.gov). Event disclosure was not intended to be related to the intervention tested. SETTING 10 NICUs in France with a 20-month follow-up, starting November 2015. PARTICIPANTS n=1019 patients with NICU stay ≥2 days with ≥1 error. EXPOSURE Characteristics of errors (type, severity, timing of discovery), patients and professionals, self-reported motives for disclosure and non-disclosure. MAIN OUTCOME AND MEASURES Rate of error disclosure reported anonymously and voluntarily by physicians and nurses; perceived parental reaction to disclosure. RESULTS Among 1822 errors concerning 1019 patients (mean gestational age: 30.8±4.5 weeks), 752 (41.3%) were disclosed. Independent risk factors for non-disclosure were nighttime discovery of error (OR 2.40; 95% CI 1.75 to 3.30), milder consequence (for moderate consequence: OR 1.85; 95% CI 0.89 to 3.86; no consequence: OR 6.49; 95% CI 2.99 to 14.11), a shorter interval between admission and error, error type and fewer beds. The most frequent reported reasons for non-disclosure were parental absence at its discovery and a perceived lack of serious consequence. CONCLUSION AND RELEVANCE In the particular context of the SEPREVEN randomised controlled trial of NICUs, staff did not disclose the majority of errors to parents, especially in the absence of moderate consequence for the infant. TRIAL REGISTRATION NUMBER NCT02598609.
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Affiliation(s)
- Loïc Passini
- Neonatal Intensive care Unit, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | | | - Gilles Dassieu
- Neonatal Intensive care Unit, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | | | - Camille Jung
- Clinical Research Center, Centre Hospitalier Intercommunal de Creteil, Creteil, France
| | - Marie-Laurence Keller
- Neonatal Intensive care Unit, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - Aline Lefebvre
- Department of Child and Adolescent Psychiatry, APHP, Paris, France
- Human Genetics and Cognitive Functions, Institut Pasteur, UMR 3571 CNRS, University Paris Diderot, Paris, France
- Child and Adolescent Psychiatry Creteil, Centre Hospitalier Intercommunal de Creteil, Creteil, France
| | - Therese Katty
- Health Law Manager, Centre Hospitalier Intercommunal de Creteil, Creteil, France
| | - Jean-Marc Baleyte
- Child and Adolescent Psychiatry Creteil, Centre Hospitalier Intercommunal de Creteil, Creteil, France
- Faculty of Health, University Paris Est Creteil, Creteil, France
| | - Richard Layese
- INSERM IMRB, CEpiA Team, University Paris Est Creteil, Creteil, France, Créteil, France
- Unité de Recherche Clinique (URC), Hôpital Henri Mondor, Assistance Publique - Hôpitaux de Paris APHP, Créteil, France
| | - Etienne Audureau
- INSERM IMRB, CEpiA Team, University Paris Est Creteil, Creteil, France, Créteil, France
- Unité de Recherche Clinique (URC), Hôpital Henri Mondor, Assistance Publique - Hôpitaux de Paris APHP, Créteil, France
| | - Laurence Caeymaex
- Neonatal Intensive care Unit, Centre Hospitalier Intercommunal de Créteil, Créteil, France
- Clinical Research Center, Centre Hospitalier Intercommunal de Creteil, Creteil, France
- Faculty of Health, University Paris Est Creteil, Creteil, France
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Balogun JA, Adekanmbi AA, Balogun FM. Surgical residents as "second victims" following exposure to medical errors in a tertiary health training facility in Nigeria: a phenomenology study. Patient Saf Surg 2023; 17:18. [PMID: 37464356 DOI: 10.1186/s13037-023-00370-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 07/10/2023] [Indexed: 07/20/2023] Open
Abstract
INTRODUCTION The "second victim" phenomenon refers to the distress and other negative consequences that physicians experience when they commit medical error. There has been increasing awareness about this phenomenon and efforts are being made to address it. However, there is dearth of information about it in developing countries. This study explored the experiences of surgical resident doctors of the University College Hospital in Ibadan, Nigeria about the "second victim" phenomenon and the support they had following medical errors. METHODS This is a phenomenology study in which qualitative data were obtained from interviews with 31 resident doctors across 10 surgical units/departments. Interviews were transcribed verbatim, and data were coded inductively. Data were analyzed using content analysis method. Themes and subthemes were generated using axial coding. The themes were then integrated using selective coding. RESULTS There were 31 participants and 10(32.3%) were females. All had witnessed other physicians encountering medical errors while 28(90.3%) had been directly involved in medical errors. Most of the errors were at the inter-operative stage. Prolonged work hours with inadequate sleep were identified as major causes of most medical errors. The feelings following medical errors were all negative and was described as 'stressful'. Most of the residents got support from their colleagues, mostly contemporaries following medical errors, and many viewed medical errors as a learning point to improve their practice. However, there was a general belief that the systemic support following medical errors was inadequate. CONCLUSION The "second victim" phenomenon was common among the study group with consequent negative effects. Normalizing discussions about medical errors, reduction of work hours and meticulous intraoperative guidance may reduce medical errors and its consequences on the surgical residents. Steps should be taken within the system to address this issue effectively.
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Affiliation(s)
- James Ayokunle Balogun
- Division of Neurosurgery, Department of Surgery, College of Medicine, University of Ibadan, No. 1, Queen Elizabeth road, University College Hospital Campus, Ibadan, 200001, Nigeria.
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Youssef C, Houchens N, Gupta A. Quality and safety in the literature: July 2023. BMJ Qual Saf 2023; 32:426-430. [PMID: 37336557 DOI: 10.1136/bmjqs-2023-016272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 04/21/2023] [Indexed: 06/21/2023]
Affiliation(s)
- Christie Youssef
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Nathan Houchens
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
- Medicine Service, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
| | - Ashwin Gupta
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
- Medicine Service, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
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Bernardinangeli C, Giannace C, Cerciello S, Grassi VM, Lodise M, Vetrugno G, De-Giorgio F. A Fifteen-Year Survey for Orthopedic Malpractice Claims in the Criminal Court of Rome. Healthcare (Basel) 2023; 11:healthcare11070962. [PMID: 37046888 PMCID: PMC10093963 DOI: 10.3390/healthcare11070962] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 03/07/2023] [Accepted: 03/23/2023] [Indexed: 03/30/2023] Open
Abstract
The number of legal disputes in the field of medical liability has increased exponentially in the last decades. The aim of this study is to investigate the outcomes of criminal cases against healthcare professionals in Italian criminal courts. The hypothesis is that the majority of cases are dismissed and/or most professionals in these cases are acquitted. This retrospective analysis considers criminal proceedings related to medical professional liability registered with the general register of crime reports of the Public Prosecutor’s Office of Rome in the time interval between 1 January 2000 and 31 December 2015. A total of 4793 criminal proceedings were ultimately identified. Proceedings related to the field of orthopedic trauma were then examined and identified. A complete analysis of 132 of the identified files (76.7%) was carried out. The field with the highest risk of disputes was determined to be the field of trauma. The most frequent complaint was found to arise from unsatisfactory surgical outcomes following elective surgery. The most affected anatomical district is the lower limb in both elective and trauma cases, followed by the upper limb in traumatology and spine cases. The surgeon is the most frequently quoted role of the professional involved. The number of physicians actually convicted (3.93%) and for whom liability was thus recognized, i.e., the existence of a causal link between their conduct and the event that took place was established, appears to be extremely small when compared with the far more significant values related to dismissals (53%) and acquittals (14.2%). Adequate legal reform aiming to reduce this disproportion is necessary to ensure physicians experience a more relaxed daily profession and to restore the original connotations of the doctor–patient relationship with the abolition of defensive medicine.
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Simpson A, Boev C, Dambaugh L. Next generation NCLEX stand-alone items: Bowtie & trend. TEACHING AND LEARNING IN NURSING 2023. [DOI: 10.1016/j.teln.2023.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
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Gawinski L, Burzynska M, Marczak M, Kozlowski R. Assessment of In-Hospital Mortality and Its Risk Factors in Patients with Myocardial Infarction Considering the Logistical Aspects of the Treatment Process-A Single-Center, Retrospective, Observational Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3603. [PMID: 36834296 PMCID: PMC9963836 DOI: 10.3390/ijerph20043603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 02/12/2023] [Accepted: 02/15/2023] [Indexed: 06/18/2023]
Abstract
Technological progress, such as the launching of a new generation of drug-coated stents as well as new antiplatelet drugs, has resulted in the treatment of myocardial infarction (MI) becoming much more effective. The aim of this study was to assess in-hospital mortality and to conduct an assessment of risk factors relevant to the in-hospital death of patients with MI. This study was based on an observational hospital registry of patients with MI (ACS GRU registry). For the purpose of the statistical analysis of the risk factors of death, a univariate logistic regression model was applied. In-hospital general mortality amounted to 7.27%. A higher death risk was confirmed in the following cases: (1) serious adverse events (SAEs) that occurred during the procedure; (2) patients transferred from another department of a hospital (OR = 2.647, p = 0.0056); (3) primary percutaneous coronary angioplasty performed on weekdays between 10 p.m. and 8 a.m. (OR = 2.540, p = 0.0146). The influence of workload and operator experience on the risk of death in a patient with MI has not been confirmed. The results of this study indicate the increasing importance of new risk factors for in-hospital death in patients with MI, such as selected logistical aspects of the MI treatment process and individual SAEs.
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Affiliation(s)
- Lukasz Gawinski
- Department of Management and Logistics in Health Care, Medical University of Lodz, 90-237 Lodz, Poland
| | - Monika Burzynska
- Department of Epidemiology and Biostatistics, Medical University of Lodz, 90-237 Lodz, Poland
| | - Michal Marczak
- Collegium of Management, WSB University in Warsaw, 03-204 Warsaw, Poland
| | - Remigiusz Kozlowski
- Center of Security Technologies in Logistics, Faculty of Management, University of Lodz, 90-237 Lodz, Poland
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Kivimäki T, Stolt M, Katajisto J, Charalambous A, Suhonen R. National registry-based data of adverse events in Finnish long-term professional homecare in 2009-2019. J Clin Nurs 2023; 32:548-557. [PMID: 35373401 DOI: 10.1111/jocn.16312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 03/14/2022] [Accepted: 03/16/2022] [Indexed: 01/17/2023]
Abstract
AIMS AND OBJECTIVES The aim of this study was to discover the nature of the adverse events in Finnish long-term professional homecare reported by professionals, and to identify the circumstances in which adverse events occur and their consequences. BACKGROUND Adverse events are incidents causing unintended and unnecessary harm to older people at home. Safety is a basic human right and a fundamental prerequisite for independent living among older people at home. Few studies have focused on both long-term professional homecare environment and the safety of older people. DESIGN The research was a descriptive registry-based study. METHODS This study consisted of adverse events (N = 61248) in Finnish public long-term professional homecare (2009-2019). Data were described using frequencies and percentages. STROBE statement checklist was chosen for reporting the study process. RESULTS By profession, practical nurses and registered nurses reported the most of adverse events (89.8%). These were either critical incidents (78.3%) or near misses (20.0%) and concerned medicine, injuries and accidents, information flow or management. Consequences for older people were usually rated from no-harm to moderate harm. For long-term professional homecare, image harm, extra financial costs, no-harm and prolonged care for older people were among the consequences. Personnel frequently observed the older people afterwards and informed older people of adverse events, yet some of actions were unknown. CONCLUSIONS Many harmful adverse events are considered harmless for older people. Sometimes this can lead to unmet care needs or missed care. The degree of harm needs to be assessed in terms of physical, mental and social health with the HaiPro reporting system for homecare. RELEVANCE TO CLINICAL PRACTICE An understanding and a comprehensive view of the situation and holistic assessment of care needs includes safety and safety risks to increase safety and feeling of safety for older people at home.
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Affiliation(s)
- Taina Kivimäki
- Department of Nursing Science, University of Turku, Turku, Finland.,Satakunta Hospital District, Pori, Finland
| | - Minna Stolt
- Department of Nursing Science, University of Turku, Turku, Finland
| | - Jouko Katajisto
- Department of Mathematics and Statistics, University of Turku, Turku, Finland
| | - Andreas Charalambous
- Department of Nursing Science, University of Turku, Turku, Finland.,Cyprus University of Technology, Limassol, Cyprus
| | - Riitta Suhonen
- Department of Nursing Science, University of Turku, Turku, Finland.,City of Turku, Welfare Division, Turku University Hospital, Turku, Finland
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Abry S, Mehrabian F, Omidi S, Karimy M, Kasmaei P, Haryalchi K. Investigation of factors related to the behavior of reporting clinical errors in nurses working in educational and medical centers in Rasht city, Iran. BMC Nurs 2022; 21:348. [PMID: 36482463 PMCID: PMC9733308 DOI: 10.1186/s12912-022-01134-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 11/30/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Report of medical error is one of the effective components in the quality of healthcare services. A significant part of medical errors can be prevented by acting appropriately. The theory of planned behavior offers a framework in which the nurse intention to perform the behavior of error reporting is investigated. This study was conducted to determine the factors related to the behavior of reporting clinical errors in nurses working in educational and medical centers in Rasht based on the theory of planned behavior in 2020. METHODS In this descriptive-analytical study, 326 nurses in all medical centers in Rasht were selected by the multi-stage random sampling method. Data collection tool was a valid and reliable questionnaire based on the theory of planned behavior. Data analysis was conducted using the SPSS software, analysis of variance, correlation, and linear regression. RESULTS 39% of nurses reported that they had reported a medical error, and the average number of error reports per nurse during the last 3 months was 1.42 errors. The predictive power of the theory of behavioral intention was 47%, and predictive constructs were attitude (B = .43), perceived behavioral control (B = .33), and subjective norm (B = .04) using linear regression. The predictive power of the theory for nurses' behavior was 3.1%. None of the demographic variables played a role in predicting the behavior of nurses' reporting clinical error, and no behavioral intention predicted the behavior of nurses' reporting clinical errors. CONCLUSION The theory of planned behavior expresses the factors affecting the behavior intention of nurses' reporting clinical errors satisfactorily. However, it was an inappropriate theory in behavior prediction. It appears that factors, such as fear of consequences of error reporting, social pressures by colleagues and officials, and lack of knowledge and skills required to identify medical errors, are the barriers to conversion of intention to the behavior of reporting clinical errors. It is necessary to provide the ground to increase nurses' report of clinical errors by acting appropriately.
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Affiliation(s)
- Somayeh Abry
- grid.411874.f0000 0004 0571 1549Department of Health Education and Promotion, School of Health, Guilan University of Medical Sciences, Rasht, Iran
| | - Fardin Mehrabian
- grid.411874.f0000 0004 0571 1549Department of Health Education and Promotion, Research Center of Health and Environment, School of Health, Guilan University of Medical Sciences, Rasht, Iran
| | - Saeed Omidi
- grid.411874.f0000 0004 0571 1549Guilan University of Medical Sciences, Rasht, Iran
| | - Mahmood Karimy
- grid.510755.30000 0004 4907 1344Department of Public Health, Social Determinants of Health Research Center, Saveh University of Medical Sciences, Saveh, Iran
| | - Parisa Kasmaei
- grid.411874.f0000 0004 0571 1549Department of Health Education and Promotion, Research Center of Health and Environment, School of Health, Guilan University of Medical Sciences, Rasht, Iran
| | - Katayoun Haryalchi
- Department of Obstetrics & Gynecology, School of Medicine, Reproductive Health Research CenterAlzahra HospitalGuilan University of Medical Science, Rasht, Iran
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14
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Palungwachira P, Montimanutt G, Musikatavorn K, Savatmongkorngul S. Reducing 48-h emergency department revisits and subsequent admissions: a retrospective study of increased emergency medicine resident floor coverage. Int J Emerg Med 2022; 15:66. [PMID: 36474146 PMCID: PMC9724369 DOI: 10.1186/s12245-022-00471-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 11/19/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Early unexpected hospital admission after emergency department (ED) discharge is an important topic regarding effective preventive measures. Reducing avoidable return visits can improve ED effectiveness and emergency care. This study evaluated the effects of an increase in the number of physicians and the 24-h coverage of emergency physicians on 48-h ED revisits with subsequent hospital admission. The characteristics and risk factors of the patients were also investigated. RESULTS This was a retrospective analysis performed 2 years before and 2 years after the implementation of an intervention in a tertiary care hospital in Thailand. The medical records of adult patients who revisited the ED within 48 h for related complaints were reviewed. The effect of the intervention was analyzed, and a prediction model was developed based on logistic regression. After implementing the intervention, the hospital admission rate at the second ED visit decreased from 44.5 to 41.1%; no significant difference was found (95% confidence interval (CI) - 5.05 to 11.78). Patients who required hospital admission had a significantly higher comorbidity score, more ED visits, and more hospitalizations within the past 12 months. A significantly higher hospital admission rate was also observed among patients older than 60 years, those who had an initial infectious diagnosis, and those who had a higher triage severity level (ESI II) at their first visit. The odds ratio (OR) showed lower odds of hospital admission at the second visit in the postintervention period; this difference was not significant (OR 0.87; 95% CI 0.61 to 1.23). CONCLUSION Our intervention did not significantly decrease the incidence of admission at an ED revisit. However, some factors identified in this study seem to have some benefits and might be helpful for preventing errors and constructing a standard discharge care plan for patients with these risk factors.
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Affiliation(s)
- Pakhawadee Palungwachira
- grid.419934.20000 0001 1018 2627Department of Emergency Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, 10330 Thailand
| | - Gunnaree Montimanutt
- grid.419934.20000 0001 1018 2627Department of Emergency Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, 10330 Thailand
| | - Khrongwong Musikatavorn
- grid.419934.20000 0001 1018 2627Department of Emergency Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, 10330 Thailand
| | - Sorravit Savatmongkorngul
- grid.10223.320000 0004 1937 0490Department of Emergency Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, 10400 Thailand
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15
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Wang Q, Lai X, Zheng F, Yu T, Wang L, Wu Y, Wang K, Zhang X, Zhou Q, Tan L. The impacts of self-expectation leadership and organizational commitment on hand hygiene behavior of medical staff based on the theory of implicit leadership. Front Psychol 2022; 13:992920. [DOI: 10.3389/fpsyg.2022.992920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 10/24/2022] [Indexed: 11/15/2022] Open
Abstract
Hand hygiene behavior (HHB) in healthcare settings remains suboptimal globally. Self-expectation leadership and organizational commitment are emphasized as important factors influencing HHB. However, there are no studies to support any relationship between self-expectation leadership and organizational commitment to HHB. This study will fill the gap by applying implicit leadership theory (ILT) to support the further promote HHB among medical staff. A cross-sectional study of 23,426 medical staff was conducted in all second-level and third-level hospitals in Hubei province, China. Based on ILT, an online self-administered and anonymous questionnaire was designed for measuring the medical staff’s self-expectation leadership, organizational commitment, and HHB based on Offermann’s 8 dimensions scale, Chang’s 3 dimensions scale, and the specification of hand hygiene for healthcare workers, respectively, in which self-expectation leadership was divided into positive traits and negative traits parts. The structural equation model was used to examine the direct, indirect, and mediating effects of the variables. Positive traits of self-expectation leadership had a positive effect on organizational commitment (β = 0.617, p < 0.001) and HHB (β = 0.180, p < 0.001). Negative traits of self-expectation leadership had a negative effect on organizational commitment (β = –0.032, p < 0.001), while a positive effect on HHB (β = 0.048, p < 0.001). The organizational commitment had a positive effect on HHB (β = 0.419, p < 0.001). The mediating effect of the organizational commitment showed positively between positive traits of self-expectation leadership and HHB (β = 0.259, p < 0.001), while negatively between negative traits of self-expectation leadership and HHB (β = –0.013, p < 0.001). Positive traits of self-expectation leadership are important predictors of promoting organizational commitment and HHB, while negative traits of self-expectation leadership have a limited impact on organizational commitment and HHB in the field of healthcare-associated infection prevention and control. These findings suggest the need to focus on positive traits of self-expectation leadership; although negative traits of self-expectation leadership can also promote HHB to a lesser degree among medical staff, it will reduce their organizational commitment.
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16
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Palacios García L, Enguita Germán M, Ruiz Sada P, Echeverría Echeverría A, González Gómez M, Rubio Obanos MT. Impact of clinical ultrasound in patients with heart failure treated in home. Med Clin (Barc) 2022; 159:420-425. [PMID: 35305810 DOI: 10.1016/j.medcli.2021.12.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 12/18/2021] [Accepted: 12/27/2021] [Indexed: 10/31/2022]
Abstract
BACKGROUND AND OBJECTIVE In Spain, more than 10% of patients discharged with acute heart failure (AHF) are readmitted in the first 30 days. This study is designed to assess whether the treatment of AHF guided by clinical ultrasound (CU) in the setting of hospitalization at home (HAH) reduces the incidence of readmission and mortality compared to the standard care (SC). PATIENTS AND METHODS A randomized, open, parallel, single-center and controlled clinical trial (RCT) was designed (NT05042752). Patients >18 years of age admitted for AHF to HAD from January 2021 to April 2021 at the Reina Sofía Hospital in Tudela were consecutively included. The patients were randomized to the UG-ultrasound group (SC and CU performed) and the CG-control group (SC). The diuretic treatment was tailored according to the findings of the SC together with the CU or according to the findings of the SC respectively. The main variables were the relative risk of readmission and mortality from AHF. RESULTS A total of 79 patients were randomized, 39 to UG and 40 to CG. Of these, only 35 of the UG and 35 of the CG completed the intervention. The risk of readmission due to AHF was reduced by 60% in UG compared to CG (RR 0.4; 95% CI: 0.1-1) and mortality by 30% (RR 0.7; 95% CI: 0.2-2.2). Despite the relevant magnitude of the effect found, the results did not reach statistical significance due to lack of power. CONCLUSION Our results suggest that in HAH, a CE guided strategy for AHF could reduce the risk of readmission and mortality compared to SC alone. However, studies with greater statistical power are needed to confirm these results.
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Affiliation(s)
- Lara Palacios García
- FEA, adjunto del Servicio de Medicina Interna, Hospital Reina Sofía de Tudela, Tudela, Navarra, España
| | - Mónica Enguita Germán
- Navarrabiomed-Hospital Universitario de Navarra (HUN)-UPNA, Pamplona, Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Pamplona, Navarra, España
| | - Pablo Ruiz Sada
- FEA, adjunto del Servicio de Medicina Interna, Hospital Reina Sofía de Tudela, Tudela, Navarra, España.
| | | | - María González Gómez
- FEA, Adjunto del Servicio de Medicina Interna, Hospital de Mérida, Mérida, Badajoz, España
| | - María Teresa Rubio Obanos
- FEA, adjunto del Servicio de Medicina Interna, Hospital Reina Sofía de Tudela, Tudela, Navarra, España
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Kim OT. Patient safety as a global health priority. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2022. [DOI: 10.15829/1728-8800-2022-3427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Patient safety is a discipline that has arisen in response to the increasing complexity of health care delivery and the associated increase in patient harm. Adverse health care events are a serious problem, causing significant harm to the patient and increasing health care costs. The World Health Organization has identified patient safety as one of the key priorities for world health. The current review presents the historical background that led to the formation of the discipline of patient safety, the determinants of adverse events in medical practice, and the main tools for dealing with them.
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Affiliation(s)
- O. T. Kim
- National Medical Research Center for Therapy and Preventive Medicine
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18
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McGrane N, O'Regan S, Dunbar P, Dunnion M, Leistikow I, Keyes L. Management and reporting of safety incidents by residential care facilities in Ireland: A thematic analysis of statutory notifications. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e4936-e4949. [PMID: 35876121 DOI: 10.1111/hsc.13905] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 06/07/2022] [Accepted: 06/18/2022] [Indexed: 06/15/2023]
Abstract
The prevention of safety incidents (SI) in health and social care settings is an ongoing undertaking. Limited research has been conducted on SIs outside of acute care. Internationally residential care facilities (RCFs) are typically regulated to promote quality and safeguarding. A part of this regulation is the statutory responsibility of RCFs to notify the regulator about SIs. Notifications include details surrounding SIs and are used to inform the regulatory monitoring approach. The recent development of the Database of Statutory Notifications from Social Care in Ireland facilitates in-depth analysis of notifications which can be used to inform the management of SIs and thus, improve quality and safety. The aim of this study was to analyse narratives provided in statutory notifications for older persons and people with disability, in order to identify current management of SIs, system vulnerabilities and reporting practices. A Qualitative Descriptive approach was taken. A random sample of notifications received in 2018 was drawn and stratified by service-type and notification-type. Data extraction was conducted against priori agreed target areas of management, system vulnerabilities and reporting practices. Inductive thematic analysis was used identifying two parent themes: 'chronology' and 'regulatory input'. 'Chronology' subthemes included 'pre-event', 'immediate response' and 'continued response'. Measures that are resident focused and follow policies and protocols in RCFs to prevent or mitigate the seriousness of SIs were evident in the immediate response and continued response. The actions taken in the immediate and continued response in turn became part of the pre-event of future SIs. Under 'regulatory input' subthemes included 'inaccurate reporting', 'lines of inquiry', 'requests for further information', 'identification of repetitive patterns' and 'satisfactory conclusion'. In conclusion, RCFs manage SIs with short and longer term actions focused on resident wellbeing. These actions in turn become part of the pre-event of future SIs. Regulatory input highlighted regulatory burden.
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Affiliation(s)
- Niall McGrane
- Health Information and Quality Authority of Ireland (HIQA), Cork, Ireland
| | - Stephaine O'Regan
- Health Information and Quality Authority of Ireland (HIQA), Cork, Ireland
| | - Paul Dunbar
- Health Information and Quality Authority of Ireland (HIQA), Cork, Ireland
| | - Mary Dunnion
- Health Information and Quality Authority of Ireland (HIQA), Cork, Ireland
| | - Ian Leistikow
- Erasmus School of Health Policy & Management, Erasmus University, Rotterdam, The Netherlands
- Dutch Health and Youth Care Inspectorate, Utrecht, The Netherlands
| | - Laura Keyes
- Health Information and Quality Authority of Ireland (HIQA), Cork, Ireland
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19
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Patel R, Dhanda AK, Georges K, Cohen DA, Patel P, Eloy JA. Length of Stay in Patients Undergoing Tracheoplasty: A NSQIP Study. Laryngoscope 2022. [PMID: 36214517 DOI: 10.1002/lary.30424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 08/21/2022] [Accepted: 09/15/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Prolonged length of stay (LOS) has been associated with increased morbidity and resource utilization in various surgical procedures. We aim to determine factors associated with increased hospital stay in patient undergoing tracheoplasty. METHODS The 2012-2018 National Surgical Quality Improvement Program (NSQIP) database was queried for patients undergoing tracheoplasty. Patient LOS was the primary clinical outcome. A LOS >75th percentile was considered as prolonged and was utilized for bivariate analysis of demographic, comorbidity, and operative characteristics. LOS was utilized as a continuous variable for multivariate linear regression analysis. RESULTS A total of 252 patients were queried. The majority of patients were female (67.5%), white (82.4%), and over the age of 65 (77.0%). Patients had a median LOS of 7 days with the 75th percentile cutoff being defined at 10 days. On bivariate analysis of associated comorbidities, patients with prolonged LOS were more commonly obese (72.4% vs. 53.1%, p = 0.009), diabetic (37.9% vs. 16.5%, p < 0.001), dyspneic (58.6% vs. 40.7%, p = 0.016), and had chronic steroid use (25.9% vs. 12.9%, p = 0.018). Multivariable logistic regression analysis demonstrated significant associations between prolonged LOS and both chronic obstructive pulmonary disorder (COPD) (OR: 3.43, p = 0.020) and chronic steroid use (OR: 3.81, p = 0.018). CONCLUSIONS This study elucidates factors associated with prolonged LOS in patients undergoing tracheoplasty. Patients with COPD and chronic steroid use were significantly associated with prolonged LOS. LEVEL OF EVIDENCE 4 Laryngoscope, 2022.
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Affiliation(s)
- Rushi Patel
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Aatin K Dhanda
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Kirolos Georges
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - David A Cohen
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Prayag Patel
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Jean Anderson Eloy
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA.,Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, New Jersey, USA.,Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA.,Department of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, New Jersey, USA.,Department of Otolaryngology and Facial Plastic Surgery, Cooperman Barnabas Medical Center - RWJ Barnabas Health, Livingston, New Jersey, USA
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20
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Ahmed FA, Asif F, Mubashir A, Aboumatar HJ, Hameed M, Haider A, Latif A. Incorporating Patient Safety and Quality Into the Medical School Curriculum: An Assessment of Student Gains. J Patient Saf 2022; 18:637-644. [PMID: 35532980 PMCID: PMC9422755 DOI: 10.1097/pts.0000000000001010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Global efforts are being made to improve health care standards and the quality of care provided. It has been shown through research that the introduction of patient safety (PS) and quality improvement (QI) concepts in the medical curriculum prepares medical students to face future challenges in their professional careers. PURPOSE This study aimed to evaluate how a brief course on QI and PS affects the knowledge, efficacy, and system thinking of medical students. METHODS A 5-day QI and PS intervention course was implemented at the Aga Khan University medical college for 98 third-year medical students in March 2021. This weeklong course of lectures, interactive sessions, and hands-on skill workshops was conducted before the students began their clinical rotations. Students' knowledge, self-efficacy, and system thinking were assessed with pretest and posttest. Students were also asked to write personal reflections and fill out a satisfaction survey at the end of the intervention. RESULTS Comparisons of pretest and posttest scores showed that the course significantly improved students' knowledge by a mean of 2.92 points (95% confidence interval, 2.30-3.53; P < 0.001) and system thinking by 0.16 points (95% confidence interval, 0.03-0.29; P = 0.018) of the maximum scores of 20 and 5 points, respectively. The students' self-assessment of PS knowledge also reflected statistically significant increases in all 9 domains ( P < 0.001). Students reported positive experiences with this course in their personal reflections. CONCLUSIONS The medical students exhibited increases in knowledge, self-efficacy, and system thinking after this weeklong intervention. The design of the course can be modified as needed and implemented at other institutions in low- and middle-income countries. A targeted long-term assessment of knowledge and attitudes is needed to fully evaluate the impact of this course.
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Affiliation(s)
- Fasih Ali Ahmed
- From the Center for Patient Safety, Aga Khan University, Karachi, Pakistan
| | - Fozia Asif
- From the Center for Patient Safety, Aga Khan University, Karachi, Pakistan
| | - Ayesha Mubashir
- From the Center for Patient Safety, Aga Khan University, Karachi, Pakistan
| | - Hanan J. Aboumatar
- Johns Hopkins University School of Medicine
- Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, Maryland
| | - Malika Hameed
- Department of Anaesthesiology, Aga Khan University, Karachi, Pakistan
| | - Adil Haider
- Medical College, Aga Khan University, Karachi, Pakistan
| | - Asad Latif
- Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, Maryland
- Department of Anaesthesiology, Aga Khan University, Karachi, Pakistan
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21
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van Dalen ASHM, Jung JJ, Nieveen van Dijkum EJM, Buskens CJ, Grantcharov TP, Bemelman WA, Schijven MP. Analyzing and Discussing Human Factors Affecting Surgical Patient Safety Using Innovative Technology: Creating a Safer Operating Culture. J Patient Saf 2022; 18:617-623. [PMID: 35985043 DOI: 10.1097/pts.0000000000000975] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Surgical errors often occur because of human factor-related issues. A medical data recorder (MDR) may be used to analyze human factors in the operating room. The aims of this study were to assess intraoperative safety threats and resilience support events by using an MDR and to identify frequently discussed safety and quality improvement issues during structured postoperative multidisciplinary debriefings using the MDR outcome report. METHODS In a cross-sectional study, 35 standard laparoscopic procedures were performed and recorded using the MDR. Outcome data were analyzed using the automated Systems Engineering Initiative for Patient Safety model. The video-assisted MDR outcome report reflects on safety threat and resilience support events (categories: person, tasks, tools and technology, psychical and external environment, and organization). Surgeries were debriefed by the entire team using this report. Qualitative data analysis was used to evaluate the debriefings. RESULTS A mean (SD) of 52.5 (15.0) relevant events were identified per surgery. Both resilience support and safety threat events were most often related to the interaction between persons (272 of 360 versus 279 of 400). During the debriefings, communication failures (also category person) were the main topic of discussion. CONCLUSIONS Patient safety threats identified by the MDR and discussed by the operating room team were most frequently related to communication, teamwork, and situational awareness. To create an even safer operating culture, educational and quality improvement initiatives should aim at training the entire operating team, as it contributes to a shared mental model of relevant safety issues.
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Affiliation(s)
| | - James J Jung
- International Centre for Surgical Safety, St Michael's Hospital, Toronto, Canada
| | | | - Christianne J Buskens
- Department of Surgery, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | | | - Willem A Bemelman
- Department of Surgery, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
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22
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Jeong S, Jeong SH. [Patient Safety Management Activities of Korean Nurses: A Meta-Analytic Path Analysis]. J Korean Acad Nurs 2022; 52:363-377. [PMID: 36117299 DOI: 10.4040/jkan.22022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 06/17/2022] [Accepted: 08/11/2022] [Indexed: 11/09/2022]
Abstract
PURPOSE This study aimed to test a hypothetical model of Korean nurses' patient safety management activities using meta-analytic path analysis. METHODS A systematic review, meta-analysis, and meta-analytic path analysis were conducted following the PRISMA and MOOSE guidelines. Seventy-four studies for the meta-analysis and 92 for the meta-analytic path analysis were included. The R software program (Version 3.6.3) was used for data analysis. RESULTS Four variables out of 49 relevant variables were selected in the meta-analysis. These four variables showed large effect sizes (ESr = .54) or median effect sizes (ESr = .33~.40) with the highest k (number of studies) in the individual, job, and organizational categories. The hypothetical model for the meta-analytic path analysis was established using these variables and patient safety management activities. Twelve hypothetical paths were set and tested. Finally, the perception of the importance of patient safety management and patient safety competency directly affected patient safety management activities. In addition, self-efficacy, the perception of the importance of patient safety management, patient safety competency, and patient safety culture, indirectly affected patient safety management activities. CONCLUSION Self-efficacy, the perception of the importance of patient safety management, patient safety competency, and the organization's patient safety culture should be enhanced to improve nurses' patient safety management activities.
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Affiliation(s)
- Seohee Jeong
- Quality Improvement Team, Jeonbuk National University Hospital, Jeonju, Korea
| | - Seok Hee Jeong
- College of Nursing · Research Institute of Nursing Science, Jeonbuk National University, Jeonju, Korea.
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23
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Kalenderian E, Hebballi NB, Franklin A, Yansane A, Ibarra Noriega AM, White J, Walji MF. Development of a Quality Improvement Dental Chart Review Training Program. J Patient Saf 2022; 18:e883-e888. [PMID: 35067625 PMCID: PMC9300767 DOI: 10.1097/pts.0000000000000965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Chart review is central to understanding adverse events (AEs) in medicine. In this article, we describe the process and results of educating chart reviewers assigned to evaluate dental AEs. METHODS We developed a Web-based training program, "Dental Patient Safety Training," which uses both independent and consensus-based curricula, for identifying AEs recorded in electronic health records in the dental setting. Training included (1) didactic education, (2) skills training using videos and guided walkthroughs, (3) quizzes with feedback, and (4) hands-on learning exercises. In addition, novice reviewers were coached weekly during consensus review discussions. TeamExpert was composed of 2 experienced reviewers, and TeamNovice included 2 chart reviewers in training. McNemar test, interrater reliability, sensitivity, specificity, positive predictive value, and negative predictive value were calculated to compare accuracy rates on the identification of charts containing AEs at the start of training and 7 months after consensus building discussions between the 2 teams. RESULTS TeamNovice completed independent and consensus development training. Initial chart reviews were conducted on a shared set of charts (n = 51) followed by additional training including consensus building discussions. There was a marked improvement in overall percent agreement, prevalence and bias-adjusted κ correlation, and diagnostic measures (sensitivity, specificity, positive predictive value, and negative predictive value) of reviewed charts between both teams from the phase I training program to phase II consensus building. CONCLUSIONS This study detailed the process of training new chart reviewers and evaluating their performance. Our results suggest that standardized training and continuous coaching improves calibration between experts and trained chart reviewers.
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Affiliation(s)
- Elsbeth Kalenderian
- University of California at San Francisco, School of Dentistry, Department of Preventive and Restorative Dental Sciences, CA, USA
- Harvard School of Dental Medicine, Boston, MA, USA
- University of Pretoria, School of Dentistry, South Africa
| | - Nutan B. Hebballi
- University of Texas Health Science Center, School of Dentistry at Houston, Houston, TX, USA
| | - Amy Franklin
- University of Texas Health Science Center, School of Dentistry at Houston, Houston, TX, USA
| | - Alfa Yansane
- University of California at San Francisco, School of Dentistry, Department of Preventive and Restorative Dental Sciences, CA, USA
| | - Ana M. Ibarra Noriega
- University of Texas Health Science Center, School of Dentistry at Houston, Houston, TX, USA
| | - Joel White
- University of California at San Francisco, School of Dentistry, Department of Preventive and Restorative Dental Sciences, CA, USA
| | - Muhammad F. Walji
- University of Texas Health Science Center, School of Dentistry at Houston, Houston, TX, USA
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Grossman ES, Hoffmann B, Tibbles C, Wolfe RE, Grossman SA. Do error rates change in the emergency department when patient volume decreases: the effect of COVID-19 on ED error. Intern Emerg Med 2022; 17:1547-1550. [PMID: 35819700 PMCID: PMC9274639 DOI: 10.1007/s11739-022-03020-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 05/27/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Elianna S Grossman
- Department of Emergency Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center Boston, Rosenberg 2, One Deaconess Road, Boston, MA, 02215, USA
| | - Beatrice Hoffmann
- Department of Emergency Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center Boston, Rosenberg 2, One Deaconess Road, Boston, MA, 02215, USA
| | - Carrie Tibbles
- Department of Emergency Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center Boston, Rosenberg 2, One Deaconess Road, Boston, MA, 02215, USA
| | - Richard E Wolfe
- Department of Emergency Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center Boston, Rosenberg 2, One Deaconess Road, Boston, MA, 02215, USA
| | - Shamai A Grossman
- Department of Emergency Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center Boston, Rosenberg 2, One Deaconess Road, Boston, MA, 02215, USA.
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Barsky M, Olson APJ, Astik GJ. Classifying and Disclosing Medical Errors. Med Clin North Am 2022; 106:675-687. [PMID: 35725233 DOI: 10.1016/j.mcna.2022.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Medical errors are an unfortunate but common occurrence in health care. It is important to understand what medical errors are and what types of harm can occur to patients. Along with recognition of the error, disclosure is an equally important part of the process. Clinicians should provide open and honest discussion about the events that occurred to patients along with feedback to institutions on ways to prevent such errors in the future.
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Affiliation(s)
- Maria Barsky
- Hospitalist Program, UC Irvine Medical Center, 101 The City Drive South, Suite 500, Orange, CA 92868, USA.
| | - Andrew P J Olson
- Section of Hospital Medicine, Division of General Internal Medicine, Department of Medicine, , University of Minnesota Medical School, 420 Delaware Street Southeast, MMC 741, Minneapolis, MN 55455, USA; Division of Pediatric Hospital Medicine, Department of Pediatrics, University of Minnesota Medical School, 420 Delaware Street Southeast, MMC 741, Minneapolis, MN 55455, USA. https://twitter.com/@andrewolsonmd
| | - Gopi J Astik
- Division of Hospital Medicine, Northwestern University Feinberg School of Medicine, 251 East Huron Street Suite 16-738, Chicago, IL 60611, USA. https://twitter.com/@gopiastik
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Quintero de Charry M, Tovar-Cuevas JR, Leon H, Ocampo CE. Incidence and risk factors of adverse events in pediatric hemato-oncological patients: A cohort study. J Healthc Qual Res 2022; 37:110-116. [PMID: 34756523 DOI: 10.1016/j.jhqr.2021.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 08/26/2021] [Accepted: 09/19/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Pediatric hemato-oncological (HO) patients are highly susceptible to the occurrence of adverse events (AE), nevertheless few research has been done in this field. Our aim was to describe the incidence, type, severity and preventability of AE in these patients, including bone marrow transplant (BMT) patients, and to identify patient's risk factors for having an AE. METHODS Retrospective cohort study. Children under 18yo hospitalized at the HO or BMT ward in 2016 were eligible for the study. Type of AE, severity and preventability were described as absolute and relative frequencies. Cumulative incidence of patients with at least one AE (CI_AE) and the rate of occurrence of all AE were calculated. Risk factors (sex, recovery probability, comorbidities and being a BMT patient) were analyzed using logistic regression. RESULTS 114 patients were included, 58% were male, average age was 8.7yo and 25 were BMT patients. 44 had at least one AE, with CI_AE of 38.6% (95%CI 29.7-47.5). Overall rate of occurrence of AE was 2.5 cases per 100 patients-day (95%CI 2.15-2.98). For BMT and non-BMT patients they were 2.8 (95%CI 2.2-3.6) and 2.5 (95%CI 1.98-3.1) respectively. Healthcare related infection was the most frequent AE. Most AE were moderate and with high preventability. Being a BMT patient was the only independent factor associated with the occurrence of at least one AE (OR=11.5, p<0.001). CONCLUSIONS Our findings suggest that AE tend to be moderate and preventable in HO pediatric patients. BMT patients seem to be at greater risk of having an AE. Strategies focused on patient safety need to account for their specific characteristics.
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Affiliation(s)
| | | | - H Leon
- Universidad Libre Carrera 109 No. 22 -00 - Valle del Lili. A.A. 1040. Cali - Valle, Colombia
| | - C E Ocampo
- Clínica Imbanaco, Grupo Quirónsalud, Cra. 38 Bis #5B2-04, Cali, Valle, Colombia.
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Emond YEJJM, Calsbeek H, Peters YAS, Bloo GJA, Teerenstra S, Westert GP, Damen J, Wollersheim HC, Wolff AP. Increased adherence to perioperative safety guidelines associated with improved patient safety outcomes: a stepped-wedge, cluster-randomised multicentre trial. Br J Anaesth 2022; 128:562-573. [PMID: 35039174 DOI: 10.1016/j.bja.2021.12.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 11/23/2021] [Accepted: 12/15/2021] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND National Dutch guidelines have been introduced to improve suboptimal perioperative care. A multifaceted implementation programme (IMPlementatie Richtlijnen Operatieve VEiligheid [IMPROVE]) has been developed to support hospitals in applying these guidelines. This study evaluated the effectiveness of IMPROVE on guideline adherence and the association between guideline adherence and patient safety. METHODS Nine hospitals participated in this unblinded, superiority, stepped-wedge, cluster RCT in patients with major noncardiac surgery (mortality risk ≥1%). IMPROVE consisted of educational activities, audit and feedback, reminders, organisational, team-directed, and patient-mediated activities. The primary outcome of the study was guideline adherence measured by nine patient safety indicators on the process (stop moments from the composite STOP bundle, and timely administration of antibiotics) and on the structure of perioperative care. Secondary safety outcomes included in-hospital complications, postoperative wound infections, mortality, length of hospital stay, and unplanned care. RESULTS Data were analysed for 1934 patients. The IMPROVE programme improved one stop moment: 'discharge from recovery room' (+16%; 95% confidence interval [CI], 9-23%). This stop moment was related to decreased mortality (-3%; 95% CI, -4% to -1%), fewer complications (-8%; 95% CI, -13% to -3%), and fewer unscheduled transfers to the ICU (-6%; 95% CI, -9% to -3%). IMPROVE negatively affected one other stop moment - 'discharge from the hospital' - possibly because of the limited resources of hospitals to improve all stop moments together. CONCLUSIONS Mixed implementation effects of IMPROVE were found. We found some positive associations between guideline adherence and patient safety (i.e. mortality, complications, and unscheduled transfers to the ICU) except for the timely administration of antibiotics. CLINICAL TRIAL REGISTRATION NTR3568 (Dutch Trial Registry).
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Affiliation(s)
- Yvette E J J M Emond
- IQ Healthcare, Radboud Institute for Health Sciences, Radboudumc, Nijmegen, The Netherlands; Department of Anesthesiology, Pain and Palliative Care, Radboud Institute for Health Sciences, Radboudumc, Nijmegen, The Netherlands.
| | - Hiske Calsbeek
- IQ Healthcare, Radboud Institute for Health Sciences, Radboudumc, Nijmegen, The Netherlands
| | - Yvonne A S Peters
- IQ Healthcare, Radboud Institute for Health Sciences, Radboudumc, Nijmegen, The Netherlands
| | - Gerrit J A Bloo
- IQ Healthcare, Radboud Institute for Health Sciences, Radboudumc, Nijmegen, The Netherlands; Department of Anesthesiology, Pain and Palliative Care, Radboud Institute for Health Sciences, Radboudumc, Nijmegen, The Netherlands
| | - Steven Teerenstra
- Department for Health Evidence, Section Biostatistics, Radboud Institute for Health Sciences, Radboudumc, Nijmegen, The Netherlands
| | - Gert P Westert
- IQ Healthcare, Radboud Institute for Health Sciences, Radboudumc, Nijmegen, The Netherlands
| | - Johan Damen
- Department of Anesthesiology, Pain and Palliative Care, Radboud Institute for Health Sciences, Radboudumc, Nijmegen, The Netherlands
| | - Hub C Wollersheim
- IQ Healthcare, Radboud Institute for Health Sciences, Radboudumc, Nijmegen, The Netherlands
| | - André P Wolff
- Department of Anesthesiology, Pain Center, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Ademe Y, Deneke A, Bekele A. Malpractice Awareness among Surgeons and Surgical Trainees in Ethiopia. Ethiop J Health Sci 2022; 32:117-126. [PMID: 35250223 PMCID: PMC8864395 DOI: 10.4314/ejhs.v32i1.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 10/23/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND In Ethiopia, a country where seeing medical errors is not rare, there is a lack of data concerning the overall awareness of medical malpractice issues among physicians. A recent study showed that 80% of malpractice claims in Ethiopia are related to some form of surgery or operation room activities. METHODS A cross-sectional survey was conducted among surgeons and surgical trainees. Data were collected anonymously by an online survey using Google forms through a 56-items structured questionnaire. Subsequently, the data were analyzed and reported employing nonparametric statistical methods with SPSS software package 26. RESULTS In our sample, the overall awareness regarding medical malpractice was relatively low. Surgery on a wrong patient (71.1%) was the most commonly reported form of malpractice, whereas unintended damage to adjacent organs (10.8%) was the most frequently disagreed up on form. In the event of a medical error, the majority (59.6%) reported readiness to disclose their error to the patient. The most common mentioned reason for not revealing a mistake was a threat of physical or verbal assault (68%). A significant number of respondents, i.e., 120(59.1%), reported being physically/verbally assaulted by a patient or their attendants at some point in their practice. CONCLUSION The findings of our study provided a general picture of surgeons' and surgical trainees' knowledge, attitude, and practice regarding medical malpractice. This study recommends more robust ethics and law training modules to surgical trainees, refresher courses to surgeons, and advanced training programs in ethics and law.
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Affiliation(s)
- Yonas Ademe
- Addis Ababa University, College of Health Sciences, School of Medicine, Department of Surgery, Addis Ababa, Ethiopia
| | - Andualem Deneke
- Addis Ababa University, College of Health Sciences, School of Medicine, Department of Surgery, Addis Ababa, Ethiopia
| | - Abebe Bekele
- University of Global Health Equity, School of Medicine, Kigali Heights, Plot 772, KG 7 AVE
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Owoc J, Mańczak M, Jabłońska M, Tombarkiewicz M, Olszewski R. Association Between Physician Burnout and Self-reported Errors: Meta-analysis. J Patient Saf 2022; 18:e180-e188. [PMID: 34951608 DOI: 10.1097/pts.0000000000000724] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Burnout among physicians is an increasingly recognized phenomenon affecting different aspects of patient care and safety. This meta-analysis quantifies association of burnout and its subscales with self-reported medical errors among physicians. METHODS This meta-analysis followed the principles formulated in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Meta-analyses of Observational Studies. The MEDLINE, PubMed, Web of Science, PsycInfo, and Eric databases were searched until February 5, 2019, using various combinations of key terms without any language restrictions: burnout, physicians, error, safety, and quality. Reference lists of selected studies were hand searched. Data were extracted from published reports. All quantitative studies reporting prevalence of burnout and its association with self-reported errors among physicians were considered. The analyses of heterogeneity (Cochran Q, I2), publication bias (Begg-Mazumdar and Egger), three subgroups, and sensitivity were performed. The effect of overall burnout and Maslach Burnout Inventory subscales on self-reported errors was calculated as odds ratios with 95% confidence interval. RESULTS Thirteen studies on 20,643 physicians and residents were included. The overall burnout among participants was associated with a significantly increased risk of self-reported errors (odds ratio = 2.72, 95% confidence interval = 2.19-3.37). Emotional exhaustion, depersonalization, and personal accomplishment were all independently predicting factors of self-reported errors. Cochran Q test and inconsistency index I2 were as follows: Q = 27.2; P = 0.0013, I2 = 67% (36%-83%). CONCLUSIONS The results provide evidence that not only overall burnout but also its subscales independently are to be associated with a significantly increased risk of self-reported errors among physicians. As self-reported errors may translate into different types of adverse events, this strong and unequivocal association should be of major concern to healthcare organizations.
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Affiliation(s)
- Jakub Owoc
- From the Department of Gerontology, Public Health and Didactics - National Institute of Geriatrics, Rheumatology and Rehabilitation in Warsaw
| | - Małgorzata Mańczak
- From the Department of Gerontology, Public Health and Didactics - National Institute of Geriatrics, Rheumatology and Rehabilitation in Warsaw
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Gohal G. Models of teaching medical errors. Pak J Med Sci 2021; 37:2020-2025. [PMID: 34912437 PMCID: PMC8613064 DOI: 10.12669/pjms.37.7.4506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 04/20/2021] [Accepted: 07/18/2021] [Indexed: 11/15/2022] Open
Abstract
Medical errors are relatively common causes of preventable iatrogenic adverse events. We have focused on teaching models in certain courses of study that have been reported to have significant positive impacts on the outcomes of teaching about medical errors. All healthcare organizations must establish suitable models of teaching about patient safety and medical errors as a preventive measure and as an early intervention strategy. Teaching undergraduate medical students and physicians in training how to manage and disclose medical errors helps them develop lifelong skills that can effectively reduce such errors. The literature search was conducted in international databases such as PubMed/MEDLINE and Google Scholar search engine using English equivalent keywords, from 1998 up to April, 2020. The search strategy used the following subject headings terms: “Medical error(s)” AND “Teaching”. Out of 40 Studies included, 6 studies were selected to have evaluated models of health care training and simulation based teaching of medical errors and patient safety in undergraduate and postgraduate medical education.
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Affiliation(s)
- Gassem Gohal
- Dr. Gassem Gohal, MD, FRCPC, ABP. Department of Pediatrics, Jazan University, Faculty of Medicine, Jazan, Saudi Arabia
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31
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Kao FC, Chang YC, Chen TS, Liu PH, Tu YK. Risk factors for unplanned return to the operating room within 24 hours: A 9-year single-center observational study. Medicine (Baltimore) 2021; 100:e28053. [PMID: 34889250 PMCID: PMC8663871 DOI: 10.1097/md.0000000000028053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 11/08/2021] [Indexed: 01/05/2023] Open
Abstract
The purpose of the retrospective case-control study was to identify the causes of and risk factors for unplanned return to the operating room (uROR) within 24 hours in surgical patients.We examined 275 cases of 24-hour uROR in our hospital from January 2010 to December 2018. The reasons for 24-hour uROR were classified into several categories. Controls were randomly matched to cases in a 1:1 ratio with the selection criteria set for the same surgeon and operation code in the same corresponding year.The mortality rate was significantly higher in patients with 24-hour uROR (11.63% vs 5.23%). Bleeding was the most common etiology (172/275; 62.55%) and technical error (14.5%) also contributed to 24-hour uROR. The clinical factors that led to bleeding included a history of liver disease (P = .032), smoking (P = .002), low platelet count in preoperative screening (P = .012), and preoperative administration of antiplatelet or anticoagulant agents (P = .014).Clinicians should recognize the risk factors for bleeding and minimize errors to avoid the increase in patient morbidity and mortality that is associated with 24-hour uROR.Level of Evidence: Level IV.
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Affiliation(s)
- Feng-Chen Kao
- Department of Orthopedics, E-Da Hospital, Kaohsiung, Taiwan
- School of Medicine for International Students, I-Shou University, Kaohsiung, Taiwan
| | - Yun-Chi Chang
- School of Medicine for International Students, I-Shou University, Kaohsiung, Taiwan
- Department of Anesthesia, E-Da Hospital, Kaohsiung, Taiwan
| | - Tzu-Shan Chen
- School of Medicine for International Students, I-Shou University, Kaohsiung, Taiwan
- Department of Medical Research, E-Da Hospital, Kaohsiung, Taiwan
| | - Ping-Hsin Liu
- School of Medicine for International Students, I-Shou University, Kaohsiung, Taiwan
- Department of Anesthesia, E-Da Hospital, Kaohsiung, Taiwan
| | - Yuan-Kun Tu
- Department of Orthopedics, E-Da Hospital, Kaohsiung, Taiwan
- School of Medicine for International Students, I-Shou University, Kaohsiung, Taiwan
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Yansane A, Tokede O, Walji M, Obadan-Udoh E, Riedy C, White J, Kalenderian E. Burnout, Engagement, and Dental Errors Among U.S. Dentists. J Patient Saf 2021; 17:e1050-e1056. [PMID: 32251244 DOI: 10.1097/pts.0000000000000673] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Errors can happen during patient care, and some result in harm to the patient. Work place stress has been well established in dentistry, but its relation with errors in the delivery of patient care is less understood. The authors evaluated the relationship between burnout, work engagement, and self-reported dental errors among American dentists. METHODS From May to August 2016, a national sample of American Dental Association member dentists were sent a validated, electronic survey assessing their levels of burnout, work engagement, and dental errors. RESULTS Of the 391 responding dentists, 46.1% reported concern that they had made a dental error in the last 6 months, 12.1% of the dentists were informed by dental staff that they may have committed an error in the last 6 months, 16% were concerned that a malpractice lawsuit would be filed against them, and 3.6% were actively involved in a malpractice lawsuit. In the adjusted analysis, multivariate logistic regression showed that dentists with either high burnout risk were more likely to report concern over a perceived error within the last 6 months. CONCLUSIONS The results suggest that dental provider burnout is potentially a key predictor of reporting perceived dental errors. It is imperative that the dental profession continue to study the effects of work-related stress, develop professional practices that decrease burnout, and reduce errors. PRACTICAL IMPLICATIONS Efforts that minimize the potential for burnout may help reduce the occurrence of errors and improve the quality of care provided to dental patients.
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Affiliation(s)
- Alfa Yansane
- From the Department of Preventive and Restorative Dental Sciences, University of California, San Francisco/UCSF School of Dentistry, San Francisco, California
| | - Oluwabunmi Tokede
- Oral Health Policy and Epidemiology Department, Harvard School of Dental Medicine, Boston, Massachusetts
| | - Muhammad Walji
- Diagnostic and Biomedical Sciences Department, University of Texas Health Science Center at Houston, School of Dentistry, Houston, Texas
| | - Enihomo Obadan-Udoh
- From the Department of Preventive and Restorative Dental Sciences, University of California, San Francisco/UCSF School of Dentistry, San Francisco, California
| | - Christine Riedy
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, Massachusetts
| | - Joel White
- From the Department of Preventive and Restorative Dental Sciences, University of California, San Francisco/UCSF School of Dentistry, San Francisco, California
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van Dijk LM, Meulman MD, van Eikenhorst L, Merten H, Schutijser BCFM, Wagner C. Can using the functional resonance analysis method, as an intervention, improve patient safety in hospitals?: a stepped wedge design protocol. BMC Health Serv Res 2021; 21:1228. [PMID: 34774048 PMCID: PMC8590349 DOI: 10.1186/s12913-021-07244-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 10/29/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Healthcare professionals are sometimes forced to adjust their work to varying conditions leading to discrepancies between hospital protocols and daily practice. We will examine the discrepancies between protocols, 'Work As Imagined' (WAI), and daily practice 'Work As Done' (WAD) to determine whether these adjustments are deliberate or accidental. The discrepancies between WAI and WAD can be visualised using the Functional Resonance Analysis Method (FRAM). FRAM will be applied to three patient safety themes: risk screening of the frail older patients; the administration of high-risk medication; and performing medication reconciliation at discharge. METHODS A stepped wedge design will be used to collect data over 16 months. The FRAM intervention consists of constructing WAI and WAD models by analysing hospital protocols and interviewing healthcare professionals, and a meeting with healthcare professionals in each ward to discuss the discrepancies between WAI and WAD. Safety indicators will be collected to monitor compliance rates. Additionally, the potential differences in resilience levels among nurses before and after the FRAM intervention will be measured using the Employee Resilience Scale (EmpRes) questionnaire. Lastly, we will monitor whether gaining insight into differences between WAI and WAD has led to behavioural and organisational change. DISCUSSION This article will assess whether using FRAM to reveal possible discrepancies between hospital protocols (WAI) and daily practice (WAD) will improve compliance with safety indicators and employee resilience, and whether these insights will lead to behavioural and organisational change. TRIAL REGISTRATION Netherlands Trial Register NL8778; https://www.trialregister.nl/trial/8778 . Registered 16 July 2020. Retrospectively registered.
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Affiliation(s)
- Liselotte M van Dijk
- Netherlands Institute for Health Services Research (Nivel), PO Box 1568, 3500, Utrecht, BN, Netherlands.
| | - Meggie D Meulman
- Netherlands Institute for Health Services Research (Nivel), PO Box 1568, 3500, Utrecht, BN, Netherlands.
| | - Linda van Eikenhorst
- Netherlands Institute for Health Services Research (Nivel), PO Box 1568, 3500, Utrecht, BN, Netherlands
| | - Hanneke Merten
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan, 1117, Amsterdam, Netherlands
| | - Bernadette C F M Schutijser
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan, 1117, Amsterdam, Netherlands
| | - Cordula Wagner
- Netherlands Institute for Health Services Research (Nivel), PO Box 1568, 3500, Utrecht, BN, Netherlands.,Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan, 1117, Amsterdam, Netherlands
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Public Reporting of Adverse Events From Long-Term Care Facilities for Older Persons and People With Disability in Ireland 2013-2019: Development of an Openly Accessible Database and Descriptive Analyses. J Am Med Dir Assoc 2021; 23:1328-1334.e2. [PMID: 34656522 DOI: 10.1016/j.jamda.2021.09.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 09/15/2021] [Accepted: 09/16/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To describe the development of an analyzable database of statutory notifications received from long-term care facilities (LTCFs) and to describe trends in receipt of notifications from 2013 to 2019. DESIGN Description of database development with descriptive and trend analyses. SETTING AND PARTICIPANTS LTCFs for older persons and for people with disability in Ireland. METHODS Data on notifications received and on centers were extracted from a system internal to the health and social services regulator and combined into an analyzable database. Variables were screened for personal information, cleaned, transformed, or redacted and combined into a database suitable for open access publication. Descriptive analyses of the volume of notifications, trends over time and breakdown by service type, notification type, and risk-rating were conducted. RESULTS The Database of Statutory Notifications from Social Care in Ireland was developed and an open access version published in February 2021. Protection of personal data was an important consideration in publishing the data publicly. Uses of the database include examination of national trends and identification of determinants of adverse events and areas for quality improvement. The number of notifications received increased over time. Quarterly notifications contributed to the largest proportion of notifications (older persons, 36.7%; disability, 39.1%). This was followed by serious injury notifications in LTCFs for older persons (33.3%) and abuse allegation notifications in LTCFs for people with disability (36.0%). Less than 1% of individual notifications were risk-rated red (highest severity level of impact on resident welfare). The types of notifications that were collectively risk-rated highest were staff misconduct, abuse allegations, and outbreaks of infectious disease. CONCLUSIONS AND IMPLICATIONS The methodology and findings can inform publications of notifications, planning and resourcing for receipt and submission of notifications, target areas for quality improvement initiatives, mandating of timelines for receipt of notifications, and the mandating of notifications in legislation.
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Tchijevitch OA, Nielsen LP, Lisby M. Life-Threatening and Fatal Adverse Drug Events in a Danish University Hospital. J Patient Saf 2021; 17:e562-e567. [PMID: 28753137 DOI: 10.1097/pts.0000000000000411] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVES Detection of adverse drug events (ADEs) in Danish hospitals relies on health care professionals' incident reporting to a national database for adverse events, but the method is incomplete; thus, fatal and life-threatening ADEs may remain unrecognized.The objectives of this study were to examine the occurrence of life-threatening and fatal ADEs in population of hospitalized patients with suspected adverse outcome and to compare these findings with the actual number of reported ADEs in the study period of 3 months. METHODS Study was designed as a cross-sectional study of adult population, hospitalized for more than 24 hours, having an unplanned transfer to an intensive care unit (ICU), or having unexpected death. Medical records were retrospectively screened by the Global Trigger Tool. All positive triggers were assessed for ADEs by a clinical pharmacologist. RESULTS Of the 26,176 patients admitted in the study period, 105 had an unplanned transfer to the ICU and 36 died unexpectedly. In total, 15 positive triggers were identified in 10 patients. Life-threatening ADEs accounted for 7.6% (8/105) of patients transferred to the ICU, and fatal ADEs constituted 5.5% (2/36) of the deceased patients. Life-threatening and fatal ADEs corresponded to an overall prevalence of 0.04% (10/26,176). Most ADEs were related to hemorrhages and respiratory problems. No serious or fatal ADEs were reported in the incident reporting system in the study period. CONCLUSIONS Ten life-threatening and fatal ADEs were uncovered as not reported in the incident reporting system. Further steps are needed for recognition and prevention of this patient safety challenge.
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Affiliation(s)
| | | | - Marianne Lisby
- Research Center for Emergency Medicine, Aarhus University Hospital, Aarhus, Denmark
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Bryant J, Carey M, Sanson-Fisher R, Turon H, Wei A, Kuss B. The Patients' Perspective: Hematological Cancer Patients' Experiences of Adverse Events as Part of Care. J Patient Saf 2021; 17:e387-e392. [PMID: 28306611 DOI: 10.1097/pts.0000000000000347] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To describe in a sample of patients with a confirmed diagnosis of a hematological cancer: (a) the proportion who self-report experiencing an unexpected adverse event as part of their care; (b) how the adverse event was handled by the health-care organization; and (c) the sociodemographic, disease, and treatment characteristics associated with experiencing an adverse event. DESIGN Cross sectional survey. SETTING Three Australian hematological oncology treatment centers. PARTICIPANTS Individuals with a confirmed diagnosis of a hematological cancer. MAIN OUTCOME MEASURES Participants were asked if they had ever experienced an adverse event in their cancer care. Those who did were asked about their perceptions concerning what the adverse event was related to, how much harm the event caused, who identified the adverse event, and how the health-care organization responded to the adverse event. RESULTS Forty-two participants (26.4%) perceived that they had experienced an unexpected adverse event as part of their care. Most were told about the event as soon as it happened (62%) and were given an explanation about why the event occurred (75%). Fewer were given information about how to take the matter further if they wished (43%). Participants who were unemployed, retired, disabled, or performed home duties and those whose employment status was "other" had higher odds of reporting an adverse event than those in full- or part-time employment. CONCLUSIONS There is a need for routinely querying patients during their treatment regarding the occurrence of unexpected adverse events. In addition, there is a need for improvement in the responses of health-care providers and the health-care system to these events in regard to full disclosure, apology, and options available to the patient for resolution.
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Affiliation(s)
- Jamie Bryant
- From the Health Behaviour Research Group, Priority Research Centre in Health Behaviour and Hunter Medical Research Institute, University of Newcastle, New South Wales
| | - Mariko Carey
- From the Health Behaviour Research Group, Priority Research Centre in Health Behaviour and Hunter Medical Research Institute, University of Newcastle, New South Wales
| | - Rob Sanson-Fisher
- From the Health Behaviour Research Group, Priority Research Centre in Health Behaviour and Hunter Medical Research Institute, University of Newcastle, New South Wales
| | - Heidi Turon
- From the Health Behaviour Research Group, Priority Research Centre in Health Behaviour and Hunter Medical Research Institute, University of Newcastle, New South Wales
| | - Andrew Wei
- Department of Haematology, Alfred Hospital and Monash University, Melbourne, Victoria
| | - Bryone Kuss
- Haematology and Molecular Medicine, Flinders Medical Centre and Flinders University, Flinders Centre for Innovation in Cancer, South Australia, Australia
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Vasudevan RS, Amin A, Hannula DL, Maisel AS. Stethoscope hygiene: A legal consideration for cardiologists practicing in a new era of infection control (COVID-19). ACTA ACUST UNITED AC 2021; 7:100039. [PMID: 34350422 PMCID: PMC8323512 DOI: 10.1016/j.ahjo.2021.100039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 07/03/2021] [Accepted: 07/21/2021] [Indexed: 12/03/2022]
Abstract
The stethoscope is a tool cherished by the field of cardiology and ubiquitous throughout medicine. However, little consideration has been given to its safe usage regarding its potential for pathogenic contamination despite thorough evidence that stethoscopes can harbor pathogens that can be transmitted to patients upon contact. The COVID-19 (SARS-COV-2) pandemic has led to increased infection control vigilance, including toward the stethoscope, as evidenced by a recent increase in literature highlighting stethoscope hygiene/contamination. A consequence of this increase in awareness is that stethoscopes may be implicated in medical malpractice lawsuits as a potential cause of healthcare-associated infections (HAIs). While there is limited evidence demonstrating a direct connection between stethoscope contamination and HAIs, malpractice lawsuits often do not require direct causative evidence. Regardless, efforts should be made to bolster stethoscope hygiene to not only mitigate patient harm, but also prevent providers from potential medical-legal conflicts. The continued relevance and utility of the stethoscope as a rapid, cost-effective diagnostic tool needs to be appropriately balanced with increased hygiene performance. Providers should anticipate increased scientific evidence and patient awareness regarding stethoscope contamination in the post-COVID-19 era.
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Affiliation(s)
- Rajiv S Vasudevan
- Department of Medicine, University of California, San Diego School of Medicine, La Jolla, CA, United States of America
| | - Alpesh Amin
- Department of Medicine, University of California, Irvine School of Medicine, Irvine, CA, United States of America
| | - Daniel L Hannula
- Rush, Hannula, Harkins, Kyler LLP, Tacoma, WA, United States of America
| | - Alan S Maisel
- Department of Medicine, University of California, San Diego School of Medicine, La Jolla, CA, United States of America
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Orenga Orenga JV, Parra Escorihuela S, Barreda Altaba I, Estarelles Marco MJ, Ghinea AD, Leal Galicia DE, López García R. Iatrogenic lesions of the peripheral nervous system in orthopaedic surgery and traumatology procedures. ACTA ACUST UNITED AC 2021. [PMID: 34112446 DOI: 10.1016/j.recote.2021.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To describe iatrogenic lesions of the peripheral nervous system and their relationship with different orthopaedic and traumatological procedures, through their assessment by means of electromyographic study. MATERIAL AND METHODS Retrospective descriptive study of the electromyographies performed in the clinical neurophysiology service of the Hospital General Universitari de Castelló between July 2015 and March 2019, recovering those in which the aetiology was diagnosed as iatrogenic in relation to surgical procedures and analysing those that were initiated after orthopaedic and traumatological procedures. RESULTS Of the total number of electromyographies reviewed, 1.37% corresponded to iatrogenic surgical lesions and 55.1% of these were secondary to orthopaedic surgery and traumatology procedures, the incidence in relation to the procedures performed was 0.65%. The most frequent locations related to injuries were the lumbar spine, hip and hand/wrist. Injuries due to postural causes not directly related to the surgical field are noteworthy. CONCLUSION Iatrogenic injuries to the peripheral nervous system after orthopaedic surgery and traumatology procedures are infrequent, but given their mechanism of injury and the high severity of most of them, it would be advisable to implement corrective mechanisms to reduce their incidence. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- J V Orenga Orenga
- Servicio de Neurofisiología Clínica, Hospital General Universitari de Castelló, Castelló, Spain.
| | - S Parra Escorihuela
- Servicio de Neurofisiología Clínica, Hospital General Universitari de Castelló, Castelló, Spain
| | - I Barreda Altaba
- Servicio de Neurofisiología Clínica, Hospital General Universitari de Castelló, Castelló, Spain
| | - M J Estarelles Marco
- Servicio de Neurofisiología Clínica, Hospital General Universitari de Castelló, Castelló, Spain
| | - A D Ghinea
- Servicio de Neurofisiología Clínica, Hospital General Universitari de Castelló, Castelló, Spain
| | - D E Leal Galicia
- Servicio de Neurofisiología Clínica, Hospital General Universitari de Castelló, Castelló, Spain
| | - R López García
- Servicio de Neurofisiología Clínica, Hospital General Universitari de Castelló, Castelló, Spain
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Henderson JW, Sweeney M, Dani M, Levy S. Geriatrician-led care model in frail cardiology patients reduces re-admissions. Future Healthc J 2021; 8:e299-e301. [PMID: 34286202 DOI: 10.7861/fhj.2021-0033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Background As the population admitted under cardiology is likely to become frailer, a geriatrician-led model of post-procedural care similar to that used in orthopaedic surgery may be beneficial. Methods In 2016, a new geriatrician-led ward was created in Hammersmith Hospital where frail cardiology patients could be transferred post-treatment. Using diagnostic coding, patients over the age of 65 years between 01 April and the 31 August for both 2016 and 2019 were identified, and data collected retrospectively from electronic patient records. An anonymised staff survey was completed following the introduction of the new service. Results Patients discharged from the geriatrician-led ward had fewer re-admissions than both cardiology-led wards in 2019 (chi-squared 5.46; p=0.02), and overall re-admissions in 2016 (chi-squared 4.34; p=0.037). The majority of surveyed respondents felt that this level of geriatrician input was useful. Conclusion Geriatrician-led post-procedural care in cardiology reduced 30-day re-admissions in an elderly cohort.
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Affiliation(s)
| | - Mark Sweeney
- Imperial College Healthcare NHS Trust, London, UK and Imperial College London, London, UK
| | - Melanie Dani
- Imperial College Healthcare NHS Trust, London, UK and Imperial College London, London, UK
| | - Shuli Levy
- Imperial College Healthcare NHS Trust, London, UK
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Arsenault-Lapierre G, Henein M, Gaid D, Le Berre M, Gore G, Vedel I. Hospital-at-Home Interventions vs In-Hospital Stay for Patients With Chronic Disease Who Present to the Emergency Department: A Systematic Review and Meta-analysis. JAMA Netw Open 2021; 4:e2111568. [PMID: 34100939 PMCID: PMC8188269 DOI: 10.1001/jamanetworkopen.2021.11568] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 04/01/2021] [Indexed: 12/17/2022] Open
Abstract
Importance Hospitalizations are costly and may lead to adverse events; hospital-at-home interventions could be a substitute for in-hospital stays, particularly for patients with chronic diseases who use health services more than other patients. Despite showing promising results, heterogeneity in past systematic reviews remains high. Objective To systematically review and assess the association between patient outcomes and hospital-at-home interventions as a substitute for in-hospital stay for community-dwelling patients with a chronic disease who present to the emergency department and are offered at least 1 home visit from a nurse and/or physician. Data Sources Databases were searched from date of inception to March 4, 2019. The databases were Ovid MEDLINE, Ovid Embase, Ovid PsycINFO, CINAHL, Health Technology Assessment, the Cochrane Library, OVID Allied and Complementary Medicine Database, the World Health Organization International Clinical Trials Registry Platform, and ClinicalTrials.gov. Study Selection Randomized clinical trials in which the experimental group received hospital-at-home interventions and the control group received the usual in-hospital care. Patients were 18 years or older with a chronic disease who presented to the emergency department and received home visits from a nurse or physician. Data Extraction and Synthesis Risk of bias was assessed, and a meta-analysis was conducted for outcomes that were reported by at least 2 studies using comparable measures. Risk ratios (RRs) were reported for binary outcomes and mean differences for continuous outcomes. Narrative synthesis was performed for other outcomes. Main Outcomes and Measures Outcomes of interest were patient outcomes, which included mortality, long-term care admission, readmission, length of treatment, out-of-pocket costs, depression and anxiety, quality of life, patient satisfaction, caregiver stress, cognitive status, nutrition, morbidity due to hospitalization, functional status, and neurological deficits. Results Nine studies were included, providing data on 959 participants (median age, 71.0 years [interquartile range, 70.0-79.9 years]; 613 men [63.9%]; 346 women [36.1%]). Mortality did not differ between the hospital-at-home and the in-hospital care groups (RR, 0.84; 95% CI, 0.61-1.15; I2 = 0%). Risk of readmission was lower (RR, 0.74; 95% CI, 0.57-0.95; I2 = 31%) and length of treatment was longer in the hospital-at-home group than in the in-hospital group (mean difference, 5.45 days; 95% CI, 1.91-8.97 days; I2 = 87%). In addition, the hospital-at-home group had a lower risk of long-term care admission than the in-hospital care group (RR, 0.16; 95% CI, 0.03-0.74; I2 = 0%). Patients who received hospital-at-home interventions had lower depression and anxiety than those who remained in-hospital, but there was no difference in functional status. Other patient outcomes showed mixed results. Conclusions and Relevance The results of this systematic review and meta-analysis suggest that hospital-at-home interventions represent a viable substitute to an in-hospital stay for patients with chronic diseases who present to the emergency department and who have at least 1 visit from a nurse or physician. Although the heterogeneity of the findings remained high for some outcomes, particularly for length of treatment, the heterogeneity of this study was comparable to that of past reviews and further explored.
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Affiliation(s)
| | - Mary Henein
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada
| | - Dina Gaid
- School of Physical and Occupational Therapy, McGill University, Montréal, Québec, Canada
| | - Mélanie Le Berre
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada
- Université de Montréal, Institut Universitaire de Gériatrie de Montréal, Montréal, Québec, Canada
| | - Genevieve Gore
- Schulich Library of Physical Sciences, Life Sciences, and Engineering, McGill University, Montréal, Québec, Canada
| | - Isabelle Vedel
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada
- Department of Family Medicine, McGill University, Montréal, Québec, Canada
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Rijpkema CJ, Verweij L, Jepma P, Latour CHM, Peters RJG, Scholte Op Reimer WJM, Buurman BM. The course of readmission in frail older cardiac patients. J Adv Nurs 2021; 77:2807-2818. [PMID: 33739473 PMCID: PMC8251632 DOI: 10.1111/jan.14828] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 02/02/2021] [Accepted: 02/28/2021] [Indexed: 12/14/2022]
Abstract
AIM The aim of this study is to explore patients' and (in)formal caregivers' perspectives on their role(s) and contributing factors in the course of unplanned hospital readmission of older cardiac patients in the Cardiac Care Bridge (CCB) program. DESIGN This study is a qualitative multiple case study alongside the CCB randomized trial, based on grounded theory principles. METHODS Five cases within the intervention group, with an unplanned hospital readmission within six months after randomization, were selected. In each case, semi-structured interviews were held with patients (n = 4), informal caregivers (n = 5), physical therapists (n = 4), and community nurses (n = 5) between April and June 2019. Patients' medical records were collected to reconstruct care processes before the readmission. Thematic analysis and the six-step analysis of Strauss & Corbin have been used. RESULTS Three main themes emerged. Patients experienced acute episodes of physical deterioration before unplanned hospital readmission. The involvement of (in)formal caregivers in adequate observation of patients' health status is vital to prevent rehospitalization (theme 1). Patients and (in)formal caregivers' perception of care needs did not always match, which resulted in hampering care support (theme 2). CCB caregivers experienced difficulties in providing care in some cases, resulting in limited care provision in addition to the existing care services (theme 3). CONCLUSION Early detection of deteriorating health status that leads to readmission was often lacking, due to the acuteness of the deterioration. Empowerment of patients and their informal caregivers in the recognition of early signs of deterioration and adequate collaboration between caregivers could support early detection. Patients' care needs and expectations should be prioritized to stimulate participation. IMPACT (In)formal caregivers may be able to prevent unplanned hospital readmission of older cardiac patients by ensuring: (1) early detection of health deterioration, (2) empowerment of patient and informal caregivers, and (3) clear understanding of patients' care needs and expectations.
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Affiliation(s)
- Corinne J. Rijpkema
- Department of Internal MedicineSection of Geriatric MedicineAmsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
| | - Lotte Verweij
- Department of CardiologyAmsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
- Center of Expertise Urban VitalityFaculty of HealthAmsterdam University of Applied ScienceAmsterdamThe Netherlands
| | - Patricia Jepma
- Department of CardiologyAmsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
- Center of Expertise Urban VitalityFaculty of HealthAmsterdam University of Applied ScienceAmsterdamThe Netherlands
| | - Corine H. M. Latour
- Center of Expertise Urban VitalityFaculty of HealthAmsterdam University of Applied ScienceAmsterdamThe Netherlands
| | - Ron J. G. Peters
- Department of CardiologyAmsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
| | - Wilma J. M. Scholte Op Reimer
- Department of CardiologyAmsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
- Research Group Chronic DiseasesUniversity of Applied Sciences UtrechtUtrechtThe Netherlands
| | - Bianca M. Buurman
- Department of Internal MedicineSection of Geriatric MedicineAmsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
- Center of Expertise Urban VitalityFaculty of HealthAmsterdam University of Applied ScienceAmsterdamThe Netherlands
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Norris B, Soncrant C, Mills PD, Gunnar W. Root Cause Analysis of Adverse Events Involving Opioid Overdoses in the Veterans Health Administration. Jt Comm J Qual Patient Saf 2021; 47:489-495. [PMID: 34130919 DOI: 10.1016/j.jcjq.2021.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 04/27/2021] [Accepted: 04/28/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The Veterans Health Administration (VHA) serves a population with compounding risk factors for opioid misuse, including chronic pain, substance use disorders, and mental health conditions. The objective of this study was to analyze opioid-related adverse events and root causes to inform mitigation strategies associated with opioid prescribing and administration. METHODS The researchers conducted a retrospective analysis of root cause analysis reports of opioid overdose events between August 1, 2012, and September 30, 2019. These adverse events were investigated locally by multidisciplinary hospital teams and reported by VHA facility patient safety managers to the National Center for Patient Safety for further aggregation and analysis. Type of event, location, and root causes were categorized. RESULTS Eighty-two adverse event reports were identified. Patients were primarily male with an average age of 61.4 years. Staff medication administration errors were the most common event type (57.3%), with most events resulting from process errors (65.9%) occurring in the health care setting (85.4%). Overall 36 events (43.9%) resulted in major or catastrophic harm. There were 172 root causes identified. The most common root causes were staff not following existing policy or lack of existing hospital policy on opioid management (18.0%); staff lacked training in areas such as managing the use or administration of opioids, correct use of opioid dispensing equipment, and recognition and proper response to an overdose (12.2%); and poor communication of opioid prescribing or administration during handoffs between clinical teams (11.6%). A lack of standardization in processes, training, and policies on opioid prescribing and screening, medication administration, equipment/pumps purchase and use, and contraband searches was a common theme throughout. CONCLUSION Errors in prescribing and administration of opioid medication can result in significant harm. A lack of standardized opioid administration practices and training, controlled substance policies, and interdisciplinary communication were frequent factors in adverse opioid events and should be a focus for future prevention.
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High Reliability Organization Principles Improve VA Workplace Burnout: The Truman THRIVE2 Model. Am J Med Qual 2021; 36:422-428. [PMID: 34010164 DOI: 10.1097/01.jmq.0000735516.35323.97] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Provider burnout is a significant health care concern. It is unclear whether high reliability organization (HRO) practices can prevent it. The Truman Veterans Affairs Medical Center (VAMC) undertook an initiative implementing HRO principles and assessed for impact on burnout metrics. This became known as the Transformative HRO Initiative Via Employee Engagement (THRIVE2) model. THRIVE2 consisted of Just Culture training, Clinical Team Training, and continuous process improvement through Lean. Truman VAMC was compared with other Veterans Health Affairs (VHA) facilities regarding burnout and employee satisfaction metrics. Truman VAMC saw significant changes in multiple HRO metrics (P < 0.001) as well as improvements in work group psychological safety and employee exhaustion (P < 0.001). High burnout rates decreased by 52% (6.2%-2.95%; P < 0.001). Truman VAMC went from 75th to the No. 1 ranked VHA facility regarding Best Places to Work. These findings have significant national policy implications given the effects of burnout.
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Abstract
OBJECTIVES To examine adverse events and associated factors and outcomes during transition from ICU to hospital ward (after ICU discharge). DESIGN Multicenter cohort study. SETTING Ten adult medical-surgical Canadian ICUs. PATIENTS Patients were those admitted to one of the 10 ICUs from July 2014 to January 2016. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Two ICU physicians independently reviewed progress and consultation notes documented in the medical record within 7 days of patient's ICU discharge date to identify and classify adverse events. The adverse event data were linked to patient characteristics and ICU and ward physician surveys collected during the larger prospective cohort study. Analyses were conducted using multivariable logistic regression. Of the 451 patients included in the study, 84 (19%) experienced an adverse event, the majority (62%) within 3 days of transfer from ICU to hospital ward. Most adverse events resulted only in symptoms (77%) and 36% were judged to be preventable. Patients with adverse events were more likely to be readmitted to the ICU (odds ratio, 5.5; 95% CI, 2.4-13.0), have a longer hospital stay (mean difference, 16.1 d; 95% CI, 8.4-23.7) or die in hospital (odds ratio, 4.6; 95% CI, 1.8-11.8) than those without an adverse event. ICU and ward physician predictions at the time of ICU discharge had low sensitivity and specificity for predicting adverse events, ICU readmissions, and hospital death. CONCLUSIONS Adverse events are common after ICU discharge to hospital ward and are associated with ICU readmission, increased hospital length of stay and death and are not predicted by ICU or ward physicians.
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Kandasamy S, Vanstone M, Colvin E, Chan T, Sherbino J, Monteiro S. "I made a mistake!": A narrative analysis of experienced physicians' stories of preventable error. J Eval Clin Pract 2021; 27:236-245. [PMID: 33399266 DOI: 10.1111/jep.13531] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 12/09/2020] [Accepted: 12/14/2020] [Indexed: 01/01/2023]
Abstract
RATIONALE, AIMS, AND OBJECTIVES The complexity of healthcare systems makes errors unavoidable. To strengthen the dialogue around how physicians experience and share medical errors, the objective of this study was to understand how generalist physicians make meaning of and grow from their medical errors. METHODS This study used a narrative inquiry approach to conduct and analyse in-depth interviews from 26 physicians from the generalist specialties of emergency, internal, and family medicine. We gathered stories via individual interview, analysed them for key components, and rewrote a "meta-story" in a chronological sequence. We conceptualized the findings into a metaphor to draw similarities, learn from, and apply new principles from other fields of practice. RESULTS Through analysis we interpreted the story of a physician who is required to make numerous decisions in a short period of time in different clinical environments among the patient's family and whilst abiding by existing rules and regulations. Through sharing stories of success and failure, the clinical supervisor can help optimize the physician's emotional growth and professional development. Similarly, through sharing and learning from stories, colleagues and trainees can also contribute to the growth of the protagonist's character and the development of clinic, hospital, and healthcare system. CONCLUSION We draw parallels between the clinical setting and a generalist physician's experiences of a medical error with the environment and practices within professional sports. Using this comparison, we discuss the potential for meaningful coaching in medical education.
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Affiliation(s)
- Sujane Kandasamy
- Department of Health Research Methods, Evidence & Impact, Health Research Methodology PhD Program, McMaster University, Hamilton, Ontario, Canada
| | - Meredith Vanstone
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada.,Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, Ontario, Canada.,McMaster Education Research, Innovation & Theory (MERIT) Program, McMaster University, Hamilton, Ontario, Canada
| | - Eamon Colvin
- School of Psychology, Clinical Psychology PhD Program, University of Ottawa, Ottawa, Ontario, Canada
| | - Teresa Chan
- McMaster Education Research, Innovation & Theory (MERIT) Program, McMaster University, Hamilton, Ontario, Canada.,Department of Medicine, Division of Emergency Medicine, McMaster University, Hamilton, Ontario, Canada.,Program for Faculty Development, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Jonathan Sherbino
- McMaster Education Research, Innovation & Theory (MERIT) Program, McMaster University, Hamilton, Ontario, Canada.,Department of Medicine, Division of Emergency Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Sandra Monteiro
- Department of Health Research Methods, Evidence & Impact, Health Research Methodology PhD Program, McMaster University, Hamilton, Ontario, Canada.,McMaster Education Research, Innovation & Theory (MERIT) Program, McMaster University, Hamilton, Ontario, Canada
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Orenga Orenga JV, Parra Escorihuela S, Barreda Altaba I, Estarelles Marco MJ, Ghinea AD, Leal Galicia DE, López García R. Iatrogenic lesions of the peripheral nervous system in orthopaedic surgery and traumatology procedures. Rev Esp Cir Ortop Traumatol (Engl Ed) 2021. [PMID: 33714695 DOI: 10.1016/j.recot.2020.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To describe iatrogenic lesions of the peripheral nervous system and their relationship with different orthopaedic and traumatological procedures, through their assessment by means of electromyographic study. MATERIAL AND METHODS Retrospective descriptive study of the electromyographies performed in the clinical neurophysiology service of the Hospital General Universitari de Castelló between July 2015 and March 2019, recovering those in which the aetiology was diagnosed as iatrogenic in relation to surgical procedures and analysing those that were initiated after orthopaedic and traumatological procedures. RESULTS Of the total number of electromyographies reviewed, 1.37% corresponded to iatrogenic surgical lesions and 55.1% of these were secondary to orthopaedic surgery and traumatology procedures, the incidence in relation to the procedures performed was 0.65%. The most frequent locations related to injuries were the lumbar spine, hip and hand/wrist. Injuries due to postural causes not directly related to the surgical field are noteworthy. CONCLUSION Iatrogenic injuries to the peripheral nervous system after orthopaedic surgery and traumatology procedures are infrequent, but given their mechanism of injury and the high severity of most of them, it would be advisable to implement corrective mechanisms to reduce their incidence. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- J V Orenga Orenga
- Servicio de Neurofisiología Clínica, Hospital General Universitari de Castelló, Castelló, España.
| | - S Parra Escorihuela
- Servicio de Neurofisiología Clínica, Hospital General Universitari de Castelló, Castelló, España
| | - I Barreda Altaba
- Servicio de Neurofisiología Clínica, Hospital General Universitari de Castelló, Castelló, España
| | - M J Estarelles Marco
- Servicio de Neurofisiología Clínica, Hospital General Universitari de Castelló, Castelló, España
| | - A D Ghinea
- Servicio de Neurofisiología Clínica, Hospital General Universitari de Castelló, Castelló, España
| | - D E Leal Galicia
- Servicio de Neurofisiología Clínica, Hospital General Universitari de Castelló, Castelló, España
| | - R López García
- Servicio de Neurofisiología Clínica, Hospital General Universitari de Castelló, Castelló, España
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Barchitta M, Maugeri A, Favara G, Riela PM, Gallo G, Mura I, Agodi A. A machine learning approach to predict healthcare-associated infections at intensive care unit admission: findings from the SPIN-UTI project. J Hosp Infect 2021; 112:77-86. [PMID: 33676936 DOI: 10.1016/j.jhin.2021.02.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 01/27/2021] [Accepted: 02/26/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Identifying patients at higher risk of healthcare-associated infections (HAIs) in intensive care units (ICUs) represents a major challenge for public health. Machine learning could improve patient risk stratification and lead to targeted infection prevention and control interventions. AIM To evaluate the performance of the Simplified Acute Physiology Score (SAPS) II for HAI risk prediction in ICUs, using both traditional statistical and machine learning approaches. METHODS Data for 7827 patients from the 'Italian Nosocomial Infections Surveillance in Intensive Care Units' project were used in this study. The Support Vector Machines (SVM) algorithm was applied to classify patients according to sex, patient origin, non-surgical treatment for acute coronary disease, surgical intervention, SAPS II at admission, presence of invasive devices, trauma, impaired immunity, and antibiotic therapy in 48 h preceding ICU admission. FINDINGS The performance of SAPS II for predicting HAI risk provides a receiver operating characteristic curve with an area under the curve of 0.612 (P<0.001) and accuracy of 56%. Considering SAPS II along with other characteristics at ICU admission, the SVM classifier was found to have accuracy of 88% and an AUC of 0.90 (P<0.001) for the test set. The predictive ability was lower when considering the same SVM model but with the SAPS II variable removed (accuracy 78%, AUC 0.66). CONCLUSIONS This study suggested that the SVM model is a useful tool for early prediction of patients at higher risk of HAIs at ICU admission.
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Affiliation(s)
- M Barchitta
- Department of Medical and Surgical Sciences and Advanced Technologies 'GF Ingrassia', University of Catania, Catania, Italy; GISIO-SItI (Italian Study Group of Hospital Hygiene), Italian Society of Hygiene, Preventive Medicine and Public Health, Italy
| | - A Maugeri
- Department of Medical and Surgical Sciences and Advanced Technologies 'GF Ingrassia', University of Catania, Catania, Italy; GISIO-SItI (Italian Study Group of Hospital Hygiene), Italian Society of Hygiene, Preventive Medicine and Public Health, Italy
| | - G Favara
- Department of Medical and Surgical Sciences and Advanced Technologies 'GF Ingrassia', University of Catania, Catania, Italy
| | - P M Riela
- Department of Mathematics and Informatics, University of Catania, Catania, Italy
| | - G Gallo
- Department of Mathematics and Informatics, University of Catania, Catania, Italy
| | - I Mura
- GISIO-SItI (Italian Study Group of Hospital Hygiene), Italian Society of Hygiene, Preventive Medicine and Public Health, Italy; Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - A Agodi
- Department of Medical and Surgical Sciences and Advanced Technologies 'GF Ingrassia', University of Catania, Catania, Italy; GISIO-SItI (Italian Study Group of Hospital Hygiene), Italian Society of Hygiene, Preventive Medicine and Public Health, Italy.
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48
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Early Prediction of Seven-Day Mortality in Intensive Care Unit Using a Machine Learning Model: Results from the SPIN-UTI Project. J Clin Med 2021; 10:jcm10050992. [PMID: 33801207 PMCID: PMC7957866 DOI: 10.3390/jcm10050992] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 02/09/2021] [Accepted: 02/12/2021] [Indexed: 12/18/2022] Open
Abstract
Patients in intensive care units (ICUs) were at higher risk of worsen prognosis and mortality. Here, we aimed to evaluate the ability of the Simplified Acute Physiology Score (SAPS II) to predict the risk of 7-day mortality, and to test a machine learning algorithm which combines the SAPS II with additional patients’ characteristics at ICU admission. We used data from the “Italian Nosocomial Infections Surveillance in Intensive Care Units” network. Support Vector Machines (SVM) algorithm was used to classify 3782 patients according to sex, patient’s origin, type of ICU admission, non-surgical treatment for acute coronary disease, surgical intervention, SAPS II, presence of invasive devices, trauma, impaired immunity, antibiotic therapy and onset of HAI. The accuracy of SAPS II for predicting patients who died from those who did not was 69.3%, with an Area Under the Curve (AUC) of 0.678. Using the SVM algorithm, instead, we achieved an accuracy of 83.5% and AUC of 0.896. Notably, SAPS II was the variable that weighted more on the model and its removal resulted in an AUC of 0.653 and an accuracy of 68.4%. Overall, these findings suggest the present SVM model as a useful tool to early predict patients at higher risk of death at ICU admission.
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49
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Kobo-Greenhut A, Sharlin O, Adler Y, Peer N, Eisenberg VH, Barbi M, Levy T, Shlomo IB, Eyal Z. Algorithmic prediction of failure modes in healthcare. Int J Qual Health Care 2021; 33:mzaa151. [PMID: 33196826 PMCID: PMC7890669 DOI: 10.1093/intqhc/mzaa151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 10/27/2020] [Accepted: 11/15/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Preventing medical errors is crucial, especially during crises like the COVID-19 pandemic. Failure Modes and Effects Analysis (FMEA) is the most widely used prospective hazard analysis in healthcare. FMEA relies on brainstorming by multi-disciplinary teams to identify hazards. This approach has two major weaknesses: significant time and human resource investments, and lack of complete and error-free results. OBJECTIVES To introduce the algorithmic prediction of failure modes in healthcare (APFMH) and to examine whether APFMH is leaner in resource allocation in comparison to the traditional FMEA and whether it ensures the complete identification of hazards. METHODS The patient identification during imaging process at the emergency department of Sheba Medical Center was analyzed by FMEA and APFMH, independently and separately. We compared between the hazards predicted by APFMH method and the hazards predicted by FMEA method; the total participants' working hours invested in each process and the adverse events, categorized as 'patient identification', before and after the recommendations resulted from the above processes were implemented. RESULTS APFMH is more effective in identifying hazards (P < 0.0001) and is leaner in resources than the traditional FMEA: the former used 21 h whereas the latter required 63 h. Following the implementation of the recommendations, the adverse events decreased by 44% annually (P = 0.0026). Most adverse events were preventable, had all recommendations been fully implemented. CONCLUSION In light of our initial and limited-size study, APFMH is more effective in identifying hazards (P < 0.0001) and is leaner in resources than the traditional FMEA. APFMH is suggested as an alternative to FMEA since it is leaner in time and human resources, ensures more complete hazard identification and is especially valuable during crisis time, when new protocols are often adopted, such as in the current days of the COVID-19 pandemic.
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Affiliation(s)
- Ayala Kobo-Greenhut
- The Israel Center for the of Failure Modes in Medical Systems, Program of Emergency Medicine, Zefat Academic College, Jrusalem St. 11, Safed 13206, Israel
| | - Ortal Sharlin
- Hospital Management, Quality and Safety Department, Sheba Medical Center, Ramat Gan, Israel
| | - Yael Adler
- Hospital Management, Quality and Safety Department, Sheba Medical Center, Ramat Gan, Israel
| | - Nitza Peer
- Hospital Management, Quality and Safety Department, Sheba Medical Center, Ramat Gan, Israel
| | - Vered H Eisenberg
- Hospital Management, Quality and Safety Department, Sheba Medical Center, Ramat Gan, Israel
| | - Merav Barbi
- Division of Diagnostic Imaging, Sheba Medical Center, Ramat Gan, Israel
| | - Talia Levy
- Division of Diagnostic Imaging, Sheba Medical Center, Ramat Gan, Israel
| | - Izhar Ben Shlomo
- The Israel Center for the of Failure Modes in Medical Systems, Program of Emergency Medicine, Zefat Academic College, Jrusalem St. 11, Safed 13206, Israel
| | - Zimlichman Eyal
- Hospital Management, Quality and Safety Department, Sheba Medical Center, Ramat Gan, Israel
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50
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Skyrud KD, Bukholm IRK. Correlation between compensated patient claims and 30-day mortality. Int J Qual Health Care 2021; 33:5903599. [PMID: 32909614 DOI: 10.1093/intqhc/mzaa111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 08/17/2020] [Accepted: 09/08/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To test if compensation claims from patients (reported to the Norwegian System of Patient Injury Compensation) are correlated with the existing quality indicator of 30-day mortality (based on data from Norwegian Patient Registry). This correlation has not been previously evaluated. DESIGN The association between patient claims and 30-day mortality at hospital trust level was assessed by the Pearson correlation coefficient. SETTING The Norwegian System of Patient Injury Compensation is a governmental agency under the Ministry of Health and Care Services and deals with patient-reported complaints about incorrect treatment in the public and private healthcare services. Patient-reported claims may be an indicator of healthcare quality, as 30-day mortality. PARTICIPANTS All 19 Norwegian hospital trusts. INTERVENTIONS : None. MAIN OUTCOME MEASURE Patient claims rates, 30-day mortality and Pearson correlation coefficient. RESULTS Both number of deaths within 30 days and number of claims have declined over time. High correlation (0.77, P < 0.001) was found between number of deaths within 30 days and the total number of claims. In addition, an even stronger association was found with approved claims, with a correlation coefficient of 0.83 (P < 0.001). Moreover, adjusted 30-day mortality was significantly correlated with the patient-claim rate using number of bed-days as denominator, but not when using number of discharges. CONCLUSIONS The results from the present study indicate an association between compensation claims from patients and 30-day mortality, suggesting that both parameters reflect the latent quality of care for the hospital trusts, but they may capture different aspects of care.
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Affiliation(s)
- Katrine Damgaard Skyrud
- Health Services Research, Health Services, Norwegian Institute of Public Health, Postbox 222 Skøyen, 0213 Oslo, Norway
| | - Ida Rashida Khan Bukholm
- Norwegian System of Patient Injury Compensation, Postboks 232 Skøyen, 0213 Oslo, Norway.,Faculty of Landscape and Society, Norwegian University of Life Sciences, Universitetstunet 3, 1430 Ås, Oslo, Norway .,Research Committee, Helgelandssykehuset HF, Postboks 601, 8607 Mo i Rana, Norway
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