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Ros E, Ros A, Austin EE, De Geer L, Lane P, Johnson A, Clay-Williams R. Sustainment of a patient flow intervention in an intensive care unit in a regional hospital in Australia: a mixed-method, 5-year follow-up study. BMJ Open 2021; 11:e047394. [PMID: 34158303 PMCID: PMC8220473 DOI: 10.1136/bmjopen-2020-047394] [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] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE In 2014, an escalation plan and morning handover meetings were implemented in an intensive care unit (ICU) to reduce access block for post-operative care. In this study, the improvement intervention is revisited 5 years on with the objective to see if the changes are sustained and to understand factors contributing to sustainability. DESIGN A mixed-method approach was used, with quantitative analysis of ICU administrative data and qualitative analysis of interviews with hospital management and ICU staff. SETTING ICU with mixed surgical and non-surgical cases in a regional hospital in Australia. PARTICIPANTS Interview participants: ICU nurses (four), ICU doctors (four) and hospital management (four). MAIN OUTCOME MEASURES Monthly number of elective surgeries were cancelled due to unavailability of ICU beds. Staff perceptions of the interventions and factors contributed to sustainability. RESULTS After a decline in elective surgeries being cancelled in the first year after the intervention, there was an increase in cancellations in the following years (χ2=16.38, p=0.003). Lack of knowledge about the intervention and competitive interests in the management of patient flow were believed to be obstacles for sustained effects of the original intervention. So were communication deficiencies that were reported within the ICU and between ICU and other departments. There are discrepancies between how nurses and doctors use the escalation plan and regard the availability of ICU beds. CONCLUSION Improvement interventions in healthcare that appear initially to be successful are not necessarily sustained over time, as was the case in this study. In healthcare, there is no such thing as a 'fix and forget' solution for interventions. Management commitment to support communication within and between microsystems, and to support healthcare staff understanding of the underlying reasons for intervention, are important implications for change and change management across healthcare systems.
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Affiliation(s)
- Eva Ros
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Axel Ros
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
- Jönköping Academy for Improvement of Health and Welfare, The School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Elizabeth E Austin
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Lina De Geer
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Department of Anaesthesiology and Intensive Care, Linköping University Hospital, Linköping, Sweden
| | - Paul Lane
- Townsville Hospital and Health Service, Townsville, Queensland, Australia
| | - Andrew Johnson
- Townsville Hospital and Health Service, Townsville, Queensland, Australia
- College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
| | - Robyn Clay-Williams
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
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Berry LL, Crane J, Deming KA, Barach P. Using Evidence to Design Cancer Care Facilities. Am J Med Qual 2020; 35:397-404. [DOI: 10.1177/1062860619897406] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The nuts and bolts of planning and designing cancer care facilities—the physical space, the social systems, the clinical and nonclinical workflows, and all of the patient-facing services—directly influence the quality of clinical care and the overall patient experience. Cancer facilities should be conceived and constructed on the basis of evidence-based design thinking and implementation, complemented by input from key stakeholders such as patients, families, and clinicians. Specifically, facilities should be designed to improve the patient experience, offer options for urgent care, maximize infection control, support and streamline the work of multidisciplinary teams, integrate research and teaching, incorporate palliative care, and look beyond mere diagnosis and treatment to patient wellness—all tailored to each cancer center’s patient population and logistical and financial constraints. From conception to completion to iterative reevaluation, motivated institutions can learn to make their own facilities reflect the excellence in cancer care that they aim to deliver to patients.
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Affiliation(s)
- Leonard L. Berry
- Texas A&M University, College Station, TX
- Institute for Healthcare Improvement, Boston, MA
| | | | | | - Paul Barach
- Wayne State University, Detroit, MI
- Jefferson College of Population Health, Philadelphia, PA
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Barach P, Dadlani GH, Lipshultz SE. Evidence-based, safety management policies for pediatric cardiac care in New York State. PROGRESS IN PEDIATRIC CARDIOLOGY 2019. [DOI: 10.1016/j.ppedcard.2019.101139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Rattray NA, Ebright P, Flanagan ME, Militello LG, Barach P, Franks Z, Rehman SU, Gordon HS, Frankel RM. Content counts, but context makes the difference in developing expertise: a qualitative study of how residents learn end of shift handoffs. BMC MEDICAL EDUCATION 2018; 18:249. [PMID: 30390668 PMCID: PMC6215683 DOI: 10.1186/s12909-018-1350-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 10/15/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Handoff education is both formal and informal and varies widely across medical school and residency training programs. Despite many efforts to improve clinical handoffs, little evidence has shown meaningful improvement. The objective of this study was to identify residents' perspectives and develop a deeper understanding on the necessary training to conduct safe and effective patient handoffs. METHODS A qualitative study focused on the analysis of cognitive task interviews targeting end-of-shift handoff experiences with 35 residents from three geographically dispersed VA facilities. The interview data were analyzed using an iterative, consensus-based team approach. Researchers discussed and agreed on code definitions and corresponding case examples. Grounded theory was used to analyze the transcripts. RESULTS Although some residents report receiving formal training in conducting handoffs (e.g., medical school coursework, resident boot camp/workshops, and handoff debriefing), many residents reported that they were only partially prepared for enacting them as interns. Experiential, practice-based learning (i.e., giving handoffs, covering night shift to match common issues to handoff content) was identified as the most suited and beneficial for delivering effective handoff training. Six skills were described as critical to learning effective handoffs: identifying pertinent information, providing anticipatory guidance, applying acquired clinical knowledge, being concise, incorporating delivery strategies, and appreciating the styles/preferences of handoff recipients. CONCLUSIONS Residents identified the immersive performance and the experience of covering night shifts as the most important aspects of learning to execute effective handoffs. Formal education alone can miss the critical role of real-time sense-making throughout the process of handing off from one trainee to another. Interventions targeting senior resident mentoring and night shift could positively influence the cognitive and performance capacity for safe, effective handoffs.
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Affiliation(s)
- Nicholas A. Rattray
- VA HSR&D Center for Health Information and Communication, Roudebush VAMC, Indianapolis, USA
- Department of Anthropology, Indiana University-Purdue University Indianapolis, Indianapolis, USA
- Regenstrief Institute, Inc., Indianapolis, USA
| | | | - Mindy E. Flanagan
- VA HSR&D Center for Health Information and Communication, Roudebush VAMC, Indianapolis, USA
| | | | - Paul Barach
- Wayne State University School of Medicine, Detroit, USA
| | - Zamal Franks
- VA HSR&D Center for Health Information and Communication, Roudebush VAMC, Indianapolis, USA
| | - Shakaib U. Rehman
- Phoenix VA Healthcare Systems, Phoenix, USA
- University of Arizona College of Medicine-Phoenix, Phoenix, USA
| | - Howard S. Gordon
- VA HSR&D Center of Innovation for Complex Chronic Healthcare, Jesse Brown VAMC, Chicago, USA
- University of Illinois at Chicago, Chicago, USA
| | - Richard M. Frankel
- VA HSR&D Center for Health Information and Communication, Roudebush VAMC, Indianapolis, USA
- Regenstrief Institute, Inc., Indianapolis, USA
- Indiana University School of Medicine, Indianapolis, USA
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Winlaw DS, Sholler GF, Barach P. Regional consolidation of pediatric cardiac surgery in New York State – Are we there yet? A destination reached or a step in the right direction? PROGRESS IN PEDIATRIC CARDIOLOGY 2018. [DOI: 10.1016/j.ppedcard.2018.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Clay-Williams R, Plumb J, Luscombe GM, Hawke C, Dalton H, Shannon G, Johnson J. Improving Teamwork and Patient Outcomes with Daily Structured Interdisciplinary Bedside Rounds: A Multimethod Evaluation. J Hosp Med 2018; 13:311-317. [PMID: 29698537 DOI: 10.12788/jhm.2850] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Previous research has shown that interdisciplinary ward rounds have the potential to improve team functioning and patient outcomes. DESIGN A convergent parallel multimethod approach to evaluate a hospital interdisciplinary ward round intervention and ward restructure. SETTING An acute medical unit in a large tertiary care hospital in regional Australia. PARTICIPANTS Thirty-two clinicians and inpatients aged 15 years and above, with acute episode of care, discharged during the year prior and the year of the intervention. INTERVENTION A daily structured interdisciplinary bedside round combined with a ward restructure. MEASUREMENTS Qualitative measures included contextual factors and measures of change and experiences of clinicians. Quantitative measures included length of stay (LOS), monthly "calls for clinical review," and cost of care delivery. RESULTS Clinicians reported improved teamwork, communication, and understanding between and within the clinical professions, and between clinicians and patients, after the intervention implementation. There was no statistically significant difference between the intervention and control wards in the change in LOS over time (Wald ?2 = 1.05; degrees of freedom [df] = 1; P = .31), but a statistically significant interaction for cost of stay, with a drop in cost over time, was observed in the intervention group, and an increase was observed in the control wards (Wald ?2 = 6.34; df = 1; P = .012). The medical wards and control wards differed significantly in how the number of monthly "calls for clinical review" changed from prestructured interdisciplinary bedside round (SIBR) to during SIBR (F (1,44) = 12.18; P = .001). CONCLUSIONS Multimethod evaluations are necessary to provide insight into the contextual factors that contribute to a successful intervention and improved clinical outcomes.
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Affiliation(s)
- Robyn Clay-Williams
- Centre for Healthcare Resilience & Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia.
| | - Jennifer Plumb
- Australian Commission on Safety and Quality in Health Care, Sydney, New South Wales, Australia
| | - Georgina M Luscombe
- The School of Rural Health, Sydney Medical School, The University of Sydney, Orange, New South Wales, Australia
| | - Catherine Hawke
- The School of Rural Health, Sydney Medical School, The University of Sydney, Orange, New South Wales, Australia
| | - Hazel Dalton
- Faculty of Health and Medicine, The University of Newcastle, Newcastle, New South Wales, Australia
| | - Gabriel Shannon
- The School of Rural Health, Sydney Medical School, The University of Sydney, Orange, New South Wales, Australia
| | - Julie Johnson
- Department of Surgery, Center for Healthcare Studies, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
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Abstract
Challenges of the current health system in the United States call for collaboration of health care professionals, careful utilization of resources, and greater efficiency of system processes. Innovations to the delivery of care include the introduction of the clinical nurse leader role to provide leadership at the point of care, where it is needed most. Clinical nurse leaders have demonstrated their ability to address needed changes and implement improvements in processes that impact the efficiency and quality of patient care across the continuum and in a variety of settings, including critical care. This article describes the role of the certified clinical nurse leader, their education and skill set, and outlines outcomes that have been realized by their efforts. Specific examples of how clinical nurse leaders impact critical care nursing are discussed.
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Collette AE, Wann K, Nevin ML, Rique K, Tarrant G, Hickey LA, Stichler JF, Toole BM, Thomason T. An exploration of nurse-physician perceptions of collaborative behaviour. J Interprof Care 2017; 31:470-478. [DOI: 10.1080/13561820.2017.1301411] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
| | - Kristen Wann
- Sharp Memorial Hospital, San Diego, California, USA
| | | | - Karen Rique
- Sharp Memorial Hospital, San Diego, California, USA
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Dunn AS, Reyna M, Radbill B, Parides M, Colgan C, Osio T, Benson A, Brown N, Cambe J, Zwerling M, Egorova N, Kaplan H. The Impact of Bedside Interdisciplinary Rounds on Length of Stay and Complications. J Hosp Med 2017; 12:137-142. [PMID: 28272588 DOI: 10.12788/jhm.2695] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Communication among team members within hospitals is typically fragmented. Bedside interdisciplinary rounds (IDR) have the potential to improve communication and outcomes through enhanced structure and patient engagement. OBJECTIVE To decrease length of stay (LOS) and complications through the transformation of daily IDR to a bedside model. DESIGN Controlled trial. SETTING 2 geographic areas of a medical unit using a clinical microsystem structure. PATIENTS 2005 hospitalizations over a 12-month period. INTERVENTIONS A bedside model (mobile interdisciplinary care rounds [MICRO]) was developed. MICRO featured a defined structure, scripting, patient engagement, and a patient safety checklist. MEASUREMENTS The primary outcomes were clinical deterioration (composite of death, transfer to a higher level of care, or development of a hospital-acquired complication) and length of stay (LOS). Patient safety culture and perceptions of bedside interdisciplinary rounding were assessed pre- and postimplementation.. RESULTS There was no difference in LOS (6.6 vs 7.0 days, P = 0.17, for the MICRO and control groups, respectively) or clinical deterioration (7.7% vs 9.3%, P = 0.46). LOS was reduced for patients transferred to the study unit (10.4 vs 14.0 days, P = 0.02, for the MICRO and control groups, respectively). Nurses and hospitalists gave significantly higher scores for patient safety climate and the efficiency of rounds after implementation of the MICRO model. LIMITATIONS The trial was performed at a single hospital. CONCLUSIONS Bedside IDR did not reduce overall LOS or clinical deterioration. Future studies should examine whether comprehensive transformation of medical units, including co-leadership, geographic cohorting of teams, and bedside interdisciplinary rounding, improves clinical outcomes compared to units without these features. Journal of Hospital Medicine 2017;12:137-142.
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Affiliation(s)
- Andrew S Dunn
- Division of Hospital Medicine, Mount Sinai Health System, New York, New York, USA
| | - Maria Reyna
- Division of Hospital Medicine, Mount Sinai Health System, New York, New York, USA
| | | | - Michael Parides
- Department of Population Health Science and Policy, Mount Sinai Medical Center, New York, New York, USA
| | | | - Tobi Osio
- Department of Nursing, Mount Sinai Health System, New York, New York, USA
| | - Ari Benson
- Department of Medicine, Mount Sinai Health System, New York, New York, USA
| | - Nicole Brown
- Department of Medicine, Mount Sinai Health System, New York, New York, USA
| | - Joy Cambe
- Department of Medicine, Mount Sinai Health System, New York, New York, USA
| | - Margo Zwerling
- Department of Medicine, Mount Sinai Health System, New York, New York, USA
| | - Natalia Egorova
- Department of Population Health Science and Policy, Mount Sinai Medical Center, New York, New York, USA
| | - Harold Kaplan
- Department of Population Health Science and Policy, Mount Sinai Medical Center, New York, New York, USA
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Karimi L, Dadich A, Fulop L, Leggat SG, Rada J, Hayes KJ, Kippist L, Eljiz K, Smyth A, Fitzgerald JA. Empirical exploration of brilliance in health care: perceptions of health professionals. AUST HEALTH REV 2016; 41:336-343. [PMID: 27607361 DOI: 10.1071/ah16047] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 06/05/2016] [Indexed: 11/23/2022]
Abstract
Objective The aim of the present study was to develop a positive organisational scholarship in health care approach to health management, informed by health managers and health professionals' experiences of brilliance in health care delivery. Methods A sample of postgraduate students with professional and/or management experience within a health service was invited to share their experiences of brilliant health services via online discussions and a survey running on the SurveyMonkey platform. A lexical analysis of student contributions was conducted using the individual as the unit of analysis. Results Using lexical analysis, the examination of themes in the concept map, the relationships between themes and the relationships between concepts identified 'care' as the most important concept in recognising brilliance in health care, followed by the concepts of 'staff' and 'patient'. Conclusions The research presents empirical material to support the emergence of an evidence-based health professional perspective of brilliance in health management. The findings support other studies that have drawn on both quantitative and qualitative materials to explore brilliance in health care. Pockets of brilliance have been previously identified as catalysts for changing health care systems. Both quality, seen as driven from the outside, and excellence, driven from within individuals, are necessary to produce brilliance. What is known about the topic? The quest for brilliance in health care is not easy but essential to reinvigorating and energising health professionals to pursue the highest possible standards of health care delivery. What does this paper add? Using an innovative methodology, the present study identified the key drivers that health care professionals believe are vital to moving in the direction of identifying brilliant performance. What are the implications for practitioners? This work presents evidence on the perceptions of leadership and management practices associated with brilliant health management. Lessons learned from exceptionally well-delivered services contain different templates for change than those dealing with failures, errors, misconduct and the resulting negativity.
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Affiliation(s)
- Leila Karimi
- Department of Public Health, School of Psychology and Public Health, La Trobe University, Plenty Road, Bundoora, Vic. 3086, Australia.
| | - Ann Dadich
- School of Business, University of Western Sydney, Locked Bag 1797, Penrith, NSW 2751, Australia.
| | - Liz Fulop
- Griffith Business School, Gold Coast Campus, Griffith University, Parklands Drive, Southport, Qld 4215, Australia.
| | - Sandra G Leggat
- Department of Public Health, School of Psychology and Public Health, La Trobe University, Plenty Road, Bundoora, Vic. 3086, Australia.
| | - Jiri Rada
- Department of Public Health, School of Psychology and Public Health, La Trobe University, Plenty Road, Bundoora, Vic. 3086, Australia.
| | - Kathryn J Hayes
- Griffith Business School, Gold Coast Campus, Griffith University, Parklands Drive, Southport, Qld 4215, Australia.
| | - Louise Kippist
- School of Business, University of Western Sydney, Locked Bag 1797, Penrith, NSW 2751, Australia.
| | - Kathy Eljiz
- Health Service Management, University of Tasmania, Tas, Australia. Email
| | - Anne Smyth
- School of Health, School of Medicine, University of New England, Armidale NSW 2351, Australia. Email
| | - Janna Anneke Fitzgerald
- Griffith Business School, Gold Coast Campus, Griffith University, Parklands Drive, Southport, Qld 4215, Australia.
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Goldsmith P, Moon J, Anderson P, Kirkup S, Williams S, Gray M. Do clinical incidents, complaints and medicolegal claims overlap? Int J Health Care Qual Assur 2015; 28:864-71. [DOI: 10.1108/ijhcqa-06-2015-0081] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
– Error reporting by healthcare staff, patient-derived complaints and patient-derived medico-legal claims are three separate processes present in most healthcare systems. It is generally assumed that all relate to the same cases. Given the high costs associated with these processes and strong desire to maximise quality and standards, the purpose of this paper is to see whether it was indeed the case that most complaints and claims related to medical errors and the relative resource allocation to each group.
Design/methodology/approach
– Electronic databases for clinical error recording, patient complaints and medico-legal claims in a large NHS healthcare provider organisation were reviewed and case overlap analysed.
Findings
– Most complaints and medico-legal claims do not associate with a prior clinical error. Disproportionate resource is required for a small number of complaints and the medico-legal claims process. Most complaints and claims are not upheld.
Research limitations/implications
– The authors have only looked at data from one healthcare provider and for one period. It would be useful to analyse other healthcare organisations over a longer time period. The authors were unable to access data on secondary staffing costs, which would have been informative. As the medico-legal process can go on for many years, the authors do not know the ultimate outcomes for all cases. The authors also do not know how many medico-legal cases were settled out of court pragmatically to minimise costs.
Practical implications
– Staff error reporting systems and patient advisory services seem to be efficient and working well. However, the broader complaints and claims process is costing considerable time and money, yet may not be useful in driving up standards. System changes to maximise helpful complaints and claims, from a quality and standards perspective, and minimise unhelpful ones are recommended.
Originality/value
– This study provides important data on the lack of overlap between errors, complaints and claims cases.
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Bazos DA, LaFave LRA, Suresh G, Shannon KC, Nuwaha F, Splaine ME. The gas cylinder, the motorcycle and the village health team member: a proof-of-concept study for the use of the Microsystems Quality Improvement Approach to strengthen the routine immunization system in Uganda. Implement Sci 2015; 10:30. [PMID: 25889485 PMCID: PMC4377204 DOI: 10.1186/s13012-015-0215-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Accepted: 01/27/2015] [Indexed: 11/30/2022] Open
Abstract
Background Although global efforts to support routine immunization (RI) system strengthening have resulted in higher immunization rates, the World Health Organization (WHO) estimates that the proportion of children receiving recommended DPT3 vaccines has stagnated at 80% for the past 3 years (WHO Fact sheet—Immunization coverage 2014, WHO, 2014). Meeting the WHO goal of 90% national DPT3 coverage may require locally based strategies to support conventional approaches. The Africa Routine Immunization Systems Essentials-System Innovation (ARISE-SI) initiative is a proof-of-concept study to assess the application of the Microsystems Quality Improvement Approach for generating local solutions to strengthen RI systems and reach those unreached by current efforts in Masaka District, Uganda. Methods The ARISE-SI intervention had three components: health unit (HU) advance preparations, an action learning collaborative, and coaching of improvement teams. The intervention was informed and assessed using qualitative and quantitative methods. Data collection focused on changes and outcomes of improvement efforts among five HUs and one district-level team during the intervention (June 2011–February 2012) and five follow-up months. Results Workshops and team meetings had a 95% attendance rate. All teams gained RI system knowledge and implemented changes to address locally identified problems. Specific changes included: RI register implementation and expanded use, Child Health Card provision and monitoring, staff cross-training, staffing pattern changes, predictable outreach schedules, and health system leader—community leader meetings. Several RI system barriers prevalent across Masaka District (e.g., lack of backup HU gas cylinders, inadequate outreach transportation, and village health team underutilization) were successfully addressed. Three of five HUs significantly increased the vaccines administered. All improvements were sustained 5 months post-intervention. External evaluation validated the findings of high levels of participant engagement, empowerment to make change, and willingness to sustain improvements. Conclusions The Microsystems Quality Improvement Approach is a comprehensive approach, grounded in systems thinking, and coupled with intensive coaching. It provides a robust framework for engaging teams in the development of unique local solutions that strengthen RI systems in resource poor settings. The sustained improvements in local RI systems from this study provide evidence that this approach may be an effective framework for enhancing the WHO’s Reaching Every District (RED) immunization strategy.
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Affiliation(s)
- Dorothy A Bazos
- Community Engagement, the Prevention Research Center at Dartmouth, The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, 35 Centerra Parkway, Lebanon, NH, 03766, USA. .,, 501 South Street, Bow, NH, 03304, USA.
| | - Lea R Ayers LaFave
- JSI Research & Training Institute, Inc., Community Health Institute, 501 South Street, 2nd Floor, Bow, NH, 03304, USA.
| | - Gautham Suresh
- Pediatrics and Community & Family Medicine, Geisel School of Medicine, Dartmouth-Hitchcock Medical Center, 1 Rope Ferry Road, Hanover, NH, 03755, USA.
| | - Kevin C Shannon
- SAC Health System, Department of Family Medicine, Loma Linda University School of Medicine, Suite 206-A, Loma, Linda, CA, 92354, USA.
| | - Fred Nuwaha
- Disease Control and Prevention, Makerere University School of Public Health, PO Box 7072, Kampala, Uganda.
| | - Mark E Splaine
- The Dartmouth Institute for Health Policy and Clinical Practice and Community and Family Medicine, Geisel School of Medicine at Dartmouth, 30 Lafayette Street, Lebanon, NH, 03766, USA.
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The influence of organizational context on the use of research by nurses in Canadian pediatric hospitals. BMC Health Serv Res 2013; 13:351. [PMID: 24034149 PMCID: PMC3848566 DOI: 10.1186/1472-6963-13-351] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Accepted: 09/06/2013] [Indexed: 11/23/2022] Open
Abstract
Background Organizational context is recognized as an important influence on the successful implementation of research by healthcare professionals. However, there is relatively little empirical evidence to support this widely held view. Methods The objective of this study was to identify dimensions of organizational context and individual (nurse) characteristics that influence pediatric nurses’ self-reported use of research. Data on research use, individual, and contextual variables were collected from registered nurses (N = 735) working on 32 medical, surgical and critical care units in eight Canadian pediatric hospitals using an online survey. We used Generalized Estimating Equation modeling to account for the correlated structure of the data and to identify which contextual dimensions and individual characteristics predict two kinds of self-reported research use: instrumental (direct) and conceptual (indirect). Results Significant predictors of instrumental research use included: at the individual level; belief suspension-implement, research use in the past, and at the hospital unit (context) level; culture, and the proportion on nurses possessing a baccalaureate degree or higher. Significant predictors of conceptual research use included: at the individual nurse level; belief suspension-implement, problem solving ability, use of research in the past, and at the hospital unit (context) level; leadership, culture, evaluation, formal interactions, informal interactions, organizational slack-space, and unit specialty. Conclusions Hospitals, by focusing attention on modifiable elements of unit context may positively influence nurses’ reported use of research. This influence of context may extend to the adoption of best practices in general and other innovative or quality interventions.
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Abstract
RÉSUMÉLes maisons de soins infirmiers sont devenues des environnements offrant des soins complexes, dont les habitants ont des besoins importants et la plupart souffrent de la démence liée a l’âge. S’appuyant sur les recherches de Hirdes et al. (2011), nous décrivons un profil des résidents dans un échantillon représentatif de 30 maisons de soins infirmiers en milieu urbain dans les provinces des Prairies, en utilisant des données de L’Instrument d’évaluation des résidents/le recueil de données minimum (Resident Assistant Instrument – Minimum Data Set 2.0) de 5 196 évaluations résidents accomplies entre le 1ier octobre et le 31ieme décembre 3011. Les résidents avaient principalement plus de 85 ans, étaient des femmes, et souffraient d’une démence liée à l’âge. Nous avons comparé le soutien et les services connexes des établissements et les caractéristiques des résidents par province, par les modèles du propriétaire-gérant, et par le nombre d’unités dans une installation. Nous avons également constaté que les établissements publics ont tendance à s’occuper des résidents ayant des caractéristiques plus exigeants : notamment, la déficience cognitive, un comportement aggressif, et l’incontinence. Aucune tendance claire n’a été observée reliant le nombre d’unités dans un établissement aux caractéristiques des résidents.
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One Lens Missing? Clarifying the Clinical Microsystem Framework With Learning Theories. Qual Manag Health Care 2013; 22:126-36. [DOI: 10.1097/qmh.0b013e31828c22e2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Foglia MB, Cohen JH, Pearlman RA, Bottrell MM, Fox E. Perceptions of Ethical Leadership and the Ethical Environment and Culture: IntegratedEthicsTMStaff Survey Data from the VA Health Care System. ACTA ACUST UNITED AC 2013. [DOI: 10.1080/21507716.2012.751070] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Ballangrud R, Hedelin B, Hall-Lord ML. Nurses' perceptions of patient safety climate in intensive care units: a cross-sectional study. Intensive Crit Care Nurs 2012; 28:344-54. [PMID: 22999498 DOI: 10.1016/j.iccn.2012.01.001] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2011] [Revised: 12/02/2011] [Accepted: 01/03/2012] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To investigate registered nurses' perceptions of the patient safety climate in intensive care units and to explore potential predictors for overall perception of safety and frequency of incident reporting. RESEARCH METHODOLOGY/DESIGN A cross-sectional design was conducted, using the questionnaire Hospital Survey on Patient Safety Culture, measuring 12 patient safety climate dimensions: seven at unit and three at hospital level, two outcomes and in addition two outcome items. SETTING Ten intensive care units (ICUs) in six hospitals in one hospital trust in Norway. RESULTS In total, 220 registered nurses (RNs) responded (72%). Seven of 12 dimensions achieved a RN proportion of positive scores over 55%. Five achieved a lower proportion. Significant differences in RNs' perceptions of patient safety were found between types of units and between the four hospitals. The total variance in the outcome measure explained by the model as a whole was for the outcome dimensions "overall perception of safety" 32%, and "frequency of incident reporting" 32%. The variables at the unit level made a significant contribution to the outcome. CONCLUSION RNs in ICU are most positive to patient safety climate at unit level, hence improvements are needed concerning incident reporting, feedback and communication about errors and organisational learning and continuous improvement.
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Miles PV. The heart of the matter: How do I know what I do works? PROGRESS IN PEDIATRIC CARDIOLOGY 2011. [DOI: 10.1016/j.ppedcard.2011.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Geng EH, Kahn JS, Chang OC, Hare CB, Christopoulos KA, Jones D, Petersen ML, Deeks SG, Havlir DV, Gandhi M. The effect of AIDS Clinical Trials Group Protocol 5164 on the time from Pneumocystis jirovecii pneumonia diagnosis to antiretroviral initiation in routine clinical practice: a case study of diffusion, dissemination, and implementation. Clin Infect Dis 2011; 53:1008-14. [PMID: 21960715 DOI: 10.1093/cid/cir608] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Diffusion, dissemination, and implementation of scientific evidence into routine clinical practice is not well understood. The Adult AIDS Clinical Trials Group (ACTG) Protocol 5164 showed that early antiretroviral therapy (ART; ie, within 14 days) after diagnosis of an opportunistic infection improved clinical outcomes, compared with later initiation. Subsequently, the San Francisco General Hospital (SFGH) HIV/AIDS Service performed the SFGH 5164 Initiative to disseminate and implement the findings of ACTG 5164. METHODS We evaluated patients who received a diagnosis of Pneumocystis jirovecii pneumonia (PCP) from 1 January 2001 through 30 March 2011. Survival analyses were used to assess changes in the time to initiation of ART after PCP, and logistic regression was used to evaluate changes in the odds of early ART (ie, within 14 days) because of ACTG 5164 and SFGH 5164 Initiative. RESULTS Among 162 patients, the adjusted hazard of ART initiation increased by 3.05 (95% confidence interval [CI], 1.86-5.02) after ACTG 5164 and by 4.89 (95% CI, 2.76-8.67) after the SFGH Initiative, compared with before ACTG 5164. When compared with before ACTG 5164, the proportion of patients who received ART within the 14 days after PCP diagnosis increased from 7.4% to 50.0% (P < .001) after ACTG 5164 and from 50.0% to 83.0% (P = .02) after the SFGH 5164 Initiative. CONCLUSIONS Diffusion of findings from of a randomized trial changed practice at an academic medical center, but dissemination and implementation efforts were required to establish early ART at acceptable levels. Early ART initiation can be achieved in real-world patient populations.
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Affiliation(s)
- Elvin H Geng
- Division of HIV/AIDS, San Francisco General Hospital, and Department of Medicine, 995 Potrero Avenue, San Francisco, CA 94110, USA.
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Measures and measurement of high-performance work systems in health care settings. Health Care Manage Rev 2011; 36:38-46. [DOI: 10.1097/hmr.0b013e3181f685a4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Sterkenburg A, Barach P, Kalkman C, Gielen M, ten Cate O. When do supervising physicians decide to entrust residents with unsupervised tasks? ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2010; 85:1408-17. [PMID: 20736669 DOI: 10.1097/acm.0b013e3181eab0ec] [Citation(s) in RCA: 191] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
PURPOSE Patient-care responsibilities stimulate trainee learning but training may compromise patient safety. The authors investigated factors guiding clinical supervisors' decisions to trust residents with critical patient-care tasks. METHOD In a mixed quantitative and qualitative descriptive study carried out at University Medical Center Utrecht, Utrecht, the Netherlands, from March to September 2008, the authors surveyed attending anesthetists and resident anesthetists regarding when attendings should entrust each of six selected critical tasks to residents. The authors conducted structured interviews with both groups, using trigger case vignettes to solicit opinions on factors that affect entrustment decisions. RESULTS Thirty-two attending anesthetists and 31 residents answered the questionnaire (response rate 58%), and 10 participants from each group were interviewed. Attendings varied in their opinions regarding how much independence to give residents, particularly postgraduate year (PGY) 2, 3, and 4 residents. PGY1 residents reported working above their expected level of competence but estimate their own ability as sufficient, whereas PGY5 residents reported working below their expected level of competence. The authors classified factors that determine entrustment into four groups: characteristics of the resident, the attending, the clinical context, and the critical task. CONCLUSIONS Residents' and attendings' opinions and impressions differ regarding what is expected from residents, what residents actually do, and what residents think they can do safely. The authors list factors affecting why and when supervisors trust residents to proceed without supervision. Future studies should address drivers behind entrustment decisions, correlations with patient outcomes, and tools that enable faculty to justify their entrustment decisions.
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Affiliation(s)
- Anneke Sterkenburg
- Center for Research and Development of Education, University Medical Center Utrecht, Utrecht, The Netherlands
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Safe Organizations: Bringing it all together. PATIENT SAFETY 2010. [DOI: 10.1002/9781444323856.ch19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Deilkås E, Hofoss D. Patient safety culture lives in departments and wards: multilevel partitioning of variance in patient safety culture. BMC Health Serv Res 2010; 10:85. [PMID: 20356351 PMCID: PMC2859742 DOI: 10.1186/1472-6963-10-85] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2009] [Accepted: 03/31/2010] [Indexed: 12/03/2022] Open
Abstract
Background Aim of study was to document 1) that patient safety culture scores vary considerably by hospital department and ward, and 2) that much of the variation is across the lowest level organizational units: the wards. Setting of study: 500-bed Norwegian university hospital, September-December 2006. Methods Data collected from 1400 staff by (the Norwegian version of) the generic version of the Safety Attitudes Questionnaire (SAQ Short Form 2006). Multilevel analysis by MLwiN version 1.10. Results Considerable parts of the score variations were at the ward and department levels. More organization level variation was seen at the ward level than at the department level. Conclusions Patient safety culture improvement efforts should not be limited to all-hospital interventions or interventions aimed at entire departments, but include involvement at the ward level, selectively aimed at low-scoring wards. Patient safety culture should be studied as closely to the patient as possible. There may be such a thing as "hospital safety culture" and the variance across hospital departments indicates the existence of department safety cultures. However, neglecting the study of patient safety culture at the ward level will mask important local variations. Safety culture research and improvement should not stop at the lowest formal level of the hospital (wards, out-patient clinics, ERs), but proceed to collect and analyze data on the micro-units within them.
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Affiliation(s)
- Ellen Deilkås
- Health Services Research Unit, Akershus University Hospital, Norway.
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Abstract
High-profile inquiries in several countries have helped to raise public awareness of safety issues and driven policy change. In obstetric critical care, various publications have highlighted organizational factors, communication, absence of guidelines, failure to follow local protocols, poor documentation and delay in identifying the deteriorating woman as issues. Patient safety in obstetric critical care is paramount because of its complexity and the vulnerability of the critically ill patient to error. The principles of risk management and its various components can be used to make improvements. A framework to achieve this is as follows: building a safety culture; leading and supporting staff; integrating risk management activity; promoting reporting; involving and communicating with patients and the public; learning and sharing safety lessons; and implementing solutions to prevent harm.
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Spector JM. Cognition and learning in the digital age: Promising research and practice. COMPUTERS IN HUMAN BEHAVIOR 2008. [DOI: 10.1016/j.chb.2007.01.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Galbraith RM, Hawkins RE, Holmboe ES. Making self-assessment more effective. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2008; 28:20-24. [PMID: 18366125 DOI: 10.1002/chp.151] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Self-assessment has been held out as an important mechanism for lifelong learning and self-improvement for health care professionals. However, there is growing concern that individual learners often interpret the results inaccurately. This idea has led to skepticism that self-assessment in its current form can ever be truly useful for lifelong professional development. We examine the proposal that self-assessment can and should be made more effective. First, relevance should be improved. The process should be tied more explicitly to the individual's actual practice profile, rather than being loosely relevant to broader constructs around the permitted scope of practice (eg, certification or licensure). In addition, self-assessment should include not only knowledge and reasoning but also what is done every day in practice, thereby broadening from competence in simulated settings to performance in real settings. Second, the impact of self-assessment should be substantially strengthened by periodic external validation of self-assessment results, together with goals set as a result and plans for further improvement. This offers to the individual the very tangible benefit of satisfying external mandates (eg, licensure and certification). In addition, impact should be reinforced by linking the results of self-assessment to subsequent learning activities including Continuing Medical Education (CME). Although these enhancements individually may not cure all of what ails self-assessment, they might ensure greater effectiveness for the purposes of lifelong learning.
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Affiliation(s)
- Robert M Galbraith
- Center for Innovation, National Board of Medical Examiners, Philadelphia, PA 19104, USA.
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Nurse Staffing in Acute Care Settings: Research Perspectives and Practice Implications. Jt Comm J Qual Patient Saf 2007; 33:30-44. [DOI: 10.1016/s1553-7250(07)33111-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Schutz AL, Counte MA, Meurer S. Assessment of patient safety research from an organizational ergonomics and structural perspective. ERGONOMICS 2007; 50:1451-84. [PMID: 17654036 DOI: 10.1080/00140130701346765] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
The aim of this study is to review patient safety improvement initiatives within a conceptual framework that builds upon principles of organizational ergonomics and emphasizes structural factors that influence patient safety. The literature review included 131 English language published studies of patient safety improvement strategies extracted using Medline, Ovid Healthstar, PubMed and CINAHL searches. Keywords for the search included: 'patient safety'; 'medical errors'; 'adverse event'; 'iatrogenic'; and truncated options for 'improve'. The multilevel, hierarchical framework offered in this paper integrates quality management principles and organizational ergonomics theory and organizes patient safety initiatives according to sociotechnical system elements within three structural levels: health policies and associated health care organizations; health care delivery organizations; and health care microsystems. Utilizing the conceptual framework, this review of patient safety improvement initiatives highlights the need for consideration of the impact of all improvement proposals on each structural component within health care systems. The review also supports the need for patient safety research to evolve from exploratory, 1-D reporting to multi-level, integrated research.
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Affiliation(s)
- A L Schutz
- Saint Louis University, School of Public Health, Salus Center, Saint Louis, MO, USA.
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Scholefield H. Embedding quality improvement and patient safety at Liverpool Women's NHS Foundation Trust. Best Pract Res Clin Obstet Gynaecol 2007; 21:593-607. [PMID: 17448729 DOI: 10.1016/j.bpobgyn.2007.02.005] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The provision of safe high-quality care in obstetrics and gynaecology is a key target in the UK National Health Service (NHS), in part because of the high cost of litigation in this area. Good risk management processes should improve safety and reduce the cost of litigation to the NHS. This chapter looks at structures and processes for improving quality and patient safety, using the stepwise approach described by the National Patient Safety Authority (NPSA). This encompasses building a safety culture, leading and supporting staff, integrating risk management activity, promoting reporting, involving and communicating with patients and the public, learning and sharing safety lessons, and implementing solutions to prevent harm. Examples from the Liverpool Women's NHS Foundation Trust are used to illustrate these steps, including how they were developed, what obstacles had to be overcome, ongoing challenges, and whether good risk management has translated into better, safer health care.
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Currie L, Watterson L. Challenges in delivering safe patient care: a commentary on a quality improvement initiative. J Nurs Manag 2007; 15:162-8. [PMID: 17352699 DOI: 10.1111/j.1365-2834.2007.00627.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The specific aim of this commentary is to identify the challenges identified by nurses in the delivery of safe patient care. In reporting, some of the messages emanating from the research and policy literature, the paper highlights the importance of taking a system approach to the investigation of patient safety failures, the conflicting evidence relating to patient deaths as a result of failures in safety, and the underlying importance of culture. The paper outlines the reasons why patient safety has become so prominent, and provides a brief description of some of the definitions and terminology in current use. The commentary articulates a number of challenges in the delivery of safe care as identified by nurses during a recent quality improvement initiative, and these are organized under the themes of organizational context, working environment, and the organization and management of care. In conclusion, the paper describes the implications arising from the quality improvement initiative and the need for further research exploring the nature of safety culture in health-care organizations.
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Affiliation(s)
- Lynne Currie
- Quality Improvement Programme, RCN Institute, Radcliffe Infirmary, Oxford, UK.
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Abella BS, Kim S, Edelson DP, Huang KN, Merchant RM, Myklebust H, Vanden Hoek TL, Becker LB. Difficulty of cardiac arrest rhythm identification does not correlate with length of chest compression pause before defibrillation. Crit Care Med 2006; 34:S427-31. [PMID: 17114972 DOI: 10.1097/01.ccm.0000246757.15898.13] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Performing high-quality cardiopulmonary resuscitation immediately before electrical defibrillation serves as an important predictor of shock success. Long preshock pauses in cardiopulmonary resuscitation frequently occur, as noted by recent clinical investigations. We sought to determine whether these long pauses were due to difficulties in identifying shockable rhythms or rather due to local factors during resuscitation attempts. DESIGN Prospective in-hospital study of cardiac arrest resuscitation attempts coupled with a retrospective review of preshock pause rhythms by 12 trained providers. Reviewers scored rhythms by ease of identification using a discrete Likert scale from 1 (most difficult to identify) to 5 (easiest to identify). The resuscitation cohort was organized into preshock pause-duration quartiles for statistical analysis. Resident physicians were then surveyed regarding human factors affecting preshock pauses. RESULTS A total of 118 preshock pauses from 45 resuscitation episodes were collected. When evaluated by quartiles of preshock pause duration, difficulty of rhythm identification did not correlate with increasing pause time. In fact, the opposite was found (longest preshock pause quartile of 23.8-60.2 secs vs. shortest pause quartile of 1.1-7.9 secs; rhythm difficulty scores, 3.2 vs. 3.0; p = .20). When 29 resident physicians who recently served on resuscitation teams were surveyed, 18 of 29 (62.1%) attributed long pauses to lack of time sense during resuscitation, and 16 of 29 (55.2%) thought that room crowding prevented rapid defibrillation. CONCLUSIONS Long cardiopulmonary resuscitation pauses before defibrillation are likely due to human factors during the resuscitation and not due to inherent difficulties with rhythm identification. This preliminary work highlights the need for more research and training in the area of team performance and human factors during resuscitation.
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Affiliation(s)
- Benjamin S Abella
- Department of Emergency Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Abstract
Serious events within healthcare occur daily exposing the failure of the system to safeguard patient and providers. The complex nature of healthcare contributes to myriad ambiguities affecting quality nursing care and patient outcomes. Leaders in healthcare organizations are looking outside the industry for ways to improve care because of the slow rates of improvement in patient safety and insufficient application of evidenced-based research in practice. Military and aviation industry strategies are recognized by clinicians in high-risk care settings such as the operating room, emergency departments, and intensive care units as having great potential to create safe and effective systems of care. Complexity science forms the basis for high reliability teams to recognize even the most minor variances in expected outcomes and take strong action to prevent serious error from occurring. Cultural and system barriers to achieving high reliability performance within healthcare and implications for team training are discussed.
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Affiliation(s)
- Leslie M McKeon
- College of Nursing, Univeristy of Tennessee Health Science Center, Memphis, TN 38163, USA.
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McBride-Henry K, Foureur M. Organisational culture, medication administration and the role of nurses. ACTA ACUST UNITED AC 2006. [DOI: 10.1002/pdh.207] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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