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Varpula J, Välimäki M, Pulkkinen J, Lantta T. Patient Falls in Seclusion Rooms in Psychiatric Inpatient Care: A Sociotechnical Probabilistic Risk Modeling Study. J Nurs Care Qual 2023; 38:190-197. [PMID: 36476941 PMCID: PMC9944373 DOI: 10.1097/ncq.0000000000000683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Patient falls are a major adverse event in psychiatric inpatient care. PURPOSE To model the risk for patient falls in seclusion rooms in psychiatric inpatient care. METHODS Sociotechnical probabilistic risk assessment (ST-PRA) was used to model the risk for falls. Data sources were the research team, literature review, and exploration groups of psychiatric nurses. Data were analyzed with fault tree analysis. RESULTS The risk for a patient fall in a seclusion room was 1.8%. Critical paths included diagnosis of a psychiatric disorder, the mechanism of falls, failure to assess and prevent falls, and psychological or physical reason. The most significant individual risk factor for falls was diagnosis of schizophrenia. CONCLUSIONS Falls that occur in seclusion events are associated with physical and psychological risk factors. Therefore, risk assessment methods and fall prevention interventions considering patient behavioral disturbance and physiological risk factors in seclusion are warranted.
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Affiliation(s)
- Jaakko Varpula
- Department of Nursing Science, University of Turku, Turku, Finland (Mr Varpula and Drs Välimäki and Lantta); Xiangya Center for Evidence-Based Practice and Healthcare Innovation, Central South University, Hunan, China (Dr Välimäki); Hospital District of Southwest Finland, Turku, Finland (Dr Pulkkinen); and Department of Nursing, Faculty of Health and Education, Manchester Metropolitan University, Manchester, United Kingdom (Dr Lantta)
| | - Maritta Välimäki
- Department of Nursing Science, University of Turku, Turku, Finland (Mr Varpula and Drs Välimäki and Lantta); Xiangya Center for Evidence-Based Practice and Healthcare Innovation, Central South University, Hunan, China (Dr Välimäki); Hospital District of Southwest Finland, Turku, Finland (Dr Pulkkinen); and Department of Nursing, Faculty of Health and Education, Manchester Metropolitan University, Manchester, United Kingdom (Dr Lantta)
| | - Johanna Pulkkinen
- Department of Nursing Science, University of Turku, Turku, Finland (Mr Varpula and Drs Välimäki and Lantta); Xiangya Center for Evidence-Based Practice and Healthcare Innovation, Central South University, Hunan, China (Dr Välimäki); Hospital District of Southwest Finland, Turku, Finland (Dr Pulkkinen); and Department of Nursing, Faculty of Health and Education, Manchester Metropolitan University, Manchester, United Kingdom (Dr Lantta)
| | - Tella Lantta
- Department of Nursing Science, University of Turku, Turku, Finland (Mr Varpula and Drs Välimäki and Lantta); Xiangya Center for Evidence-Based Practice and Healthcare Innovation, Central South University, Hunan, China (Dr Välimäki); Hospital District of Southwest Finland, Turku, Finland (Dr Pulkkinen); and Department of Nursing, Faculty of Health and Education, Manchester Metropolitan University, Manchester, United Kingdom (Dr Lantta)
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Svensson J. Patient Safety Strategies in Psychiatry and How They Construct the Notion of Preventable Harm: A Scoping Review. J Patient Saf 2022; 18:245-252. [PMID: 34347739 PMCID: PMC9359776 DOI: 10.1097/pts.0000000000000885] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The literature on patient safety in psychiatry has not been explored systematically in terms of what interventions are used, how they are used, and what type of (preventable) harm is targeted. The aims of this scoping review are to explore patient safety strategies used in psychiatry and determine how they construct the notion of preventable harm. METHOD A scoping review of literature on patient safety in psychiatry published in English between 2000 and 2019 was conducted using Scopus, MEDLINE, PsycInfo, and CINAHL. Keywords of patient safety strategies and possible outcomes were coded from the results, discussion, or conclusion. Patient safety strategies were inductively categorized into themes according to the focus of the strategy. RESULTS The review introduces 7 focus areas of patient safety strategies identified within the psychiatric literature: "risk management," "healthcare practitioners," "patient observation," "patient involvement," "computerized methods," "admission and discharge," and "security." The result shows that patient safety strategies mainly aim to reduce suicide, self-harm, violence, and falls and present a large diversity of measures, often aimed at reducing variability while increasing standardization. CONCLUSIONS The strategies that are supported in the literature to achieve safer psychiatry mainly arise from linear cause-effect models and rely on staff performance, competence, and compliance. Contemporary safety science acknowledges the performance variability of everyday normal work and sees risk as the dynamic migration of these daily activities. The field of psychiatry has not yet included this view of safety in the strategic actions to reduce preventable harm.
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Affiliation(s)
- Jakob Svensson
- From the Division of Risk Management and Societal Safety, Lund University, Sweden
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Ban Q, Lyu M, Gao W, Chen Y, Yao J. Study on Collision Detection Techniques for the Informed Design of Natural Views in Healthcare Environments. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2022; 15:229-245. [PMID: 35341333 DOI: 10.1177/19375867221084220] [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: 11/16/2022]
Abstract
BACKGROUND Natural views are an important design strategy for the application of ecological resources in built environments. Numerous clinical studies have indicated that views of nature-for example, plants-can effectively promote patient recovery by relieving their postoperative pains and negative emotions during hospitalization. AIMS This study demonstrates an intelligent method that develops algorithms of using collision detection techniques in Building Information Modeling to evaluate outdoor plant visibility for patients. METHODS These algorithms are digitized into a Revit plug-in program, which can be viewed as a design-aided tool for architects with the purpose of informing healthcare environment design in the decision-making process. RESULTS Its acceptability and effectiveness are evaluated based on the consultations in beta tests. CONCLUSIONS It is believed that this method can improve the work efficiency of evaluating natural views in wards and help architects implement an informed design of built environments for better health performance. All findings in this study can contribute to the development of computational intelligence and social sustainability in the near future.
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Affiliation(s)
- Qichao Ban
- Innovation Institute for Sustainable Maritime Architecture Research and Technology (iSMART), Qingdao University of Technology, Qingdao, China.,College of Architecture and Urban Planning, Qingdao University of Technology, Qingdao, China
| | - Min Lyu
- Innovation Institute for Sustainable Maritime Architecture Research and Technology (iSMART), Qingdao University of Technology, Qingdao, China.,College of Architecture and Urban Planning, Qingdao University of Technology, Qingdao, China
| | - Weijun Gao
- Innovation Institute for Sustainable Maritime Architecture Research and Technology (iSMART), Qingdao University of Technology, Qingdao, China.,Faculty of Environmental Engineering, University of Kitakyushu, Fukuoka, Japan
| | - Yulin Chen
- School of Architecture and Urban Planning, Shandong Jianzhu University, Jinan, China
| | - Jiawei Yao
- College of Architecture and Urban Planning, Tongji University, Shanghai, China
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Turner K, Bjarnadottir R, Jo A, Repique RJR, Thomas J, Green JF, Staggs VS. Patient Falls and Injuries in U.S. Psychiatric Care: Incidence and Trends. Psychiatr Serv 2020; 71:899-905. [PMID: 32600184 DOI: 10.1176/appi.ps.202000004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The goal of this study was to estimate the incidence of falls (total, injurious, and assisted) in U.S. psychiatric care across 6 years (April 2013-March 2019). METHODS Data on falls among patients of adult and geriatric psychiatric units of general, acute care, and psychiatric hospital inpatient units from the National Database of Nursing Quality Indicators were used for this 6-year study. Total falls, assisted falls (i.e., falls broken or slowed by staff), and injurious falls were calculated, along with trends in total and injurious fall rates. RESULTS The sample included 1,159 units in 720 hospitals. Of the 119,246 falls reported, 25,807 (21.6%) resulted in injury. Only 7.0% of the total falls in psychiatric units were assisted by a staff member. Falling unassisted was associated with a higher likelihood of fall-related injury (adjusted odds ratio=1.69, 95% confidence interval=1.59 to 1.80). The total fall rate (8.55 per 1,000 patient-days) and injurious fall rate (1.97 per 1,000 patient-days) were highest for geriatric psychiatric units in general hospitals. Total and injurious fall rates in psychiatric units in general hospitals declined during the study (total fall rate declined by 10% for adult psychiatric units in general hospitals). There was no clear trend in total or injurious fall rates for units in psychiatric hospitals. CONCLUSIONS Falls are a persistent problem in psychiatric care settings. Few fall-prevention programs have been tested in these settings, which have unique risk factors for falls. Additional research is needed to develop fall-prevention interventions in psychiatric care.
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Affiliation(s)
- Kea Turner
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, and Department of Oncological Sciences, University of South Florida Morsani College of Medicine, Tampa (Turner); Department of Family, Community, and Health Systems Science, College of Nursing (Bjarnadottir) and Department of Health Services Research, Management, and Policy, College of Public Health and Health Professions (Jo), University of Florida, Gainesville; Shands Psychiatric Hospital, Gainesville (Repique); Department of Nursing and Patient Services, University of Florida Health Shands Hospital, Gainesville (Thomas, Green); Health Services and Outcomes Research, Children's Mercy Kansas City, and School of Medicine, University of Missouri-Kansas City, Kansas City (Staggs)
| | - Ragnhildur Bjarnadottir
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, and Department of Oncological Sciences, University of South Florida Morsani College of Medicine, Tampa (Turner); Department of Family, Community, and Health Systems Science, College of Nursing (Bjarnadottir) and Department of Health Services Research, Management, and Policy, College of Public Health and Health Professions (Jo), University of Florida, Gainesville; Shands Psychiatric Hospital, Gainesville (Repique); Department of Nursing and Patient Services, University of Florida Health Shands Hospital, Gainesville (Thomas, Green); Health Services and Outcomes Research, Children's Mercy Kansas City, and School of Medicine, University of Missouri-Kansas City, Kansas City (Staggs)
| | - Ara Jo
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, and Department of Oncological Sciences, University of South Florida Morsani College of Medicine, Tampa (Turner); Department of Family, Community, and Health Systems Science, College of Nursing (Bjarnadottir) and Department of Health Services Research, Management, and Policy, College of Public Health and Health Professions (Jo), University of Florida, Gainesville; Shands Psychiatric Hospital, Gainesville (Repique); Department of Nursing and Patient Services, University of Florida Health Shands Hospital, Gainesville (Thomas, Green); Health Services and Outcomes Research, Children's Mercy Kansas City, and School of Medicine, University of Missouri-Kansas City, Kansas City (Staggs)
| | - Renee John R Repique
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, and Department of Oncological Sciences, University of South Florida Morsani College of Medicine, Tampa (Turner); Department of Family, Community, and Health Systems Science, College of Nursing (Bjarnadottir) and Department of Health Services Research, Management, and Policy, College of Public Health and Health Professions (Jo), University of Florida, Gainesville; Shands Psychiatric Hospital, Gainesville (Repique); Department of Nursing and Patient Services, University of Florida Health Shands Hospital, Gainesville (Thomas, Green); Health Services and Outcomes Research, Children's Mercy Kansas City, and School of Medicine, University of Missouri-Kansas City, Kansas City (Staggs)
| | - Jamie Thomas
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, and Department of Oncological Sciences, University of South Florida Morsani College of Medicine, Tampa (Turner); Department of Family, Community, and Health Systems Science, College of Nursing (Bjarnadottir) and Department of Health Services Research, Management, and Policy, College of Public Health and Health Professions (Jo), University of Florida, Gainesville; Shands Psychiatric Hospital, Gainesville (Repique); Department of Nursing and Patient Services, University of Florida Health Shands Hospital, Gainesville (Thomas, Green); Health Services and Outcomes Research, Children's Mercy Kansas City, and School of Medicine, University of Missouri-Kansas City, Kansas City (Staggs)
| | - Jeanette F Green
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, and Department of Oncological Sciences, University of South Florida Morsani College of Medicine, Tampa (Turner); Department of Family, Community, and Health Systems Science, College of Nursing (Bjarnadottir) and Department of Health Services Research, Management, and Policy, College of Public Health and Health Professions (Jo), University of Florida, Gainesville; Shands Psychiatric Hospital, Gainesville (Repique); Department of Nursing and Patient Services, University of Florida Health Shands Hospital, Gainesville (Thomas, Green); Health Services and Outcomes Research, Children's Mercy Kansas City, and School of Medicine, University of Missouri-Kansas City, Kansas City (Staggs)
| | - Vincent S Staggs
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, and Department of Oncological Sciences, University of South Florida Morsani College of Medicine, Tampa (Turner); Department of Family, Community, and Health Systems Science, College of Nursing (Bjarnadottir) and Department of Health Services Research, Management, and Policy, College of Public Health and Health Professions (Jo), University of Florida, Gainesville; Shands Psychiatric Hospital, Gainesville (Repique); Department of Nursing and Patient Services, University of Florida Health Shands Hospital, Gainesville (Thomas, Green); Health Services and Outcomes Research, Children's Mercy Kansas City, and School of Medicine, University of Missouri-Kansas City, Kansas City (Staggs)
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Advancing evidence-based healthcare facility design: a systematic literature review. Health Care Manag Sci 2020; 23:453-480. [PMID: 32447606 DOI: 10.1007/s10729-020-09506-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 04/15/2020] [Indexed: 12/21/2022]
Abstract
Healthcare facility design is a complex process that brings together diverse stakeholders and ideally aligns operational, environmental, experiential, clinical, and organizational objectives. The challenges inherent in facility design arise from the dynamic and complex nature of healthcare itself, and the growing accountability to the quadruple aims of enhancing patient experience, improving population health, reducing costs, and improving staff work life. Many healthcare systems and design practitioners are adopting an evidence-based approach to facility design, defined broadly as basing decisions about the built environment on credible and rigorous research and linking facility design to quality outcomes. Studies focused on architectural options and concepts in the evidence-based design literature have largely employed observation, surveys, post-occupancy study, space syntax analysis, or have been retrospective in nature. Fewer studies have explored layout optimization frameworks, healthcare layout modeling, applications of artificial intelligence, and layout robustness. These operations research/operations management approaches are highly valuable methods to inform healthcare facility design process in its earliest stages and measure performance in quantitative terms, yet they are currently underutilized. A primary objective of this paper is to begin to bridge this gap. This systematic review summarizes 65 evidence-based research studies related to facility layout and planning concepts published from 2008 through 2018, and categorizes them by methodology, area of focus, typology, and metrics of interest. The review identifies gaps in the existing literature and proposes solutions to advance evidence-based healthcare facility design. This work is the first of its kind to review the facility design literature across the disciplines of evidence-based healthcare design research, healthcare systems engineering, and operations research/operations management. The review suggests areas for future study that will enhance evidence-based healthcare facility designs through the integration of operations research and management science methods.
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