Clinical inertia in rheumatology practice

Evaluating the Relationship Between Inertia Levels and Tendency to Medical Errors Among Nurses in Paediatric Clinics

OBJECTIVE

This study aimed to evaluate the relationship between the inertia levels of nurses working in paediatric clinics and their tendency to make medical errors.

METHODS

This descriptive study was conducted between April 2023 and June 2023 with nurses working in the paediatric clinics of a training and research hospital in a province in eastern Turkey. The Descriptive Information Form, Inertia Scale (IS) and Nursing Tendency to Medical Errors Scale (NTMSE) were used as data collection tools. The entire population was targeted without using a sampling method, and the study was completed with 221 nurses.

RESULTS

Of the nurses, 52.9% were between 26 and 33 years of age, and 52.0% were female. Additionally, 66.1% were single, 50.7% had an income less than their expenses, and 77.8% held a bachelor's degree. Inertia was significantly associated with age, marital status, income level, professional experience, duration of work and medical error training, while it was found to be lower among nurses who followed scientific publications (p < 0.05). However, there was no statistical correlation between the mean total score of the NTMSE and the descriptive characteristics (p > 0.05). An association was found between age and the falls subscale of the NTMSE, while nurses working in paediatric units exhibited higher malpractice tendencies in the falls, patient monitoring, and material safety subscales (p < 0.05). No statistically significant correlation was found between the IS and NTMSE (p > 0.05).

CONCLUSION

The study determined that the inertia levels of nurses working in paediatric clinics were moderate and their tendency to make medical errors was low. Regular training programmes and professional development activities should be planned to reduce inertia levels and enhance professional performance. Additionally, improving the working conditions of nurses and strengthening supportive monitoring mechanisms are essential to prevent medical errors.

Comparison of the SLE Risk Probability Index (SLERPI) scale against the European League Against Rheumatism/American College of Rheumatology (ACR/EULAR) and Systemic Lupus International Collaborating Clinics (SLICC) criteria

INTRODUCTION

Timely diagnosis and proper recognition of Systemic Lupus Erythematosus (SLE) is essential to establish early management in inpatients and outpatients. There are different classification scales to identify SLE, which include various clinical and serological aspects. In 2021, the SLE Risk Probability Index (SLERPI) was published, which focuses predominantly on the clinical characteristics of patients with suspected SLE and uses a simple algorithm for early recognition of the disease. The aim of this study is to compare the European League Against Rheumatism/American College of Rheumatology (ACR/EULAR) classification criteria, the Systemic Lupus International Collaborating Clinics (SLICC) criteria, and the SLERPI criteria in a cohort of Colombian patients with SLE and to analyze the correlations observed between their absolute scores.

METHODS

A registry of SLE patients from two referral hospitals in Bogotá, Colombia, was used. 2021 SLERPI, 2019 ACR/EULAR, and 2012 SLICC scores were calculated for each patient and the correlations found between the scales were analyzed. The sensitivities of each were compared, and frequency analyses were conducted among different clinical and laboratory variables.

RESULTS

Between 2016 and 2019, 146 patients diagnosed with SLE were registered, including inpatients and outpatients. The median age was 36 years (interquartile range 26-51), and 82.2% were women. According to the SLERPI criteria, a high prevalence of antinuclear antibodies (92%), immunological disorders (71%), and arthritis (64%) were observed. The most used treatments were corticosteroids (87.6%) and chloroquine (67.8%). A Spearman evaluation analysis was performed, with a moderately strong correlation of 0.76 (p = .000) between the SLERPI and ACR/EULAR scales and very strong correlation of 0.80 (p = .000) between the SLERPI and SLICC. Patients classified with SLE according to the SLERPI scale exhibited a higher incidence of hematological compromise, along with elevated levels of serological markers such as anti-DNA antibodies. Additionally, this group more commonly received treatments involving corticosteroids and azathioprine, and displayed a higher prevalence of hypertension.

CONCLUSION

The SLERPI scale could be useful in the diagnosis of SLE, especially in early stages, given its good correlation with other classification scales and its good sensitivity.

Clinical Inertia: A Wider Perspective and Proposed Classification Criteria

Clinical inertia is very common in day-to-day practice, and the factors contributing to that can be physician-related, patient-related, or health-care-related. Clinical inertia is commonly described in chronic asymptomatic illness. We searched the PubMed and Scopus databases for original articles and reviews. Based on the search result, in this review article, we redefine various terminologies to avoid confusion and propose classification criteria for the early identification of clinical inertia. Clinical inertia is also present in acute illness and in symptomatic disease. Early identification of clinical inertia is difficult because of very vague terminologies which have been used interchangeably as well as because of the lack of definitive classification criteria. In this article, we redefine clinical inertia and propose criteria for early identification, which will be useful for both clinicians and academicians. This review will help clinicians to identify and rectify various aspects of clinical inertia.