ChatGPT: opportunities and risks in the fields of medical care, teaching, and research

ChatGPT is a virtual assistant with artificial intelligence (AI) that uses natural language to communicate, i.e., it holds conversations as those that would take place with another human being. It can be applied at all educational levels, including medical education, where it can impact medical training, research, the writing of scientific articles, clinical care, and personalized medicine. It can modify interactions between physicians and patients and thus improve the standards of healthcare quality and safety, for example, by suggesting preventive measures in a patient that sometimes are not considered by the physician for multiple reasons. ChatGPT potential uses in medical education, as a tool to support the writing of scientific articles, as a medical care assistant for patients and doctors for a more personalized medical approach, are some of the applications discussed in this article. Ethical aspects, originality, inappropriate or incorrect content, incorrect citations, cybersecurity, hallucinations, and plagiarism are some examples of situations to be considered when using AI-based tools in medicine.

Analysis of Critical Incident Reporting System as an indicator of quality healthcare in a cardiology center in Tbilisi, Georgia

Critical Incident Reporting System (CIRS) have become most common patient safety tools in healthcare. The purpose of this study was to determine how effectively CIRS is used and how well healthcare professionals recognize it as a risk management tool. A quantitative approach using a cross sectional survey was adopted. The most common critical incidents were due to lack of personal attention and related to individual errors. The most of the critical incidents arise from non-adherence to guidelines and standards. CIRS can be seen as an effective clinical risk management tool that can be used to identify potential sources of critical incidents and help ensure patient safety at a healthcare organization.

Validation in Spanish of the Ottawa scale for non-technical skills in health personnel in crisis situations

INTRODUCTION

Non-technical skills are related to morbi-mortality in medicine; it has been proposed that 46% of fatal outcomes are explained to limitations in non-technical skills and only 5% to technical skills deficiencies, however, there is no validated instrument or scale in spanish that allows its evaluation in the management of medical crisis.

OBJECTIVE

To evaluate the psychometric properties of a Spanish-adapted version of the "Ottawa crisis resource management (CRM) global rating scale (GRS)" in medical staff involved in critical decision-making based in high-fidelity simulation, which could be beneficial to impact patient safety and improve clinical outcomes.

METHODS

Transversal cultural instrument validation and adaptation study, included 91 participants who simulated a medical crisis between 2018 and 2019, and to whom the Spanish version of the CRM-GRS was applied in order to evaluate its psychometric properties.

RESULTS

A cultural adaptation with translation into Spanish of the CRM-GRS was made. Subsequently, the scale was applied to 91 participants. An internal consistency (Cronbach's alpha) greater than 0.9 was found in each dimension. The level of inter-rater reliability, evaluated by the interclass coefficient was 0.59 to 0.69, and test-retest reliability with an interclass coefficient greater than 0.7. The validity of the convergent construct was moderate (interclass coefficient between 0.6 and 0.7 for all domains) and the validity of the divergent construct between 0.4 and 0.5 was found adequate.

CONCLUSION

The translated and adapted Spanish version of the CRM-GRS in crisis had adequate internal consistency, reliability, and construct validity.

Validation in spanish of the Ottawa scale for non-techical skills in health personnel in crisis situations

INTRODUCTION

Non-technical skills are related to morbi-mortality in medicine; it has been proposed that 46% of fatal outcomes are explained to limitations in non-technical skills and only 5% to technical skills deficiencies, however, there is no validated instrument or scale in spanish that allows its evaluation in the management of medical crisis.

OBJECTIVE

To evaluate the psychometric properties of a Spanish-adapted version of the "Ottawa crisis resource management (CRM) global rating scale (GRS)" in medical staff involved in critical decision-making based in high-fidelity simulation, which could be beneficial to impact patient safety and improve clinical outcomes.

METHODS

Transversal cultural instrument validation and adaptation study, included 91 participants who simulated a medical crisis between 2018 and 2019, and to whom the Spanish version of the CRM-GRS was applied in order to evaluate its psychometric properties.

RESULTS

A cultural adaptation with translation into Spanish of the CRM-GRS was made. Subsequently, the scale was applied to 91 participants. An internal consistency (Cronbach's alpha) greater than 0.9 was found in each dimension. The level of inter-rater reliability, evaluated by the interclass coefficient was 0.59 to 0.69, and test-retest reliability with an interclass coefficient greater than 0.7. The validity of the convergent construct was moderate (interclass coefficient between 0.6 and 0.7 for all domains) and the validity of the divergent construct between 0.4 and 0.5 was found adequate.

CONCLUSION

The translated and adapted Spanish version of the CRM-GRS in crisis had adequate internal consistency, reliability, and construct validity.

Frequency of outpatient care adverse events in an occupational mutual insurance company in Spain

BACKGROUND

Occupational mutual insurance companies (OMICs), in collaboration with the Spanish Social Security System, provide healthcare and manage the economic benefits for the workers in Spain. They have ambulatory care centers that attend outpatient trauma pathology, although most of the studies published have focused on surgical and hospital activity. The aim of this study was to detect adverse events (AEs) in outpatient trauma care in the context of an OMIC.

METHODS

A cohort study designed to identify harmful safety incidents (adverse events, AEs) in 2017 was conducted. A random sample of 313 medical records among patients who were visited more than 3 medical and nursing attendances during their outpatient process. The AEs detected were classified according to category, severity and preventability.

RESULTS

We identified 48 AEs (15.3% of medical records, 95% CI 11.3-19.3), most of them procedure-related, while 27 (56.2%) were preventable and 46 mild (95.8%).

CONCLUSIONS

The AEs identified are double than those found in primary care general consultations in Spain and are close to the lower range of studies on surgical AEs in traumatology and orthopedics. Preventable AEs were within expected limits. Over half of AEs are preventable, within that group, the mild AEs have an increased rate of preventability. These results highlight the relevance of research of patient safety in the outpatient care of trauma and orthopaedic procedures in an OMIC for patient safety and contribute to introduce improvements in outpatient care.

Cross-cultural adaptation to the Spanish context and evaluation of the content validity of the Second Victim Experience and Support Tool (SVEST-E) questionnaire

OBJECTIVES

To carry out a cross-cultural adaptation of the Second Victim Experience and Support Tool (SVEST) questionnaire to the Spanish context, and to evaluate its content validity (CVI).

METHODS

The translation and cultural adaptation of a measuring instrument by means of translation and back translation conducted through the participation of 20 health professionals. The content validation was carried out through the participation of 10 experts. The content validity of each item (CVI-I), the content validity index per expert (CVI-E) and the content validity total (CVI-T) were calculated for the questionnaire. Corrections were carried out for probable random agreement and the statistical calculation Kappa (K*) modified for each item of the instrument.

RESULTS

The final instrument obtained (SVEST-E) has a CVI-Total of 0.87 and consists of 36 total items, subdivided into 7 dimensions, 2 outcome variables and a support option section maintaining the same structure as the original questionnaire. Thirty items had a CVI-I with values over ≥°0.79.

CONCLUSIONS

The SVEST-E questionnaire is an equivalent of the original and is an instrument that could help to evaluate the second victim experiences of healthcare professionals in our country. It is an instrument with adequate content validity to measure the experience of second victims in health professionals in our country.

Cross-cultural adaptation to the Spanish context and evaluation of the content validity of the Second Victim Experience and Support Tool (SVEST-E) questionnaire

OBJECTIVES

To carry out a cross-cultural adaptation of the Second Victim Experience and Support Tool (SVEST) questionnaire to the Spanish context, and to evaluate its content validity (CVI).

METHODS

The translation and cultural adaptation of a measuring instrument by means of translation and back translation conducted through the participation of 20 health professionals. The content validation was carried out through the participation of 10 experts. The content validity of each item (CVI-I), the content validity index per expert (CVI-E) and the content validity total (CVI-T) were calculated for the questionnaire. Corrections were carried out for probable random agreement and the statistical calculation Kappa (K*) modified for each item of the instrument.

RESULTS

The final instrument obtained (SVEST-E) has a CVI-Total of 0.87 and consists of 36 total items, subdivided into 7 dimensions, 2 outcome variables and a support option section maintaining the same structure as the original questionnaire. Thirty items had a CVI-I with values over ≥̊0.79.

CONCLUSIONS

The SVEST-E questionnaire is an equivalent of the original and is an instrument that could help to evaluate the second victim experiences of healthcare professionals in our country. It is an instrument with adequate content validity to measure the experience of second victims in health professionals in our country.

Factors attributable to the cancellation of programmed surgeries

Objective

To analyze the factors attributable to the cancellation of surgeries of a third level health institution in the city of Valledupar, Cesar / Colombia (2017-2018).

Material and methods

Descriptive, retrospective, cross-sectional study. Data from the hospital surgical unit adverse case file were collected for 6 surgical specialties.

Results

They showed that in 2017 there was a surgical suspension of 4% of the total of scheduled surgeries that were (3339), for 2018 the rate was 3% with a total of scheduled surgeries (1733). The reason for the suspension for both periods was the factor related to the patient's adverse conditions with 45.9 and 38.5% respectively. The specialty most affected for these cases was the specialty of general surgery with the same percentage value in both periods of 4%.

Conclusion

The results give us an idea of the factors present for the cancellation of scheduled surgeries and the need to apply measures to guarantee patient safety.

[Avoidable adverse events in primary care. Retrospective cohort study to determine their frequency and severity]

Puntos clave•

Las intervenciones en seguridad del paciente, como las prácticas seguras, buscan reducir el número de incidentes para la seguridad de los pacientes, particularmente el número de eventos adversos evitables.

•

El número de eventos adversos evitables en atención primaria en España se ha duplicado con respecto a los datos aportados por el estudio APEAS (Estudio de la Seguridad de los Pacientes en atención primaria de Salud) realizado en 2008.

•

Uno de cada 30 eventos adversos evitables supone un daño grave y permanente en el adulto.

Objetivo

Determinar la frecuencia de eventos adversos evitables (EAE) en atención primaria (AP).

Diseño

Estudio retrospectivo de cohortes.

Emplazamiento

consultas de medicina de familia y pediatría de Andalucía, Aragón, Castilla La Mancha, Cataluña, Madrid, Navarra y Comunidad Valenciana.

Participantes

Se determinó revisar un mínimo de 2.397 historias clínicas (nivel de confianza del 95% y una precisión del 2%). La muestra se estratificó por grupos de edad de forma proporcional a su frecuentación y con revisión paritaria de historias de hombres y mujeres.

Mediciones principales

Número y gravedad de los EAE identificados entre febrero de 2018 y septiembre de 2019.

Resultados

Se revisaron un total de 2.557 historias clínicas (1.928, 75.4% de pacientes adultos y 629, 24.6% pediátricos). Se identificaron 182 EAE que afectaron a 168 pacientes (7,1%, IC 95% 6,1-8,1%); en adultos 7,6% (IC 95% 6,4-8,8%) y 5,7% (IC 95% 3,9-7,5%) en pacientes pediátricos. Las mujeres sufrieron más EAE que los hombres (p = 0,004). La incidencia de EAE en niños y niñas fue similar (p = 0,3). 6 (4.1%) de los EAE supusieron un daño permanente en pacientes adultos.

Conclusiones

Buscar fórmulas para incrementar la seguridad en AP, particularmente en pacientes mujeres, debe seguir siendo un objetivo prioritario incluso en pediatría. Uno de cada 24 EAE supone un daño grave y permanente en el adulto.

Bed 13 is not worse than any other. A retrospective cohort study

INTRODUCTION

Risk management and patient safety are closely related, following this premise some industries have adopted measures to omit number 13. Healthcare is not left behind, in some hospital the day of surgery's or bed numbering avoid number 13. The objective was to assess whether it is necessary to redesign the safety policies implemented in hospitals based on avoiding 13 in the numbering of rooms/beds.

METHODS

A retrospective cohort study was conducted. Mortality and the number of adverse events suffered by patients admitted to rooms/beds numbering 13 (bad chance) or 7 (fair chance) over a two-year period to Intensive Care Unit, Medicine, Gastroenterology, Surgery, and Paediatric service were registered and compared.

RESULTS

A total of 8553 admissions were included. They had similar length-of-stay and Charlson Index scores (p-value=0.435). Mortality of bed 13 was 268 (6.2%, 95% CI 5.5-6.9) and 282 in bed 7 (6.7%, 95% CI 5.9-7.5) (p-value=0.3). A total of 422 adverse events from 4342 admissions (9.7%, 95% CI 8.9-10.6) occurred in bed 13, while in bed 7 the count of adverse events was 398 in 4211 admissions (9.4%, 95% CI 8.6-10.4) (p-value=0.6). Odds Ratio for mortality was equal to 0.9 (95% CI 0.8-1.1) and suffering adverse events when admitted to bed 13 versus bed 7 was 1.03 (95% CI 0.9-1.2).

CONCLUSIONS

Bed 13 is not a risk factor for patient safety. Hospitals should pay attention to causes and interventions to avoid adverse events based on evidence rather than beliefs or myths.

Ethical evaluation of medical errors and the patient's safety

In the offer of health care services, errors may arise that are repeated, so when one has occurred, it is essential to reflect on the elements that could cause it and act on them; however, in general, there is a natural tendency to hide them, mainly due to fear of sanctions or lawsuits. The ethics of clinical safety finds it essential to reveal errors, including almost errors or those without significant consequences, betting on transparent management of them. No error should be filed, since its review in an honest and open manner is not only an ethical obligation, but it can also help to lessen its effects and improve the doctor-patient relationship. Achieving safe medical care requires continuous learning about how the different components of the system interact, this implies putting into practice the behaviors that have shown their effectiveness to reduce the probability of the appearance of faults and errors, increase their detection and reduce their consequences, as well as continuing to investigate the factors that contribute to improving patient safety and the quality of care. In this paper we analyze the incidents related to patient safety, through statistical information from the Comisión Nacional de Arbitraje Médico (CONAMED), referring to complaint files concluded by arbitral award in the 2012-2016 period.

[Detection of adverse events using trigger tools in 2hospital units in Spain]

INTRODUCTION

Adverse events (AE) related to health care are frequent due to the nature of this activity, and for this reason, it is necessary to develop methods to detect them and prevent their recurrence. One of these methods uses what are called trigger tools, which are markers that allow AE to be identified retrospectively for subsequent analysis.

OBJECTIVES

To evaluate the usefulness of a trigger tools system to detect AE related to patient safety in Internal Medicine and General Surgery units of a tertiary referral hospital. As secondary objectives, measurements were made of the rate of AE, its prevalence in admissions, as well as a description of the different types of AE, and to evaluate the time spent using this tool.

MATERIAL AND METHODS

A retrospective descriptive study of patients admitted to the units of Internal Medicine and General Surgery and discharged during 2016. Inclusion criteria were hospital stay over 24h and the presence of a complete clinical record of the studied acute episode. Patients admitted to short-stay units were excluded. A verification questionnaire was designed to registry key study variables and associated AE.

RESULTS

The study included 118 patients from Internal Medicine and 115 from General Surgery. The presence of at least one trigger was detected in 86 (72.9%) Internal Medicine and 56 (48.7%) General Surgery patients. Of these, 13 (15.1%) were associated with the presence of an AE in Internal Medicine and 34 (60.7%) in General Surgery. The trigger tool system failed to detect 7 AE, 4 of them in Internal Medicine. The median of triggers identified in each patient was 1.5 (IQR p25-p75: 1-2.5) in Internal Medicine and 2 (IQR p25-p75: 1-4) in General Surgery. In total, 262 positive triggers were detected, of which 157 corresponded to Internal Medicine, most of them related to early emergency re-admission after discharge. Most of the identified AEs required re-hospitalisation or extending the length of stay.

CONCLUSIONS

Trigger tools systems are useful for the detection and characterisation of AE, which helps to analyse and implement improvement measures.

Personal, situational and organizational aspects that influence the impact of patient safety incidents: A qualitative study

OBJECTIVES

When a patient safety incident (PSI) occurs, not only the patient, but also the involved health professional can suffer. This study focused on this so-called "second victim" of a patient safety incident and aimed to examine: (1) experienced symptoms in the aftermath of a patient safety incident; (2) applied coping strategies; (3) the received versus needed support and (4) the aspects that influenced whether one becomes a second victim.

MATERIALS AND METHODS

Thirty-one in-depth interviews were performed with physicians, nurses and midwives who have been involved in a patient safety incident.

RESULTS

The symptoms were categorized under personal and professional impact. Both problem focused and emotion focused coping strategies were used in the aftermath of a PSI. Problem focused strategies such as performing a root cause analysis and the opportunity to learn from what happened were the most appreciated, but negative emotional responses such as repression and flight were common. Support from colleagues and supervisors who were involved in the same event, peer supporters or professional experts were the most needed. A few individuals described emotional support from the healthcare institution as unwanted. Rendered support was largely dependent on the organizational culture, a stigma remained among healthcare professionals to openly discuss patient safety incidents. Three aspects influenced the extent to which a healthcare professional became a second victim: personal, situational and organizational aspects.

CONCLUSION

These findings indicated that a multifactorial approach including individual and emotional support to second victims is crucial.