Fetoscopic laser versus amnioreduction, septostomy, and expected management for the treatment of twin-twin transfusion syndrome (TTTS): an economic evaluation analysis in Iran

BACKGROUND

Twin-twin transfusion syndrome (TTTS) affects 10-15% of monochorionic twin pregnancies. Without treatment, their mortality rates would be considerable. There are differences in survival rate between different therapeutic modalities. This study aims to compare the cost-effectiveness of Fetoscopic laser versus amnioreduction, septostomy, and expected management in the treatment of twin-to-twin transfusion syndrome (TTTS).

METHODS

This is a cost-effectiveness analysis of the treatment strategies in patients with TTTS. A decision tree model was used to estimate the clinical and economic outcomes with a pregnancy period time horizon. Medical direct costs were extracted in a quantitative study, and survival rates were determined as effectiveness measures based on a review. A probabilistic sensitivity analysis was used to measure the effects of uncertainty in the model parameters. The TreeAge, Excel and R software were used for analyzing data.

RESULTS

In the first phase, 75 studies were included in the review. Based on the meta-analysis, a total of 7183 women treated with Fetoscopic laser, the perinatal survival of at least one twin-based pregnancy was 69%. In the second phase, the results showed that expected management and amnioreduction have the lowest (791.6$) and highest cost (2020.8$), respectively. Based on the decision model analysis, expected management had the lowest cost ($791.67) and the highest rate in at least one survival (89%), it was used only in early stages of TTTS. Fetoscopic laser surgery, with the mean cost 871.46$ and an overall survival rate of 0.69 considered the most cost-effectiveness strategy in other stages of TTTS.

CONCLUSION

Our model found Fetoscopic laser surgery in all stages of TTTS to be the most cost-effective therapy for patients with TTTS. Fetoscopic laser surgery thus should be considered a reasonable treatment option for TTTS.

Frequency and influential factors on occurrence of medical errors: A three-year cross-sectional study

BACKGROUND

Despite efforts to improve patient safety, medical errors (MEs) continue to recur. Proper utilization of reported MEs can be effective in preventing their recurrence. This study investigated the errors reported in 3 years and examined the factors affecting them.

MATERIALS AND METHODS

This descriptive analytical study was conducted using the errors reported in 20 hospitals under the auspices of one of Iran's medical universities from 2018 to 2020. All reported errors were investigated by an expert panel.

RESULTS

In total, 6584 reported errors were grouped into four main categories based on the type of error. The highest reported errors were related to the management and treatment procedures. Analyses of the factors influencing medical errors revealed that 15 factors affected the occurrence of errors. An increasing trend of error was found in 9 of the 15 identified factors. Incorrect documenting of the physician's order in the nursing Kardex and noncompliance with the patient identification guide were the highest with 16.03 and 15.47%, respectively.

CONCLUSION

The most identified factor was the incorrect registration of the physician's prescription on the nursing card; therefore, it seems that the use of computerized physician order entry should be considered. Furthermore, the mere existence and training of patient safety guides cannot help prevent errors. Not only should the underlying causes of errors be carefully identified and investigated but it also requires serious determination to follow the patient's safety instructions from the highest to the lowest levels of the health system.

Recurrence of medical errors despite years of preventive measures: A grounded theory study

BACKGROUND

Despite great efforts to improve patient safety, serious preventable medical errors continue to occur. Accurate rooting causes of error recurrence are essential for reviewing methods to prevent them. This study aimed to identify the main causes of the recurrence of medical errors despite their previous occurrence.

MATERIALS AND METHODS

This qualitative study was performed using the grounded theory method, with theoretical sampling from April to July 2021, through semi-structured interviews with 25 experts and treatment staff of hospitals under the auspices of four universities of medical sciences in Iran.

RESULTS

Four main parts were identified: 1) primary and secondary factors leading to the occurrence of errors, 2) error prevention policies, 3) causes of error repetition, and 4) contextual factors.

CONCLUSION

The attention, seriousness, and commitment of health system managers, from top to bottom, to patient safety are essential for preventing error recurrence. The institutionalization of patient safety education from universities and attention to individual, social, and cultural factors should also be given serious attention.

Factors affecting the recurrence of medical errors in hospitals and the preventive strategies: a scoping review

Due to the high value of human life, the occurrence of even one error that leads to death or complications is of great consequence and requires serious attention. Although significant efforts have been made to ensure patient safety, serious medical errors continue to exist. This study aimed to identify the factors associated with the recurrence of medical errors and strategies to prevent them through a scoping review. Data were gathered through a scoping review of PubMed, Embase, Scopus, and Cochrane Library databases during August 2020. Articles related to factors influencing the recurrence of errors despite the available information, as well as articles related to measures taken worldwide to prevent them, were included in study. Overall, 32 articles were selected out of the 3422 primary papers. Two main categories of factors were identified as influential in error recurrence: human factors (fatigue, stress, inadequate knowledge) and environmental and organizational factors (ineffective management, distractions, poor teamwork). The six effective strategies for preventing error recurrence included the use of electronic systems, attention to human behaviors, proper workplace management, workplace culture, training, and teamwork.It was concluded that using a combination of methods related to health management, psychology, behavioral sciences and electronic systems can be effective in preventing the recurrence of errors.

Barriers to Medical Error Reporting

BACKGROUND

This study was conducted to explore the prevalence of medical error underreporting and associated barriers.

METHODS

This cross-sectional study was performed from September to December 2012. Five hospitals, affiliated with Hamadan University of Medical Sciences, in Hamedan, Iran were investigated. A self-administered questionnaire was used for data collection. Participants consisted of physicians, nurses, midwives, residents, interns, and staffs of radiology and laboratory departments.

RESULTS

Overall, 50.26% of subjects had committed but not reported medical errors. The main reasons mentioned for underreporting were lack of effective medical error reporting system (60.0%), lack of proper reporting form (51.8%), lack of peer supporting a person who has committed an error (56.0%), and lack of personal attention to the importance of medical errors (62.9%). The rate of committing medical errors was higher in men (71.4%), age of 50-40 years (67.6%), less-experienced personnel (58.7%), educational level of MSc (87.5%), and staff of radiology department (88.9%).

CONCLUSIONS

This study outlined the main barriers to reporting medical errors and associated factors that may be helpful for healthcare organizations in improving medical error reporting as an essential component for patient safety enhancement.