1
|
Forrest C, O'Sullivan MJ, Ryan M, O'Tuathaigh C, Browne TJ, Rock K, O'Leary MJ, Madden D, O'Reilly S. Patients' and doctors' views and experiences of the patient safety trajectory of breast cancer care. Breast 2024; 75:103699. [PMID: 38460442 PMCID: PMC10943021 DOI: 10.1016/j.breast.2024.103699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Accepted: 02/23/2024] [Indexed: 03/11/2024] Open
Abstract
INTRODUCTION Successful breast cancer outcomes can be jeopardised by adverse events. Understanding and integrating patients' and doctors' perspectives into care trajectories could improve patient safety. This study assessed their views on, and experiences of, medical error and patient safety. METHODS A cross-sectional, quantitative 20-40 item questionnaire for patients attending Cork University Hospital Cancer Centre and breast cancer doctors in the Republic of Ireland was developed. Domains included demographics, medical error experience, patient safety opinions and concerns. RESULTS 184 patients and 116 doctors completed the survey. Of the doctors, 41.4% felt patient safety had deteriorated over the previous five years and 54.3% felt patient safety measures were inadequate compared to 13.0% and 27.7% of patients respectively. Of the 30 patients who experienced medical errors/negligence claims, 18 reported permanent or long-term physical and emotional effects. Forty-two of 48 (87.5%) doctors who experienced medical errors/negligence claims reported emotional health impacts. Almost half of doctors involved in negligence claims considered early retirement. Forty-four patients and 154 doctors didn't experience errors but reported their patient safety concerns. Doctors were more concerned about communication and administrative errors, staffing and organisational factors compared to patients. Multiple barriers to error reporting were highlighted. CONCLUSION This is the first study to assess patients' and doctors' patient safety views and medical error/negligence claims experiences in breast cancer care in Ireland. Experience of medical error/negligence claims had long-lasting implications for both groups. Doctors were concerned about a multitude of errors and causative factors. Failure to embed these findings is a missed opportunity to improve safety.
Collapse
Affiliation(s)
- Clara Forrest
- Academic Track Intern Programme, Intern Network Executive, School of Medicine, University College Cork, Cork, Ireland.
| | - Martin J O'Sullivan
- Department of Surgery, Cork University Hospital, Wilton, Cork, Ireland; Cancer Research@UCC, College of Medicine and Health, University College Cork, Cork, Ireland
| | - Max Ryan
- Department of Radiology, Cork University Hospital, Wilton, Cork, Ireland
| | - Colm O'Tuathaigh
- Medical Education Unit, School of Medicine, University College Cork, Cork, Ireland
| | - Tara Jane Browne
- Department of Histopathology, Cork University Hospital, Wilton, Cork, Ireland
| | - Kathy Rock
- Cancer Research@UCC, College of Medicine and Health, University College Cork, Cork, Ireland; Department of Radiation Oncology, Cork University Hospital, Wilton, Cork, Ireland
| | - Mary Jane O'Leary
- Department of Palliative Medicine, Marymount University Hospice and Hospital, Bishopstown, Cork, Ireland
| | | | - Seamus O'Reilly
- Cancer Research@UCC, College of Medicine and Health, University College Cork, Cork, Ireland; Department of Medical Oncology, Cork University Hospital, Wilton, Cork, Ireland
| |
Collapse
|
2
|
Kanji FF, Choi E, Dallas KB, Avenido R, Jamnagerwalla J, Pannell S, Eilber K, Catchpole K, Cohen TN, Anger JT. The impact of resident training on robotic operative times: is there a July Effect? J Robot Surg 2024; 18:208. [PMID: 38727857 PMCID: PMC11087355 DOI: 10.1007/s11701-024-01929-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 03/24/2024] [Indexed: 05/13/2024]
Abstract
It is unknown whether the July Effect (a theory that medical errors and organizational inefficiencies increase during the influx of new surgical residents) exists in urologic robotic-assisted surgery. The aim of this study was to investigate the impact of urology resident training on robotic operative times at the beginning of the academic year. A retrospective chart review was conducted for urologic robotic surgeries performed at a single institution between 2008 and 2019. Univariate and multivariate mix model analyses were performed to determine the association between operative time and patient age, estimated blood loss, case complexity, robotic surgical system (Si or Xi), and time of the academic year. Differences in surgery time and non-surgery time were assessed with/without resident presence. Operative time intervals were included in the analysis. Resident presence correlated with increased surgery time (38.6 min (p < 0.001)) and decreased non-surgery time (4.6 min (p < 0.001)). Surgery time involving residents decreased by 8.7 min after 4 months into the academic year (July-October), and by an additional 5.1 min after the next 4 months (p = 0.027, < 0.001). When compared across case types stratified by complexity, surgery time for cases with residents significantly varied. Cases without residents did not demonstrate such variability. Resident presence was associated with prolonged surgery time, with the largest effect occurring in the first 4 months and shortening later in the year. However, resident presence was associated with significantly reduced non-surgery time. These results help to understand how new trainees impact operating room times.
Collapse
Affiliation(s)
- Falisha F Kanji
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Eunice Choi
- Division of Urology, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Kai B Dallas
- Division of Urology and Urologic Oncology, Department of Surgery, City of Hope, Lancaster, CA, USA
| | - Raymund Avenido
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | | | | | - Karyn Eilber
- Division of Urology, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Ken Catchpole
- Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Tara N Cohen
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Jennifer T Anger
- Department of Urology, University of California, San Diego, 9400 Campus Point Drive, #7897, La Jolla, CA, 92037, USA.
| |
Collapse
|
3
|
Connolly A, Kirwan M, Matthews A. A scoping review of the methodological approaches used in retrospective chart reviews to validate adverse event rates in administrative data. Int J Qual Health Care 2024; 36:mzae037. [PMID: 38662407 PMCID: PMC11086704 DOI: 10.1093/intqhc/mzae037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 03/08/2024] [Accepted: 04/23/2024] [Indexed: 04/26/2024] Open
Abstract
Patient safety is a key quality issue for health systems. Healthcare acquired adverse events (AEs) compromise safety and quality; therefore, their reporting and monitoring is a patient safety priority. Although administrative datasets are potentially efficient tools for monitoring rates of AEs, concerns remain over the accuracy of their data. Chart review validation studies are required to explore the potential of administrative data to inform research and health policy. This review aims to present an overview of the methodological approaches and strategies used to validate rates of AEs in administrative data through chart review. This review was conducted in line with the Joanna Briggs Institute methodological framework for scoping reviews. Through database searches, 1054 sources were identified, imported into Covidence, and screened against the inclusion criteria. Articles that validated rates of AEs in administrative data through chart review were included. Data were extracted, exported to Microsoft Excel, arranged into a charting table, and presented in a tabular and descriptive format. Fifty-six studies were included. Most sources reported on surgical AEs; however, other medical specialties were also explored. Chart reviews were used in all studies; however, few agreed on terminology for the study design. Various methodological approaches and sampling strategies were used. Some studies used the Global Trigger Tool, a two-stage chart review method, whilst others used alternative single-, two-stage, or unclear approaches. The sources used samples of flagged charts (n = 24), flagged and random charts (n = 11), and random charts (n = 21). Most studies reported poor or moderate accuracy of AE rates. Some studies reported good accuracy of AE recording which highlights the potential of using administrative data for research purposes. This review highlights the potential for administrative data to provide information on AE rates and improve patient safety and healthcare quality. Nonetheless, further work is warranted to ensure that administrative data are accurate. The variation of methodological approaches taken, and sampling techniques used demonstrate a lack of consensus on best practice; therefore, further clarity and consensus are necessary to develop a more systematic approach to chart reviewing.
Collapse
Affiliation(s)
- Anna Connolly
- School of Nursing, Psychotherapy and Community Health, Dublin City University, Dublin D09 V209, Ireland
| | - Marcia Kirwan
- School of Nursing, Psychotherapy and Community Health, Dublin City University, Dublin D09 V209, Ireland
| | - Anne Matthews
- School of Nursing, Psychotherapy and Community Health, Dublin City University, Dublin D09 V209, Ireland
| |
Collapse
|
4
|
Packendorff N, Magnusson C, Wibring K, Axelsson C, Hagiwara MA. Development of a trigger tool to identify harmful incidents, no harm incidents, and near misses in prehospital emergency care. Scand J Trauma Resusc Emerg Med 2024; 32:38. [PMID: 38685120 PMCID: PMC11059688 DOI: 10.1186/s13049-024-01209-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 04/21/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Emergency Medical Services (EMS) are a unique setting because care for the chief complaint is given across all ages in a complex and high-risk environment that may pose a threat to patient safety. Traditionally, a reporting system is commonly used to raise awareness of adverse events (AEs); however, it could fail to detect an AE. Several methods are needed to evaluate patient safety in EMS. In this light, this study was conducted to (1) develop a national ambulance trigger tool (ATT) with a guide containing descriptions of triggers, examples of use, and categorization of near misses (NMs), no harm incidents (NHIs), and harmful incidents (HIs) and (2) use the ATT on randomly selected ambulance records. METHODS The ambulance trigger tool was developed in a stepwise manner through (1) a literature review; (2) three sessions of structured group discussions with an expert panel having knowledge of emergency medical service, patient safety, and development of trigger tools; (3) a retrospective record review of 900 randomly selected journals with three review teams from different geographical locations; and (4) inter-rater reliability testing between reviewers. RESULTS From the literature review, 34 triggers were derived. After removing clinically irrelevant ones and combining others through three sessions of structured discussions, 19 remained. The most common triggers identified in the 900 randomly selected records were deviation from treatment guidelines (30.4%), the patient is non conveyed after EMS assessment (20.8%), and incomplete documentation (14.4%). The positive triggers were categorized as a near miss (40.9%), no harm (3.7%), and harmful incident (0.2%). Inter-rater reliability testing showed good agreement in both sessions. CONCLUSION This study shows that a trigger tool together with a retrospective record review can be used as a method to measure the frequency of harmful incidents, no harm incidents, and near misses in the EMS, thus complementing the traditional reporting system to realize increased patient safety.
Collapse
Affiliation(s)
- Niclas Packendorff
- Prehospen-Centre for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden.
- Department of Prehospital Emergency Care, Sahlgrenska University Hospital, Gothenburg, Sweden.
| | - Carl Magnusson
- Prehospen-Centre for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
- Department of Prehospital Emergency Care, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Kristoffer Wibring
- Department of Ambulance and Prehospital Care, Region Halland, Sweden
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Christer Axelsson
- Prehospen-Centre for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
- Department of Prehospital Emergency Care, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Magnus Andersson Hagiwara
- Prehospen-Centre for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
| |
Collapse
|
5
|
Denecke K, Paula H. Analysis of Critical Incident Reports Using Natural Language Processing. Stud Health Technol Inform 2024; 313:1-6. [PMID: 38682495 DOI: 10.3233/shti240002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2024]
Abstract
A Critical Incident Reporting System (CIRS) collects anecdotal reports from employees, which serve as a vital source of information about incidents that could potentially harm patients. OBJECTIVES To demonstrate how natural language processing (NLP) methods can help in retrieving valuable information from such incident data. METHODS We analyzed frequently occurring terms and sentiments as well as topics in data from the Swiss National CIRRNET database from 2006 to 2023 using NLP and BERTopic modelling. RESULTS We grouped the topics into 10 major themes out of which 6 are related to medication. Overall, they reflect the global trends in adverse events in healthcare (surgical errors, venous thromboembolism, falls). Additionally, we identified errors related to blood testing, COVID-19, handling patients with diabetes and pediatrics. 40-50% of the messages are written in a neutral tone, 30-40% in a negative tone. CONCLUSION The analysis of CIRS messages using text analysis tools helped in getting insights into common sources of critical incidents in Swiss healthcare institutions. In future work, we want to study more closely the relations, for example between sentiment and topics.
Collapse
Affiliation(s)
| | - Helmut Paula
- Stiftung Patientensicherheit Schweiz, Zürich, Switzerland
| |
Collapse
|
6
|
Yaow CYL, Ng QX, Chong RIH, Ong C, Chong NZY, Yap NLX, Hong ASY, Tan BKT, Loh AHP, Wong ASY, Tan HK. Intraoperative adverse events among surgeons in Singapore: a multicentre cross-sectional study on impact and support. BMC Health Serv Res 2024; 24:512. [PMID: 38659030 PMCID: PMC11040834 DOI: 10.1186/s12913-024-10998-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 04/16/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND It is known that many surgeons encounter intraoperative adverse events which can result in Second Victim Syndrome (SVS), with significant detriment to their emotional and physical health. There is, however, a paucity of Asian studies in this space. The present study thus aimed to explore the degree to which the experience of an adverse event is common among surgeons in Singapore, as well as its impact, and factors affecting their responses and perceived support systems. METHODS A self-administered survey was sent to surgeons at four large tertiary hospitals. The 42-item questionnaire used a systematic closed and open approach, to assess: Personal experience with intraoperative adverse events, emotional, psychological and physical impact of these events and perceived support systems. RESULTS The response rate was 57.5% (n = 196). Most respondents were male (54.8%), between 35 and 44 years old, and holding the senior consultant position. In the past 12 months alone, 68.9% recalled an adverse event. The emotional impact was significant, including sadness (63.1%), guilt (53.1%) and anxiety (45.4%). Speaking to colleagues was the most helpful support source (66.7%) and almost all surgeons did not receive counselling (93.3%), with the majority deeming it unnecessary (72.2%). Notably, 68.1% of the surgeons had positive takeaways, gaining new insight and improving vigilance towards errors. Both gender and surgeon experience did not affect the likelihood of errors and emotional impact, but more experienced surgeons were less likely to have positive takeaways (p = 0.035). Individuals may become advocates for patient safety, while simultaneously championing the cause of psychological support for others. CONCLUSIONS Intraoperative adverse events are prevalent and its emotional impact is significant, regardless of the surgeon's experience or gender. While colleagues and peer discussions are a pillar of support, healthcare institutions should do more to address the impact and ensuing consequences.
Collapse
Affiliation(s)
- Clyve Yu Leon Yaow
- NUS Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Qin Xiang Ng
- Health Services Research Unit, Singapore General Hospital, Singapore, Singapore.
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore.
| | - Ryan Ian Houe Chong
- NUS Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Clarence Ong
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Nicolette Zy-Yin Chong
- NUS Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Nicole Li Xian Yap
- NUS Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Ashley Shuen Ying Hong
- NUS Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Benita Kiat Tee Tan
- Department of General Surgery, Sengkang General Hospital, Singapore, Singapore
| | - Amos Hong Pheng Loh
- Department of Paediatric Surgery, KK Women's and Children's Hospital, Singapore, Singapore
| | | | - Hiang Khoon Tan
- Division of Surgery and Surgical Oncology, Singapore General Hospital and National Cancer Centre Singapore, Singapore, Singapore
- Singhealth Duke-NUS Global Health Institute, Singapore, Singapore
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States
| |
Collapse
|
7
|
Elwardi K, Bakkali M, Laglaoui A. Management of adverse events in a Moroccan regional hospital: a state of art and perspectives. Pan Afr Med J 2024; 47:69. [PMID: 38681100 PMCID: PMC11055191 DOI: 10.11604/pamj.2024.47.69.41560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 12/29/2023] [Indexed: 05/01/2024] Open
Abstract
Introduction the risk management system is useful to identify, analyze, and reduce the risk occurrence of adverse events (AEs) in health services. This system suggests useful improvements to patients and to the whole institution and also contributes to the acquisition of a collective and organizational safety culture. This study presented a state of the art of the management of AEs identified in different services of a regional hospital in the north of Morocco. Methods this is a retrospective cross-sectional exploratory study carried out from 2017 to 2019 using observations and semi-structured interviews, which were recorded, re-transcribed, and analyzed. Data was also collected from audit reports, results of investigations of the nosocomial infection control committee and the risk management commission, AEs declaration sheets, and meetings reports. Results a number of 83 AEs were recorded, 10 of which were urgent. The reported events were related to care, infection risk, the drugs circuit, and medico-technical events. Two hundred cases of nosocomial infections were also recorded, of which 75 occurred in the intensive care unit and 35 in the maternity service. Surgical site infections were the most frequently reported complication. Adverse events were related to organizational failure, equipment problems, and errors related to professional practices. Conclusion our findings may guide the improvement of the event management system in order to reduce the occurrence of future incidents. Thus, improving the risk management system requires setting up training strategies for staff on the importance of this system and its mode of operation.
Collapse
Affiliation(s)
- Khadija Elwardi
- Research Laboratory of Biotechnology and Biomolecular Engineering, Faculty of Sciences and Techniques of Tangier, Abdelmalek Essaadi University, Tangier, Morocco
| | - Mohammed Bakkali
- Research Laboratory of Biotechnology and Biomolecular Engineering, Faculty of Sciences and Techniques of Tangier, Abdelmalek Essaadi University, Tangier, Morocco
| | - Amin Laglaoui
- Research Laboratory of Biotechnology and Biomolecular Engineering, Faculty of Sciences and Techniques of Tangier, Abdelmalek Essaadi University, Tangier, Morocco
| |
Collapse
|
8
|
Bates DW, Levine DM, Salmasian H, Syrowatka A, Shahian DM, Lipsitz S, Zebrowski JP, Myers LC, Logan MS, Roy CG, Iannaccone C, Frits ML, Volk LA, Dulgarian S, Amato MG, Edrees HH, Sato L, Folcarelli P, Einbinder JS, Reynolds ME, Mort E. The Safety of Inpatient Health Care. N Engl J Med 2023; 388:142-153. [PMID: 36630622 DOI: 10.1056/nejmsa2206117] [Citation(s) in RCA: 51] [Impact Index Per Article: 51.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Adverse events during hospitalization are a major cause of patient harm, as documented in the 1991 Harvard Medical Practice Study. Patient safety has changed substantially in the decades since that study was conducted, and a more current assessment of harm during hospitalization is warranted. METHODS We conducted a retrospective cohort study to assess the frequency, preventability, and severity of patient harm in a random sample of admissions from 11 Massachusetts hospitals during the 2018 calendar year. The occurrence of adverse events was assessed with the use of a trigger method (identification of information in a medical record that was previously shown to be associated with adverse events) and from review of medical records. Trained nurses reviewed records and identified admissions with possible adverse events that were then adjudicated by physicians, who confirmed the presence and characteristics of the adverse events. RESULTS In a random sample of 2809 admissions, we identified at least one adverse event in 23.6%. Among 978 adverse events, 222 (22.7%) were judged to be preventable and 316 (32.3%) had a severity level of serious (i.e., caused harm that resulted in substantial intervention or prolonged recovery) or higher. A preventable adverse event occurred in 191 (6.8%) of all admissions, and a preventable adverse event with a severity level of serious or higher occurred in 29 (1.0%). There were seven deaths, one of which was deemed to be preventable. Adverse drug events were the most common adverse events (accounting for 39.0% of all events), followed by surgical or other procedural events (30.4%), patient-care events (which were defined as events associated with nursing care, including falls and pressure ulcers) (15.0%), and health care-associated infections (11.9%). CONCLUSIONS Adverse events were identified in nearly one in four admissions, and approximately one fourth of the events were preventable. These findings underscore the importance of patient safety and the need for continuing improvement. (Funded by the Controlled Risk Insurance Company and the Risk Management Foundation of the Harvard Medical Institutions.).
Collapse
Affiliation(s)
- David W Bates
- From the Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital (D.W.B., D.M.L., H.S., A.S., S.L., C.I., M.L.F., S.D., M.G.A., H.H.E., L.S.), the Department of Health Care Policy (E.M.), Harvard Medical School (D.W.B., D.M.L., H.S., A.S., D.M.S., S.L., J.P.Z., M.S.L., H.H.E., L.S., E.M.), the Department of Health Policy and Management, Harvard T.H. Chan School of Public Health (D.W.B.), the Edward P. Lawrence Center for Quality and Safety (D.M.S., J.P.Z., E.M.), the Division of Cardiac Surgery, Department of Surgery (D.M.S.), the Department of Psychiatry (J.P.Z.), the Division of Nephrology (M.S.L.), and the Division of General Internal Medicine (E.M.), Massachusetts General Hospital, and the Controlled Risk Insurance Company and the Risk Management Foundation of the Harvard Medical Institutions (L.S., P.F., J.S.E., M.E.R.) - all in Boston; the Kaiser Permanente Northern California Division of Research, Oakland (L.C.M.); Maine Medical Center, Portland (C.G.R.); and Mass General Brigham, Somerville, MA (L.A.V.)
| | - David M Levine
- From the Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital (D.W.B., D.M.L., H.S., A.S., S.L., C.I., M.L.F., S.D., M.G.A., H.H.E., L.S.), the Department of Health Care Policy (E.M.), Harvard Medical School (D.W.B., D.M.L., H.S., A.S., D.M.S., S.L., J.P.Z., M.S.L., H.H.E., L.S., E.M.), the Department of Health Policy and Management, Harvard T.H. Chan School of Public Health (D.W.B.), the Edward P. Lawrence Center for Quality and Safety (D.M.S., J.P.Z., E.M.), the Division of Cardiac Surgery, Department of Surgery (D.M.S.), the Department of Psychiatry (J.P.Z.), the Division of Nephrology (M.S.L.), and the Division of General Internal Medicine (E.M.), Massachusetts General Hospital, and the Controlled Risk Insurance Company and the Risk Management Foundation of the Harvard Medical Institutions (L.S., P.F., J.S.E., M.E.R.) - all in Boston; the Kaiser Permanente Northern California Division of Research, Oakland (L.C.M.); Maine Medical Center, Portland (C.G.R.); and Mass General Brigham, Somerville, MA (L.A.V.)
| | - Hojjat Salmasian
- From the Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital (D.W.B., D.M.L., H.S., A.S., S.L., C.I., M.L.F., S.D., M.G.A., H.H.E., L.S.), the Department of Health Care Policy (E.M.), Harvard Medical School (D.W.B., D.M.L., H.S., A.S., D.M.S., S.L., J.P.Z., M.S.L., H.H.E., L.S., E.M.), the Department of Health Policy and Management, Harvard T.H. Chan School of Public Health (D.W.B.), the Edward P. Lawrence Center for Quality and Safety (D.M.S., J.P.Z., E.M.), the Division of Cardiac Surgery, Department of Surgery (D.M.S.), the Department of Psychiatry (J.P.Z.), the Division of Nephrology (M.S.L.), and the Division of General Internal Medicine (E.M.), Massachusetts General Hospital, and the Controlled Risk Insurance Company and the Risk Management Foundation of the Harvard Medical Institutions (L.S., P.F., J.S.E., M.E.R.) - all in Boston; the Kaiser Permanente Northern California Division of Research, Oakland (L.C.M.); Maine Medical Center, Portland (C.G.R.); and Mass General Brigham, Somerville, MA (L.A.V.)
| | - Ania Syrowatka
- From the Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital (D.W.B., D.M.L., H.S., A.S., S.L., C.I., M.L.F., S.D., M.G.A., H.H.E., L.S.), the Department of Health Care Policy (E.M.), Harvard Medical School (D.W.B., D.M.L., H.S., A.S., D.M.S., S.L., J.P.Z., M.S.L., H.H.E., L.S., E.M.), the Department of Health Policy and Management, Harvard T.H. Chan School of Public Health (D.W.B.), the Edward P. Lawrence Center for Quality and Safety (D.M.S., J.P.Z., E.M.), the Division of Cardiac Surgery, Department of Surgery (D.M.S.), the Department of Psychiatry (J.P.Z.), the Division of Nephrology (M.S.L.), and the Division of General Internal Medicine (E.M.), Massachusetts General Hospital, and the Controlled Risk Insurance Company and the Risk Management Foundation of the Harvard Medical Institutions (L.S., P.F., J.S.E., M.E.R.) - all in Boston; the Kaiser Permanente Northern California Division of Research, Oakland (L.C.M.); Maine Medical Center, Portland (C.G.R.); and Mass General Brigham, Somerville, MA (L.A.V.)
| | - David M Shahian
- From the Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital (D.W.B., D.M.L., H.S., A.S., S.L., C.I., M.L.F., S.D., M.G.A., H.H.E., L.S.), the Department of Health Care Policy (E.M.), Harvard Medical School (D.W.B., D.M.L., H.S., A.S., D.M.S., S.L., J.P.Z., M.S.L., H.H.E., L.S., E.M.), the Department of Health Policy and Management, Harvard T.H. Chan School of Public Health (D.W.B.), the Edward P. Lawrence Center for Quality and Safety (D.M.S., J.P.Z., E.M.), the Division of Cardiac Surgery, Department of Surgery (D.M.S.), the Department of Psychiatry (J.P.Z.), the Division of Nephrology (M.S.L.), and the Division of General Internal Medicine (E.M.), Massachusetts General Hospital, and the Controlled Risk Insurance Company and the Risk Management Foundation of the Harvard Medical Institutions (L.S., P.F., J.S.E., M.E.R.) - all in Boston; the Kaiser Permanente Northern California Division of Research, Oakland (L.C.M.); Maine Medical Center, Portland (C.G.R.); and Mass General Brigham, Somerville, MA (L.A.V.)
| | - Stuart Lipsitz
- From the Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital (D.W.B., D.M.L., H.S., A.S., S.L., C.I., M.L.F., S.D., M.G.A., H.H.E., L.S.), the Department of Health Care Policy (E.M.), Harvard Medical School (D.W.B., D.M.L., H.S., A.S., D.M.S., S.L., J.P.Z., M.S.L., H.H.E., L.S., E.M.), the Department of Health Policy and Management, Harvard T.H. Chan School of Public Health (D.W.B.), the Edward P. Lawrence Center for Quality and Safety (D.M.S., J.P.Z., E.M.), the Division of Cardiac Surgery, Department of Surgery (D.M.S.), the Department of Psychiatry (J.P.Z.), the Division of Nephrology (M.S.L.), and the Division of General Internal Medicine (E.M.), Massachusetts General Hospital, and the Controlled Risk Insurance Company and the Risk Management Foundation of the Harvard Medical Institutions (L.S., P.F., J.S.E., M.E.R.) - all in Boston; the Kaiser Permanente Northern California Division of Research, Oakland (L.C.M.); Maine Medical Center, Portland (C.G.R.); and Mass General Brigham, Somerville, MA (L.A.V.)
| | - Jonathan P Zebrowski
- From the Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital (D.W.B., D.M.L., H.S., A.S., S.L., C.I., M.L.F., S.D., M.G.A., H.H.E., L.S.), the Department of Health Care Policy (E.M.), Harvard Medical School (D.W.B., D.M.L., H.S., A.S., D.M.S., S.L., J.P.Z., M.S.L., H.H.E., L.S., E.M.), the Department of Health Policy and Management, Harvard T.H. Chan School of Public Health (D.W.B.), the Edward P. Lawrence Center for Quality and Safety (D.M.S., J.P.Z., E.M.), the Division of Cardiac Surgery, Department of Surgery (D.M.S.), the Department of Psychiatry (J.P.Z.), the Division of Nephrology (M.S.L.), and the Division of General Internal Medicine (E.M.), Massachusetts General Hospital, and the Controlled Risk Insurance Company and the Risk Management Foundation of the Harvard Medical Institutions (L.S., P.F., J.S.E., M.E.R.) - all in Boston; the Kaiser Permanente Northern California Division of Research, Oakland (L.C.M.); Maine Medical Center, Portland (C.G.R.); and Mass General Brigham, Somerville, MA (L.A.V.)
| | - Laura C Myers
- From the Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital (D.W.B., D.M.L., H.S., A.S., S.L., C.I., M.L.F., S.D., M.G.A., H.H.E., L.S.), the Department of Health Care Policy (E.M.), Harvard Medical School (D.W.B., D.M.L., H.S., A.S., D.M.S., S.L., J.P.Z., M.S.L., H.H.E., L.S., E.M.), the Department of Health Policy and Management, Harvard T.H. Chan School of Public Health (D.W.B.), the Edward P. Lawrence Center for Quality and Safety (D.M.S., J.P.Z., E.M.), the Division of Cardiac Surgery, Department of Surgery (D.M.S.), the Department of Psychiatry (J.P.Z.), the Division of Nephrology (M.S.L.), and the Division of General Internal Medicine (E.M.), Massachusetts General Hospital, and the Controlled Risk Insurance Company and the Risk Management Foundation of the Harvard Medical Institutions (L.S., P.F., J.S.E., M.E.R.) - all in Boston; the Kaiser Permanente Northern California Division of Research, Oakland (L.C.M.); Maine Medical Center, Portland (C.G.R.); and Mass General Brigham, Somerville, MA (L.A.V.)
| | - Merranda S Logan
- From the Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital (D.W.B., D.M.L., H.S., A.S., S.L., C.I., M.L.F., S.D., M.G.A., H.H.E., L.S.), the Department of Health Care Policy (E.M.), Harvard Medical School (D.W.B., D.M.L., H.S., A.S., D.M.S., S.L., J.P.Z., M.S.L., H.H.E., L.S., E.M.), the Department of Health Policy and Management, Harvard T.H. Chan School of Public Health (D.W.B.), the Edward P. Lawrence Center for Quality and Safety (D.M.S., J.P.Z., E.M.), the Division of Cardiac Surgery, Department of Surgery (D.M.S.), the Department of Psychiatry (J.P.Z.), the Division of Nephrology (M.S.L.), and the Division of General Internal Medicine (E.M.), Massachusetts General Hospital, and the Controlled Risk Insurance Company and the Risk Management Foundation of the Harvard Medical Institutions (L.S., P.F., J.S.E., M.E.R.) - all in Boston; the Kaiser Permanente Northern California Division of Research, Oakland (L.C.M.); Maine Medical Center, Portland (C.G.R.); and Mass General Brigham, Somerville, MA (L.A.V.)
| | - Christopher G Roy
- From the Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital (D.W.B., D.M.L., H.S., A.S., S.L., C.I., M.L.F., S.D., M.G.A., H.H.E., L.S.), the Department of Health Care Policy (E.M.), Harvard Medical School (D.W.B., D.M.L., H.S., A.S., D.M.S., S.L., J.P.Z., M.S.L., H.H.E., L.S., E.M.), the Department of Health Policy and Management, Harvard T.H. Chan School of Public Health (D.W.B.), the Edward P. Lawrence Center for Quality and Safety (D.M.S., J.P.Z., E.M.), the Division of Cardiac Surgery, Department of Surgery (D.M.S.), the Department of Psychiatry (J.P.Z.), the Division of Nephrology (M.S.L.), and the Division of General Internal Medicine (E.M.), Massachusetts General Hospital, and the Controlled Risk Insurance Company and the Risk Management Foundation of the Harvard Medical Institutions (L.S., P.F., J.S.E., M.E.R.) - all in Boston; the Kaiser Permanente Northern California Division of Research, Oakland (L.C.M.); Maine Medical Center, Portland (C.G.R.); and Mass General Brigham, Somerville, MA (L.A.V.)
| | - Christine Iannaccone
- From the Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital (D.W.B., D.M.L., H.S., A.S., S.L., C.I., M.L.F., S.D., M.G.A., H.H.E., L.S.), the Department of Health Care Policy (E.M.), Harvard Medical School (D.W.B., D.M.L., H.S., A.S., D.M.S., S.L., J.P.Z., M.S.L., H.H.E., L.S., E.M.), the Department of Health Policy and Management, Harvard T.H. Chan School of Public Health (D.W.B.), the Edward P. Lawrence Center for Quality and Safety (D.M.S., J.P.Z., E.M.), the Division of Cardiac Surgery, Department of Surgery (D.M.S.), the Department of Psychiatry (J.P.Z.), the Division of Nephrology (M.S.L.), and the Division of General Internal Medicine (E.M.), Massachusetts General Hospital, and the Controlled Risk Insurance Company and the Risk Management Foundation of the Harvard Medical Institutions (L.S., P.F., J.S.E., M.E.R.) - all in Boston; the Kaiser Permanente Northern California Division of Research, Oakland (L.C.M.); Maine Medical Center, Portland (C.G.R.); and Mass General Brigham, Somerville, MA (L.A.V.)
| | - Michelle L Frits
- From the Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital (D.W.B., D.M.L., H.S., A.S., S.L., C.I., M.L.F., S.D., M.G.A., H.H.E., L.S.), the Department of Health Care Policy (E.M.), Harvard Medical School (D.W.B., D.M.L., H.S., A.S., D.M.S., S.L., J.P.Z., M.S.L., H.H.E., L.S., E.M.), the Department of Health Policy and Management, Harvard T.H. Chan School of Public Health (D.W.B.), the Edward P. Lawrence Center for Quality and Safety (D.M.S., J.P.Z., E.M.), the Division of Cardiac Surgery, Department of Surgery (D.M.S.), the Department of Psychiatry (J.P.Z.), the Division of Nephrology (M.S.L.), and the Division of General Internal Medicine (E.M.), Massachusetts General Hospital, and the Controlled Risk Insurance Company and the Risk Management Foundation of the Harvard Medical Institutions (L.S., P.F., J.S.E., M.E.R.) - all in Boston; the Kaiser Permanente Northern California Division of Research, Oakland (L.C.M.); Maine Medical Center, Portland (C.G.R.); and Mass General Brigham, Somerville, MA (L.A.V.)
| | - Lynn A Volk
- From the Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital (D.W.B., D.M.L., H.S., A.S., S.L., C.I., M.L.F., S.D., M.G.A., H.H.E., L.S.), the Department of Health Care Policy (E.M.), Harvard Medical School (D.W.B., D.M.L., H.S., A.S., D.M.S., S.L., J.P.Z., M.S.L., H.H.E., L.S., E.M.), the Department of Health Policy and Management, Harvard T.H. Chan School of Public Health (D.W.B.), the Edward P. Lawrence Center for Quality and Safety (D.M.S., J.P.Z., E.M.), the Division of Cardiac Surgery, Department of Surgery (D.M.S.), the Department of Psychiatry (J.P.Z.), the Division of Nephrology (M.S.L.), and the Division of General Internal Medicine (E.M.), Massachusetts General Hospital, and the Controlled Risk Insurance Company and the Risk Management Foundation of the Harvard Medical Institutions (L.S., P.F., J.S.E., M.E.R.) - all in Boston; the Kaiser Permanente Northern California Division of Research, Oakland (L.C.M.); Maine Medical Center, Portland (C.G.R.); and Mass General Brigham, Somerville, MA (L.A.V.)
| | - Sevan Dulgarian
- From the Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital (D.W.B., D.M.L., H.S., A.S., S.L., C.I., M.L.F., S.D., M.G.A., H.H.E., L.S.), the Department of Health Care Policy (E.M.), Harvard Medical School (D.W.B., D.M.L., H.S., A.S., D.M.S., S.L., J.P.Z., M.S.L., H.H.E., L.S., E.M.), the Department of Health Policy and Management, Harvard T.H. Chan School of Public Health (D.W.B.), the Edward P. Lawrence Center for Quality and Safety (D.M.S., J.P.Z., E.M.), the Division of Cardiac Surgery, Department of Surgery (D.M.S.), the Department of Psychiatry (J.P.Z.), the Division of Nephrology (M.S.L.), and the Division of General Internal Medicine (E.M.), Massachusetts General Hospital, and the Controlled Risk Insurance Company and the Risk Management Foundation of the Harvard Medical Institutions (L.S., P.F., J.S.E., M.E.R.) - all in Boston; the Kaiser Permanente Northern California Division of Research, Oakland (L.C.M.); Maine Medical Center, Portland (C.G.R.); and Mass General Brigham, Somerville, MA (L.A.V.)
| | - Mary G Amato
- From the Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital (D.W.B., D.M.L., H.S., A.S., S.L., C.I., M.L.F., S.D., M.G.A., H.H.E., L.S.), the Department of Health Care Policy (E.M.), Harvard Medical School (D.W.B., D.M.L., H.S., A.S., D.M.S., S.L., J.P.Z., M.S.L., H.H.E., L.S., E.M.), the Department of Health Policy and Management, Harvard T.H. Chan School of Public Health (D.W.B.), the Edward P. Lawrence Center for Quality and Safety (D.M.S., J.P.Z., E.M.), the Division of Cardiac Surgery, Department of Surgery (D.M.S.), the Department of Psychiatry (J.P.Z.), the Division of Nephrology (M.S.L.), and the Division of General Internal Medicine (E.M.), Massachusetts General Hospital, and the Controlled Risk Insurance Company and the Risk Management Foundation of the Harvard Medical Institutions (L.S., P.F., J.S.E., M.E.R.) - all in Boston; the Kaiser Permanente Northern California Division of Research, Oakland (L.C.M.); Maine Medical Center, Portland (C.G.R.); and Mass General Brigham, Somerville, MA (L.A.V.)
| | - Heba H Edrees
- From the Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital (D.W.B., D.M.L., H.S., A.S., S.L., C.I., M.L.F., S.D., M.G.A., H.H.E., L.S.), the Department of Health Care Policy (E.M.), Harvard Medical School (D.W.B., D.M.L., H.S., A.S., D.M.S., S.L., J.P.Z., M.S.L., H.H.E., L.S., E.M.), the Department of Health Policy and Management, Harvard T.H. Chan School of Public Health (D.W.B.), the Edward P. Lawrence Center for Quality and Safety (D.M.S., J.P.Z., E.M.), the Division of Cardiac Surgery, Department of Surgery (D.M.S.), the Department of Psychiatry (J.P.Z.), the Division of Nephrology (M.S.L.), and the Division of General Internal Medicine (E.M.), Massachusetts General Hospital, and the Controlled Risk Insurance Company and the Risk Management Foundation of the Harvard Medical Institutions (L.S., P.F., J.S.E., M.E.R.) - all in Boston; the Kaiser Permanente Northern California Division of Research, Oakland (L.C.M.); Maine Medical Center, Portland (C.G.R.); and Mass General Brigham, Somerville, MA (L.A.V.)
| | - Luke Sato
- From the Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital (D.W.B., D.M.L., H.S., A.S., S.L., C.I., M.L.F., S.D., M.G.A., H.H.E., L.S.), the Department of Health Care Policy (E.M.), Harvard Medical School (D.W.B., D.M.L., H.S., A.S., D.M.S., S.L., J.P.Z., M.S.L., H.H.E., L.S., E.M.), the Department of Health Policy and Management, Harvard T.H. Chan School of Public Health (D.W.B.), the Edward P. Lawrence Center for Quality and Safety (D.M.S., J.P.Z., E.M.), the Division of Cardiac Surgery, Department of Surgery (D.M.S.), the Department of Psychiatry (J.P.Z.), the Division of Nephrology (M.S.L.), and the Division of General Internal Medicine (E.M.), Massachusetts General Hospital, and the Controlled Risk Insurance Company and the Risk Management Foundation of the Harvard Medical Institutions (L.S., P.F., J.S.E., M.E.R.) - all in Boston; the Kaiser Permanente Northern California Division of Research, Oakland (L.C.M.); Maine Medical Center, Portland (C.G.R.); and Mass General Brigham, Somerville, MA (L.A.V.)
| | - Patricia Folcarelli
- From the Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital (D.W.B., D.M.L., H.S., A.S., S.L., C.I., M.L.F., S.D., M.G.A., H.H.E., L.S.), the Department of Health Care Policy (E.M.), Harvard Medical School (D.W.B., D.M.L., H.S., A.S., D.M.S., S.L., J.P.Z., M.S.L., H.H.E., L.S., E.M.), the Department of Health Policy and Management, Harvard T.H. Chan School of Public Health (D.W.B.), the Edward P. Lawrence Center for Quality and Safety (D.M.S., J.P.Z., E.M.), the Division of Cardiac Surgery, Department of Surgery (D.M.S.), the Department of Psychiatry (J.P.Z.), the Division of Nephrology (M.S.L.), and the Division of General Internal Medicine (E.M.), Massachusetts General Hospital, and the Controlled Risk Insurance Company and the Risk Management Foundation of the Harvard Medical Institutions (L.S., P.F., J.S.E., M.E.R.) - all in Boston; the Kaiser Permanente Northern California Division of Research, Oakland (L.C.M.); Maine Medical Center, Portland (C.G.R.); and Mass General Brigham, Somerville, MA (L.A.V.)
| | - Jonathan S Einbinder
- From the Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital (D.W.B., D.M.L., H.S., A.S., S.L., C.I., M.L.F., S.D., M.G.A., H.H.E., L.S.), the Department of Health Care Policy (E.M.), Harvard Medical School (D.W.B., D.M.L., H.S., A.S., D.M.S., S.L., J.P.Z., M.S.L., H.H.E., L.S., E.M.), the Department of Health Policy and Management, Harvard T.H. Chan School of Public Health (D.W.B.), the Edward P. Lawrence Center for Quality and Safety (D.M.S., J.P.Z., E.M.), the Division of Cardiac Surgery, Department of Surgery (D.M.S.), the Department of Psychiatry (J.P.Z.), the Division of Nephrology (M.S.L.), and the Division of General Internal Medicine (E.M.), Massachusetts General Hospital, and the Controlled Risk Insurance Company and the Risk Management Foundation of the Harvard Medical Institutions (L.S., P.F., J.S.E., M.E.R.) - all in Boston; the Kaiser Permanente Northern California Division of Research, Oakland (L.C.M.); Maine Medical Center, Portland (C.G.R.); and Mass General Brigham, Somerville, MA (L.A.V.)
| | - Mark E Reynolds
- From the Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital (D.W.B., D.M.L., H.S., A.S., S.L., C.I., M.L.F., S.D., M.G.A., H.H.E., L.S.), the Department of Health Care Policy (E.M.), Harvard Medical School (D.W.B., D.M.L., H.S., A.S., D.M.S., S.L., J.P.Z., M.S.L., H.H.E., L.S., E.M.), the Department of Health Policy and Management, Harvard T.H. Chan School of Public Health (D.W.B.), the Edward P. Lawrence Center for Quality and Safety (D.M.S., J.P.Z., E.M.), the Division of Cardiac Surgery, Department of Surgery (D.M.S.), the Department of Psychiatry (J.P.Z.), the Division of Nephrology (M.S.L.), and the Division of General Internal Medicine (E.M.), Massachusetts General Hospital, and the Controlled Risk Insurance Company and the Risk Management Foundation of the Harvard Medical Institutions (L.S., P.F., J.S.E., M.E.R.) - all in Boston; the Kaiser Permanente Northern California Division of Research, Oakland (L.C.M.); Maine Medical Center, Portland (C.G.R.); and Mass General Brigham, Somerville, MA (L.A.V.)
| | - Elizabeth Mort
- From the Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital (D.W.B., D.M.L., H.S., A.S., S.L., C.I., M.L.F., S.D., M.G.A., H.H.E., L.S.), the Department of Health Care Policy (E.M.), Harvard Medical School (D.W.B., D.M.L., H.S., A.S., D.M.S., S.L., J.P.Z., M.S.L., H.H.E., L.S., E.M.), the Department of Health Policy and Management, Harvard T.H. Chan School of Public Health (D.W.B.), the Edward P. Lawrence Center for Quality and Safety (D.M.S., J.P.Z., E.M.), the Division of Cardiac Surgery, Department of Surgery (D.M.S.), the Department of Psychiatry (J.P.Z.), the Division of Nephrology (M.S.L.), and the Division of General Internal Medicine (E.M.), Massachusetts General Hospital, and the Controlled Risk Insurance Company and the Risk Management Foundation of the Harvard Medical Institutions (L.S., P.F., J.S.E., M.E.R.) - all in Boston; the Kaiser Permanente Northern California Division of Research, Oakland (L.C.M.); Maine Medical Center, Portland (C.G.R.); and Mass General Brigham, Somerville, MA (L.A.V.)
| |
Collapse
|
9
|
Affiliation(s)
- William V Padula
- Department of Pharmaceutical and Health Economics, School of Pharmacy, University of Southern California, Los Angeles
- Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles
| | - Peter J Pronovost
- University Hospitals Cleveland Medical Center, Cleveland, Ohio
- School of Medicine, Case Western Reserve University, Cleveland, Ohio
| |
Collapse
|
10
|
Affiliation(s)
- Lucas Weiser
- L. Weiser is a fourth-year medical student, University of California, San Francisco School of Medicine, San Francisco, California; ; ORCID: https://orcid.org/0000-0003-2159-6416
| |
Collapse
|
11
|
Warshavsky A, Rosen R, Neuman U, Nard-Carmel N, Shapira U, Trejo L, Fliss DM, Horowitz G. Accuracy of Pathology Reports on Neck Dissection Specimens: A Retrospective Case Series Study. Isr Med Assoc J 2022; 24:85-88. [PMID: 35187896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Accuracy of the number and location of pathological lymph nodes (LNs) in the pathology report of a neck dissection (ND) is of vital importance. OBJECTIVES To quantify the error rate in reporting the location and number of pathologic LNs in ND specimens. METHODS All patients who had undergone a formal ND that included at least neck level 1 for a clinical N1 disease between January 2010 and December 2017 were included in the study. The error rate of the pathology reports was determined by various means: comparing preoperative imaging and pathological report, reporting a disproportionate LN distribution between the different neck levels, and determining an erroneous location of the submandibular gland (SMG) in the pathology report. Since the SMG must be anatomically located in neck level 1, any mistake in reporting it was considered a categorical error. RESULTS A total of 227 NDs met the inclusion criteria and were included in the study. The study included 128 patients who had undergone a dissection at levels 1-3, 68 at levels 1-4, and 31 at levels 1-5. The best Kappa score for correlation between preoperative imaging and final pathology was 0.50. There were nine cases (3.9%) of a disproportionate LN distribution in the various levels. The SMG was inaccurately reported outside neck level 1 in 17 cases (7.5%). CONCLUSIONS At least 7.5% of ND reports were inaccurate in this investigation. The treating physician should be alert to red flags in the pathological report.
Collapse
Affiliation(s)
- Anton Warshavsky
- Departments of Otolaryngology Head and Neck Surgery and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Roni Rosen
- Departments of Otolaryngology Head and Neck Surgery and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Uri Neuman
- Departments of Otolaryngology Head and Neck Surgery and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Narin Nard-Carmel
- Departments of Otolaryngology Head and Neck Surgery and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Udi Shapira
- Departments of Otolaryngology Head and Neck Surgery and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Leonor Trejo
- Institute of Pathology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dan M Fliss
- Departments of Otolaryngology Head and Neck Surgery and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gilad Horowitz
- Departments of Otolaryngology Head and Neck Surgery and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
12
|
Abstract
IMPORTANCE Progress in understanding and preventing diagnostic errors has been modest. New approaches are needed to help clinicians anticipate and prevent such errors. Delineating recurring diagnostic pitfalls holds potential for conceptual and practical ways for improvement. OBJECTIVES To develop the construct and collect examples of "diagnostic pitfalls," defined as clinical situations and scenarios vulnerable to errors that may lead to missed, delayed, or wrong diagnoses. DESIGN, SETTING, AND PARTICIPANTS This qualitative study used data from January 1, 2004, to December 31, 2016, from retrospective analysis of diagnosis-related patient safety incident reports, closed malpractice claims, and ambulatory morbidity and mortality conferences, as well as specialty focus groups. Data analyses were conducted between January 1, 2017, and December 31, 2019. MAIN OUTCOMES AND MEASURES From each data source, potential diagnostic error cases were identified, and the following information was extracted: erroneous and correct diagnoses, presenting signs and symptoms, and areas of breakdowns in the diagnostic process (using Diagnosis Error Evaluation and Research and Reliable Diagnosis Challenges taxonomies). From this compilation, examples were collected of disease-specific pitfalls; this list was used to conduct a qualitative analysis of emerging themes to derive a generic taxonomy of diagnostic pitfalls. RESULTS A total of 836 relevant cases were identified among 4325 patient safety incident reports, 403 closed malpractice claims, 24 ambulatory morbidity and mortality conferences, and 355 focus groups responses. From these, 661 disease-specific diagnostic pitfalls were identified. A qualitative review of these disease-specific pitfalls identified 21 generic diagnostic pitfalls categories, which included mistaking one disease for another disease (eg, aortic dissection is misdiagnosed as acute myocardial infarction), failure to appreciate test result limitations, and atypical disease presentations. CONCLUSIONS AND RELEVANCE Recurring types of pitfalls were identified and collected from diagnostic error cases. Clinicians could benefit from knowledge of both disease-specific and generic cross-cutting pitfalls. Study findings can potentially inform educational and quality improvement efforts to anticipate and prevent future errors.
Collapse
Affiliation(s)
- Gordon D. Schiff
- Division of General Internal Medicine and Primary Care, Brigham and Women’s Hospital, Boston, Massachusetts
- Center for Patient Safety Research and Practice, Brigham and Women’s Hospital, Boston, Massachusetts
- Center for Primary Care, Harvard Medical School, Boston, Massachusetts
| | - Mayya Volodarskaya
- Department of Surgery, Rush University Medical Center, Chicago, Illinois
| | - Elise Ruan
- Department of Medicine, Montefiore Medical Center, Bronx, New York
| | - Andrea Lim
- Department of Internal Medicine, Kaiser Permanente, San Francisco, California
| | - Adam Wright
- Department of Biomedical Informatics, Vanderbilt University, Nashville, Tennessee
| | - Hardeep Singh
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, Texas
| | - Harry Reyes Nieva
- Division of General Internal Medicine and Primary Care, Brigham and Women’s Hospital, Boston, Massachusetts
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
- Department of Biomedical Informatics, Columbia University, New York, New York
| |
Collapse
|
13
|
Abstract
This cohort study uses data from a survey of US medical interns to assess the prevalence of self-reported disability and program accommodations and the association between accommodations, depressive symptoms, and self-reported medical errors among resident physicians.
Collapse
Affiliation(s)
- Lisa M. Meeks
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor
| | | | - Elena Frank
- Michigan Neuroscience Institute, University of Michigan Medical School, Ann Arbor
| | | | | | - Srijan Sen
- Eisenberg Family Depression Center, University of Michigan Medical School, Ann Arbor
| |
Collapse
|
14
|
Alghamdi NS, Algarni YA, Ain TS, Alfaifi HM, AlQarni AA, Mashyakhi JQ, Alasmari SE, Alshahrani MM. Endodontic mishaps during root canal treatment performed by undergraduate dental students: An observational study. Medicine (Baltimore) 2021; 100:e27757. [PMID: 34964733 PMCID: PMC8615340 DOI: 10.1097/md.0000000000027757] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 10/27/2021] [Indexed: 01/05/2023] Open
Abstract
Endodontic mishaps during root canal treatment (RCT) are considered to be one of the most commonly encountered errors, which affect the quality of treatment and may have dangerous health implications for patients.The present study was conducted to assess the frequency and types of endodontic mishaps in root canal-treated teeth performed by undergraduate dental students.A total 404 endodontically treated teeth were performed by undergraduate dental students of King Khalid University College of Dentistry, Abha, Kingdom of Saudi Arabia. The radiographs of the endodontically treated teeth were studied for a period of 6 months, and the related demographic data were collected from patient files.The most commonly identified mishaps were related to obturation, where the maximum number of cases (68.1%) had under-obturated root canals. More endodontic mishaps were performed by students in level 9 education. The upper left 2nd molar teeth had a higher frequency of mishaps, and molars were found to have more access-related mishaps. Lastly, access-related and instrument-related mishaps had a low frequency of occurrence.The majority of endodontic mishaps found in the study sample were related to root canal obturation. The undergraduate students at level 9 were less proficient in conducting RCTs with many endodontic mishaps when compared to the cases performed by students at higher levels. The study suggests relevant guidance for dental students while performing RCTs, especially during obturation of the root canals.
Collapse
Affiliation(s)
- Nuha S. Alghamdi
- Department of Restorative Dental Sciences, King Khalid University, College of Dentistry, Abha, Saudi Arabia
| | - Youssef A. Algarni
- Department of Restorative Dental Sciences, King Khalid University, College of Dentistry, Abha, Saudi Arabia
| | - Tasneem Sakinatul Ain
- Division of Preventive Dentistry, King Khalid University, College of Dentistry, Abha, Saudi Arabia
| | - Haifa M. Alfaifi
- King Khalid University, College of Dentistry, Abha, Saudi Arabia
| | - Alaa A. AlQarni
- King Khalid University, College of Dentistry, Abha, Saudi Arabia
| | | | - Sara E. Alasmari
- King Khalid University, College of Dentistry, Abha, Saudi Arabia
| | | |
Collapse
|
15
|
Gaube S, Cecil J, Wagner S, Schicho A. The relationship between health IT characteristics and organizational variables among German healthcare workers. Sci Rep 2021; 11:17752. [PMID: 34493751 PMCID: PMC8423839 DOI: 10.1038/s41598-021-96851-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 08/13/2021] [Indexed: 11/08/2022] Open
Abstract
Health information technologies (HITs) are widely employed in healthcare and are supposed to improve quality of care and patient safety. However, so far, their implementation has shown mixed results, which might be explainable by understudied psychological factors of human-HIT interaction. Therefore, the present study investigates the association between the perception of HIT characteristics and psychological and organizational variables among 445 healthcare workers via a cross-sectional online survey in Germany. The proposed hypotheses were tested using structural equation modeling. The results showed that good HIT usability was associated with lower levels of techno-overload and lower IT-related strain. In turn, experiencing techno-overload and IT-related strain was associated with lower job satisfaction. An effective error management culture at the workplace was linked to higher job satisfaction and a slightly lower frequency of self-reported medical errors. About 69% of surveyed healthcare workers reported making errors less frequently than their colleagues, suggesting a bias in either the perception or reporting of errors. In conclusion, the study's findings indicate that ensuring high perceived usability when implementing HITs is crucial to avoiding frustration among healthcare workers and keeping them satisfied. Additionally healthcare facilities should invest in error management programs since error management culture is linked to other important organizational variables.
Collapse
Affiliation(s)
- Susanne Gaube
- Department of Infection Prevention and Infectious Diseases, University Hospital Regensburg, Regensburg, Germany.
- LMU Center for Leadership and People Management, LMU Munich, Munich, Germany.
- Department of Psychology, University of Regensburg, Regensburg, Germany.
| | - Julia Cecil
- LMU Center for Leadership and People Management, LMU Munich, Munich, Germany
- Department of Psychology, University of Regensburg, Regensburg, Germany
| | - Simon Wagner
- Department of Psychology, University of Regensburg, Regensburg, Germany
| | - Andreas Schicho
- Department of Radiology, University Hospital Regensburg, Regensburg, Germany
| |
Collapse
|
16
|
Hewitt DB, Ellis RJ, Chung JW, Cheung EO, Moskowitz JT, Huang R, Merkow RP, Yang AD, Hu YY, Cohen ME, Ko CY, Hoyt DB, Bilimoria KY. Association of Surgical Resident Wellness With Medical Errors and Patient Outcomes. Ann Surg 2021; 274:396-402. [PMID: 32282379 DOI: 10.1097/sla.0000000000003909] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The aims of this study were to: (1) measure the prevalence of self-reported medical error among general surgery trainees, (2) assess the association between general surgery resident wellness (ie, burnout and poor psychiatric well-being) and self-reported medical error, and (3) examine the association between program-level wellness and objectively measured patient outcomes. SUMMARY OF BACKGROUND DATA Poor wellness is prevalent among surgical trainees but the impact on medical error and objective patient outcomes (eg, morbidity or mortality) is unclear as existing studies are limited to physician and patient self-report of events and errors, small cohorts, or examine few outcomes. METHODS A cross-sectional survey was administered immediately following the January 2017 American Board of Surgery In-training Examination to clinically active general surgery residents to assess resident wellness and self-reported error. Postoperative patient outcomes were ascertained using a validated national clinical data registry. Associations were examined using multivariable logistic regression models. RESULTS Over a 6-month period, 22.5% of residents reported committing a near miss medical error, and 6.9% reported committing a harmful medical error. Residents were more likely to report a harmful medical error if they reported frequent burnout symptoms [odds ratio 2.71 (95% confidence interval 2.16-3.41)] or poor psychiatric well-being [odds ratio 2.36 (95% confidence interval 1.92-2.90)]. However, there were no significant associations between program-level resident wellness and any of the independently, objectively measured postoperative American College of Surgeons National Surgical Quality improvement Program outcomes examined. CONCLUSIONS Although surgical residents with poor wellness were more likely to self-report a harmful medical error, there was not a higher rate of objectively reported outcomes for surgical patients treated at hospitals with higher rates of burnout or poor psychiatric well-being.
Collapse
Affiliation(s)
- Daniel Brock Hewitt
- Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago IL
- Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, PA
| | - Ryan J Ellis
- Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago IL
- American College of Surgeons, Chicago, IL
| | - Jeanette W Chung
- Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago IL
| | - Elaine O Cheung
- Department of Medical Social Sciences, Northwestern University, Chicago, IL
| | - Judith T Moskowitz
- Department of Medical Social Sciences, Northwestern University, Chicago, IL
| | - Reiping Huang
- Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago IL
| | - Ryan P Merkow
- Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago IL
- American College of Surgeons, Chicago, IL
| | - Anthony D Yang
- Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago IL
| | - Yue-Yung Hu
- Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago IL
- Division of Pediatric Surgery, Ann & Robert H. Lurie Children's Hospital, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | | | | | | | - Karl Y Bilimoria
- Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago IL
- American College of Surgeons, Chicago, IL
| |
Collapse
|
17
|
Mottrie A, Mazzone E, Wiklund P, Graefen M, Collins JW, De Groote R, Dell’Oglio P, Puliatti S, Gallagher AG. Objective assessment of intraoperative skills for robot-assisted radical prostatectomy (RARP): results from the ERUS Scientific and Educational Working Groups Metrics Initiative. BJU Int 2021; 128:103-111. [PMID: 33251703 PMCID: PMC8359192 DOI: 10.1111/bju.15311] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To develop and seek consensus from procedure experts on the metrics that best characterise a reference robot-assisted radical prostatectomy (RARP) and determine if the metrics distinguished between the objectively assessed RARP performance of experienced and novice urologists, as identifying objective performance metrics for surgical training in robotic surgery is imperative for patient safety. MATERIALS AND METHODS In Study 1, the metrics, i.e. 12 phases of the procedure, 81 steps, 245 errors and 110 critical errors for a reference RARP were developed and then presented to an international Delphi panel of 19 experienced urologists. In Study 2, 12 very experienced surgeons (VES) who had performed >500 RARPs and 12 novice urology surgeons performed a RARP, which was video recorded and assessed by two experienced urologists blinded as to subject and group. Percentage agreement between experienced urologists for the Delphi meeting and Mann-Whitney U- and Kruskal-Wallis tests were used for construct validation of the newly identified RARP metrics. RESULTS At the Delphi panel, consensus was reached on the appropriateness of the metrics for a reference RARP. In Study 2, the results showed that the VES performed ~4% more procedure steps and made 72% fewer procedure errors than the novices (P = 0.027). Phases VIIa and VIIb (i.e. neurovascular bundle dissection) best discriminated between the VES and novices. LIMITATIONS VES whose performance was in the bottom half of their group demonstrated considerable error variability and made five-times as many errors as the other half of the group (P = 0.006). CONCLUSIONS The international Delphi panel reached high-level consensus on the RARP metrics that reliably distinguished between the objectively scored procedure performance of VES and novices. Reliable and valid performance metrics of RARP are imperative for effective and quality assured surgical training.
Collapse
Affiliation(s)
- Alexandre Mottrie
- Orsi AcademyMelleBelgium
- Department of UrologyOnze Lieve Vrouw Hospital (OLV)AalstBelgium
| | - Elio Mazzone
- Orsi AcademyMelleBelgium
- Department of UrologyOnze Lieve Vrouw Hospital (OLV)AalstBelgium
- Division of Oncology/Unit of UrologyURIL’Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ospedale San RaffaeleMilanItaly
- Vita‐Salute San Raffaele UniversityMilanItaly
| | - Peter Wiklund
- Department of UrologyKarolinska InstitutetStockholmSweden
- Department of UrologyIcahn School of Medicine at Mount Sinai Health SystemNew YorkNYUSA
| | - Markus Graefen
- Martini‐Klinik Prostate Cancer CenterUniversity Hospital Hamburg‐EppendorfHamburgGermany
| | - Justin W. Collins
- Orsi AcademyMelleBelgium
- Department of Uro‐oncologyUniversity College London Hospital (UCLH)LondonUK
| | - Ruben De Groote
- Orsi AcademyMelleBelgium
- Department of UrologyOnze Lieve Vrouw Hospital (OLV)AalstBelgium
| | - Paolo Dell’Oglio
- Orsi AcademyMelleBelgium
- Department of UrologyASST Grande Ospedale Metropolitano NiguardaMilanItaly
| | - Stefano Puliatti
- Orsi AcademyMelleBelgium
- Department of UrologyOnze Lieve Vrouw Hospital (OLV)AalstBelgium
- Department of UrologyUniversity of Modena and Reggio EmiliaModenaItaly
| | - Anthony G. Gallagher
- Orsi AcademyMelleBelgium
- Faculty of Life and Health SciencesUlster UniversityNorthern IrelandUK
| |
Collapse
|
18
|
Long S, Thomas GW, Karam MD, Marsh JL, Anderson DD. Surgical Skill Can be Objectively Measured From Fluoroscopic Images Using a Novel Image-based Decision Error Analysis (IDEA) Score. Clin Orthop Relat Res 2021; 479:1386-1394. [PMID: 33399401 PMCID: PMC8133282 DOI: 10.1097/corr.0000000000001623] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 12/07/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND To advance orthopaedic surgical skills training and assessment, more rigorous and objective performance measures are needed. In hip fracture repair, the tip-apex distance is a commonly used summative performance metric with clear clinical relevance, but it does not capture the skill exercised during the process of achieving the final implant position. This study introduces and evaluates a novel Image-based Decision Error Analysis (IDEA) score that better captures performance during fluoroscopically-assisted wire navigation. QUESTIONS/PURPOSES (1) Can wire navigation skill be objectively measured from a sequence of fluoroscopic images? (2) Are skill behaviors observed in a simulated environment also exhibited in the operating room? Additionally, we sought to define an objective skill metric that demonstrates improvement associated with accumulated surgical experience. METHODS Performance was evaluated both on a hip fracture wire navigation simulator and in the operating room during actual fracture surgery. After examining fluoroscopic image sequences from 176 consecutive simulator trials (performed by 58 first-year orthopaedic residents) and 21 consecutive surgical procedures (performed by 19 different orthopaedic residents and one attending orthopaedic surgeon), three main categories of erroneous skill behavior were identified: off-target wire adjustments, out-of-plane wire adjustments, and off-target drilling. Skill behaviors were measured by comparing wire adjustments made between consecutive images against the goal of targeting the apex of the femoral head as part of our new IDEA scoring methodology. Decision error metrics (frequency, magnitude) were correlated with other measures (image count and tip-apex distance) to characterize factors related to surgical performance on both the simulator and in the operating room. An IDEA composite score integrating decision errors (off-target wire adjustments, out-of-plane wire adjustments, and off-target drilling) and the final tip-apex distance to produce a single metric of overall performance was created and compared with the number of hip wire navigation cases previously completed (such as surgeon experience levels). RESULTS The IDEA methodology objectively analyzed 37,000 images from the simulator and 688 images from the operating room. The number of decision errors (7 ± 5 in the operating room and 4 ± 3 on the simulator) correlated with fluoroscopic image count (33 ± 14 in the operating room and 20 ± 11 on the simulator) in both the simulator and operating room environments (R2 = 0.76; p < 0.001 and R2 = 0.71; p < 0.001, respectively). Decision error counts did not correlate with the tip-apex distance (16 ± 4 mm in the operating room and 12 ± 5 mm on the simulator) for either the simulator or the operating room (R2 = 0.08; p = 0.15 and R2 = 0.03; p = 0.47, respectively), indicating that the tip-apex distance is independent of decision errors. The IDEA composite score correlated with surgical experience (R2 = 0.66; p < 0.001). CONCLUSION The fluoroscopic images obtained in the course of placing a guide wire contain a rich amount of information related to surgical skill. This points the way to an objective measure of skill that also has potential as an educational tool for residents. Future studies should expand this analysis to the wide variety of procedures that rely on fluoroscopic images. CLINICAL RELEVANCE This study has shown how resident skill development can be objectively assessed from fluoroscopic image sequences. The IDEA scoring provides a basis for evaluating the competence of a resident. The score can be used to assess skill at key timepoints throughout residency, such as when rotating onto/off of a new surgical service and before performing certain procedures in the operating room, or as a tool for debriefing/providing feedback after a procedure is completed.
Collapse
Affiliation(s)
- Steven Long
- S. Long, G. W. Thomas, M. D. Karam, J. L. Marsh, D. D. Anderson, Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, IA, USA
- S. Long, D. D. Anderson, Department of Biomedical Engineering, University of Iowa, Iowa City, IA, USA
- G. W. Thomas, D. D. Anderson, Department of Industrial and Systems Engineering, University of Iowa, Iowa City, IA, USA
| | - Geb W. Thomas
- S. Long, G. W. Thomas, M. D. Karam, J. L. Marsh, D. D. Anderson, Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, IA, USA
- S. Long, D. D. Anderson, Department of Biomedical Engineering, University of Iowa, Iowa City, IA, USA
- G. W. Thomas, D. D. Anderson, Department of Industrial and Systems Engineering, University of Iowa, Iowa City, IA, USA
| | - Matthew D. Karam
- S. Long, G. W. Thomas, M. D. Karam, J. L. Marsh, D. D. Anderson, Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, IA, USA
- S. Long, D. D. Anderson, Department of Biomedical Engineering, University of Iowa, Iowa City, IA, USA
- G. W. Thomas, D. D. Anderson, Department of Industrial and Systems Engineering, University of Iowa, Iowa City, IA, USA
| | - J. Lawrence Marsh
- S. Long, G. W. Thomas, M. D. Karam, J. L. Marsh, D. D. Anderson, Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, IA, USA
- S. Long, D. D. Anderson, Department of Biomedical Engineering, University of Iowa, Iowa City, IA, USA
- G. W. Thomas, D. D. Anderson, Department of Industrial and Systems Engineering, University of Iowa, Iowa City, IA, USA
| | - Donald D. Anderson
- S. Long, G. W. Thomas, M. D. Karam, J. L. Marsh, D. D. Anderson, Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, IA, USA
- S. Long, D. D. Anderson, Department of Biomedical Engineering, University of Iowa, Iowa City, IA, USA
- G. W. Thomas, D. D. Anderson, Department of Industrial and Systems Engineering, University of Iowa, Iowa City, IA, USA
| |
Collapse
|
19
|
Srivatsa S, Vira S, Schils J, Shook S, Gill A, Krishnaney AA. Reducing Wrong-level Spinal Surgeries Through Root Cause Analyses: A 10-year Longitudinal Analysis of a Single Tertiary Institution's Iterative Policy Improvements. Spine (Phila Pa 1976) 2021; 46:E648-E654. [PMID: 33306612 DOI: 10.1097/brs.0000000000003864] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
MINI This study is a comprehensive narrative of all wrong-level spine surgeries and prevention strategies employed at our institution between 2008 and 2019, and aims to provide a roadmap for developing a rigorous prevention protocol. We systematically track root cause analyses and policy changes to determine which prevention strategies are most effective.
Collapse
Affiliation(s)
| | - Shaleen Vira
- Department of Orthopedic Surgery, UT Southwestern, Dallas, TX
| | - Jean Schils
- Department of Diagnostic Radiology, Cleveland Clinic, Cleveland, OH
| | - Steven Shook
- Department of Neurology, Cleveland Clinic, Cleveland, OH
| | - Amanjit Gill
- Department of Diagnostic Radiology, Cleveland Clinic, Cleveland, OH
| | | |
Collapse
|
20
|
Abstract
IMPORTANCE Despite widespread recognition and known harms, serious surgical errors, known as surgical never events, endure. The California Department of Public Health (CDPH) has developed an oversight system to capture never events and a platform for process improvement that has not yet been critically appraised. OBJECTIVES To examine surgical never events occurring in hospitals in California and summarize recommendations to prevent future events. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study identified 386 CDPH hospital administrative penalty reports, of which 142 were ascribable to never events occurring during surgery. These never events were identified and summarized from January 1, 2007, to December 31, 2017. A directed qualitative approach was used to analyze CDPH-mandated corrective steps to reduce future errors in this multicenter study of all accredited hospitals in California. Inclusion of surgical never event records was based on definitions established by the US Department of Health and Human Services National Quality Forum. Data analysis was performed from January 1, 2019, to November 30, 2020. EXPOSURES Never events include death or disability of an American Society of Anesthesiologists class I patient, wrong site or wrong surgery, retained foreign objects, burns, equipment failure leading to intraoperative injury, nonapproved experimental procedures, insufficient surgeon presence or privileges, or fall from the operating room table. MAIN OUTCOMES AND MEASURES Incident rates, consequences, and improvement plans to prevent additional never events were outcomes of interest. RESULTS A total of 142 never events were reported to the CDPH (1 per 200 000 operations). Annual surgical volume for hospitals with events was 9203 vs 3251 cases for hospitals without events (P < .001). A total of 94 of 142 events (66.2%) were retained foreign objects ranging from Kocher clamps to drain sponges. Wrong site or patient surgery accounted for 22 events (15.5%), surgical burns for 11 (7.7%), and other for 15 (10.6%). Other included insufficient surgeon presence, equipment failure, or falls in the operating room. Improvement plans included 18 unique categories of recommendations from regulators, many focusing on proper use of checklists. Regulators mandated a mean (SD) of 13 (7) corrective actions in the improvement plans. Policy adherence monitoring (119 [90.2%]), revision of existing policy (84 [63.6%]), and education regarding policy (83 [62.9%]) were common action items, whereas disciplinary action toward staff was rare (11 [8.3%]). CONCLUSIONS AND RELEVANCE Surgical never events are a rare issue in California. Numerous strategies have evolved to reduce errors, many involving the thorough and proper use of intraoperative checklists.
Collapse
Affiliation(s)
- Andrew J. Cohen
- James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Hansen Lui
- Department of Urology, University of California, San Francisco
| | - Micha Zheng
- Department of Urology, University of California, San Francisco
| | - Bhagat Cheema
- Department of Urology, University of California, San Francisco
| | - German Patino
- Department of Urology, University of California, San Francisco
| | - Michael A. Kohn
- Department of Biostatistics and Epidemiology, University of California, San Francisco
| | | | - Benjamin N. Breyer
- Department of Urology, University of California, San Francisco
- Department of Biostatistics and Epidemiology, University of California, San Francisco
| |
Collapse
|
21
|
Zanetti ACB, Dias BM, Bernardes A, Capucho HC, Balsanelli AP, de Moura AA, Soato R, Gabriel CS. Incidence and preventability of adverse events in adult patients admitted to a Brazilian teaching hospital. PLoS One 2021; 16:e0249531. [PMID: 33857137 PMCID: PMC8049336 DOI: 10.1371/journal.pone.0249531] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 03/04/2021] [Indexed: 11/19/2022] Open
Abstract
Objective To analyze the incidence and preventability of adverse events related to health care in adult patients admitted to a Brazilian teaching hospital. Methods A retrospective cohort study, in which the incidence and preventability of adverse events related to health care were based on a two-stage retrospective review of 368 medical records (nurses and pharmacist review of medical records, followed by physicians review of triggered medical records) of adult patients whose hospitalizations occurred during 2015 in a high-complexity public teaching hospital located in Brazil. Data were collected from February 2018 to February 2019. Results A total of 266 adverse events were observed in 124 patients. The incidence of adverse events related to health care was 33.7% (95% CI 0.29–0.39), and the incidence density was 4.97 adverse events per 100 patient-days. Adverse events were responsible for 701 additional days of hospitalization, and the estimated length of additional hospital stay attributable to them was, on average, 6.8 days per event. The most common types of events were related to general care (60; 22.6%), medications (50; 18.8%), nosocomial infection (35; 13.2%), any other type (11; 4.1%), and diagnoses (2; 0.8%). Regarding the severity of adverse events, it was found that 168 (63.2%) were mild, 55 (20.7%) were moderate, and 43 (16.2%) were severe. In addition, it was estimated that 155 (58.3%) events were preventable. The length of a patient’s hospital stay was identified as a risk factor for the occurrence of adverse events (RR 1.20; 95% CI 1.04–1.39). Conclusions Through knowledge of the incidence, nature, severity, preventability, and risk factors for the occurrence of adverse events, it is possible to create the opportunities to prioritize the implementation of strategies for mitigating specific events based on reliable data and concrete information.
Collapse
Affiliation(s)
- Ariane Cristina Barboza Zanetti
- Department of General and Specialized Nursing, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil
- * E-mail:
| | - Bruna Moreno Dias
- Department of General and Specialized Nursing, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil
| | - Andrea Bernardes
- Department of General and Specialized Nursing, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil
| | - Helaine Carneiro Capucho
- Department of Pharmacy, Faculty of Health Sciences, University of Brasilia, Brasília, Distrito Federal, Brazil
| | - Alexandre Pazetto Balsanelli
- Department of Administration of Health and Nursing Services, Paulista School of Nursing, Federal University of São Paulo – UNIFESP, São Paulo – SP, Brazil
| | - André Almeida de Moura
- Department of General and Specialized Nursing, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil
| | - Rodrigo Soato
- Department of General and Specialized Nursing, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil
| | - Carmen Silvia Gabriel
- Department of General and Specialized Nursing, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil
| |
Collapse
|
22
|
Russotto V, Myatra SN, Laffey JG, Tassistro E, Antolini L, Bauer P, Lascarrou JB, Szułdrzyński K, Camporota L, Pelosi P, Sorbello M, Higgs A, Greif R, Putensen C, Agvald-Öhman C, Chalkias A, Bokums K, Brewster D, Rossi E, Fumagalli R, Pesenti A, Foti G, Bellani G. Intubation Practices and Adverse Peri-intubation Events in Critically Ill Patients From 29 Countries. JAMA 2021; 325:1164-1172. [PMID: 33755076 PMCID: PMC7988368 DOI: 10.1001/jama.2021.1727] [Citation(s) in RCA: 200] [Impact Index Per Article: 66.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
IMPORTANCE Tracheal intubation is one of the most commonly performed and high-risk interventions in critically ill patients. Limited information is available on adverse peri-intubation events. OBJECTIVE To evaluate the incidence and nature of adverse peri-intubation events and to assess current practice of intubation in critically ill patients. DESIGN, SETTING, AND PARTICIPANTS The International Observational Study to Understand the Impact and Best Practices of Airway Management in Critically Ill Patients (INTUBE) study was an international, multicenter, prospective cohort study involving consecutive critically ill patients undergoing tracheal intubation in the intensive care units (ICUs), emergency departments, and wards, from October 1, 2018, to July 31, 2019 (August 28, 2019, was the final follow-up) in a convenience sample of 197 sites from 29 countries across 5 continents. EXPOSURES Tracheal intubation. MAIN OUTCOMES AND MEASURES The primary outcome was the incidence of major adverse peri-intubation events defined as at least 1 of the following events occurring within 30 minutes from the start of the intubation procedure: cardiovascular instability (either: systolic pressure <65 mm Hg at least once, <90 mm Hg for >30 minutes, new or increase need of vasopressors or fluid bolus >15 mL/kg), severe hypoxemia (peripheral oxygen saturation <80%) or cardiac arrest. The secondary outcomes included intensive care unit mortality. RESULTS Of 3659 patients screened, 2964 (median age, 63 years; interquartile range [IQR], 49-74 years; 62.6% men) from 197 sites across 5 continents were included. The main reason for intubation was respiratory failure in 52.3% of patients, followed by neurological impairment in 30.5%, and cardiovascular instability in 9.4%. Primary outcome data were available for all patients. Among the study patients, 45.2% experienced at least 1 major adverse peri-intubation event. The predominant event was cardiovascular instability, observed in 42.6% of all patients undergoing emergency intubation, followed by severe hypoxemia (9.3%) and cardiac arrest (3.1%). Overall ICU mortality was 32.8%. CONCLUSIONS AND RELEVANCE In this observational study of intubation practices in critically ill patients from a convenience sample of 197 sites across 29 countries, major adverse peri-intubation events-in particular cardiovascular instability-were observed frequently.
Collapse
Affiliation(s)
- Vincenzo Russotto
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Department of Emergency and Intensive Care, University Hospital San Gerardo, Monza, Italy
| | - Sheila Nainan Myatra
- Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - John G. Laffey
- Regenerative Medicine Institute at CURAM Centre for Medical Devices, School of Medicine, National University of Ireland Galway, Galway, Ireland
- Anesthesia and Intensive Care Medicine, University Hospital Galway, Galway, Ireland
| | - Elena Tassistro
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Bicocca Center of Bioinformatics, Biostatistics and Bioimaging (B4 center), University of Milano-Bicocca, Monza, Italy
| | - Laura Antolini
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Bicocca Center of Bioinformatics, Biostatistics and Bioimaging (B4 center), University of Milano-Bicocca, Monza, Italy
| | - Philippe Bauer
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota
| | | | - Konstanty Szułdrzyński
- Department of Interdisciplinary Intensive Care, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Luigi Camporota
- Health Centre for Human and Applied Physiological Sciences, Department of Adult Critical Care, Guy's and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Paolo Pelosi
- Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy
| | - Massimiliano Sorbello
- Anesthesia and Intensive Care, Policlinico Vittorio Emanuele San Marco University Hospital, Catania, Italy
| | - Andy Higgs
- Anaesthesia and Intensive Care Medicine, Warrington and Halton Hospitals NHS Foundation Trust, Warrington, United Kingdom
| | - Robert Greif
- Department of Anaesthesiology and Pain Therapy, Bern University Hospital, University of Bern, Bern, Switzerland
- School of Medicine, Sigmund Freud University Vienna, Vienna, Austria
| | - Christian Putensen
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
| | - Christina Agvald-Öhman
- Anaesthesiology and Intensive Care, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | | | | | - David Brewster
- Intensive Care Unit, Cabrini Hospital, Malvern, Victoria, Australia
- Central Clinical School, Monash University, Clayton, Victoria, Australia
| | - Emanuela Rossi
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Bicocca Center of Bioinformatics, Biostatistics and Bioimaging (B4 center), University of Milano-Bicocca, Monza, Italy
| | - Roberto Fumagalli
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Department of Anesthesiology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Antonio Pesenti
- Dipartimento di Anestesia, Rianimazione ed Emergenza-Urgenza, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giuseppe Foti
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Department of Emergency and Intensive Care, University Hospital San Gerardo, Monza, Italy
| | - Giacomo Bellani
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Department of Emergency and Intensive Care, University Hospital San Gerardo, Monza, Italy
| |
Collapse
|
23
|
Affiliation(s)
| | - Deborah Korenstein
- Lown Institute, 21 Longwood Ave, Brookline, MA 02446, USA
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Weill Cornell Medical College, New York, NY, USA
| |
Collapse
|
24
|
Patel J, Otto E, Taylor JS, Mostow EN, Vidimos A, Lucas J, Khetarpal S, Regotti K, Kaw U. Patient safety in dermatology: a ten-year update. Dermatol Online J 2021; 27:13030/qt9cp0t2wt. [PMID: 33865273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 04/12/2021] [Indexed: 06/12/2023] Open
Abstract
OBJECTIVE We update and expand our 2010 article in this journal, Patient safety in dermatology: A review of the literature [4][DH1]. METHODS PubMed at the National Center for Biotechnology Information (NCBI), United States National Library of Medicine (NLM) was searched September 2019 for English language articles published between 2009 and 2019 concerning patient safety and medical error in dermatology. Potentially relevant articles and communications were critically evaluated by the authors with selected references from 2020 added to include specific topics: medication errors, diagnostic errors including telemedicine, office-based surgery, wrong-site procedures, infections including COVID-19, falls, laser safety, scope of practice, and electronic health records. SUMMARY Hospitals and clinics are adopting the methods of high-reliability organizations to identify and change ineffective practice patterns. Although systems issues are emphasized in patient safety, people are critically important to effective teamwork and leadership. Advancements in procedural and cosmetic dermatology, organizational and clinical guidelines, and the revolution in information technology and electronic health records have introduced new sources of potential error. CONCLUSION Despite the growing number of dermatologic patient safety studies, our review supports a continuing need for further studies and reports to reduce the number of preventable errors and provide optimal care.
Collapse
Affiliation(s)
| | | | - James S Taylor
- Department of Dermatology, Dermatology Plastic Surgery Institute, Cleveland Clinic and Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland OH.
| | | | | | | | | | | | | |
Collapse
|
25
|
Temsah MH, Al-Eyadhy A, Alsohime F, Nassar SM, AlHoshan TN, Alebdi HA, Almojel F, AlBattah MA, Narayan O, Alhaboob A, Hasan GM, Abujamea A. Unintentional exposure and incidental findings during conventional chest radiography in the pediatric intensive care unit. Medicine (Baltimore) 2021; 100:e24760. [PMID: 33655939 PMCID: PMC7939184 DOI: 10.1097/md.0000000000024760] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 01/25/2021] [Indexed: 01/04/2023] Open
Abstract
Radiation overexposure is common in chest X-ray (CXRs) of pediatric patients. However, overexposure may reveal incidental findings that can help to guide patient management or warrant quality improvement.To assess the prevalence of overexposure in CXRs in pediatric intensive care unit (PICU); and identify the incidental findings within overexposed areas, we conducted a retrospective cohort study of children who were admitted to PICU. Two independent evaluators reviewed patient's charts and digital CXRs according to the American College of Radiology standards; to evaluate overexposure of the anatomical parameters and incidental findings.A total of 400 CXRs of 85 patients were reviewed. The mean number of CXRs per patient was 4.7. Almost all (99.75%) CXRs met the criteria for overexposure, with the most common being upper abdomen (99.2%), upper limbs (97%) and neck (95.7%). In addition, 43% of these X-rays were cropped by the radiology technician to appear within the requested perimeter. There was a significant association between field cropping and overexposure (t-test: t = 9.8, P < .001). Incidental findings were seen in 41.5% of the radiographs; with the most common being gaseous abdominal distension (73.1%), low-positioned nasogastric tube (24.6%), and constipation (10.3%).Anatomical overexposure in routine CXRs remains high and raises a concern in PICU practice. Appropriate collimation of the X-ray beam, rather than electronically cropping the image, is highly recommended to minimize hiding incidental findings in the cropped-out areas. Redefining the anatomic boundaries of CXR in critically ill infants and children may need further studies and consideration. Quality improvement initiatives to minimize radiation overexposure in PICU are recommended, especially in younger children and those with more severe illness upon PICU admission.
Collapse
Affiliation(s)
- Mohamad-Hani Temsah
- College of Medicine, King Saud University
- Pediatric Intensive Care Unit, Pediatric Department, King Saud University Medical City
- Prince Abdullah Ben Khalid Celiac Disease Research Chair, King Saud University, Riyadh, Saudi Arabia
| | - Ayman Al-Eyadhy
- College of Medicine, King Saud University
- Pediatric Intensive Care Unit, Pediatric Department, King Saud University Medical City
| | - Fahad Alsohime
- College of Medicine, King Saud University
- Pediatric Intensive Care Unit, Pediatric Department, King Saud University Medical City
| | | | | | | | | | | | | | - Ali Alhaboob
- College of Medicine, King Saud University
- Pediatric Intensive Care Unit, Pediatric Department, King Saud University Medical City
| | - Gamal Mohamad Hasan
- Pediatric Intensive Care Unit, Pediatric Department, King Saud University Medical City
- Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Abdullah Abujamea
- College of Medicine, King Saud University
- Radiology Department, King Saud University Medical City, Riyadh, Saudi Arabia
| |
Collapse
|
26
|
Abstract
OBJECTIVE The aim of the study was to evaluate the psychometric properties of a newly developed survey tool measuring omissions in primary care. METHODS The Errors of Care Omission Survey (ECOS) is the only known tool to measure critical omissions ("errors") in primary care from the perspectives of primary care providers (PCPs), both physicians and nurse practitioners. The tool has 31 items grouped into the following four subscales: Self-Management Support, Follow-up, Emotional Health Support, and Care Integration. A cross-sectional survey design was used to mail the tool to PCPs and 582 PCPs in one state in the U.S. completed and returned the survey. Exploratory factor analysis with target rotation was carried out. Internal consistency reliability of identified subscales was investigated. RESULTS Four factors emerged representing domains of omissions in primary care. The original Follow-up and Care Integration subscales were retained. The items on Self-Management Support and Emotional Health Support subscales loaded differently on two factors, which were labeled Patient Self-Management and Family Engagement subscales, suggesting that conceptually PCPs separate patient and family involvement in patient care. Seven poorly performing or redundant items were removed. The remaining 24 items measure patient self-management, family engagement, follow-up, and care integration domains of omissions in primary care. The ECOS subscales have acceptable internal consistency reliability with Cronbach's α ranging from 0.90 to 0.97. CONCLUSIONS The ECOS can be used in primary care to identify critical omissions, so actions can be taken by clinicians and administrators to prevent them before they result in patient harm. Further testing of the ECOS is recommended with diverse samples.
Collapse
|
27
|
Abstract
ABSTRACT This study examined the prevalence and predictors of moral injury (MI) symptoms in 181 health care professionals (HPs; 71% physicians) recruited from Duke University Health Systems in Durham, NC. Participants completed an online questionnaire between November 13, 2019, and March 12, 2020. Sociodemographic, clinical, religious, depression/anxiety, and clinician burnout were examined as predictors of MI symptoms, assessed by the Moral Injury Symptoms Scale-Health Professional, in bivariate and stepwise multivariate analyses. The prevalence of MI symptoms causing at least moderate functional impairment was 23.9%. Younger age, shorter time in practice, committing medical errors, greater depressive or anxiety symptoms, greater clinician burnout, no religious affiliation, and lower religiosity correlated with MI symptoms in bivariate analyses. Independent predictors in multivariate analyses were the commission of medical errors in the past month, lower religiosity, and, especially, severity of clinician burnout. Functionally limiting MI symptoms are present in a significant proportion of HPs and are associated with medical errors and clinician burnout.
Collapse
Affiliation(s)
| | | | - ZhiZhong Wang
- Department of Epidemiology, School of Public Health, Zunyi Medical University, Zunyi, Guizhou, China
| | - Harold G Koenig
- Department of Psychiatry, Duke University, Durham, North Carolina
| |
Collapse
|
28
|
Abstract
A previously healthy man, intubated in the intensive care unit (ICU) for respiratory failure due to coronavirus disease 2019 (COVID-19), required central venous access for vasopressor infusion. The intensivists were occupied managing other critically ill patients, so an available intern attempted to place a triple-lumen catheter in the right internal jugular vein using only anatomic landmarks for guidance. When the access needle was inserted, pulsatile return of blood was noted.
Collapse
Affiliation(s)
- Karen Woo
- Division of Vascular Surgery, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - David Rigberg
- Division of Vascular Surgery, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Peter F Lawrence
- Division of Vascular Surgery, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California
| |
Collapse
|
29
|
Affiliation(s)
- Sheila Leatherman
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill
| | | |
Collapse
|
30
|
Affiliation(s)
- Hardeep Singh
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, Texas
| | - Pascale Carayon
- Department of Industrial & Systems Engineering, Wisconsin Institute for Healthcare Systems Engineering, University of Wisconsin-Madison, Madison, Wisconsin
| |
Collapse
|
31
|
Trockel MT, Menon NK, Rowe SG, Stewart MT, Smith R, Lu M, Kim PK, Quinn MA, Lawrence E, Marchalik D, Farley H, Normand P, Felder M, Dudley JC, Shanafelt TD. Assessment of Physician Sleep and Wellness, Burnout, and Clinically Significant Medical Errors. JAMA Netw Open 2020; 3:e2028111. [PMID: 33284339 DOI: 10.1001/jamanetworkopen.2020.28111] [Citation(s) in RCA: 84] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
IMPORTANCE Sleep-related impairment in physicians is an occupational hazard associated with long and sometimes unpredictable work hours and may contribute to burnout and self-reported clinically significant medical error. OBJECTIVE To assess the associations between sleep-related impairment and occupational wellness indicators in physicians practicing at academic-affiliated medical centers and the association of sleep-related impairment with self-reported clinically significant medical errors, before and after adjusting for burnout. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study used physician wellness survey data collected from 11 academic-affiliated medical centers between November 2016 and October 2018. Analysis was completed in January 2020. A total of 19 384 attending physicians and 7257 house staff physicians at participating institutions were invited to complete a wellness survey. The sample of responders was used for this study. EXPOSURES Sleep-related impairment. MAIN OUTCOMES AND MEASURES Association between sleep-related impairment and occupational wellness indicators (ie, work exhaustion, interpersonal disengagement, overall burnout, and professional fulfillment) was hypothesized before data collection. Assessment of the associations of sleep-related impairment and burnout with self-reported clinically significant medical errors (ie, error within the last year resulting in patient harm) was planned after data collection. RESULTS Of all physicians invited to participate in the survey, 7700 of 19 384 attending physicians (40%) and 3695 of 7257 house staff physicians (51%) completed sleep-related impairment items, including 5279 women (46%), 5187 men (46%), and 929 (8%) who self-identified as other gender or elected not to answer. Because of institutional variation in survey domain inclusion, self-reported medical error responses from 7538 physicians were available for analyses. Spearman correlations of sleep-related impairment with interpersonal disengagement (r = 0.51; P < .001), work exhaustion (r = 0.58; P < .001), and overall burnout (r = 0.59; P < .001) were large. Sleep-related impairment correlation with professional fulfillment (r = -0.40; P < .001) was moderate. In a multivariate model adjusted for gender, training status, medical specialty, and burnout level, compared with low sleep-related impairment levels, moderate, high, and very high levels were associated with increased odds of self-reported clinically significant medical error, by 53% (odds ratio, 1.53; 95% CI, 1.12-2.09), 96% (odds ratio, 1.96; 95% CI, 1.46-2.63), and 97% (odds ratio, 1.97; 95% CI, 1.45-2.69), respectively. CONCLUSIONS AND RELEVANCE In this study, sleep-related impairment was associated with increased burnout, decreased professional fulfillment, and increased self-reported clinically significant medical error. Interventions to mitigate sleep-related impairment in physicians are warranted.
Collapse
Affiliation(s)
| | - Nikitha K Menon
- Stanford University School of Medicine, Palo Alto, California
| | | | | | - Randall Smith
- Stanford University School of Medicine, Palo Alto, California
| | - Ming Lu
- Stanford University School of Medicine, Palo Alto, California
| | - Peter K Kim
- Physician Affiliate Group of New York, New York, New York
| | | | | | | | | | | | - Mila Felder
- Advocate Christ Medical Center, Oak Lawn, Illinois
| | - Jessica C Dudley
- Brigham and Women's Hospital-Partners HealthCare, Boston, Massachusetts
| | | |
Collapse
|
32
|
Abstract
IMPORTANCE Addressing physician suicide requires understanding its association with possible risk factors such as burnout and depression. OBJECTIVE To assess the association between burnout and suicidal ideation after adjusting for depression and the association of burnout and depression with self-reported medical errors. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study was conducted from November 12, 2018, to February 15, 2019. Attending and postgraduate trainee physicians randomly sampled from the American Medical Association Physician Masterfile were emailed invitations to complete an online survey in waves until a convenience sample of more than 1200 practicing physicians agreed to participate. MAIN OUTCOMES AND MEASURES The primary outcome was the association of burnout with suicidal ideation after adjustment for depression. The secondary outcome was the association of burnout and depression with self-reported medical errors. Burnout, depression, suicidal ideation, and medical errors were measured using subscales of the Stanford Professional Fulfillment Index, Maslach Burnout Inventory-Human Services Survey for Medical Personnel, and Mini-Z burnout survey and the Patient-Reported Outcomes Measurement Information System depression Short Form. Associations were evaluated using multivariable regression models. RESULTS Of the 1354 respondents, 893 (66.0%) were White, 1268 (93.6%) were non-Hispanic, 762 (56.3%) were men, 912 (67.4%) were non-primary care physicians, 934 (69.0%) were attending physicians, and 824 (60.9%) were younger than 45 years. Each SD-unit increase in burnout was associated with 85% increased odds of suicidal ideation (odds ratio [OR], 1.85; 95% CI, 1.47-2.31). After adjusting for depression, there was no longer an association (OR, 0.85; 95% CI, 0.63-1.17). In the adjusted model, each SD-unit increase in depression was associated with 202% increased odds of suicidal ideation (OR, 3.02; 95% CI, 2.30-3.95). In the adjusted model for self-reported medical errors, each SD-unit increase in burnout was associated with an increase in self-reported medical errors (OR, 1.48; 95% CI, 1.28-1.71), whereas depression was not associated with self-reported medical errors (OR, 1.01; 95% CI, 0.88-1.16). CONCLUSIONS AND RELEVANCE The results of this cross-sectional study suggest that depression but not physician burnout is directly associated with suicidal ideation. Burnout was associated with self-reported medical errors. Future investigation might examine whether burnout represents an upstream intervention target to prevent suicidal ideation by preventing depression.
Collapse
Affiliation(s)
- Nikitha K. Menon
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
| | - Tait D. Shanafelt
- Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Christine A. Sinsky
- Professional Satisfaction and Practice Sustainability, American Medical Association, Chicago, Illinois
| | - Mark Linzer
- Department of Medicine, Hennepin Healthcare, Minneapolis, Minnesota
| | - Lindsey Carlasare
- Professional Satisfaction and Practice Sustainability, American Medical Association, Chicago, Illinois
| | - Keri J. S. Brady
- Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, Massachusetts
| | | | - Mickey T. Trockel
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
| |
Collapse
|
33
|
Abstract
Workplace bullying is an important nursing issue that can influence a nurse's propensity to commit practice errors. This systematic review examines the influence of bullying behaviors on nursing practice errors and includes articles from 2012 to 2017 that focus on bullying among nurses in multiple health care settings, including ORs, emergency departments, and acute inpatient and critical-care units. Analysis of 14 relevant articles revealed four themes: the influence of the work environment on nursing practice errors, individual-level connections between bullying and nursing practice errors, barriers to teamwork, and communication impairment. This review indicates that nurses perceive that bullying influences nursing practice errors and patient outcomes, although the mechanisms are unclear. Additional research is needed to elucidate the effects of bullying on nursing practice errors and patient outcomes.
Collapse
|
34
|
Ghali H, Cheikh AB, Bhiri S, Fredj SB, Layouni S, Khefacha S, Dhidah L, Rejeb MB, Latiri HS. [Adverse events in a Tunisian university hospital: incidence and risk factors]. Sante Publique 2020; 32:189-198. [PMID: 32989948 DOI: 10.3917/spub.202.0189] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To determine the incidence and risk factors of adverse events (AE) in a Tunisian university hospital. METHOD We carried out a longitudinal observational study in 2016 over a period of 3 months in the Sahloul university hospital of Sousse, Tunisia. Data were collected using a pretested form filled by doctors previously trained in the collection methodology, upon each visit to all hospitalized patients. RESULTS Overall, 1,357 patients were eligible. We identified 168 AEs in 131 patients with AEs incidence of 12.4% (95% CI: [7.41 – 17.38]), and patient incidence of 9.7% (95% CI: [4.63 – 14.76]). The incidence density of AEs was 1.8 events per 100 days of hospitalization. Hospital acquired infection and unplanned readmission related to previous healthcare management were the most common AEs (43.4 and 12.5% respectively). Multivariate analysis revealed as independent factors of AEs: surgery (P = 0.013; RR = 1.68; CI: [1.11-2.54]), the use of central-venous-catheter (P < 10–3; RR = 4.1 ; CI: [2.1-8]), tracheotomy (P = 0.001; RR = 21.8; CI: [3.7-127.8]), transfusion (P = 0.014; RR = 2.1; CI: [1.16-3.87]) and drug intake (P = 0.04; RR = 2.2; CI: [1.04-4.7]). CONCLUSION The present study showed a high incidence of AEs and the involvement of invasive devices in their occurrence. Thus, targeted interventions are needed.
Collapse
|
35
|
Ferorelli D, Solarino B, Trotta S, Mandarelli G, Tattoli L, Stefanizzi P, Bianchi FP, Tafuri S, Zotti F, Dell’Erba A. Incident Reporting System in an Italian University Hospital: A New Tool for Improving Patient Safety. Int J Environ Res Public Health 2020; 17:ijerph17176267. [PMID: 32872189 PMCID: PMC7503737 DOI: 10.3390/ijerph17176267] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 08/24/2020] [Accepted: 08/25/2020] [Indexed: 01/05/2023]
Abstract
Clinical risk management constitutes a central element in the healthcare systems in relation to the reverberation that it establishes, and as regards the optimization of clinical outcomes for the patient. The starting point for a right clinical risk management is represented by the identification of non-conforming results. The aim of the study is to carry out a systematic analysis of all data received in the first three years of adoption of a reporting system, revealing the strengths and weaknesses. The results emerged showed an increasing trend in the number of total records. Notably, 86.0% of the records came from the medical category. Moreover, 41.0% of the records reported the possible preventive measures that could have averted the event and in 30% of the reports are hints to be put in place to avoid the repetition of the events. The second experimental phase is categorizing the events reported. Implementing the reporting system, it would guarantee a virtuous cycle of learning, training and reallocation of resources. By sensitizing health workers to a correct use of the incident reporting system, it could become a virtuous error learning system. All this would lead to a reduction in litigation and an implementation of the therapeutic doctor–patient alliance.
Collapse
Affiliation(s)
- Davide Ferorelli
- Interdisciplinary Department of Medicine, Section of Legal Medicine, University of Bari, Piazza Giulio Cesare 11, 70100 Bari, Italy; (B.S.); (S.T.); (G.M.); (F.Z.); (A.D.)
- Correspondence: ; Tel.: +39-3284138388
| | - Biagio Solarino
- Interdisciplinary Department of Medicine, Section of Legal Medicine, University of Bari, Piazza Giulio Cesare 11, 70100 Bari, Italy; (B.S.); (S.T.); (G.M.); (F.Z.); (A.D.)
| | - Silvia Trotta
- Interdisciplinary Department of Medicine, Section of Legal Medicine, University of Bari, Piazza Giulio Cesare 11, 70100 Bari, Italy; (B.S.); (S.T.); (G.M.); (F.Z.); (A.D.)
| | - Gabriele Mandarelli
- Interdisciplinary Department of Medicine, Section of Legal Medicine, University of Bari, Piazza Giulio Cesare 11, 70100 Bari, Italy; (B.S.); (S.T.); (G.M.); (F.Z.); (A.D.)
| | - Lucia Tattoli
- Città della Salute e della Scienza di Torino, Turin Hospital, 10126 Torino, Italy;
| | - Pasquale Stefanizzi
- Biomedical Science and Human Oncology, University of Bari, Piazza Giulio Cesare 11, 70100 Bari, Italy; (P.S.); (F.P.B.); (S.T.)
| | - Francesco Paolo Bianchi
- Biomedical Science and Human Oncology, University of Bari, Piazza Giulio Cesare 11, 70100 Bari, Italy; (P.S.); (F.P.B.); (S.T.)
| | - Silvio Tafuri
- Biomedical Science and Human Oncology, University of Bari, Piazza Giulio Cesare 11, 70100 Bari, Italy; (P.S.); (F.P.B.); (S.T.)
| | - Fiorenza Zotti
- Interdisciplinary Department of Medicine, Section of Legal Medicine, University of Bari, Piazza Giulio Cesare 11, 70100 Bari, Italy; (B.S.); (S.T.); (G.M.); (F.Z.); (A.D.)
| | - Alessandro Dell’Erba
- Interdisciplinary Department of Medicine, Section of Legal Medicine, University of Bari, Piazza Giulio Cesare 11, 70100 Bari, Italy; (B.S.); (S.T.); (G.M.); (F.Z.); (A.D.)
| |
Collapse
|
36
|
Newberry R, Brown D, Mitchell T, Maddry JK, Arana AA, Achay J, Rahm S, Long B, Becker T, Grier G, Davies G. Prospective Randomized Trial of Standard Left Anterolateral Thoracotomy Versus Modified Bilateral Clamshell Thoracotomy Performed by Emergency Physicians. Ann Emerg Med 2020; 77:317-326. [PMID: 32807537 DOI: 10.1016/j.annemergmed.2020.05.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 05/13/2020] [Accepted: 05/29/2020] [Indexed: 11/18/2022]
Abstract
STUDY OBJECTIVE Resuscitative thoracotomy is a time-sensitive, lifesaving procedure that may be performed by emergency physicians. The left anterolateral thoracotomy (LAT) is the standard technique commonly used in the United States to gain rapid access to critical intrathoracic structures. However, the smaller incision and subsequent limited exposure may not be optimal for the nonsurgical specialist to complete time-sensitive interventions. The modified bilateral anterior clamshell thoracotomy (MCT) developed by Barts Health NHS Trust clinicians at London's Air Ambulance overcomes these inherent difficulties, maximizes thoracic cavity visualization, and may be the ideal technique for the nonsurgical specialist. The aim of this study is to identify the optimal technique for the nonsurgical-specialist-performed resuscitative thoracotomy. Secondary aims of the study are to identify technical difficulties, procedural concerns, and physician preferences. METHODS Emergency medicine staff and senior resident physicians were recruited from an academic Level I trauma center. Subjects underwent novel standardized didactic and skills-specific training on both the MCT and LAT techniques. Later, subjects were randomized to the order of intervention and performed both techniques on separate fresh, nonfrozen human cadaver specimens. Success was determined by a board-certified surgeon and defined as complete delivery of the heart from the pericardial sac and subsequent 100% occlusion of the descending thoracic aorta with a vascular clamp. The primary outcome was time to successful completion of the resuscitative thoracotomy technique. Secondary outcomes included successful exposure of the heart, successful descending thoracic aortic cross clamping, successful procedural completion, time to exposure of the heart, time to descending thoracic aortic cross-clamp placement, number and type of iatrogenic injuries, correct anatomic structure identification, and poststudy participant questionnaire. RESULTS Sixteen emergency physicians were recruited; 15 met inclusion criteria. All participants were either emergency medicine resident (47%) or emergency medicine staff (53%). The median number of previously performed training LATs was 12 (interquartile range 6 to 15) and the median number of previously performed MCTs was 1 (interquartile range 1 to 1). The success rates of our study population for the MCT and LAT techniques were not statistically different (67% versus 40%; difference 27%; 95% confidence interval -61% to 8%). However, staff emergency physicians were significantly more successful with the MCT compared with the LAT (88% versus 25%; difference 63%; 95% CI 9% to 92%). Overall, the MCT also had a significantly higher proportion of injury-free trials compared with the LAT technique (33% versus 0%; difference 33%; 95% CI 57% to 9%). Physician procedure preference favored the MCT over the LAT (87% versus 13%; difference 74%; 95% CI 23% to 97%). CONCLUSION Resuscitative thoracotomy success rates were lower than expected in this capable subject population. Success rates and procedural time for the MCT and LAT were similar. However, the MCT had a higher success rate when performed by staff emergency physicians, resulted in less periprocedural iatrogenic injuries, and was the preferred technique by most subjects. The MCT is a potentially feasible alternative resuscitative thoracotomy technique that requires further investigation.
Collapse
Affiliation(s)
- Ryan Newberry
- United States Army Institute of Surgical Research, Fort Sam Houston, TX; SAUSHEC EMS and Disaster Medicine Fellowship Program, Fort Sam Houston, TX; Uniformed Services University, Department of Military and Emergency Medicine, Bethesda, MD; Barts Health NHS Trust, Royal London Hospital, Whitechapel, London, United Kingdom.
| | - Derek Brown
- SAUSHEC EMS and Disaster Medicine Fellowship Program, Fort Sam Houston, TX
| | - Thomas Mitchell
- United States Army Institute of Surgical Research, Fort Sam Houston, TX
| | - Joseph K Maddry
- United States Air Force En Route Care Research Center, Fort Sam Houston, TX
| | - Allyson A Arana
- United States Air Force En Route Care Research Center, Fort Sam Houston, TX
| | | | - Stephen Rahm
- Centre for Emergency Health Sciences, Spring Branch, TX
| | - Brit Long
- Department of Emergency Medicine, San Antonio Military Medical Center, Fort Sam Houston, TX
| | - Tyson Becker
- Department of Trauma Surgery, San Antonio Military Medical Center, Fort Sam Houston, TX
| | - Gareth Grier
- Barts Health NHS Trust, Royal London Hospital, Whitechapel, London, United Kingdom; The Institute of Pre-Hospital Care at London's Air Ambulance, Royal London Hospital, Whitechapel, London, United Kingdom
| | - Gareth Davies
- Barts Health NHS Trust, Royal London Hospital, Whitechapel, London, United Kingdom; The Institute of Pre-Hospital Care at London's Air Ambulance, Royal London Hospital, Whitechapel, London, United Kingdom
| |
Collapse
|
37
|
Marotti JD, Boivin ME, Egressy KV, Gutmann EJ. Error detection via patient engagement: Wrong-side designation in cytology reports of a computed tomography-guided lung biopsy with rapid on-site evaluation. Cancer Cytopathol 2020; 128:681-684. [PMID: 32662940 DOI: 10.1002/cncy.22302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 01/13/2020] [Accepted: 05/12/2020] [Indexed: 11/08/2022]
|
38
|
Landrigan CP, Rahman SA, Sullivan JP, Vittinghoff E, Barger LK, Sanderson AL, Wright KP, O'Brien CS, Qadri S, St Hilaire MA, Halbower AC, Segar JL, McGuire JK, Vitiello MV, de la Iglesia HO, Poynter SE, Yu PL, Zee PC, Lockley SW, Stone KL, Czeisler CA. Effect on Patient Safety of a Resident Physician Schedule without 24-Hour Shifts. N Engl J Med 2020; 382:2514-2523. [PMID: 32579812 PMCID: PMC7405505 DOI: 10.1056/nejmoa1900669] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The effects on patient safety of eliminating extended-duration work shifts for resident physicians remain controversial. METHODS We conducted a multicenter, cluster-randomized, crossover trial comparing two schedules for pediatric resident physicians during their intensive care unit (ICU) rotations: extended-duration work schedules that included shifts of 24 hours or more (control schedules) and schedules that eliminated extended shifts and cycled resident physicians through day and night shifts of 16 hours or less (intervention schedules). The primary outcome was serious medical errors made by resident physicians, assessed by intensive surveillance, including direct observation and chart review. RESULTS The characteristics of ICU patients during the two work schedules were similar, but resident physician workload, described as the mean (±SD) number of ICU patients per resident physician, was higher during the intervention schedules than during the control schedules (8.8±2.8 vs. 6.7±2.2). Resident physicians made more serious errors during the intervention schedules than during the control schedules (97.1 vs. 79.0 per 1000 patient-days; relative risk, 1.53; 95% confidence interval [CI], 1.37 to 1.72; P<0.001). The number of serious errors unitwide were likewise higher during the intervention schedules (181.3 vs. 131.5 per 1000 patient-days; relative risk, 1.56; 95% CI, 1.43 to 1.71). There was wide variability among sites, however; errors were lower during intervention schedules than during control schedules at one site, rates were similar during the two schedules at two sites, and rates were higher during intervention schedules than during control schedules at three sites. In a secondary analysis that was adjusted for the number of patients per resident physician as a potential confounder, intervention schedules were no longer associated with an increase in errors. CONCLUSIONS Contrary to our hypothesis, resident physicians who were randomly assigned to schedules that eliminated extended shifts made more serious errors than resident physicians assigned to schedules with extended shifts, although the effect varied by site. The number of ICU patients cared for by each resident physician was higher during schedules that eliminated extended shifts. (Funded by the National Heart, Lung, and Blood Institute; ROSTERS ClinicalTrials.gov number, NCT02134847.).
Collapse
Affiliation(s)
- Christopher P Landrigan
- From the Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital (C.P.L., S.A.R., J.P.S., L.K.B., C.S.O., S.Q., M.A.S.H., S.W.L., C.A.C.), the Division of Sleep Medicine, Harvard Medical School (C.P.L., S.A.R., L.K.B., M.A.S.H., S.W.L., C.A.C.), and the Division of General Pediatrics, Department of Pediatrics (C.P.L.), and the Division of Critical Care Medicine, Department of Anesthesiology, Critical Care, and Pain Medicine (A.L.S.), Boston Children's Hospital - all in Boston; the University of California, San Francisco (E.V., K.L.S.), and California Pacific Medical Center Research Institute (K.L.S.), San Francisco; the Sleep and Chronobiology Laboratory, Department of Integrative Physiology, University of Colorado Boulder, Boulder (K.P.W.), and Children's Hospital Colorado, University of Colorado School of Medicine, Aurora (A.C.H.); the University of Iowa Stead Family Children's Hospital, Iowa City (J.L.S.); Seattle Children's Hospital (J.K.M.) and the University of Washington (M.V.V., H.O.I.), Seattle; Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati (S.E.P.); University of Virginia Children's Hospital, Charlottesville (P.L.Y.); and the Department of Neurology and Center for Circadian and Sleep Medicine, Northwestern University, Feinberg School of Medicine, Chicago (P.C.Z.)
| | - Shadab A Rahman
- From the Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital (C.P.L., S.A.R., J.P.S., L.K.B., C.S.O., S.Q., M.A.S.H., S.W.L., C.A.C.), the Division of Sleep Medicine, Harvard Medical School (C.P.L., S.A.R., L.K.B., M.A.S.H., S.W.L., C.A.C.), and the Division of General Pediatrics, Department of Pediatrics (C.P.L.), and the Division of Critical Care Medicine, Department of Anesthesiology, Critical Care, and Pain Medicine (A.L.S.), Boston Children's Hospital - all in Boston; the University of California, San Francisco (E.V., K.L.S.), and California Pacific Medical Center Research Institute (K.L.S.), San Francisco; the Sleep and Chronobiology Laboratory, Department of Integrative Physiology, University of Colorado Boulder, Boulder (K.P.W.), and Children's Hospital Colorado, University of Colorado School of Medicine, Aurora (A.C.H.); the University of Iowa Stead Family Children's Hospital, Iowa City (J.L.S.); Seattle Children's Hospital (J.K.M.) and the University of Washington (M.V.V., H.O.I.), Seattle; Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati (S.E.P.); University of Virginia Children's Hospital, Charlottesville (P.L.Y.); and the Department of Neurology and Center for Circadian and Sleep Medicine, Northwestern University, Feinberg School of Medicine, Chicago (P.C.Z.)
| | - Jason P Sullivan
- From the Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital (C.P.L., S.A.R., J.P.S., L.K.B., C.S.O., S.Q., M.A.S.H., S.W.L., C.A.C.), the Division of Sleep Medicine, Harvard Medical School (C.P.L., S.A.R., L.K.B., M.A.S.H., S.W.L., C.A.C.), and the Division of General Pediatrics, Department of Pediatrics (C.P.L.), and the Division of Critical Care Medicine, Department of Anesthesiology, Critical Care, and Pain Medicine (A.L.S.), Boston Children's Hospital - all in Boston; the University of California, San Francisco (E.V., K.L.S.), and California Pacific Medical Center Research Institute (K.L.S.), San Francisco; the Sleep and Chronobiology Laboratory, Department of Integrative Physiology, University of Colorado Boulder, Boulder (K.P.W.), and Children's Hospital Colorado, University of Colorado School of Medicine, Aurora (A.C.H.); the University of Iowa Stead Family Children's Hospital, Iowa City (J.L.S.); Seattle Children's Hospital (J.K.M.) and the University of Washington (M.V.V., H.O.I.), Seattle; Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati (S.E.P.); University of Virginia Children's Hospital, Charlottesville (P.L.Y.); and the Department of Neurology and Center for Circadian and Sleep Medicine, Northwestern University, Feinberg School of Medicine, Chicago (P.C.Z.)
| | - Eric Vittinghoff
- From the Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital (C.P.L., S.A.R., J.P.S., L.K.B., C.S.O., S.Q., M.A.S.H., S.W.L., C.A.C.), the Division of Sleep Medicine, Harvard Medical School (C.P.L., S.A.R., L.K.B., M.A.S.H., S.W.L., C.A.C.), and the Division of General Pediatrics, Department of Pediatrics (C.P.L.), and the Division of Critical Care Medicine, Department of Anesthesiology, Critical Care, and Pain Medicine (A.L.S.), Boston Children's Hospital - all in Boston; the University of California, San Francisco (E.V., K.L.S.), and California Pacific Medical Center Research Institute (K.L.S.), San Francisco; the Sleep and Chronobiology Laboratory, Department of Integrative Physiology, University of Colorado Boulder, Boulder (K.P.W.), and Children's Hospital Colorado, University of Colorado School of Medicine, Aurora (A.C.H.); the University of Iowa Stead Family Children's Hospital, Iowa City (J.L.S.); Seattle Children's Hospital (J.K.M.) and the University of Washington (M.V.V., H.O.I.), Seattle; Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati (S.E.P.); University of Virginia Children's Hospital, Charlottesville (P.L.Y.); and the Department of Neurology and Center for Circadian and Sleep Medicine, Northwestern University, Feinberg School of Medicine, Chicago (P.C.Z.)
| | - Laura K Barger
- From the Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital (C.P.L., S.A.R., J.P.S., L.K.B., C.S.O., S.Q., M.A.S.H., S.W.L., C.A.C.), the Division of Sleep Medicine, Harvard Medical School (C.P.L., S.A.R., L.K.B., M.A.S.H., S.W.L., C.A.C.), and the Division of General Pediatrics, Department of Pediatrics (C.P.L.), and the Division of Critical Care Medicine, Department of Anesthesiology, Critical Care, and Pain Medicine (A.L.S.), Boston Children's Hospital - all in Boston; the University of California, San Francisco (E.V., K.L.S.), and California Pacific Medical Center Research Institute (K.L.S.), San Francisco; the Sleep and Chronobiology Laboratory, Department of Integrative Physiology, University of Colorado Boulder, Boulder (K.P.W.), and Children's Hospital Colorado, University of Colorado School of Medicine, Aurora (A.C.H.); the University of Iowa Stead Family Children's Hospital, Iowa City (J.L.S.); Seattle Children's Hospital (J.K.M.) and the University of Washington (M.V.V., H.O.I.), Seattle; Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati (S.E.P.); University of Virginia Children's Hospital, Charlottesville (P.L.Y.); and the Department of Neurology and Center for Circadian and Sleep Medicine, Northwestern University, Feinberg School of Medicine, Chicago (P.C.Z.)
| | - Amy L Sanderson
- From the Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital (C.P.L., S.A.R., J.P.S., L.K.B., C.S.O., S.Q., M.A.S.H., S.W.L., C.A.C.), the Division of Sleep Medicine, Harvard Medical School (C.P.L., S.A.R., L.K.B., M.A.S.H., S.W.L., C.A.C.), and the Division of General Pediatrics, Department of Pediatrics (C.P.L.), and the Division of Critical Care Medicine, Department of Anesthesiology, Critical Care, and Pain Medicine (A.L.S.), Boston Children's Hospital - all in Boston; the University of California, San Francisco (E.V., K.L.S.), and California Pacific Medical Center Research Institute (K.L.S.), San Francisco; the Sleep and Chronobiology Laboratory, Department of Integrative Physiology, University of Colorado Boulder, Boulder (K.P.W.), and Children's Hospital Colorado, University of Colorado School of Medicine, Aurora (A.C.H.); the University of Iowa Stead Family Children's Hospital, Iowa City (J.L.S.); Seattle Children's Hospital (J.K.M.) and the University of Washington (M.V.V., H.O.I.), Seattle; Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati (S.E.P.); University of Virginia Children's Hospital, Charlottesville (P.L.Y.); and the Department of Neurology and Center for Circadian and Sleep Medicine, Northwestern University, Feinberg School of Medicine, Chicago (P.C.Z.)
| | - Kenneth P Wright
- From the Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital (C.P.L., S.A.R., J.P.S., L.K.B., C.S.O., S.Q., M.A.S.H., S.W.L., C.A.C.), the Division of Sleep Medicine, Harvard Medical School (C.P.L., S.A.R., L.K.B., M.A.S.H., S.W.L., C.A.C.), and the Division of General Pediatrics, Department of Pediatrics (C.P.L.), and the Division of Critical Care Medicine, Department of Anesthesiology, Critical Care, and Pain Medicine (A.L.S.), Boston Children's Hospital - all in Boston; the University of California, San Francisco (E.V., K.L.S.), and California Pacific Medical Center Research Institute (K.L.S.), San Francisco; the Sleep and Chronobiology Laboratory, Department of Integrative Physiology, University of Colorado Boulder, Boulder (K.P.W.), and Children's Hospital Colorado, University of Colorado School of Medicine, Aurora (A.C.H.); the University of Iowa Stead Family Children's Hospital, Iowa City (J.L.S.); Seattle Children's Hospital (J.K.M.) and the University of Washington (M.V.V., H.O.I.), Seattle; Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati (S.E.P.); University of Virginia Children's Hospital, Charlottesville (P.L.Y.); and the Department of Neurology and Center for Circadian and Sleep Medicine, Northwestern University, Feinberg School of Medicine, Chicago (P.C.Z.)
| | - Conor S O'Brien
- From the Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital (C.P.L., S.A.R., J.P.S., L.K.B., C.S.O., S.Q., M.A.S.H., S.W.L., C.A.C.), the Division of Sleep Medicine, Harvard Medical School (C.P.L., S.A.R., L.K.B., M.A.S.H., S.W.L., C.A.C.), and the Division of General Pediatrics, Department of Pediatrics (C.P.L.), and the Division of Critical Care Medicine, Department of Anesthesiology, Critical Care, and Pain Medicine (A.L.S.), Boston Children's Hospital - all in Boston; the University of California, San Francisco (E.V., K.L.S.), and California Pacific Medical Center Research Institute (K.L.S.), San Francisco; the Sleep and Chronobiology Laboratory, Department of Integrative Physiology, University of Colorado Boulder, Boulder (K.P.W.), and Children's Hospital Colorado, University of Colorado School of Medicine, Aurora (A.C.H.); the University of Iowa Stead Family Children's Hospital, Iowa City (J.L.S.); Seattle Children's Hospital (J.K.M.) and the University of Washington (M.V.V., H.O.I.), Seattle; Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati (S.E.P.); University of Virginia Children's Hospital, Charlottesville (P.L.Y.); and the Department of Neurology and Center for Circadian and Sleep Medicine, Northwestern University, Feinberg School of Medicine, Chicago (P.C.Z.)
| | - Salim Qadri
- From the Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital (C.P.L., S.A.R., J.P.S., L.K.B., C.S.O., S.Q., M.A.S.H., S.W.L., C.A.C.), the Division of Sleep Medicine, Harvard Medical School (C.P.L., S.A.R., L.K.B., M.A.S.H., S.W.L., C.A.C.), and the Division of General Pediatrics, Department of Pediatrics (C.P.L.), and the Division of Critical Care Medicine, Department of Anesthesiology, Critical Care, and Pain Medicine (A.L.S.), Boston Children's Hospital - all in Boston; the University of California, San Francisco (E.V., K.L.S.), and California Pacific Medical Center Research Institute (K.L.S.), San Francisco; the Sleep and Chronobiology Laboratory, Department of Integrative Physiology, University of Colorado Boulder, Boulder (K.P.W.), and Children's Hospital Colorado, University of Colorado School of Medicine, Aurora (A.C.H.); the University of Iowa Stead Family Children's Hospital, Iowa City (J.L.S.); Seattle Children's Hospital (J.K.M.) and the University of Washington (M.V.V., H.O.I.), Seattle; Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati (S.E.P.); University of Virginia Children's Hospital, Charlottesville (P.L.Y.); and the Department of Neurology and Center for Circadian and Sleep Medicine, Northwestern University, Feinberg School of Medicine, Chicago (P.C.Z.)
| | - Melissa A St Hilaire
- From the Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital (C.P.L., S.A.R., J.P.S., L.K.B., C.S.O., S.Q., M.A.S.H., S.W.L., C.A.C.), the Division of Sleep Medicine, Harvard Medical School (C.P.L., S.A.R., L.K.B., M.A.S.H., S.W.L., C.A.C.), and the Division of General Pediatrics, Department of Pediatrics (C.P.L.), and the Division of Critical Care Medicine, Department of Anesthesiology, Critical Care, and Pain Medicine (A.L.S.), Boston Children's Hospital - all in Boston; the University of California, San Francisco (E.V., K.L.S.), and California Pacific Medical Center Research Institute (K.L.S.), San Francisco; the Sleep and Chronobiology Laboratory, Department of Integrative Physiology, University of Colorado Boulder, Boulder (K.P.W.), and Children's Hospital Colorado, University of Colorado School of Medicine, Aurora (A.C.H.); the University of Iowa Stead Family Children's Hospital, Iowa City (J.L.S.); Seattle Children's Hospital (J.K.M.) and the University of Washington (M.V.V., H.O.I.), Seattle; Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati (S.E.P.); University of Virginia Children's Hospital, Charlottesville (P.L.Y.); and the Department of Neurology and Center for Circadian and Sleep Medicine, Northwestern University, Feinberg School of Medicine, Chicago (P.C.Z.)
| | - Ann C Halbower
- From the Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital (C.P.L., S.A.R., J.P.S., L.K.B., C.S.O., S.Q., M.A.S.H., S.W.L., C.A.C.), the Division of Sleep Medicine, Harvard Medical School (C.P.L., S.A.R., L.K.B., M.A.S.H., S.W.L., C.A.C.), and the Division of General Pediatrics, Department of Pediatrics (C.P.L.), and the Division of Critical Care Medicine, Department of Anesthesiology, Critical Care, and Pain Medicine (A.L.S.), Boston Children's Hospital - all in Boston; the University of California, San Francisco (E.V., K.L.S.), and California Pacific Medical Center Research Institute (K.L.S.), San Francisco; the Sleep and Chronobiology Laboratory, Department of Integrative Physiology, University of Colorado Boulder, Boulder (K.P.W.), and Children's Hospital Colorado, University of Colorado School of Medicine, Aurora (A.C.H.); the University of Iowa Stead Family Children's Hospital, Iowa City (J.L.S.); Seattle Children's Hospital (J.K.M.) and the University of Washington (M.V.V., H.O.I.), Seattle; Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati (S.E.P.); University of Virginia Children's Hospital, Charlottesville (P.L.Y.); and the Department of Neurology and Center for Circadian and Sleep Medicine, Northwestern University, Feinberg School of Medicine, Chicago (P.C.Z.)
| | - Jeffrey L Segar
- From the Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital (C.P.L., S.A.R., J.P.S., L.K.B., C.S.O., S.Q., M.A.S.H., S.W.L., C.A.C.), the Division of Sleep Medicine, Harvard Medical School (C.P.L., S.A.R., L.K.B., M.A.S.H., S.W.L., C.A.C.), and the Division of General Pediatrics, Department of Pediatrics (C.P.L.), and the Division of Critical Care Medicine, Department of Anesthesiology, Critical Care, and Pain Medicine (A.L.S.), Boston Children's Hospital - all in Boston; the University of California, San Francisco (E.V., K.L.S.), and California Pacific Medical Center Research Institute (K.L.S.), San Francisco; the Sleep and Chronobiology Laboratory, Department of Integrative Physiology, University of Colorado Boulder, Boulder (K.P.W.), and Children's Hospital Colorado, University of Colorado School of Medicine, Aurora (A.C.H.); the University of Iowa Stead Family Children's Hospital, Iowa City (J.L.S.); Seattle Children's Hospital (J.K.M.) and the University of Washington (M.V.V., H.O.I.), Seattle; Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati (S.E.P.); University of Virginia Children's Hospital, Charlottesville (P.L.Y.); and the Department of Neurology and Center for Circadian and Sleep Medicine, Northwestern University, Feinberg School of Medicine, Chicago (P.C.Z.)
| | - John K McGuire
- From the Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital (C.P.L., S.A.R., J.P.S., L.K.B., C.S.O., S.Q., M.A.S.H., S.W.L., C.A.C.), the Division of Sleep Medicine, Harvard Medical School (C.P.L., S.A.R., L.K.B., M.A.S.H., S.W.L., C.A.C.), and the Division of General Pediatrics, Department of Pediatrics (C.P.L.), and the Division of Critical Care Medicine, Department of Anesthesiology, Critical Care, and Pain Medicine (A.L.S.), Boston Children's Hospital - all in Boston; the University of California, San Francisco (E.V., K.L.S.), and California Pacific Medical Center Research Institute (K.L.S.), San Francisco; the Sleep and Chronobiology Laboratory, Department of Integrative Physiology, University of Colorado Boulder, Boulder (K.P.W.), and Children's Hospital Colorado, University of Colorado School of Medicine, Aurora (A.C.H.); the University of Iowa Stead Family Children's Hospital, Iowa City (J.L.S.); Seattle Children's Hospital (J.K.M.) and the University of Washington (M.V.V., H.O.I.), Seattle; Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati (S.E.P.); University of Virginia Children's Hospital, Charlottesville (P.L.Y.); and the Department of Neurology and Center for Circadian and Sleep Medicine, Northwestern University, Feinberg School of Medicine, Chicago (P.C.Z.)
| | - Michael V Vitiello
- From the Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital (C.P.L., S.A.R., J.P.S., L.K.B., C.S.O., S.Q., M.A.S.H., S.W.L., C.A.C.), the Division of Sleep Medicine, Harvard Medical School (C.P.L., S.A.R., L.K.B., M.A.S.H., S.W.L., C.A.C.), and the Division of General Pediatrics, Department of Pediatrics (C.P.L.), and the Division of Critical Care Medicine, Department of Anesthesiology, Critical Care, and Pain Medicine (A.L.S.), Boston Children's Hospital - all in Boston; the University of California, San Francisco (E.V., K.L.S.), and California Pacific Medical Center Research Institute (K.L.S.), San Francisco; the Sleep and Chronobiology Laboratory, Department of Integrative Physiology, University of Colorado Boulder, Boulder (K.P.W.), and Children's Hospital Colorado, University of Colorado School of Medicine, Aurora (A.C.H.); the University of Iowa Stead Family Children's Hospital, Iowa City (J.L.S.); Seattle Children's Hospital (J.K.M.) and the University of Washington (M.V.V., H.O.I.), Seattle; Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati (S.E.P.); University of Virginia Children's Hospital, Charlottesville (P.L.Y.); and the Department of Neurology and Center for Circadian and Sleep Medicine, Northwestern University, Feinberg School of Medicine, Chicago (P.C.Z.)
| | - Horacio O de la Iglesia
- From the Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital (C.P.L., S.A.R., J.P.S., L.K.B., C.S.O., S.Q., M.A.S.H., S.W.L., C.A.C.), the Division of Sleep Medicine, Harvard Medical School (C.P.L., S.A.R., L.K.B., M.A.S.H., S.W.L., C.A.C.), and the Division of General Pediatrics, Department of Pediatrics (C.P.L.), and the Division of Critical Care Medicine, Department of Anesthesiology, Critical Care, and Pain Medicine (A.L.S.), Boston Children's Hospital - all in Boston; the University of California, San Francisco (E.V., K.L.S.), and California Pacific Medical Center Research Institute (K.L.S.), San Francisco; the Sleep and Chronobiology Laboratory, Department of Integrative Physiology, University of Colorado Boulder, Boulder (K.P.W.), and Children's Hospital Colorado, University of Colorado School of Medicine, Aurora (A.C.H.); the University of Iowa Stead Family Children's Hospital, Iowa City (J.L.S.); Seattle Children's Hospital (J.K.M.) and the University of Washington (M.V.V., H.O.I.), Seattle; Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati (S.E.P.); University of Virginia Children's Hospital, Charlottesville (P.L.Y.); and the Department of Neurology and Center for Circadian and Sleep Medicine, Northwestern University, Feinberg School of Medicine, Chicago (P.C.Z.)
| | - Sue E Poynter
- From the Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital (C.P.L., S.A.R., J.P.S., L.K.B., C.S.O., S.Q., M.A.S.H., S.W.L., C.A.C.), the Division of Sleep Medicine, Harvard Medical School (C.P.L., S.A.R., L.K.B., M.A.S.H., S.W.L., C.A.C.), and the Division of General Pediatrics, Department of Pediatrics (C.P.L.), and the Division of Critical Care Medicine, Department of Anesthesiology, Critical Care, and Pain Medicine (A.L.S.), Boston Children's Hospital - all in Boston; the University of California, San Francisco (E.V., K.L.S.), and California Pacific Medical Center Research Institute (K.L.S.), San Francisco; the Sleep and Chronobiology Laboratory, Department of Integrative Physiology, University of Colorado Boulder, Boulder (K.P.W.), and Children's Hospital Colorado, University of Colorado School of Medicine, Aurora (A.C.H.); the University of Iowa Stead Family Children's Hospital, Iowa City (J.L.S.); Seattle Children's Hospital (J.K.M.) and the University of Washington (M.V.V., H.O.I.), Seattle; Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati (S.E.P.); University of Virginia Children's Hospital, Charlottesville (P.L.Y.); and the Department of Neurology and Center for Circadian and Sleep Medicine, Northwestern University, Feinberg School of Medicine, Chicago (P.C.Z.)
| | - Pearl L Yu
- From the Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital (C.P.L., S.A.R., J.P.S., L.K.B., C.S.O., S.Q., M.A.S.H., S.W.L., C.A.C.), the Division of Sleep Medicine, Harvard Medical School (C.P.L., S.A.R., L.K.B., M.A.S.H., S.W.L., C.A.C.), and the Division of General Pediatrics, Department of Pediatrics (C.P.L.), and the Division of Critical Care Medicine, Department of Anesthesiology, Critical Care, and Pain Medicine (A.L.S.), Boston Children's Hospital - all in Boston; the University of California, San Francisco (E.V., K.L.S.), and California Pacific Medical Center Research Institute (K.L.S.), San Francisco; the Sleep and Chronobiology Laboratory, Department of Integrative Physiology, University of Colorado Boulder, Boulder (K.P.W.), and Children's Hospital Colorado, University of Colorado School of Medicine, Aurora (A.C.H.); the University of Iowa Stead Family Children's Hospital, Iowa City (J.L.S.); Seattle Children's Hospital (J.K.M.) and the University of Washington (M.V.V., H.O.I.), Seattle; Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati (S.E.P.); University of Virginia Children's Hospital, Charlottesville (P.L.Y.); and the Department of Neurology and Center for Circadian and Sleep Medicine, Northwestern University, Feinberg School of Medicine, Chicago (P.C.Z.)
| | - Phyllis C Zee
- From the Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital (C.P.L., S.A.R., J.P.S., L.K.B., C.S.O., S.Q., M.A.S.H., S.W.L., C.A.C.), the Division of Sleep Medicine, Harvard Medical School (C.P.L., S.A.R., L.K.B., M.A.S.H., S.W.L., C.A.C.), and the Division of General Pediatrics, Department of Pediatrics (C.P.L.), and the Division of Critical Care Medicine, Department of Anesthesiology, Critical Care, and Pain Medicine (A.L.S.), Boston Children's Hospital - all in Boston; the University of California, San Francisco (E.V., K.L.S.), and California Pacific Medical Center Research Institute (K.L.S.), San Francisco; the Sleep and Chronobiology Laboratory, Department of Integrative Physiology, University of Colorado Boulder, Boulder (K.P.W.), and Children's Hospital Colorado, University of Colorado School of Medicine, Aurora (A.C.H.); the University of Iowa Stead Family Children's Hospital, Iowa City (J.L.S.); Seattle Children's Hospital (J.K.M.) and the University of Washington (M.V.V., H.O.I.), Seattle; Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati (S.E.P.); University of Virginia Children's Hospital, Charlottesville (P.L.Y.); and the Department of Neurology and Center for Circadian and Sleep Medicine, Northwestern University, Feinberg School of Medicine, Chicago (P.C.Z.)
| | - Steven W Lockley
- From the Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital (C.P.L., S.A.R., J.P.S., L.K.B., C.S.O., S.Q., M.A.S.H., S.W.L., C.A.C.), the Division of Sleep Medicine, Harvard Medical School (C.P.L., S.A.R., L.K.B., M.A.S.H., S.W.L., C.A.C.), and the Division of General Pediatrics, Department of Pediatrics (C.P.L.), and the Division of Critical Care Medicine, Department of Anesthesiology, Critical Care, and Pain Medicine (A.L.S.), Boston Children's Hospital - all in Boston; the University of California, San Francisco (E.V., K.L.S.), and California Pacific Medical Center Research Institute (K.L.S.), San Francisco; the Sleep and Chronobiology Laboratory, Department of Integrative Physiology, University of Colorado Boulder, Boulder (K.P.W.), and Children's Hospital Colorado, University of Colorado School of Medicine, Aurora (A.C.H.); the University of Iowa Stead Family Children's Hospital, Iowa City (J.L.S.); Seattle Children's Hospital (J.K.M.) and the University of Washington (M.V.V., H.O.I.), Seattle; Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati (S.E.P.); University of Virginia Children's Hospital, Charlottesville (P.L.Y.); and the Department of Neurology and Center for Circadian and Sleep Medicine, Northwestern University, Feinberg School of Medicine, Chicago (P.C.Z.)
| | - Katie L Stone
- From the Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital (C.P.L., S.A.R., J.P.S., L.K.B., C.S.O., S.Q., M.A.S.H., S.W.L., C.A.C.), the Division of Sleep Medicine, Harvard Medical School (C.P.L., S.A.R., L.K.B., M.A.S.H., S.W.L., C.A.C.), and the Division of General Pediatrics, Department of Pediatrics (C.P.L.), and the Division of Critical Care Medicine, Department of Anesthesiology, Critical Care, and Pain Medicine (A.L.S.), Boston Children's Hospital - all in Boston; the University of California, San Francisco (E.V., K.L.S.), and California Pacific Medical Center Research Institute (K.L.S.), San Francisco; the Sleep and Chronobiology Laboratory, Department of Integrative Physiology, University of Colorado Boulder, Boulder (K.P.W.), and Children's Hospital Colorado, University of Colorado School of Medicine, Aurora (A.C.H.); the University of Iowa Stead Family Children's Hospital, Iowa City (J.L.S.); Seattle Children's Hospital (J.K.M.) and the University of Washington (M.V.V., H.O.I.), Seattle; Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati (S.E.P.); University of Virginia Children's Hospital, Charlottesville (P.L.Y.); and the Department of Neurology and Center for Circadian and Sleep Medicine, Northwestern University, Feinberg School of Medicine, Chicago (P.C.Z.)
| | - Charles A Czeisler
- From the Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital (C.P.L., S.A.R., J.P.S., L.K.B., C.S.O., S.Q., M.A.S.H., S.W.L., C.A.C.), the Division of Sleep Medicine, Harvard Medical School (C.P.L., S.A.R., L.K.B., M.A.S.H., S.W.L., C.A.C.), and the Division of General Pediatrics, Department of Pediatrics (C.P.L.), and the Division of Critical Care Medicine, Department of Anesthesiology, Critical Care, and Pain Medicine (A.L.S.), Boston Children's Hospital - all in Boston; the University of California, San Francisco (E.V., K.L.S.), and California Pacific Medical Center Research Institute (K.L.S.), San Francisco; the Sleep and Chronobiology Laboratory, Department of Integrative Physiology, University of Colorado Boulder, Boulder (K.P.W.), and Children's Hospital Colorado, University of Colorado School of Medicine, Aurora (A.C.H.); the University of Iowa Stead Family Children's Hospital, Iowa City (J.L.S.); Seattle Children's Hospital (J.K.M.) and the University of Washington (M.V.V., H.O.I.), Seattle; Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati (S.E.P.); University of Virginia Children's Hospital, Charlottesville (P.L.Y.); and the Department of Neurology and Center for Circadian and Sleep Medicine, Northwestern University, Feinberg School of Medicine, Chicago (P.C.Z.)
| |
Collapse
|
39
|
Mikos M, Banaszewska A, Kutaj-Wąsikowska H, Kutryba B, Czerw A, Badowska-Kozakiewicz AM, Wójtowicz E. Occurrence of adverse events in the activity of hospital wards in the opinions of doctors and nursing management staff. Ann Agric Environ Med 2020; 27:306-309. [PMID: 32588611 DOI: 10.26444/aaem/106234] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
INTRODUCTION An adverse event is an incident induced while providing health care services or resulting from it, not related to the natural course of a given disease or health condition, which causes or is likely to cause negative consequences for the patient, including their death, a threat to life, the necessity of hospitalisation or its prolongation, permanent or considerable health detriment; or is a foetal disease, congenital defect or the result of foetal damage. OBJECTIVE The aim of this analysis is to explore the problem of the occurrence of adverse events from the perspective of doctors and ward nurses who manage wards. MATERIAL AND METHODS The research on the occurrence of adverse events among doctors and nurses (the management staff) was conducted with the use of a postal survey. RESULTS It was ascertained that 86.5% of the medical personnel had taken part in an adverse event, of which 20.2% took part in an occurrence associated with pharmacotherapy, 16.2% - in an event related to diagnostics and diagnosis, or an infection - 15.7%. 14.2% of respondents were involved in an occurrence linked to a medical device malfunction, and 14.1% - in an adverse event related to an operation. CONCLUSIONS The adverse events most often identified in the nursing professional group are occurrences associated with pharmacotherapy, and in the doctors' professional group - occurrences related to diagnostics and diagnosis. The research established that the most frequent reason for not informing patients about the occurrence of an adverse event is fear of their filing a complaint. Medical management staff show high acceptance of an adverse event reporting system as a tool for improving patient safety.
Collapse
Affiliation(s)
- Marcin Mikos
- Department of Emergency Medical Services, Faculty of Medicine Andrzej Frycz Modrzewski Krakow University, Poland
| | | | | | - Barbara Kutryba
- National Center for Quality Assessment in Health Care, Krakow, Poland
| | - Aleksandra Czerw
- Department of Health Economics and Medical Law, Medical University of Warsaw, Warsaw, Poland
| | | | - Ewa Wójtowicz
- National Center for Quality Assessment in Health Care, Krakow, Poland
| |
Collapse
|
40
|
Turrentine FE, Schenk WG, McMurry TL, Tache-Leon CA, Jones RS. Surgical errors and the relationships of disease, risks, and adverse events. Am J Surg 2020; 220:1572-1578. [PMID: 32456774 DOI: 10.1016/j.amjsurg.2020.05.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 04/18/2020] [Accepted: 05/05/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Relationships between surgical errors and adverse events have not been fully explored and were examined in this study. MATERIALS AND METHODS This retrospective cohort study reviewed records of deceased surgical patients over 12 months. Bivariate associations between predictors and errors were examined. RESULTS 84 deaths occurred following 5,209 operations. Errors in care (63%) compared to those without had significantly more adverse events, (98% vs 80% respectively, p = 0.004). Significant association occurred between error and emergency status, p = 0.016); length of stay >10 days, p = 0.011; adverse events, p = 0.005). Regression results indicated number of adverse events (OR = 1.27, 95% CI (1.08-1.49), p = 0.003) and length of stay (OR = 1.05, 95% CI (1.01-1.09), p = 0.008) were associated with surgical errors. CONCLUSIONS Examining postoperative adverse events in error cases identified opportunities for improvement. Reducing medical errors requires measuring medical errors.
Collapse
Affiliation(s)
| | | | - Timothy L McMurry
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA.
| | | | - R Scott Jones
- Department of Surgery, University of Virginia, Charlottesville, VA, USA.
| |
Collapse
|
41
|
Abstract
IMPORTANCE Despite the broad adoption of electronic health record (EHR) systems across the continuum of care, safety problems persist. OBJECTIVE To measure the safety performance of operational EHRs in hospitals across the country during a 10-year period. DESIGN, SETTING, AND PARTICIPANTS This case series included all US adult hospitals nationwide that used the National Quality Forum Health IT Safety Measure EHR computerized physician order entry safety test administered by the Leapfrog Group between 2009 and 2018. Data were analyzed from July 1, 2018 to December 1, 2019. EXPOSURE The Health IT Safety Measure test, which uses simulated medication orders that have either injured or killed patients previously to evaluate how well hospital EHRs could identify medication errors with potential for patient harm. MAIN OUTCOMES AND MEASURES Descriptive statistics for performance on the assessment test over time were calculated at the overall test score level, type of decision support category level, and EHR vendor level. RESULTS Among 8657 hospital-years observed during the study, mean (SD) scores on the overall test increased from 53.9% (18.3%) in 2009 to 65.6% (15.4%) in 2018. Mean (SD) hospital score for the categories representing basic clinical decision support increased from 69.8% (20.8%) in 2009 to 85.6% (14.9%) in 2018. For the categories representing advanced clinical decision support, the mean (SD) score increased from 29.6% (22.4%) in 2009 to 46.1% (21.6%) in 2018. There was considerable variation in test performance by EHR. CONCLUSIONS AND RELEVANCE These findings suggest that despite broad adoption and optimization of EHR systems in hospitals, wide variation in the safety performance of operational EHR systems remains across a large sample of hospitals and EHR vendors. Hospitals using some EHR vendors had significantly higher test scores. Overall, substantial safety risk persists in current hospital EHR systems.
Collapse
Affiliation(s)
- David C. Classen
- Division of Clinical Epidemiology, University of Utah School of Medicine, Salt Lake City
| | | | - Zoe Co
- Department of General Internal Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Lisa P. Newmark
- Clinical and Quality Analysis, Partners Healthcare, Somerville, Massachusetts
| | - Diane Seger
- Clinical and Quality Analysis, Partners Healthcare, Somerville, Massachusetts
| | | | - David W. Bates
- Department of General Internal Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
- Clinical and Quality Analysis, Partners Healthcare, Somerville, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
42
|
Naome T, James M, Christine A, Mugisha TI. Practice, perceived barriers and motivating factors to medical-incident reporting: a cross-section survey of health care providers at Mbarara regional referral hospital, southwestern Uganda. BMC Health Serv Res 2020; 20:276. [PMID: 32245459 PMCID: PMC7118859 DOI: 10.1186/s12913-020-05155-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 03/25/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Medical-incident reporting (MIR) ensures patient safety and delivery of quality of care by minimizing unintentional harm among health care providers. We explored medical-incident reporting practices, perceived barriers and motivating factors among health care providers at Mbarara Regional Referral Hospital (MRRH). METHODS We conducted a cross-sectional descriptive study on 158 health provider at Mbarara Regional Referral Hospital (MRRH), Western Uganda. Data was gathered using a structured questionnaire and analyzed with SPSS. The chi-square was used to determine factors associated with MIR at MRRH. RESULTS The results showed that there was no formal incident reporting structure. However the medical-incidences identified were: medication errors (89.9%), diagnostic errors (71.5%), surgical errors (52.5%) and preventive error (47.7%). The motivating factors of MIR were: establishment of a good communication system, instituting corrective action on the reported incidents and reinforcing health workers knowledge on MIR (p-value 0.004); presence of effective organizational systems like: written guidelines, practices of open door policy, no blame approach, and team work were significantly associated with MIR (p-value 0.000). On the other hand, perceived barriers to MIR were: lack of knowledge on incidents and their reporting, non-existence of an incident reporting team and fear of being punished (p- value 0.669). CONCLUSION Medical Incident Reporting at MRRH was sub-optimal. Therefore setting up an incident management team and conducting routine training MIR among health care workers will increase patient safety.
Collapse
Affiliation(s)
| | - Mwesigwa James
- Clarke International University, P.O Box 7782, Kampala, Uganda
| | | | | |
Collapse
|
43
|
TROIANO G, NANTE N, FANELLI A, ROSSOLINI G, PECILE P, BORDONARO P, PERUZZI B, LO RUBBIO M, TANINI T, DURANTI C, PICCINNO G, NICCOLINI F. The experience of Careggi Hospital (Florence) regarding Not Received Samples (NRS): a pilot study of Risk Management in the Clinical Laboratory. J Prev Med Hyg 2020; 61:E6-E8. [PMID: 32490262 PMCID: PMC7225659 DOI: 10.15167/2421-4248/jpmh2020.61.1.1218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 02/05/2020] [Indexed: 11/16/2022]
Affiliation(s)
- G. TROIANO
- Department of Molecular and Developmental Medicine, University of Siena, Italy
- Correspondence: Gianmarco Troiano, University of Siena, Department of Molecular and Developmental Medicine, via A. Moro 2, 53100 Siena, Italy - E-mail:
| | - N. NANTE
- Department of Molecular and Developmental Medicine, University of Siena, Italy
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
44
|
Waterson P. Causation, levels of analysis and explanation in systems ergonomics - A Closer Look at the UK NHS Morecambe Bay investigation. Appl Ergon 2020; 84:103011. [PMID: 31987507 DOI: 10.1016/j.apergo.2019.103011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 10/11/2019] [Accepted: 11/22/2019] [Indexed: 06/10/2023]
Abstract
This paper extends an earlier examination of the concept of 'mesoergonomics' (Karsh et al., 2014) and its application to Human Factors/Ergonomics (HFE). Karsh et al. (2014) developed a framework for mesoergonomic inquiry based on a set of steps and questions, the purpose of which was to encourage researchers to cross system levels in the studies (e.g., organisation-group-individual levels of analysis) and to explore alternative causal mechanisms and relationships within their data. The present paper further develops the framework and draws on previous work across a diverse range of sources (safety science, systems theory, the sociology of disaster and ethology) which has examined the subject of accident causation, levels of analysis and explanatory factors contributing to system failure. The outcomes from this exercise are a revised framework which seeks to explore what we term 'isomorphisms' and includes questions covering: (a) how internal isomorphisms develop or evolve within the system; and, (b) how these isomorphisms are shaped by cultural, professional and other forms of external influence. The workings of the revised framework are illustrated through using the example of the UK NHS Morecambe Bay Investigation (Kirkup, 2015). The paper concludes with a summary of ways forward for the framework, as well as new directions for theory within systems ergonomics/human factors.
Collapse
Affiliation(s)
- Patrick Waterson
- Human Factors and Complex Systems Group, School of Design and Creative Arts, Loughborough University, Loughborough, LE11 3TU, UK.
| |
Collapse
|
45
|
Eulmesekian PG, Alvarez JP, Ceriani Cernadas JM, Pérez A, Berberis S, Kondratiuk Y. The occurrence of adverse events is associated with increased morbidity and mortality in children admitted to a single pediatric intensive care unit. Eur J Pediatr 2020; 179:473-482. [PMID: 31814049 DOI: 10.1007/s00431-019-03528-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 10/22/2019] [Accepted: 11/10/2019] [Indexed: 11/30/2022]
Abstract
Healthcare can cause harm. The goal of this study is to evaluate the association between the occurrence of adverse events (AEs) and morbidity-mortality in critically ill children. A prospective cohort study was designed. All children admitted to the Pediatric Intensive Care Unit (PICU) between August 2016 and July 2017 were followed. An AE was considered any harm associated with a healthcare-related incident. AEs were identified in two steps: first, adverse clinical incidents (ACI) were recognized through direct observation and active surveillance by PICU physicians, and then the patient safety committee evaluated every ACI to define which would be considered an AE. The outcome was hospital morbidity-mortality. There were 467 ACI registered, 249 (53.31%) were considered AEs and the rate was 4.27/100 patient days. From the 842 children included, 142 (16.86%) suffered AEs, 39 (4.63%) experienced morbidity-mortality: 33 (3.92%) died, and 6 (0.71%) had morbidity. Multivariate analysis revealed that the occurrence of AEs was significantly associated with morbidity-mortality, OR 5.70 (CI95% 2.58-12.58, p = 0.001). This association was independent of age and severity of illness score.Conclusion: Experiencing AEs significantly increased the risk of morbidity-mortality in this cohort of PICU children.What is Known:• Many children suffer healthcare-associated harm during pediatric intensive care hospitalization.What is New:• This prospective cohort study shows that experiencing adverse events during pediatric intensive care hospitalization significantly increases the risk of morbidity and mortality independent of age and severity of illness at admission.
Collapse
Affiliation(s)
- Pablo G Eulmesekian
- Pediatric Intensive Care Unit, Hospital Italiano de Buenos Aires, Perón 4190, CP 1181, Autonomous City of Buenos Aires, Argentina.
| | - Juan P Alvarez
- Pediatric Intensive Care Unit, Hospital Italiano de Buenos Aires, Perón 4190, CP 1181, Autonomous City of Buenos Aires, Argentina
| | - José M Ceriani Cernadas
- Patient Safety Committee|, Hospital Italiano de Buenos Aires, Autonomous City of Buenos Aires, Argentina
| | - Augusto Pérez
- Pediatric Intensive Care Unit, Hospital Italiano de Buenos Aires, Perón 4190, CP 1181, Autonomous City of Buenos Aires, Argentina
| | - Stefanía Berberis
- Pediatric Intensive Care Unit, Hospital Italiano de Buenos Aires, Perón 4190, CP 1181, Autonomous City of Buenos Aires, Argentina
| | - Yanel Kondratiuk
- Pediatric Intensive Care Unit, Hospital Italiano de Buenos Aires, Perón 4190, CP 1181, Autonomous City of Buenos Aires, Argentina
| |
Collapse
|
46
|
Abstract
The medico-legal autopsy is an essential tool in investigating deaths caused by an adverse event in health care, for both clinical risk management and for professional liability issues. However, there are no statistics available regarding the frequency of autopsies performed due to suspected adverse events. This study aimed to determine the number of medico-legal autopsies done because of presumed adverse events, whether these events were unintentional, medical errors or cases in which malpractice was suspected. Furthermore, differences in treatment types, causes and manner of death were analyzed. The data was obtained from all medico-legal autopsies performed in Northern Finland and Lapland during 2014-2015 (n = 2027). Adverse events were suspected in 181 (8.9%) cases. The suspicions of an adverse event occurring were most often related to medication, gastrointestinal surgery and orthopedic surgery. The manner of death was classified as medical (or surgical) treatment or investigative procedure in 22 (12.2%) cases. The causes of death were completely unrelated to the suspected adverse event in 41 (22.7%) cases. In conclusion, the frequency of presumed adverse events was quite high in this data set, but in the majority of the cases, the suspicion of an adverse event causing death was disproved by an autopsy. Nonetheless, proper investigation of these cases is essential to ensure legal protection of the deceased, next of kin and health care personnel, as well as to support clinical risk management.
Collapse
Affiliation(s)
- Lasse Pakanen
- Forensic Medicine Unit, National Institute for Health and Welfare (THL), P.O. Box 310, FI-90101, Oulu, Finland.
- Department of Forensic Medicine, Research Unit of Internal Medicine, Medical Research Center Oulu, University of Oulu, P.O. Box 5000, FI-90014, Oulu, Finland.
| | - Noora Keinänen
- Forensic Medicine Unit, National Institute for Health and Welfare (THL), P.O. Box 310, FI-90101, Oulu, Finland
| | - Paula Kuvaja
- Forensic Medicine Unit, National Institute for Health and Welfare (THL), P.O. Box 310, FI-90101, Oulu, Finland
- Department of Pathology, Oulu University Hospital, P.O. Box 50, FI-90029 - OYS, Oulu, Finland
| |
Collapse
|
47
|
Schaefer MK, Perkins KM, Perz JF. Patient Notification Events Due to Syringe Reuse and Mishandling of Injectable Medications by Health Care Personnel-United States, 2012-2018: Summary and Recommended Actions for Prevention and Response. Mayo Clin Proc 2020; 95:243-254. [PMID: 31883694 PMCID: PMC7864048 DOI: 10.1016/j.mayocp.2019.08.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 07/23/2019] [Accepted: 08/13/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To summarize patient notifications resulting from unsafe injection practices by health care personnel in the United States and describe recommended actions for prevention and response. PATIENTS AND METHODS We examined records of events involving communications to groups of patients, conducted from January 1, 2012, through December 31, 2018, in which bloodborne pathogen testing was recommended or offered because of potential exposure to unsafe injection practices by health care personnel in the United States. Information compiled included: health care setting(s), type of unsafe injection practice(s), number of patients notified, number of outbreak-associated infections, and whether evidence suggesting bloodborne pathogen transmission prompted the notification. We compared these numbers with a similar review conducted from January 1, 2001, through December 31, 2011. RESULTS From 2012 through 2018, more than 66,748 patients were notified as part of 38 patient notification events. Twenty-one involved exposures in non-hospital settings. Twenty-five involved syringe and/or needle reuse in the context of routine patient care; 11 involved drug tampering by a health care provider. The majority of events (n=25) were prompted by identification of unsafe injection practices alone, absent any documented infections at the time of notification. Outbreak-associated hepatitis B virus and/or hepatitis C virus infections were documented for 11 of the events; 8 involved patient-to-patient transmission, and 3 involved provider-to-patient transmission. CONCLUSIONS Since 2001, nearly 200,000 patients in the United States were notified about potential exposure to blood-contaminated medications or injection equipment. Facility leadership has an obligation to ensure adherence to safe injection practices and to respond properly if unsafe injection practices are identified.
Collapse
Affiliation(s)
- Melissa K Schaefer
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, GA.
| | - Kiran M Perkins
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, GA
| | - Joseph F Perz
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, GA
| |
Collapse
|
48
|
Marra AR, Algwizani A, Alzunitan M, Brennan TMH, Edmond MB. Descriptive Epidemiology of Safety Events at an Academic Medical Center. Int J Environ Res Public Health 2020; 17:ijerph17010353. [PMID: 31947963 PMCID: PMC6982027 DOI: 10.3390/ijerph17010353] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 12/26/2019] [Accepted: 01/02/2020] [Indexed: 11/16/2022]
Abstract
Background: Adverse safety events in healthcare are of great concern, and despite an increasing focus on the prevention of error and harm mitigation, the epidemiology of safety events remains incomplete. Methods: We performed an analysis of all reported safety events in an academic medical center using a voluntary incident reporting surveillance system for patient safety. Safety events were classified as: serious (reached the patient and resulted in moderate to severe harm or death); precursor (reached the patient and resulted in minimal or no detectable harm); and near miss (did not reach the patient). Results: During a three-year period, there were 31,817 events reported. Most of the safety events were precursor safety events (reached the patient and resulted in minimal harm or no detectable harm), corresponding to 77.3%. Near misses accounted for 10.8%, and unsafe conditions for 11.8%. The number of reported serious safety events was low, accounting for only 0.1% of all safety events. Conclusions: The reports analysis of these events should lead to a better understanding of risks in patient care and ways to mitigate it.
Collapse
Affiliation(s)
- Alexandre R. Marra
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA 52242, USA; (A.A.); (M.A.); (T.M.H.B.); (M.B.E.)
- Division of Medical Practice, Hospital Israelita Albert Einstein, 05652 São Paulo, Brazil
- Correspondence: ; Tel.: +1-319-353-7155; Fax: +1-319-353-7043
| | - Abdullah Algwizani
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA 52242, USA; (A.A.); (M.A.); (T.M.H.B.); (M.B.E.)
- Division of Infectious Diseases, Prince Mohammad Bin Abdulaziz Hospital, Riyadh 14214, Saudi Arabia
| | - Mohammed Alzunitan
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA 52242, USA; (A.A.); (M.A.); (T.M.H.B.); (M.B.E.)
- Department of Infection Prevention and Control, King Abdulaziz Medical City, National Guard-Health Affairs, Riyadh 14611, Saudi Arabia
| | - Theresa M. H. Brennan
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA 52242, USA; (A.A.); (M.A.); (T.M.H.B.); (M.B.E.)
| | - Michael B. Edmond
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA 52242, USA; (A.A.); (M.A.); (T.M.H.B.); (M.B.E.)
| |
Collapse
|
49
|
Popivanov G, Cirocchi R, Popov G, Stefanovski P, Andonova R, Kjossev K, Tonchev P, Tabakov M, Penkov M, Ivanov P, Mutafchiyski V. An analysis of missed cases with surgical emergencies admitted in non-surgical departments. Case series and а review of the literature. G Chir 2020; 41:66-72. [PMID: 32038014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
INTRODUCTION The delayed diagnosis in emergency surgery can be associated with significant morbidity and mortality and often lead to litigations. The aim of the present work is to analyse the outcome in cases with non-trauma surgical emergencies wrongly admitted in non-surgical departments. METHODS A retrospective trial in two independent University hospitals was conducted. The first group encompassed the patients worked-up in the Surgical unit of Emergency department (2014-2018). The second one included all cases visited Emergency department (2018). Only cases with acute abdomen and delayed diagnosis and operation were included. The analysis included the proportion of the delayed diagnosis, time between admission and operation, intraoperative diagnosis, complications and mortality rate. RESULTS In the first group there were 30 194 visits in the surgical unit with 15 836 hospitalizations (52.4%). Twenty patients of the last (0.13%) were admitted in the Clinic of Infectious disease and subsequently operated. The mean delay between hospitalization and operation was 3 days (1-10). Seventeen patients (85%) were operated with mortality of 10%. In the second group, there were a total of 22 760 visits with 11 562 discharged cases. Of the last, 1.7% (n=192) were re-admitted in a surgical ward, 25 of which underwent urgent surgery (0.2%). CONCLUSIONS The missed surgical cases represent only a small proportion of the patients in emergency department. The causes for wrong initial admissions in our series were misinterpretation of the symptoms, insufficient clinical examination and underuse of US and CT. The careful clinical assessment, point-of care US and CT may decrease the rate of the delayed diagnosis.
Collapse
|
50
|
Mazeikiene S, Stasiuniene J, Vasiljevaite D, Laima S, Chmieliauskas S, Fomin D, Simakauskas R, Jasulaitis A. Deontological examination as a criterion for the assessment of personal healthcare professional quality: A Strobe compliant retrospective study. Medicine (Baltimore) 2020; 99:e18770. [PMID: 32011467 PMCID: PMC7220242 DOI: 10.1097/md.0000000000018770] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Discrepancies between clinical and autopsy diagnoses range from 30% to 37%. The significance of deontological examinations remains high. In the pursuit of proper evaluation of diagnostic discrepancies, the establishment of pathogenesis, the mechanism of death, and a correct diagnosis are of particular importance.A retrospective study of deontological examinations, aimed at the detection of medical errors and carried out by the State Forensic Medicine Service during the period 1989 to 2016, was performed. The clinical and autopsy data from 1007 cases were collected in compliance with the research protocol.The number of deontological examinations tends to increase. In 60% of cases, the deceased were men. Most cases were in the age group of 50 to 59 years. Most examinations were carried out in relation to improperly provided healthcare services and the patient's death in surgery, admission, intensive care and obstetrics-gynecology departments. In 13% of cases, the diagnosis did not coincide and, in 79% of cases, the diagnoses fully coincided. In 68% of cases, the medical error was disproved.The number of deontological examinations is increasing. In most cases, clinical and autopsy diagnoses fully matched. Incorrectly clinically diagnosed intracranial injuries were the most common diagnostic mistakes. The data are similar to the results of research in other countries and would be relevant to ensuring the prevention of medical mistakes and the improvement of healthcare quality.
Collapse
|