1
|
Lounsbury O, Sujan M, Catchpole K. From Compliance to Collaboration: Learning From Transatlantic Frameworks for Healthcare Safety Improvement. J Patient Saf 2024:01209203-990000000-00249. [PMID: 39105630 DOI: 10.1097/pts.0000000000001257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/07/2024]
Affiliation(s)
| | - Mark Sujan
- University of York, York, United Kingdom
| | - Ken Catchpole
- Medical University of South Carolina, Columbia, South Carolina
| |
Collapse
|
2
|
Roth MJ, Maggio LA, Costello JA, Samuel A. E-learning Interventions for Quality Improvement Continuing Medical Education-A Scoping Review. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2024:00005141-990000000-00116. [PMID: 39028318 DOI: 10.1097/ceh.0000000000000564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/20/2024]
Abstract
INTRODUCTION Improving health care quality and patient safety are top priorities for the medical field. Robust continuing medical education (CME) programs represent major interventions to effectively teach quality improvement (QI) principles to practicing physicians. In particular, eLearning, a term describing online and distance learning interventions using digital tools, provides a means for CME interventions to reach broader audiences. Although there has been a focus on CME addressing QI, no knowledge synthesis has focused specifically on eLearning interventions. The purpose of this review was to examine the current landscape of eLearning interventions in QI-focused CME. METHODS We conducted a scoping review using the framework developed by Arksey and O'Malley as revised by Levac. We searched five databases and identified 2467 prospective publications, which two authors independently screened for inclusion. From each included article, two authors independently extracted data on the instructional modalities and QI tools used and met regularly to achieve consensus. RESULTS Twenty-one studies were included. Most studies used blended instruction (n = 12) rather than solely eLearning interventions. Salient findings included the importance of coaching from QI experts and institutional support for planning and implementing eLearning interventions. Lack of protected time and resources for participants were identified as barriers to participation in CME activities, with small practices being disproportionately affected. DISCUSSION Partnerships between CME developers and sponsoring organizations are vital in creating sustainable eLearning interventions for QI-focused CME. Remote coaching can be an effective strategy to provide ongoing support to geographically separated learners.
Collapse
Affiliation(s)
- Michael J Roth
- Dr. Roth: Assistant Professor of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD. Dr. Maggio: Professor of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD. Mr. Costello: Research Associate, Uniformed Services University of the Health Sciences, Bethesda, MD. Dr. Samuel: Associate Professor of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD
| | | | | | | |
Collapse
|
3
|
Hamad DM, Subacius H, Thomas A, Guttman MP, Tillmann BW, Jerath A, Haas B, Nathens AB. A multidimensional approach to identifying high-performing trauma centers across the United States. J Trauma Acute Care Surg 2024; 97:125-133. [PMID: 38480489 DOI: 10.1097/ta.0000000000004313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/26/2024]
Abstract
INTRODUCTION The differentiators of centers performing at the highest level of quality and patient safety are likely both structural and cultural. We aimed to combine five indicators representing established domains of trauma quality and to identify and describe the structural characteristics of consistently performing centers. METHODS Using American College of Surgeons Trauma Quality Improvement Program data from 2017 to 2020, we evaluated five quality measures across several care domains for adult patients in levels I and II trauma centers: (1) time to operating room for patients with abdominal gunshot wounds and shock, (2) proportion of patients receiving timely venous thromboembolism prophylaxis, (3) failure to rescue (death following a complication), (4) major hospital complications, and (5) mortality. Overall performance was summarized as a composite score incorporating all measures. Centers were ranked from highest to lowest performer. Principal component analysis showed the influence of each indicator on overall performance and supported the composite score approach. RESULTS We identified 272 levels I and II centers, with 28 and 27 centers in the top and bottom 10%, respectively. Patients treated in high-performing centers had significant lower rates of death major complications and failure to rescue, compared with low-performing centers ( p < 0.001). The median time to operating room for gunshot wound was almost half that in high compared with low-performing centers, and rates of timely venous thromboembolism prophylaxis were over twofold greater ( p < 0.001). Top performing centers were more likely to be level I centers and cared for a higher number of severely injured patients per annum. Each indicator contributed meaningfully to the variation in scores and centers tended to perform consistently across most indicators. CONCLUSION The combination of multiple indicators across dimensions of quality sets a higher standard for performance evaluation and allows the discrimination of centers based on structural elements, specifically level 1 status, and trauma center volume. LEVEL OF EVIDENCE Therapeutic /Care Management; Level IV.
Collapse
Affiliation(s)
- Doulia M Hamad
- From the Department of Surgery (D.M.H., M.P.G., B.H., A.B.N.), Sunnybrook Health Sciences Center and the University of Toronto; Institute of Health Policy, Management, and Evaluation (D.M.H., A.B.N.), University of Toronto, Toronto, Ontario, Canada; The Society of Thoracic Surgeons (H.S.), Chicago, Illinois; Medical College of Wisconsin (A.T.), Milwaukee, Wisconsin; Interdepartmental Division of Critical Care (B.W.T., B.H.), University of Toronto; Tory Trauma Program (B.W.T., A.B.N.), Sunnybrook Health Sciences Center; Department of Medicine (B.W.T.), Division of Respirology and Critical Care Medicine, University Health Network; Sunnybrook Research Institute (B.W.T., A.J., B.H., A.B.N.), Sunnybrook Health Sciences Centre; Department of Anesthesia (A.J.), Sunnybrook Health Sciences Center University of Toronto; Department of Critical Care Medicine (B.H.), Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; and American College of Surgeons (A.B.N.), Chicago, Illinois
| | | | | | | | | | | | | | | |
Collapse
|
4
|
Uematsu H, Uemura M, Kurihara M, Yamamoto H, Umemura T, Kitano F, Hiramatsu M, Nagao Y. Development of a scoring system to quantify errors from semantic characteristics in incident reports. BMJ Health Care Inform 2024; 31:e100935. [PMID: 38642920 PMCID: PMC11033660 DOI: 10.1136/bmjhci-2023-100935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 04/02/2024] [Indexed: 04/22/2024] Open
Abstract
OBJECTIVES Incident reporting systems are widely used to identify risks and enable organisational learning. Free-text descriptions contain important information about factors associated with incidents. This study aimed to develop error scores by extracting information about the presence of error factors in incidents using an original decision-making model that partly relies on natural language processing techniques. METHODS We retrospectively analysed free-text data from reports of incidents between January 2012 and December 2022 from Nagoya University Hospital, Japan. The sample data were randomly allocated to equal-sized training and validation datasets. We conducted morphological analysis on free text to segment terms from sentences in the training dataset. We calculated error scores for terms, individual reports and reports from staff groups according to report volume size and compared these with conventional classifications by patient safety experts. We also calculated accuracy, recall, precision and F-score values from the proposed 'report error score'. RESULTS Overall, 114 013 reports were included. We calculated 36 131 'term error scores' from the 57 006 reports in the training dataset. There was a significant difference in error scores between reports of incidents categorised by experts as arising from errors (p<0.001, d=0.73 (large)) and other incidents. The accuracy, recall, precision and F-score values were 0.8, 0.82, 0.85 and 0.84, respectively. Group error scores were positively associated with expert ratings (correlation coefficient, 0.66; 95% CI 0.54 to 0.75, p<0.001) for all departments. CONCLUSION Our error scoring system could provide insights to improve patient safety using aggregated incident report data.
Collapse
Affiliation(s)
- Haruhiro Uematsu
- Department of Quality and Patient Safety, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Masakazu Uemura
- Department of Patient Safety, Nagoya University Hospital, Nagoya, Aichi, Japan
| | - Masaru Kurihara
- Department of Patient Safety, Nagoya University Hospital, Nagoya, Aichi, Japan
| | - Hiroo Yamamoto
- Department of Patient Safety, Nagoya University Hospital, Nagoya, Aichi, Japan
| | - Tomomi Umemura
- Department of Patient Safety, Nagoya University Hospital, Nagoya, Aichi, Japan
| | - Fumimasa Kitano
- Department of Patient Safety, Nagoya University Hospital, Nagoya, Aichi, Japan
| | - Mariko Hiramatsu
- Department of Patient Safety, Nagoya University Hospital, Nagoya, Aichi, Japan
| | - Yoshimasa Nagao
- Department of Quality and Patient Safety, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
- Department of Patient Safety, Nagoya University Hospital, Nagoya, Aichi, Japan
| |
Collapse
|
5
|
Raval MV. Invited Commentary: Making Operating Rooms Safer: Communication, Teamwork, and Investment in Technologies Are Needed. J Am Coll Surg 2023; 237:872-873. [PMID: 37646440 DOI: 10.1097/xcs.0000000000000848] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
|
6
|
Kane J, Munn L, Kane SF, Srulovici E. Defining Speaking Up in the Healthcare System: a Systematic Review. J Gen Intern Med 2023; 38:3406-3413. [PMID: 37670070 PMCID: PMC10682351 DOI: 10.1007/s11606-023-08322-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 07/03/2023] [Indexed: 09/07/2023]
Abstract
BACKGROUND Communication issues have been shown to contribute to healthcare errors. For years healthcare professionals have been told to "speak up." What "speak up" means is unclear, as it has been defined and operationalized in many ways. Thus, this study aimed to systematically review the literature regarding definitions and measurements of speaking up in the healthcare system and to develop a single, comprehensive definition and operationalization of the concept. METHODS PubMed, CINAHL, PsychoInfo, and Communication/Mass Media Complete databases were searched from 1999 to 2020. Publications were included if they mentioned speaking up for patient safety or any identified synonyms. Articles that used the term speaking up concerning non-health-related topics were excluded. This systematic review utilized Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. RESULTS A total of 294 articles met the inclusion criteria, yet only 58 articles focused on speaking up. While the most common synonym terms identified were "speak up" and "raise concern," only 43 articles defined speaking up. Accordingly, a modified definition was developed for speaking up-A healthcare professional identifying a concern that might impact patient safety and using his or her voice to raise the concern to someone with the power to address it. DISCUSSION Speaking up is considered important for patient safety. Yet, there has been a lack of agreement on the definition and operationalization of speaking up. This review demonstrates that speaking up should be reconceptualized to provide a single definition for speaking up in healthcare.
Collapse
Affiliation(s)
- Julia Kane
- School of Nursing, Fayetteville State University, Fayetteville, NC, USA
| | - Lindsay Munn
- Clinical and Translational Science Institute, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Shawn F Kane
- Department of Family Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Einav Srulovici
- The Cheryl Spencer Department of Nursing, University of Haifa, Haifa, Israel.
| |
Collapse
|
7
|
Ho VT, Klumpp TR, Liang WH, Prestegaard M, Horwitz M, Hamilton BK, Page K, Jaglowski S, Huber J, Martinez C, Shenoy V, Chen A, Rizzo D. Cell Therapy Informatics: Updates on the Integration of HCT/IEC Functionalities into an Electronic Medical Record System in the US to Promote Efficiency, Patient Safety, Research, and Data Interoperability. Transplant Cell Ther 2023; 29:539-547. [PMID: 37379969 DOI: 10.1016/j.jtct.2023.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 06/21/2023] [Indexed: 06/30/2023]
Abstract
The use of electronic health/medical record (EMR) systems has streamlined medical practice and improved efficiency of clinical care in recent years. However, EMR systems are not generally well designed to support research and tracking of longitudinal outcomes across populations, which are particularly important in hematopoietic stem cell transplantation (HCT) and immune effector cell therapy (IEC), where data reporting to registries and regulatory agencies are often required. Since its formation in 2014, the HCT EMR user group has worked with a large EMR vendor (Epic) to develop many functionalities within the EMR to improve the care of HCT/IEC patients and facilitate the capture of HCT/IEC data in an easily interoperable format. Awareness and the widespread adoption of these new tools among transplant centers remains a challenge, however. In this report, we aim to increase awareness and adoption of these new features in the Epic EMR across the transplantation community, advocate for the use of data standards, and promote future collaboration with other commercial EMRs to develop standardized HCT/IEC content to improve patient care and facilitate interoperable data exchange.
Collapse
Affiliation(s)
- Vincent T Ho
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts.
| | - Thomas R Klumpp
- Department of Medical Oncology, Thomas Jefferson University School of Medicine, Philadelphia, Pennsylvania
| | - Wayne H Liang
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta and Emory University, Atlanta, Georgia
| | | | - Mitchell Horwitz
- Adult Blood and Marrow Transplant Program, Duke University Medical Center, Durham, North Carolina
| | - Betty K Hamilton
- Blood and Marrow Transplant Program, Cleveland Clinic, Cleveland, Ohio
| | - Kristin Page
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Madison, Wisconsin
| | | | - John Huber
- Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Charles Martinez
- Department of Stem Cell Transplantation and Cellular Therapy, MD Anderson Cancer Center, Houston, Texas
| | - Vinaya Shenoy
- Software Development, Epic Systems Corporation, Verona, Wisconsin
| | - Allen Chen
- Pediatric Hematology and Oncology, Johns Hopkins University, Baltimore, Maryland
| | - Douglas Rizzo
- Division of Hematology and Oncology, Froedtert & the Medical College of Wisconsin Cancer Center Cancer, Medical College of Wisconsin, Madison, Wisconsin
| |
Collapse
|
8
|
Immonen H, Raekallio M, Holmström AR. Promoting veterinary medication safety - Exploring the competencies of community pharmacy professionals in veterinary pharmacotherapy. Vet Anim Sci 2023; 21:100310. [PMID: 37664413 PMCID: PMC10468355 DOI: 10.1016/j.vas.2023.100310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2023] Open
Abstract
The science of veterinary medicine is currently lacking studies on medication safety, although its importance in protecting animals from medication errors is central. Pharmacy professionals have an important role in ensuring medication safety of both prescription and over-the-counter medications of animals. However, this requires adequate competencies of pharmacy professionals in veterinary pharmacotherapy. The present study aimed to explore the competencies of pharmaceutical staff in community pharmacies in veterinary pharmacotherapy, which factors influence these competencies and what kind of information sources they typically use on veterinary pharmacotherapy. The study was conducted as a cross-sectional online survey targeted to pharmacy professionals in the Finnish community pharmacies, providing 596 responses. Less than half of the respondents (41%, n = 246) are considered to possess good competencies in veterinary pharmacotherapy. A third of the respondents (35%, n = 211) would dispense an anti-inflammatory drug for an animal off-label, whereas 24% (n = 145) would not interview the pet owner to discover the need for internal parasite medication before dispensing the drug. A small proportion (<1%, n = 5) would have dispensed a broad-spectrum internal parasite medication. Approximately a quarter of the respondents (27%, n = 159) stated that they acquired information on pharmacotherapy only from the material produced by the manufacturers of veterinary drugs. The competencies of pharmacy professionals in veterinary pharmacotherapy need to be strengthened in many areas to better promote veterinary medication safety. It should also be ensured that pharmacy professionals can access and use independent, high-quality information on veterinary pharmacotherapy.
Collapse
Affiliation(s)
- H. Immonen
- Faculty of Pharmacy, Division of pharmacology and pharmacotherapy, University of Helsinki, Viikinkaari 5 E, 00014, Finland
| | - M.R. Raekallio
- Faculty of Veterinary Medicine, Department of Equine and Small Animal Medicine, University of Helsinki, Koetilantie 2, 00014, Finland
| | - A-R. Holmström
- Faculty of Pharmacy, Division of pharmacology and pharmacotherapy, University of Helsinki, Viikinkaari 5 E, 00014, Finland
- Faculty of Veterinary Medicine, Department of Equine and Small Animal Medicine, University of Helsinki, Koetilantie 2, 00014, Finland
| |
Collapse
|
9
|
Hanners A, Alston A, Masciola R. The business of Doctor of Nursing Practice (DNP) education: Practical application strategies to apply business concepts in DNP education. J Prof Nurs 2023; 46:45-51. [PMID: 37188421 DOI: 10.1016/j.profnurs.2022.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 11/02/2022] [Accepted: 11/05/2022] [Indexed: 03/06/2023]
Abstract
PURPOSE The purpose of this article is to 1) review updated business competencies in The Essentials: Core Competencies for Professional Nursing Education for Advanced-Level Nursing Education (2021) and 2) suggest strategies on how to integrate business and finance concepts encompassing quality, safety, and systems-based practice into DNP educational curricula. BACKGROUND The Institute of Medicine recognizes strong nursing leadership on all system levels from "bedside to boardroom" as critical to redesigning healthcare that is affordable and accessible. The business of healthcare requires the DNP-prepared nurse to be equipped to understand and navigate business principles necessary for sustainable change to improve patient outcomes. The updated 2021 AACN Essentials include enhanced business concepts and competencies as curricular elements to prepare practice-ready DNP prepared leaders. FINDINGS Current healthcare translation of research to practice has historically been slow, and only recently has the average time for research to translate to practice decreased from 17 years to 15 years. DNP-prepared nurses, as evidence-based practice and quality improvement experts, are positioned perfectly to reduce this research translation time gap to improve patient outcomes by implementing evidence-based change. Employers outside the academic setting, and arguably even within the academic setting, often fail to understand this unique skill set of a DNP-prepared nurse. A lack of business expertise disadvantages s the DNP-prepared nurses 'ability to effectively communicate and demonstrate the ROI and value added to an organization or interprofessional team. Achieving competency with business concepts during DNP education such as marketing, budgeting, return on investment, healthcare finance and interprofessional collaboration are critical components for a practice-ready DNP graduate as noted within the revised AACN Essentials (2021). DISCUSSION The didactic content of business education that meets the 2021 AACN Essentials can be integrated in established DNP core courses or through creating new courses in the curriculum. Students through innovative assignments, immersion experiences, and the DNP final scholarly project can demonstrate application and competence of learned business principles. Strategically integrating business concepts into DNP curriculum provides multiple benefits to the DNP graduate, organizations, and ultimately, patients.
Collapse
|
10
|
The Essential Pharmacist. PHYSICIAN ASSISTANT CLINICS 2023. [DOI: 10.1016/j.cpha.2022.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
|
11
|
Paquay M, Diep AN, Kabanda Z, Ancion A, Piazza J, Ghuysen A. Impact of the Covid-19 crisis on the hospital work environment and organization: A mixed-methods study. INTERNATIONAL JOURNAL OF HEALTHCARE MANAGEMENT 2023. [DOI: 10.1080/20479700.2023.2190252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Affiliation(s)
- Méryl Paquay
- Emergency Department, University Hospital of Liege, Quartier Hôpital, Liege, Belgium
- Center for Medical Simulation of Liege, Quartier Hôpital, University of Liege, Liege, Belgium
| | - Anh Nguyet Diep
- Biostatistics Unit, Quartier Hôpital, University of Liège, Liège, Belgium
| | - Zoé Kabanda
- Center for Medical Simulation of Liege, Quartier Hôpital, University of Liege, Liege, Belgium
| | - Aurore Ancion
- Emergency Department, University Hospital of Liege, Quartier Hôpital, Liege, Belgium
| | - Justine Piazza
- Emergency Department, University Hospital of Liege, Quartier Hôpital, Liege, Belgium
| | - Alexandre Ghuysen
- Emergency Department, University Hospital of Liege, Quartier Hôpital, Liege, Belgium
- Center for Medical Simulation of Liege, Quartier Hôpital, University of Liege, Liege, Belgium
| |
Collapse
|
12
|
Dyrbye LN, Gordon J, O'Horo J, Belford SM, Wright M, Satele DV, West CP. Relationships Between EHR-Based Audit Log Data and Physician Burnout and Clinical Practice Process Measures. Mayo Clin Proc 2023; 98:398-409. [PMID: 36868747 DOI: 10.1016/j.mayocp.2022.10.027] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 10/19/2022] [Accepted: 10/31/2022] [Indexed: 03/05/2023]
Abstract
OBJECTIVE To explore the relationship of electronic health record (EHR)-based audit log data with physician burnout and clinical practice process measures. METHODS From September 4 to October 7, 2019, we surveyed physicians in a larger academic medical department and matched responses to August 1 through October 31, 2019, EHR-based audit log data. Multivariable regression analysis evaluated the relationship between log data and burnout and the interrelationship between log data and turnaround time for In Basket messages and percentage of encounters closed within 24 hours. RESULTS Of the 537 physicians surveyed, 413 (77%) responded. On multivariable analysis, number of In Basket messages received per day (each additional message: odds ratio, 1.04 [95% CI, 1.02 to 1.07]; P<.001) and time spent in the EHR outside scheduled patient care (each additional hour: odds ratio, 1.01 [95% CI, 1.00 to 1.02]; P=.04) were associated with burnout. Time spent doing In Basket work (each additional minute: parameter estimate, -0.11 [95% CI, -0.19 to -0.03]; P=.01) and in the EHR outside scheduled patient care (each additional hour: parameter estimate, 0.04 [95% CI, 0.01 to 0.06]; P=.002) were associated with turnaround time (days per message) for In Basket messages. None of the variables explored were independently associated with percentage of encounters closed within 24 hours. CONCLUSION Electronic health record-based audit log data of workload relate to odds of burnout and responsiveness to patient-related inquiries and results. Further study is needed to determine whether interventions that reduce the number of and time spent doing In Basket messages or time spent in the EHR outside scheduled patient care reduce physician burnout and improve clinical practice process measures.
Collapse
Affiliation(s)
- Liselotte N Dyrbye
- Department of Medicine. University of Colorado School of Medicine, Denver, CO.
| | - Joel Gordon
- Department of Family Medicine, Mayo Clinic Health System, Mankato, MN; Deparment of Medicine, Division of Public Health, Infectious Disease, and Occupational Medicine
| | - John O'Horo
- Division of Public Health, Infectious Diseases and Occupational Medicine, Rochester, MN
| | | | | | - Daniel V Satele
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
| | - Colin P West
- Department of Medicine, Division of General Internal Medicine
| |
Collapse
|
13
|
Multidrug Interactions: Why Do They Occur and How to Handle? Clin Ther 2023; 45:99-105. [PMID: 36682993 DOI: 10.1016/j.clinthera.2022.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 12/16/2022] [Accepted: 12/21/2022] [Indexed: 01/21/2023]
Abstract
A nonoptimized medication therapy (NOMT) event is an iatrogenic hazard or incident associated with medications and is a leading cause of death, serious injury, and illness. NOMT events are often related to multidrug interactions in patients with polypharmacy. In these patients, NOMT events can be avoided by using advanced clinical decision support systems and clinical interventions such as separating the time of administration of certain drugs during the day. At the individual level, medication reconciliation is a first logical step for reducing adverse side effects. Then, intersubject variability in drug response should be considered to optimize patient drug regimens. Furthermore, patient pharmacogenomic status information can help ensure appropriateness of drug therapy. However, in patients with polypharmacy, such information is most valuable when combined with phenoconversion probability. At a population level, the virtual addition of drugs to various drug regimens and the use of a medication risk score can help predict the risk of NOMT events. This review outlines some of the mechanisms behind multidrug interactions and their association with drug safety and NOMTs, polypharmacy and its impact on patient outcomes, the value of pharmacogenomics, and an assessment of simulation studies and the virtual addition of drugs to a drug regimen using real-world data. (Clin Ther. 2023;45:XXX-XXX) © 2023 Elsevier HS Journals, Inc.
Collapse
|
14
|
Uematsu H, Uemura M, Kurihara M, Umemura T, Hiramatsu M, Kitano F, Fukami T, Nagao Y. Development of a Novel Scoring System to Quantify the Severity of Incident Reports: An Exploratory Research Study. J Med Syst 2022; 46:106. [PMID: 36503962 DOI: 10.1007/s10916-022-01893-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Accepted: 11/18/2022] [Indexed: 12/14/2022]
Abstract
Incident reporting systems have been widely adopted to collect information about patient safety incidents. Much of the value of incident reports lies in the free-text section. Computer processing of semantic information may be helpful to analyze this. We developed a novel scoring system for decision making to assess the severity of incidents using the semantic characteristics of the text in incident reports, and compared its results with experts' opinions. We retrospectively analyzed free-text data from incident reports from January 2012 to September 2021 at Nagoya University Hospital, Aichi, Japan. The sample was allocated to training and validation datasets using the hold-out method. Morphological analysis was used to segment terms in the training dataset. We calculated a severity term score, a severity report score and severity group score, by report volume size, and compared these with conventional severity classifications by patient safety experts and reporters. We allocated 96,082 incident reports into two groups. We calculated 1,802 severity term scores from the 48,041 reports in the training dataset. There was a significant difference in severity report score between reports categorized as severe and not severe by experts (95% confidence interval [CI] -0.83 to -0.80, p < 0.001, d = 0.81). Severity group scores were positively associated with severity ratings from experts and reporters (correlation coefficients 0.73 [95% CI 0.63-0.80, p < 0.001] and 0.79 [95% CI 0.71-0.85, p < 0.001]) for all departments. Our severity scoring system could therefore contribute to better organizational patient safety.
Collapse
Affiliation(s)
- Haruhiro Uematsu
- Department of Patient Safety, Nagoya University Hospital, 65 Tsurumai-cho, Showa-ku, 466-8560, Nagoya, Japan.
| | - Masakazu Uemura
- Department of Patient Safety, Nagoya University Hospital, 65 Tsurumai-cho, Showa-ku, 466-8560, Nagoya, Japan
| | - Masaru Kurihara
- Department of Patient Safety, Nagoya University Hospital, 65 Tsurumai-cho, Showa-ku, 466-8560, Nagoya, Japan
| | - Tomomi Umemura
- Department of Patient Safety, Nagoya University Hospital, 65 Tsurumai-cho, Showa-ku, 466-8560, Nagoya, Japan
| | - Mariko Hiramatsu
- Department of Patient Safety, Nagoya University Hospital, 65 Tsurumai-cho, Showa-ku, 466-8560, Nagoya, Japan
| | - Fumimasa Kitano
- Department of Patient Safety, Nagoya University Hospital, 65 Tsurumai-cho, Showa-ku, 466-8560, Nagoya, Japan
| | - Tatsuya Fukami
- Department of Patient Safety, Shimane University Hospital, Izumo, Japan
| | - Yoshimasa Nagao
- Department of Patient Safety, Nagoya University Hospital, 65 Tsurumai-cho, Showa-ku, 466-8560, Nagoya, Japan
| |
Collapse
|
15
|
Ko CY, Martin G, Dixon-Woods M. Three Observations for Improving Efforts in Surgical Quality Improvement. JAMA Surg 2022; 157:1073-1074. [PMID: 36069864 DOI: 10.1001/jamasurg.2022.3122] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
This Viewpoint assesses current deficits in surgical quality improvement efforts and describes ways to potentially improve these initiatives for better outcomes.
Collapse
Affiliation(s)
- Clifford Y Ko
- The American College of Surgeons, Chicago, Illinois.,The David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Graham Martin
- THIS Institute at the University of Cambridge, Cambridge, United Kingdom
| | - Mary Dixon-Woods
- THIS Institute at the University of Cambridge, Cambridge, United Kingdom
| |
Collapse
|
16
|
Claessens F, Castro EM, Jans A, Jacobs L, Seys D, Van Wilder A, Brouwers J, Van der Auwera C, De Ridder D, Vanhaecht K. Patients' and kin's perspective on healthcare quality compared to Lachman's multidimensional quality model: Focus group interviews. PATIENT EDUCATION AND COUNSELING 2022; 105:3151-3159. [PMID: 35843847 DOI: 10.1016/j.pec.2022.07.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 07/02/2022] [Accepted: 07/07/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES To identify key attributes of healthcare quality relevant to patients and kin and to compare them to Lachman's multidimensional quality model. METHODS Four focus groups with patients and kin were conducted using a semi-structured interview guide and a purposive sampling method. Classical content analysis and constant comparison method were used to focus data analysis on individual and group level. RESULTS Communication with patients, kin and professionals emerged as a new dimension from interview transcripts. Other identified key attributes largely corresponded with Lachman's multidimensional quality model. They were mainly classified in dimensions: 'Partnership and Co-Production', 'Dignity and Respect' and 'Effectiveness'. Technical quality dimensions were linked to organisational aspects of care in terms of staffing levels and time. The dimension 'Eco-friendly' was not addressed by patients or kin. CONCLUSIONS The results enhance the comprehension of healthcare quality and contribute to its academic understanding by validating Lachman's multidimensional quality model from patients' and kin's perspective. The model robustness is increased by including communication as a quality dimension surrounding technical domains and core values. PRACTICE IMPLICATIONS The key attributes can serve as a holistic framework for healthcare organisations to design their quality management system. An instrument can be developed to measure key attributes.
Collapse
Affiliation(s)
- Fien Claessens
- Leuven Institute for Healthcare Policy - Department of Public Health, KU Leuven - University of Leuven, Leuven, Belgium.
| | - Eva Marie Castro
- Leuven Institute for Healthcare Policy - Department of Public Health, KU Leuven - University of Leuven, Leuven, Belgium; Department of Quality Management, Regionaal Ziekenhuis Heilig Hart Tienen, Tienen, Belgium
| | - Anneke Jans
- Leuven Institute for Healthcare Policy - Department of Public Health, KU Leuven - University of Leuven, Leuven, Belgium; Department of Quality Management, Sint-Trudo Ziekenhuis, Sint-Truiden, Belgium
| | - Laura Jacobs
- Department of Quality Management, University Hospitals Leuven, Leuven, Belgium
| | - Deborah Seys
- Leuven Institute for Healthcare Policy - Department of Public Health, KU Leuven - University of Leuven, Leuven, Belgium
| | - Astrid Van Wilder
- Leuven Institute for Healthcare Policy - Department of Public Health, KU Leuven - University of Leuven, Leuven, Belgium
| | - Jonas Brouwers
- Leuven Institute for Healthcare Policy - Department of Public Health, KU Leuven - University of Leuven, Leuven, Belgium; Department of Orthopaedics, University Hospitals Leuven, Leuven, Belgium
| | - Charlotte Van der Auwera
- Leuven Institute for Healthcare Policy - Department of Public Health, KU Leuven - University of Leuven, Leuven, Belgium
| | - Dirk De Ridder
- Leuven Institute for Healthcare Policy - Department of Public Health, KU Leuven - University of Leuven, Leuven, Belgium; Department of Quality Management, University Hospitals Leuven, Leuven, Belgium
| | - Kris Vanhaecht
- Leuven Institute for Healthcare Policy - Department of Public Health, KU Leuven - University of Leuven, Leuven, Belgium; Department of Quality Management, University Hospitals Leuven, Leuven, Belgium.
| |
Collapse
|
17
|
O'Donnell WJ. Reducing Administrative Harm in Medicine - Clinicians and Administrators Together. N Engl J Med 2022; 386:2429-2432. [PMID: 35731659 DOI: 10.1056/nejmms2202174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Walter J O'Donnell
- From the Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, and the Division of Pulmonary and Critical Care Medicine, Harvard Medical School - both in Boston
| |
Collapse
|
18
|
Pediatric surgical errors: A systematic scoping review. J Pediatr Surg 2022; 57:616-621. [PMID: 34366133 PMCID: PMC8792106 DOI: 10.1016/j.jpedsurg.2021.07.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 07/07/2021] [Accepted: 07/22/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Medical errors were largely concealed prior to the landmark report "To Err Is Human". The purpose of this systematic scoping review was to determine the extent pediatric surgery defines and studies errors, and to explore themes among papers focused on errors in pediatric surgery. METHODS The methodological framework used to conduct this scoping study has been outlined by Arksey and O'Malley. In January 2020, PubMed, the Cochrane Database of Systematic Reviews, and the Cochrane Central Register of Controlled Trials were searched. Oxford Level of Evidence was assigned to each study; only studies rated Level 3 or higher were included. RESULTS Of 3,064 initial studies, 12 were included in the final analysis: 4 cohort studies, and 8 outcome/audit studies. This data represented 5,442,000 aggregate patients and 8,893 errors. There were 6 different error definitions and 5 study methods. Common themes amongst the studies included a systems-focused approach, an increase in errors seen with increased complexity, and studies exploring the relationship between error and adverse events. CONCLUSIONS This study revealed multiple error definitions, multiple error study methods, and common themes described in the pediatric surgical literature. Opportunities exist to improve the safety of surgical care of children by reducing errors. Original Scientific Research Type of Study: Systematic Scoping Review Level of Evidence Rating: 1.
Collapse
|
19
|
Miltner R, Pesch L, Mercado S, Dammrich T, Stafford T, Hunter J, Stewart G. Why Competency Standardization Matters for Improvement: An Assessment of the Healthcare Quality Workforce. J Healthc Qual 2021; 43:263-274. [PMID: 34463669 DOI: 10.1097/jhq.0000000000000316] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
ABSTRACT Healthcare transformation requires a healthcare quality workforce with the requisite expertise to lead, oversee, and implement positive change within healthcare organizations. The National Association for Healthcare Quality (NAHQ) Competency Framework, which spans 29 competencies across 8 domains of healthcare quality, outlines the specific knowledge and skills needed to advance personal and organizational quality goals. This study describes 1,671 responses to the NAHQ Professional Assessment survey from a diverse group of healthcare quality professionals representative of NAHQ's professional community. Results show that two-thirds of respondents indicated they are working in 4 or more competency domains, with 85% reporting working in Performance and Process Improvement. Results also indicate that individuals who hold the Certified Professional in Healthcare Quality (CPHQ) certification perform work at more advanced levels across all eight domains of the competency framework. This was statistically significant for 13 of the 29 competencies including all three competency statements within the Performance and Process Improvement domain. Healthcare organizations need a workforce with specialized quality and safety expertise to advance quality goals, and this study suggests that those who invest in continued professional development by attaining the CPHQ certification may be better positioned to contribute meaningfully to advance these goals and improve organizational outcomes.
Collapse
|
20
|
Eldh AC, Joelsson-Alm E, Wretenberg P, Hälleberg-Nyman M. Onset PrevenTIon of urinary retention in Orthopaedic Nursing and rehabilitation, OPTION-a study protocol for a randomised trial by a multi-professional facilitator team and their first-line managers' implementation strategy. Implement Sci 2021; 16:65. [PMID: 34174917 PMCID: PMC8233619 DOI: 10.1186/s13012-021-01135-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 06/08/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Onset PrevenTIon of urinary retention in Orthopaedic Nursing and rehabilitation, OPTION, project aims to progress knowledge translation vis-à-vis evidence-based bladder monitoring in orthopaedic care, to decrease the risk of urinary retention, and voiding complications. Urinary retention is common whilst in hospital for hip surgery. If not properly identified and managed, there is a high risk of complications, some lifelong and life threatening. Although evidence-based guidelines are available, the implementation is lagging. METHODS Twenty orthopaedic sites are cluster randomised into intervention and control sites, respectively. The intervention sites assemble local facilitator teams among nursing and rehabilitation staff, including first-line managers. The teams receive a 12-month support programme, including face-to-face events and on-demand components to map and bridge barriers to guideline implementation, addressing leadership behaviours and de-implementation of unproductive routines. All sites have access to the guidelines via a public healthcare resource, but the control sites have no implementation support. Baseline data collection includes structured assessments of urinary retention procedures via patient records, comprising incidence and severity of voiding issues and complications, plus interviews with managers and staff, and surveys to all hip surgery patients with interviews across all sites. Further assessments of context include the Alberta Context Tool used with staff, the 4Ps tool for preference-based patient participation used with patients, and data on economic aspects of urinary bladder care. During the implementation intervention, all events are recorded, and the facilitators keep diaries. Post intervention, the equivalent data collections will be repeated twice, and further data will include experiences of the intervention and guideline implementation. Data will be analysed with statistical analyses, including comparisons before and after, and between intervention and control sites. The qualitative data are subjected to content analysis, and mixed methods are applied to inform both clinical outcomes and the process evaluation, corresponding to a hybrid design addressing effectiveness, experiences, and outcomes. DISCUSSION The OPTION trial has a potential to account for barriers and enablers for guideline implementation in the orthopaedic context in general and hip surgery care in particular. Further, it may progress the understanding of implementation leadership by dyads of facilitators and first-line managers. TRIAL REGISTRATION The study was registered as NCT04700969 with the U.S. National Institutes of Health Clinical Trials Registry on 8 January 2021, that is, prior to the baseline data collection.
Collapse
Affiliation(s)
- Ann Catrine Eldh
- Department of Health, Medicine and Caring Sciences, Linköping University, SE-581 83, Linköping, Sweden.
- Department of Public Health and Caring Sciences, Uppsala University, Box 564, SE-751 22, Uppsala, Sweden.
| | - Eva Joelsson-Alm
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Södersjukhuset, SE-118 83, Stockholm, Sweden
| | - Per Wretenberg
- Faculty of Health and Medicine, Department of Orthopedics, Örebro University, SE-701 82, Örebro, Sweden
| | - Maria Hälleberg-Nyman
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, SE-701 82, Örebro, Sweden
| |
Collapse
|