1
|
Marra AR, Algwizani A, Alzunitan M, Brennan TMH, Edmond MB. Descriptive Epidemiology of Safety Events at an Academic Medical Center. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND 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] [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
|
2
|
|
3
|
Abstract
The last decade has seen an explosion in the growth of digital data. Since 2005, the total amount of digital data created or replicated on all platforms and devices has been doubling every 2 years, from an estimated 132 exabytes (132 billion gigabytes) in 2005 to 4.4 zettabytes (4.4 trillion gigabytes) in 2013, and a projected 44 zettabytes (44 trillion gigabytes) in 2020. This growth has been driven in large part by the rise of social media along with more powerful and connected mobile devices, with an estimated 75% of information in the digital universe generated by individuals rather than entities. Transactions and communications including payments, instant messages, Web searches, social media updates, and online posts are all becoming part of a vast pool of data that live "in the cloud" on clusters of servers located in remote data centers. The amount of accumulating data has become so large that it has given rise to the term Big Data. In many ways, Big Data is just a buzzword, a phrase that is often misunderstood and misused to describe any sort of data, no matter the size or complexity. However, there is truth to the assertion that some data sets truly require new management and analysis techniques.
Collapse
|
4
|
Abstract
Perioperative outcomes research has gained widespread interest and is viewed as increasingly important among different specialties, including anesthesiology. Outcomes research studies serve to help in the adjustment of risk, allocation of resources, and formulation of hypotheses to guide future research. Pursuing high-quality research projects requires familiarity with a wide range of research methods, and concepts are ideally learned in a dedicated setting. Skills associated with the use of these methods as well as with scientific publishing in general, however, are increasingly challenging to acquire. This article was intended to describe the curriculum and implementation of the Perioperative Medicine and Regional Anesthesia Research Fellowship at the Hospital for Special Surgery. We also proposed a method to evaluate the success of a research fellowship curriculum.
Collapse
|
5
|
Hayden JA, Killian L, Zygmunt A, Babineau J, Martin-Misener R, Jensen JL, Carter AJ. Methods of a multi-faceted rapid knowledge synthesis project to inform the implementation of a new health service model: Collaborative Emergency Centres. Syst Rev 2015; 4:7. [PMID: 25588468 PMCID: PMC4320554 DOI: 10.1186/2046-4053-4-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Accepted: 10/20/2014] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND The aim of this rapid knowledge synthesis was to provide relevant research evidence to inform the implementation of a new health service in Nova Scotia, Canada: Collaborative Emergency Centres (CECs). CECs propose to deliver both primary and urgent care to rural populations where traditional delivery is a challenge. This paper reports on the methods used in a rapid knowledge synthesis project to provide timely evidence to policy makers about this novel healthcare delivery model. METHODS We used a variety of methods, including a jurisdictional/scoping review, modified systematic review methodologies, and integrated knowledge translation. We scanned publicly available information about similar centres across our country to identify important components of CECs and CEC-type models to operationalize the definition of a CEC. We conducted literature searches in PubMed, CINAHL, and EMBASE, and in the grey literature, to identify evidence on the key structures and processes and effectiveness of CEC-type models of care delivery. Our searches were limited to published systematic reviews. The research team facilitated two integrated knowledge translation workshops during the project to engage stakeholders, to refine the research goals and objectives, and to share interim and final results. Citations and included articles were categorized by whether they addressed the CEC model or component structures and processes. Data and key messages were extracted from these reviews to inform implementation. RESULTS CEC-type models have limited peer-reviewed evidence available; no peer-reviewed studies on CECs as a standalone healthcare model were found. As a result, our evidence search and synthesis was revised to focus on core CEC-type structures and processes, prioritized through consensus methods with the stakeholder group, and resulted in provision of a meaningful evidence synthesis to help inform the development and implementation of CECs in Nova Scotia. CONCLUSIONS A variety of methods and partnership with decision-makers and stakeholders enabled the project to address the limitations in the evidence regarding CECs and meet the challenge of identifying the best available evidence in a transparent way to meet the needs of decision-makers in a short timeframe.
Collapse
Affiliation(s)
- Jill A Hayden
- />Department of Community Health and Epidemiology, Dalhousie University, 5790 University Avenue, Halifax, NS B3H 1V7 Canada
- />Nova Scotia Cochrane Resource Centre, Dalhousie University, 5790 University Avenue, Halifax, NS B3H 1V7 Canada
| | - Lara Killian
- />Nova Scotia Cochrane Resource Centre, Dalhousie University, 5790 University Avenue, Halifax, NS B3H 1V7 Canada
| | - Austin Zygmunt
- />Department of Community Health and Epidemiology, Dalhousie University, 5790 University Avenue, Halifax, NS B3H 1V7 Canada
| | - Jessica Babineau
- />Toronto Rehabilitation Institute, University Health Network, 550 University Avenue, Toronto, ON M5G 2A2 Canada
| | - Ruth Martin-Misener
- />School of Nursing, Dalhousie University, 5869 University Avenue, Halifax, NS B3H 3J5 Canada
| | - Jan L Jensen
- />Emergency Health Services, 239 Brownlow Avenue, Suite 300, Dartmouth, NS B3B2B2 Canada
- />Department of Emergency Medicine, Division of Emergency Medical Services, Dalhousie University, QEII Health Sciences Centre, Halifax Infirmary, Room 3019, 1796 Summer Street, Halifax, NS B3H 3A7 Canada
| | - Alix J Carter
- />Emergency Health Services, 239 Brownlow Avenue, Suite 300, Dartmouth, NS B3B2B2 Canada
- />Department of Emergency Medicine, Division of Emergency Medical Services, Dalhousie University, QEII Health Sciences Centre, Halifax Infirmary, Room 3019, 1796 Summer Street, Halifax, NS B3H 3A7 Canada
| |
Collapse
|
6
|
Bowyer A, Jakobsson J, Ljungqvist O, Royse C. A review of the scope and measurement of postoperative quality of recovery. Anaesthesia 2014; 69:1266-78. [DOI: 10.1111/anae.12730] [Citation(s) in RCA: 95] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2014] [Indexed: 12/14/2022]
Affiliation(s)
- A. Bowyer
- Department of Anaesthesia and Pain Management; Royal Melbourne Hospital; Parkville Victoria Australia
| | - J. Jakobsson
- Department for Anaesthesia and Intensive Care; Institution of Clinical Sciences; Danderyd Hospital; Karolinska Institutet; Stockholm Sweden
| | - O. Ljungqvist
- Department of Surgery; Örebro University Hospital; 701 85 Örebro & Institution of Molecular Medicine and Surgery; Karolinska Insitutet; Karolinska Sweden
| | - C. Royse
- Department of Surgery; The University of Melbourne; Parkville Victoria Australia
| |
Collapse
|
7
|
Utilization of national patient registries by clinical nurse specialist: opportunities and implications. CLIN NURSE SPEC 2013; 28:56-62. [PMID: 24309578 DOI: 10.1097/nur.0000000000000018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE The purpose of this article was to describe how clinical nurse specialists can be instrumental in getting involved in the process of joining a national disease registry to improve patient outcomes. BACKGROUND Clinical patient data registries provide longitudinal data on developmental outcomes in chronic, lifelong diseases affecting children. Recognition and application of their use have historically allowed for collection of benchmarking data, improved understanding of disease processes and patient outcomes, and improved quality of life. DESCRIPTION OF THE PROJECT A group of advanced practice nurses in a university-based multispecialty clinic, through evidence-based practice, embarked on the process of joining the National Spina Bifida Patient Registry sponsored by the Centers for Disease Control and Prevention. OUTCOME By taking the lead as project managers, this group of advanced practice nurses obtained buy-in from physicians and multispecialty team members of the Spina Bifida Clinic in the university children's hospital where they practice. An institutional review board application was submitted to their university children's hospital internal review board and currently approved. CONCLUSION This project demonstrates how dynamic utilization of core competencies through application of specific knowledge and skill sets supports the advanced practice nurse's instrumental role in actively initiating, promoting, and supporting participation in clinical patient data registries that seek improved patient outcomes at the national level. IMPLICATIONS Clinical nurse specialists quantify their role and purpose when connecting their interventions and influence to patient outcomes with utilization of resources, such as a national patient data registry.
Collapse
|
8
|
Cata JP, Kurz A. Challenges in research related to perioperative cancer care and cancer outcomes. Best Pract Res Clin Anaesthesiol 2013; 27:457-64. [PMID: 24267551 DOI: 10.1016/j.bpa.2013.10.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Accepted: 10/07/2013] [Indexed: 12/18/2022]
Abstract
Surgery is one of the most commonly used treatments to attempt cure of early-stage and some late-stage solid tumours. Paradoxically, surgery itself and some of the medical interventions involved in the perioperative care of cancer patients may be associated with an increased chance of metastasis. Researchers and perioperative clinicians have studied the phenomenon of surgery-induced immunosuppression and postoperative cancer recurrence for several decades. Unfortunately, the translation of basic science research into human studies is not clear. Moreover, a recent proliferation of retrospective studies with conflicting results and significant limitations has not shed light on the understanding of whether regional anaesthesia, anti-inflammatory interventions or blockade of the sympathetic response improve survival after cancer surgery. Ultimately, randomised controlled trials are required to answer some of the questions raised by preclinical and retrospective studies; however, investigators face many challenges in conducting these trials. Unless sufficient funding is obtained and cooperative research is developed in the near future, clinicians will not know whether anticancer perioperative interventions are useful to improve cancer-related survivals.
Collapse
Affiliation(s)
- Juan P Cata
- Department of Anaesthesiology and Perioperative Medicine, The University of Texas - MD Anderson Cancer Center, Houston, TX, USA.
| | | |
Collapse
|
9
|
Esteve N, Valdivia J, Ferrer A, Mora C, Ribera H, Garrido P. [Do anesthetic techniques influence postoperative outcomes? Part I]. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2013; 60:37-46. [PMID: 23116699 DOI: 10.1016/j.redar.2012.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2011] [Accepted: 09/04/2012] [Indexed: 06/01/2023]
Abstract
The influence of anesthetic technique on postoperative outcomes has opened a wide field of research in recent years. High-risk patients undergoing non-cardiac surgery are those who have higher incidence of postoperative complications and mortality. A proper definition of this group of patients should focus maximal efforts and resources to improve the results. In view of the significant reduction in postoperative mortality and morbidity in last 20 years, perioperative research should take into account new indicators to investigate the role of anesthetic techniques on postoperative outcomes. Studies focused on the evaluation of intermediate outcomes would probably discriminate better effectiveness differences between anesthetic techniques. We review some of the major controversies arising in the literature about the impact of anesthetic techniques on postoperative outcomes. We have grouped the impact of these techniques into 9 major investigation areas: mortality, cardiovascular complications, respiratory complications, postoperative cognitive dysfunction, chronic postoperative pain, cancer recurrence, postoperative nausea/vomiting, surgical outcomes and resources utilization. In this first part of the review, we discuss the basis on postoperative outcomes research, mortality, cardiovascular and respiratory complications.
Collapse
Affiliation(s)
- N Esteve
- Hospital Universitario Son Espases, Palma de Mallorca, Islas Baleares, España.
| | | | | | | | | | | |
Collapse
|
10
|
Vener DF, Guzzetta N, Jacobs JP, Williams GD. Development and Implementation of a New Data Registry in Congenital Cardiac Anesthesia. Ann Thorac Surg 2012. [DOI: 10.1016/j.athoracsur.2012.06.070] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
11
|
Kadry B, Feaster WW, Macario A, Ehrenfeld JM. Anesthesia Information Management Systems: Past, Present, and Future of Anesthesia Records. ACTA ACUST UNITED AC 2012; 79:154-65. [DOI: 10.1002/msj.21281] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
|
12
|
Freundlich RE, Kheterpal S. Perioperative effectiveness research using large databases. Best Pract Res Clin Anaesthesiol 2011; 25:489-98. [DOI: 10.1016/j.bpa.2011.08.008] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2011] [Accepted: 08/22/2011] [Indexed: 12/18/2022]
|
13
|
Flynn B, Vernick W, Ellis J. β-Blockade in the perioperative management of the patient with cardiac disease undergoing non-cardiac surgery. Br J Anaesth 2011; 107 Suppl 1:i3-15. [DOI: 10.1093/bja/aer380] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
|
14
|
Accusation of Salami publication: the new bane of large database investigations? Young investigators beware! Eur J Anaesthesiol 2011; 28:545-6. [PMID: 21505343 DOI: 10.1097/eja.0b013e328346ae10] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|