1
|
Valli C, Schäfer WLA, Bañeres J, Groene O, Arnal-Velasco D, Leite A, Suñol R, Ballester M, Gibert Guilera M, Wagner C, Calsbeek H, Emond Y, J. Heideveld-Chevalking A, Kristensen K, Huibertina Davida van Tuyl L, Põlluste K, Weynants C, Garel P, Sousa P, Talving P, Marx D, Žaludek A, Romero E, Rodríguez A, Orrego C. Improving quality and patient safety in surgical care through standardisation and harmonisation of perioperative care (SAFEST project): A research protocol for a mixed methods study. PLoS One 2024; 19:e0304159. [PMID: 38870215 PMCID: PMC11175406 DOI: 10.1371/journal.pone.0304159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 05/03/2024] [Indexed: 06/15/2024] Open
Abstract
INTRODUCTION Adverse events in health care affect 8% to 12% of patients admitted to hospitals in the European Union (EU), with surgical adverse events being the most common types reported. AIM SAFEST project aims to enhance perioperative care quality and patient safety by establishing and implementing widely supported evidence-based perioperative patient safety practices to reduce surgical adverse events. METHODS We will conduct a mixed-methods hybrid type III implementation study supporting the development and adoption of evidence-based practices through a Quality Improvement Learning Collaborative (QILC) in co-creation with stakeholders. The project will be conducted in 10 hospitals and related healthcare facilities of 5 European countries. We will assess the level of adherence to the standardised practices, as well as surgical complications incidence, patient-reported outcomes, contextual factors influencing the implementation of the patient safety practices, and sustainability. The project will consist of six components: 1) Development of patient safety standardised practices in perioperative care; 2) Guided self-evaluation of the standardised practices; 3) Identification of priorities and actions plans; 4) Implementation of a QILC strategy; 5) Evaluation of the strategy effectiveness; 6) Patient empowerment for patient safety. Sustainability of the project will be ensured by systematic assessment of sustainability factors and business plans. Towards the end of the project, a call for participation will be launched to allow other hospitals to conduct the self-evaluation of the standardized practices. DISCUSSION The SAFEST project will promote patient safety standardized practices in the continuum of care for adult patients undergoing surgery. This project will result in a broad implementation of evidence-based practices for perioperative care, spanning from the care provided before hospital admission to post-operative recovery at home or outpatient facilities. Different implementation challenges will be faced in the application of the evidence-based practices, which will be mitigated by developing context-specific implementation strategies. Results will be disseminated in peer-reviewed publications and will be available in an online platform.
Collapse
Affiliation(s)
- Claudia Valli
- Avedis Donabedian Research Institute, Barcelona, Spain
- Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Willemijn L. A. Schäfer
- Netherlands Institute for Health Services Research (Nivel), Utrecht, The Netherlands
- Department of Surgery, Northwestern Quality Improvement, Research & Education in Surgery, Northwestern University, Chicago, IL, United States of America
| | - Joaquim Bañeres
- Avedis Donabedian Research Institute, Barcelona, Spain
- Universidad Autónoma de Barcelona, Barcelona, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Barcelona, Spain
| | - Oliver Groene
- OptiMedis AG, Hamburg, Germany
- Faculty of Management, Economics and Society, University of Witten/Herdecke, Witten, Germany
| | - Daniel Arnal-Velasco
- Spanish Anaesthesia and Reanimation Incident Reporting System (SENSAR), Alcorcon, Spain
| | - Andreia Leite
- NOVA National School of Public Health, Public Health Research Center, Comprehensive Health Research Center, CHRC, NOVA University Lisbon, Lisbon, Portugal
- Department of Epidemiology, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisboa, Portugal
| | - Rosa Suñol
- Avedis Donabedian Research Institute, Barcelona, Spain
- Universidad Autónoma de Barcelona, Barcelona, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Barcelona, Spain
| | - Marta Ballester
- Avedis Donabedian Research Institute, Barcelona, Spain
- Universidad Autónoma de Barcelona, Barcelona, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Barcelona, Spain
| | - Marc Gibert Guilera
- Avedis Donabedian Research Institute, Barcelona, Spain
- Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Cordula Wagner
- Netherlands Institute for Health Services Research (Nivel), Utrecht, The Netherlands
| | - Hiske Calsbeek
- Scientific Center for Quality of Healthcare (IQ healthcare), Radboud Institute for Health Sciences (RIHS), Radboud University Medical Center, Nijmegen, The Netherlands
| | - Yvette Emond
- Scientific Center for Quality of Healthcare (IQ healthcare), Radboud Institute for Health Sciences (RIHS), Radboud University Medical Center, Nijmegen, The Netherlands
| | | | | | | | - Kaja Põlluste
- Department of Internal Medicine, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
| | - Cathy Weynants
- European Society of Anaesthesiology and Intensive Care (ESAIC), Brussels, Belgium
| | - Pascal Garel
- European Hospital and Healthcare Federation, Brussels, Belgium
| | - Paulo Sousa
- NOVA National School of Public Health, Public Health Research Center, Comprehensive Health Research Center, CHRC, NOVA University Lisbon, Lisbon, Portugal
| | - Peep Talving
- Department of Surgery, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
- Department of Surgery, North Estonia Medical Centre, Tallinn, Estonia
| | - David Marx
- Spojená Akreditační Komise–Czech accreditation commission, Prague, Czech Republic
| | - Adam Žaludek
- Spojená Akreditační Komise–Czech accreditation commission, Prague, Czech Republic
- Department of Public Health, Charles University, Third Faculty of Medicine, Prague, Czech Republic
| | - Eva Romero
- Spanish Anaesthesia and Reanimation Incident Reporting System (SENSAR), Alcorcon, Spain
| | - Anna Rodríguez
- Avedis Donabedian Research Institute, Barcelona, Spain
- Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Carola Orrego
- Avedis Donabedian Research Institute, Barcelona, Spain
- Universidad Autónoma de Barcelona, Barcelona, Spain
- Department of Surgery, Northwestern Quality Improvement, Research & Education in Surgery, Northwestern University, Chicago, IL, United States of America
| | | |
Collapse
|
2
|
Labrague LJ. Nurses' adherence to patient safety protocols and its relationship with adverse patient events. J Nurs Scholarsh 2024; 56:282-290. [PMID: 37950503 DOI: 10.1111/jnu.12942] [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: 07/18/2023] [Revised: 10/12/2023] [Accepted: 10/25/2023] [Indexed: 11/12/2023]
Abstract
INTRODUCTION Ensuring patient safety is a critical component of healthcare delivery, and nurses play a vital role in adhering to patient safety protocols to prevent adverse events. However, studies linking nurses' adherence to these protocols with patient outcomes is scarce. This study has two-fold purposes: (1) to examine determinants of nurses' adherence to patient safety protocols, and (2) to investigate the relationship between nurses' adherence to patient safety protocols and adverse patient events. DESIGN A cross-sectional design. METHODS A total of 343 clinical nurses from five hospitals in the Philippines were included in this study. Two standardized scales were used to collect data, including the Patient Safety Adherence Scale and the Adverse Patient Events Scale. Data collection took place from April 2022 to August 2022. RESULTS Adherence to patient safety protocols was generally moderate to high (M = 4.483), while nurse-reported adverse events occurred at a lower frequency (M = 1.150). Lower adherence rates were identified in areas such as reporting safety errors (M = 3.950), conducting fall risk assessments (M = 4.299), and adhering to pressure ulcer prevention guidelines (M = 3.979). Patients' and their families' complaints (M = 2.129) and abuses (M = 1.475) were the most frequently reported adverse events. Increased adherence to safety protocols was associated with higher reporting of adverse patient events (β = 0.115, p < 0.001). CONCLUSION Higher adherence to patient safety protocols resulted in an increased reporting of adverse patient events. The factors identified that contributed to nurses' adherence to patient safety protocols can be utilized in the development of strategies aimed at improving compliance, especially in areas where adherence is currently low. CLINICAL RELEVANCE Healthcare organizations should prioritize efforts to enhance adherence to patient safety protocols, particularly in areas with lower compliance rates, through relevant trainings, resource provision, and support systems. Promoting a culture of open communication and reporting can significantly contribute to reducing adverse events and improving patient safety.
Collapse
Affiliation(s)
- Leodoro J Labrague
- Marcella Niehoff School of Nursing, Loyola University Chicago, Chicago, Illinois, USA
| |
Collapse
|
3
|
Laur C, Ladak Z, Hall A, Solbak NM, Nathan N, Buzuayne S, Curran JA, Shelton RC, Ivers N. Sustainability, spread, and scale in trials using audit and feedback: a theory-informed, secondary analysis of a systematic review. Implement Sci 2023; 18:54. [PMID: 37885018 PMCID: PMC10604689 DOI: 10.1186/s13012-023-01312-0] [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: 05/19/2023] [Accepted: 10/05/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND Audit and feedback (A&F) is a widely used implementation strategy to influence health professionals' behavior that is often tested in implementation trials. This study examines how A&F trials describe sustainability, spread, and scale. METHODS This is a theory-informed, descriptive, secondary analysis of an update of the Cochrane systematic review of A&F trials, including all trials published since 2011. Keyword searches related to sustainability, spread, and scale were conducted. Trials with at least one keyword, and those identified from a forward citation search, were extracted to examine how they described sustainability, spread, and scale. Results were qualitatively analyzed using the Integrated Sustainability Framework (ISF) and the Framework for Going to Full Scale (FGFS). RESULTS From the larger review, n = 161 studies met eligibility criteria. Seventy-eight percent (n = 126) of trials included at least one keyword on sustainability, and 49% (n = 62) of those studies (39% overall) frequently mentioned sustainability based on inclusion of relevant text in multiple sections of the paper. For spread/scale, 62% (n = 100) of trials included at least one relevant keyword and 51% (n = 51) of those studies (31% overall) frequently mentioned spread/scale. A total of n = 38 studies from the forward citation search were included in the qualitative analysis. Although many studies mentioned the need to consider sustainability, there was limited detail on how this was planned, implemented, or assessed. The most frequent sustainability period duration was 12 months. Qualitative results mapped to the ISF, but not all determinants were represented. Strong alignment was found with the FGFS for phases of scale-up and support systems (infrastructure), but not for adoption mechanisms. New spread/scale themes included (1) aligning affordability and scalability; (2) balancing fidelity and scalability; and (3) balancing effect size and scalability. CONCLUSION A&F trials should plan for sustainability, spread, and scale so that if the trial is effective, the benefits can continue. A deeper empirical understanding of the factors impacting A&F sustainability is needed. Scalability planning should go beyond cost and infrastructure to consider other adoption mechanisms, such as leadership, policy, and communication, that may support further scalability. TRIAL REGISTRATION Registered with Prospero in May 2022. CRD42022332606.
Collapse
Affiliation(s)
- Celia Laur
- Women's College Hospital Institute for Health System Solutions and Virtual Care, 76 Grenville Street, Toronto, ON, M5S 1B2, Canada.
- Institute of Health Policy, Management and Evaluation, Health Sciences Building, University of Toronto, 155 College Street, Suite 425, Toronto, ON, M5T 3M6, Canada.
| | - Zeenat Ladak
- Women's College Hospital Institute for Health System Solutions and Virtual Care, 76 Grenville Street, Toronto, ON, M5S 1B2, Canada
- Ontario Institute for Studies in Education, University of Toronto, 252 Bloor Street West, Toronto, ON, M5S 1V6, Canada
| | - Alix Hall
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia
- National Centre of Implementation Science, The University of Newcastle, Newcastle, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Newcastle, NSW, Australia
| | - Nathan M Solbak
- Physician Learning Program, Continuing Medical Education and Professional Development, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta, T2N 4Z6, Canada
- Health Quality Programs, Queen's University, 92 Barrie Street, Kingston, ON, K7L 3N6, Canada
| | - Nicole Nathan
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia
- National Centre of Implementation Science, The University of Newcastle, Newcastle, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Newcastle, NSW, Australia
| | - Shewit Buzuayne
- Women's College Hospital Institute for Health System Solutions and Virtual Care, 76 Grenville Street, Toronto, ON, M5S 1B2, Canada
| | - Janet A Curran
- School of Nursing, Faculty of Health, Dalhousie University, Halifax, NS, B3H 4R2, Canada
| | - Rachel C Shelton
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Noah Ivers
- Women's College Hospital Institute for Health System Solutions and Virtual Care, 76 Grenville Street, Toronto, ON, M5S 1B2, Canada
- Institute of Health Policy, Management and Evaluation, Health Sciences Building, University of Toronto, 155 College Street, Suite 425, Toronto, ON, M5T 3M6, Canada
- Department of Family and Community Medicine, University of Toronto, 500 University Ave, Toronto, M5G 1V7, Canada
| |
Collapse
|
4
|
Ludbrook G, Grocott MPW, Heyman K, Clarke-Errey S, Royse C, Sleigh J, Solomon LB. Outcomes of Postoperative Overnight High-Acuity Care in Medium-Risk Patients Undergoing Elective and Unplanned Noncardiac Surgery. JAMA Surg 2023:2804485. [PMID: 37133876 PMCID: PMC10157507 DOI: 10.1001/jamasurg.2023.1035] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Importance Postoperative complications are increasing, risking patients' health and health care sustainability. High-acuity postoperative units may benefit outcomes, but existing data are very limited. Objective To evaluate whether a new high-acuity postoperative unit, advanced recovery room care (ARRC), reduces complications and health care utilization compared with usual ward care (UC). Design, Setting, and Participants In this observational cohort study, adults who were undergoing noncardiac surgery at a single-center tertiary adult hospital, anticipated to stay in hospital for 2 or more nights, were scheduled for postoperative ward care, and at medium risk (defined as predicted 30-day mortality of 0.7% to 5% by the National Safety Quality Improvement Program risk calculator) were included. Allocation to ARRC was based on bed availability. From 2405 patients assessed for eligibility with National Safety Quality Improvement Program risk scoring, 452 went to ARRC and 419 to UC, with 8 lost to 30-day follow-up. Propensity scoring identified 696 patients with matched pairs. Patients were treated between March and November 2021, and data were analyzed from January to September 2022. Interventions ARRC is an extended postanesthesia care unit (PACU), staffed by anesthesiologists and nurses (1 nurse to 2 patients) collaboratively with surgeons, with capacity for invasive monitoring and vasoactive infusions. ARRC patients were treated until the morning after surgery, then transferred to surgical wards. UC patients were transferred to surgical wards after usual PACU care. Main Outcome and Measures The primary end point was days at home at 30 days. Secondary end points were health facility utilization, medical emergency response (MER)-level complications, and mortality. Analyses compared groups before and after propensity scoring matching. Results Of 854 included patients, 457 (53.5%) were male, and the mean (SD) age was 70.0 (14.4) years. Days at home at 30 days was greater with ARRC compared with UC (mean [SD] time, 17 [11] vs 15 [11] days; P = .04). During the first 24 hours, more patients were identified with MER-level complications in ARRC (43 [12.4%] vs 13 [3.7%]; P < .001), but after return to the ward, these were less frequent from days 2 to 9 (9 [2.6%] vs 22 [6.3%]; P = .03). Length of hospital stay, hospital readmissions, emergency department visits, and mortality were similar. Conclusions and Relevance For medium-risk patients, brief high-acuity care with ARRC allowed enhanced detection and management of early MER-level complications, which was followed by a decreased incidence of subsequent MER-level complications after discharge to the ward and by increased days at home at 30 days.
Collapse
Affiliation(s)
- Guy Ludbrook
- Central Adelaide Local Health Network, Adelaide, Australia
- The University of Adelaide, Adelaide, Australia
| | - Michael P W Grocott
- Perioperative and Critical Care Research Theme, Southampton NIHR Biomedical Research Centre, University Hospital Southampton, University of Southampton, Southampton, United Kingdom
| | - Kathy Heyman
- Central Adelaide Local Health Network, Adelaide, Australia
| | - Sandy Clarke-Errey
- Statistical Consulting Centre, The University of Melbourne, Parkville, Australia
| | - Colin Royse
- Department of Surgery, The University of Melbourne, Royal Melbourne Hospital, Parkville, Australia
- Outcomes Research Consortium, Cleveland Clinic, Cleveland, Ohio
| | - Jamie Sleigh
- The University of Auckland, Peter Rothwell Academic Centre, Waikato Hospital, Hamilton West, Hamilton, New Zealand
| | - L Bogdan Solomon
- Central Adelaide Local Health Network, Adelaide, Australia
- The University of Adelaide, Adelaide, Australia
| |
Collapse
|
5
|
Vauk S, Seelandt JC, Huber K, Grande B, Kolbe M. Exposure to incivility does not hinder speaking up: a randomised controlled high-fidelity simulation-based study. Br J Anaesth 2022; 129:776-787. [PMID: 36075775 DOI: 10.1016/j.bja.2022.07.050] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 06/27/2022] [Accepted: 07/26/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Speaking up with concerns is critical for patient safety. We studied whether witnessing a civil (i.e. polite, respectful) response to speaking up would increase the occurrence of further speaking up by hospital staff members as compared with witnessing a pseudo-civil (i.e. vague and slightly dismissive) or rude response. METHODS In this RCT in a single, large academic teaching hospital, a single simulated basic life support scenario was designed to elicit standardised opportunities to speak up. Participants in teams of two or three were randomly assigned to one of three experimental conditions in which the degree of civility in reacting to speaking up was manipulated by an embedded simulated person. Speaking up behaviour was assessed by behaviour coding of the video recordings of the team interactions by applying 10 codes using The Observer XT 14.1. Data were analysed using multilevel modelling. RESULTS The sample included 125 interprofessional hospital staff members (82 [66%] women, 43 [34%] men). Participants were more likely to speak up when they felt psychologically safe (γ=0.47; standard error [se]=0.19; 95% confidence interval [CI], 0.09-0.85; P=0.017). Participants were more likely to speak up in the rude condition than in the other conditions (γ=0.28; se=0.12; 95% CI, 0.05-0.52; P=0.019). Across conditions, participants spoke up most frequently by structuring inquiry (n=289, 31.52%), proactive (n=240, 26.17%), and reactive (n=148, 16.14%) instruction statements, and gestures (n=139, 15.16%). CONCLUSION Our study challenges current assumptions about the interplay of civility and speaking up behaviour in healthcare.
Collapse
Affiliation(s)
- Stefanie Vauk
- Simulation Centre, University Hospital Zurich, Zurich, Switzerland
| | - Julia C Seelandt
- Simulation Centre, University Hospital Zurich, Zurich, Switzerland
| | - Katja Huber
- Simulation Centre, University Hospital Zurich, Zurich, Switzerland
| | - Bastian Grande
- Simulation Centre, University Hospital Zurich, Zurich, Switzerland; Institute of Anaesthesiology, University Hospital Zurich, Zurich, Switzerland
| | - Michaela Kolbe
- Simulation Centre, University Hospital Zurich, Zurich, Switzerland; ETH Zurich, Zurich, Switzerland.
| |
Collapse
|
6
|
Improving safety and outcomes in perioperative care: does implementation matter? Br J Anaesth 2022; 128:747-751. [PMID: 35227460 DOI: 10.1016/j.bja.2022.01.026] [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: 12/09/2021] [Revised: 01/22/2022] [Accepted: 01/23/2022] [Indexed: 11/21/2022] Open
Abstract
The IMPROVE study describes a large perioperative quality improvement project with reporting of both compliance with improvement activities and patient outcomes. It highlights the importance of such projects, as well as the challenges in implementing change and proving benefit. Challenges identified include the importance of effective training in practice change, selection of trial design and relevant quality measures, and how the context of quality improvement initiatives may influence outcomes. Quality improvement programmes of this nature, despite the difficulties with implementation and trial design, remain a high priority because of their positive influence on improving clinical practice.
Collapse
|