Toward learning from patient safety reporting systems

Validation of a natural language processing algorithm using national reporting data to improve identification of anesthesia-related ADVerse evENTs: The "ADVENTURE" study

BACKGROUND

Reporting and analysis of adverse events (AE) is associated with improved health system learning, quality outcomes, and patient safety. Manual text analysis is time-consuming, costly, and prone to human errors. We aimed to demonstrate the feasibility of novel machine learning and natural language processing (NLP) approaches for early predictions of adverse events and provide input to direct quality improvement and patient safety initiatives.

METHODS

We used machine learning to analyze 9559 continuously reported AE by clinicians and healthcare systems to the French National Health accreditor (HAS) between January 1, 2009, and December 31, 2020 . We validated the labeling of 135,000 unique de-identified AE reports and determined the associations between different system's root causes and patient consequences. The model was validated by independent expert anesthesiologists.

RESULTS

The machine learning (ML) and Artificial Intelligence (AI) model trained on 9559 AE datasets accurately categorized 8800 (88%) of reported AE. The three most frequent AE types were "difficult orotracheal intubation" (16.9% of AE reports), "medication error" (10.5%), and "post-induction hypotension" (6.9%). The accuracy of the AI model reached 70.9% sensitivity, 96.6% specificity for "difficult intubation", 43.2% sensitivity, and 98.9% specificity for "medication error."

CONCLUSIONS

This unsupervised ML method provides an accurate, automated, AI-supported search algorithm that ranks and helps to understand complex risk patterns and has greater speed, precision, and clarity when compared to manual human data extraction. Machine learning and Natural language processing (NLP) models can effectively be used to process natural language AE reports and augment expert clinician input. This model can support clinical applications and methodological standards and used to better inform and enhance decision-making for improved risk management and patient safety.

TRIAL REGISTRATION

The study was approved by the ethics committee of the French Society of Anesthesiology (IRB 00010254-2020-20) and the CNIL (CNIL: 118 58 95) and the study was registered with ClinicalTrials.gov (NCT: NCT05185479).

A text mining approach to categorize patient safety event reports by medication error type

Patient safety reporting systems give healthcare provider staff the ability to report medication related safety events and errors; however, many of these reports go unanalyzed and safety hazards go undetected. The objective of this study is to examine whether natural language processing can be used to better categorize medication related patient safety event reports. 3,861 medication related patient safety event reports that were previously annotated using a consolidated medication error taxonomy were used to develop three models using the following algorithms: (1) logistic regression, (2) elastic net, and (3) XGBoost. After development, models were tested, and model performance was analyzed. We found the XGBoost model performed best across all medication error categories. 'Wrong Drug', 'Wrong Dosage Form or Technique or Route', and 'Improper Dose/Dose Omission' categories performed best across the three models. In addition, we identified five words most closely associated with each medication error category and which medication error categories were most likely to co-occur. Machine learning techniques offer a semi-automated method for identifying specific medication error types from the free text of patient safety event reports. These algorithms have the potential to improve the categorization of medication related patient safety event reports which may lead to better identification of important medication safety patterns and trends.

Is the Implementation of an Interprofessional Communication Smart Phone Application Associated With Improved Survival Among Critically Ill Surgical Patients?

INTRODUCTION

Patients admitted to intensive care units (ICUs) have high rates of mortality and morbidity. Improved communication between providers within ICUs may reduce morbidity. The goal of this study is to leverage a natural experiment of the temporally staggered implementation of a smart phone application for interprofessional communication to quantify the association with postoperative mortality and morbidity among critically ill surgical patients.

METHODS

We conducted an observational case-control study and utilized a difference-in-difference model to determine the impact of temporally staggered implementation of an interprofessional communication smart phone application on mortality, postoperative hyperglycemia, malnutrition, venous thromboembolism (VTE), and surgical site infections. Our study included patients who underwent surgical procedures and were admitted to the ICU at one of three hospitals (one academic medical center, hospital A, and two community hospitals, hospitals B and C) in a single health system between March 2018 and April 2021.

RESULTS

Our cohort consisted of 1457 patients, of which 1174 were hospitalized at hospital A and 283 at hospitals B and C. In the full cohort, 80 (5.6%) patients died during ICU admission. Difference-in-difference analysis demonstrated a relative difference in mortality of 4.8% [1.1%-8.5%] (P = 0.04) at hospitals B and C compared to hospital A after the implementation of the application. Our model demonstrated a 2.5% difference in VTEs [1.1%-3.8%], P = 0.03. There were no significant reductions in hyperglycemia, malnutrition, or surgical site infection.

CONCLUSIONS

The implementation of an interprofessional communication smart phone application is associated with reduced mortality and VTE incidence among critically ill surgical patients across three diverse hospitals.

A Novel Assessment Using a Panoramic Video Camera of Resuscitation Quality in Patients following Out-of-Hospital Cardiac Arrest

The assessment of cardiopulmonary resuscitation and teamwork quality in prehospital settings has always been challenging. Currently, commercialized quality-monitored chest pads and single-angle cameras are being used to monitor prehospital the resuscitation quality in patients following out-of-hospital cardiac arrest (OHCA). However, both these methods have drawbacks. In New Taipei City, we introduced the panoramic video camera as a novel method to assess the resuscitation quality of OHCA patients to monitor both technical skills and teamwork. The panoramic video camera enabled a comprehensive evaluation of prehospital resuscitation, thereby allowing team members to evaluate their performance by reviewing the video after resuscitation. This is the first step toward improving the evaluation of prehospital resuscitation. Using this panoramic video camera and a high-speed internet connection, real-time resuscitation feedback from the dispatch center or medical directors can be provided promptly, thus, making prehospital resuscitation safe and efficient.

Nontechnical skills training in intensive care units: Protocol for a systematic review and meta-analysis

This study is aimed at describing a protocol for a systematic review and meta-analysis to assess the effect of nontechnical skills training on the acquisition of knowledge, skills or attitudes, and changes in behavior at the workplace, of healthcare professionals working in intensive care units (ICUs), as well as the effect on outcomes at an organizational level. We will search for original studies in the PubMed/Medline, Scopus, Web of Science, Science Direct, EMBASE and PsycINFO databases. Studies with a clinical trial or quasi-experimental design will be included. Two reviewers will independently screen and assess the included studies, with any disagreements being resolved by a third reviewer. We will summarize the findings using a narrative approach and, if possible, conduct a quantitative synthesis (meta-analysis). We will conduct the protocol following the Preferred Reporting Items for Systematic Review and Meta-Analyses Protocols (PRISMA-P) guidelines. The review will summarize the current evidence on nontechnical skills training in ICUs, examining satisfaction with the training program, improvements in knowledge about nontechnical skills and the adoption of safety behaviors, as well as improvement in outcomes for the organization, such as mortality rates, length of stay and cost indicators. We expect that the systematic review could indicate effective strategies for training ICU professionals in nontechnical skills and also determine whether these strategies really improve the safety culture and professional knowledge and behaviors, as well as patient outcomes and safety.

Using Community Detection Techniques to Identify Themes in COVID-19-Related Patient Safety Event Reports

OBJECTIVES

The COVID-19 pandemic has transformed how healthcare is delivered to patients. As the pandemic progresses and healthcare systems continue to adapt, it is important to understand how these changes in care have changed patient care. This study aims to use community detection techniques to identify and facilitate analysis of themes in patient safety event (PSE) reports to better understand COVID-19 pandemic's impact on patient safety. With this approach, we also seek to understand how community detection techniques can be used to better identify themes and extract information from PSE reports.

METHODS

We used community detection techniques to group 2082 PSE reports from January 1, 2020, to January 31, 2021, that mentioned COVID-19 into 65 communities. We then grouped these communities into 8 clinically relevant themes for analysis.

RESULTS

We found the COVID-19 pandemic is associated with the following clinically relevant themes: (1) errors due to new and unknown COVID-19 protocols/workflows; (2) COVID-19 patients developing pressure ulcers; (3) unsuccessful/incomplete COVID-19 testing; (4) inadequate isolation of COVID-19 patients; (5) inappropriate/inadequate care for COVID-19 patients; (6) COVID-19 patient falls; (7) delays or errors communicating COVID-19 test results; and (8) COVID-19 patients developing venous thromboembolism.

CONCLUSIONS

Our study begins the long process of understanding new challenges created by the pandemic and highlights how machine learning methods can be used to understand these and similar challenges. Using community detection techniques to analyze PSE reports and identify themes within them can help give healthcare systems the necessary information to improve patient safety and the quality of care they deliver.

Nursing management of the critical thinking and care quality of ICU nurses: A cross-sectional study

AIM

To explore the effectiveness of a digital learning management system in enhancing intensive care unit nurses' critical care knowledge and critical thinking tendency.

BACKGROUND

Learning intensive care unit knowledge and skills is essential for the continuing education of nurses, and impacts patient health outcomes. Enhancing intensive care unit nurses' critical care abilities is a medical care quality concern in clinical practice.

METHODS

A cross-sectional study was conducted with 212 participants to investigate the effects of a digital learning system on care quality.

RESULTS

After the implementation of the digital learning system, intensive care unit nurses' critical care knowledge and critical thinking skills increased significantly. High-level nurses had higher critical thinking scores. All participants associated critical care knowledge with improved quality of care.

CONCLUSION

The digital learning management system enhanced intensive care unit nurses' critical care knowledge. Optimizing nursing care safety and quality requires that nursing staff to be at an adequate level, which improves their critical care ability.

IMPLICATIONS FOR NURSING MANAGEMENT

A well-designed digital learning management system with structured classes may allow intensive care unit nurses to learn effectively and can be used for continuing education. These results are of interest to nursing management staff who want to invest in the continued professional development of intensive care unit nurses to improve critical care knowledge, critical thinking skills, care quality, and health care value.

Assessing patient safety culture in 15 intensive care units: a mixed-methods study

BACKGROUND

Within hospitals, intensive care units (ICUs) are particularly high-risk areas for medical errors and adverse events that could occur due to the complexity of care and the patients' fragile medical conditions. Assessing patient safety culture (PSC) is essential to have a broad view on patient safety issues, to orientate future improvement actions and optimize quality of care and patient safety outcomes. This study aimed at assessing PSC in 15 Tunisian ICUs using mixed methods approach.

METHODS

A cross-sectional mixed methods approach using a sequential explanatory design was conducted from December 2019 to January 2020. The first quantitative stage was conducted in 15 ICUs belonging to the two university hospitals in the region of Sousse (Tunisia). All the 344 healthcare professionals (clinical staff) working for more than 1 month in these ICUs were contacted in order to take part in the study. In the second qualitative stage 12 participants were interviewed based on purposive sampling.

RESULTS

All of the PSC dimensions had a score of less than 50%. The developed dimension was 'teamwork within units' (48.8%). The less developed dimensions were 'frequency of event reporting' (20.8%), 'communication openness' (22.2%) and 'non-punitive response to error' (19.7%). Interviews' thematic analysis revealed four main themes including "Hospital management/system failure", "Teamwork and communication", "Error management" and "Working conditions".

CONCLUSION

This research revealed that PSC is still in need of improvement and provided a clearer picture of the patient safety issues that require specific attention. Improving PSC through the use of quality management and error reporting systems may help to improve patient safety outcomes.

Assessing the quality of patient handovers between ambulance services and emergency department – development and validation of the emergency department human factors in handover tool

Background

Patient handover between prehospital care and the emergency department plays a key role in patient safety. Therefore, we aimed to create a validated tool for measuring quality of communication and interprofessional relations during handover in this specific setting.

Methods

Based on a theoretical framework a comprehensive item pool on information transfer and human factors in emergency department handovers was created and refined in a modified Delphi survey involving clinical experts. Based on a pre-test, items were again revised. The resulting Emergency Department Human Factors in Handover tool (ED-HFH) was validated in a field test at the emergency department of a German university hospital from July to December 2017. The ED-HFH was completed by emergency department and ambulance service staff participating in handovers and by an external observer. Description of item characteristics, exploratory factor analysis, analyses on internal consistency and interrater reliability by intraclass-correlation. Construct validity was analysed by correlation with an overall rating on quality of the handover.

Results

The draft of the ED-HFH contained 24 items, 90 of 102 eligible staff members participated in the field test completing 133 questionnaires on 38 observed handovers. Four items were deleted after analysis of item characteristics. Factor analysis supported a single factor explaining 39% of variance in the items. Therefore, a sum-score was calculated with a possible range between 14 and 70. The median value of the sum-score in the sample was 61.5, Cronbach’s α was 0.83, intraclass-correlation was 0.52, the correlation with the overall rating of hand-over quality was ρ = 0.83 (p ≤ 0.001).

Conclusions

The ED-HFH showed its feasibility, reliability and validity as a measure of quality of information transfer and human factors in handovers between ambulance services  and the emergency department. It promises to be a useful tool for quality assurance and staff training.

Nurse-nurse collaboration and performance among nurses in intensive care units

BACKGROUND

An essential element for offering high-quality care in the intensive care units (ICUs) is the intraprofessional collaboration among nurses, which facilitates the exchange of knowledge and information and hence improves performance. More research is needed to understand the relationship between the nurse-nurse collaboration and job performance in the ICUs due to the multidimensionality of both concepts, the complexity of the ICU environment, and the lack of studies.

AIM

To examine the relationship between nurse-nurse collaboration and self-perceived nurse performance among Jordanian nurses in ICUs.

DESIGN

Descriptive, correlational cross-sectional design was used.

METHODS

Data were collected through an online survey including the demographic questionnaire, the nurse-nurse collaboration scale, and six-dimensions scale for nursing performance.

RESULTS

In total, 155 critical care nurses participated (response rate = 46.97%). Self-perceived job performance was significantly associated with gender (t = -3.189, P = .002), age (r = -0.301, P < .01), workplace (F = 28.20, P = .001), the type of ICU (F = 17.70, P = .001), and the number of assigned patients (r = 0.407, P < .01). Among all nurse-nurse collaboration subscales, only the conflict management subscale was an independent significant predictor of self-perceived nursing performance (t = 3.06, B = 3.066, P = .003).

CONCLUSIONS

Effective conflict management is associated with better nurse performance, which could ultimately improve patient care in ICUs.

RELEVANCE TO CLINICAL PRACTICE

Conflict resolution is an important dimension of optimal nurse-nurse collaboration and has an important effect on nursing performance. Nurses and nurse managers in ICUs need to attend workshops and training programs in conflict management.

What Do We Know About Teamwork in Chinese Hospitals? A Systematic Review

Background and Objective: Improving quality of care is one of the primary goals in current Chinese hospital reforms. Teamwork can play an essential role. Characteristics of teamwork and interventions for improving teamwork in hospitals have been widely studied. However, most of these studies are from a Western context; evidence from China is scarce. Because of the contextual differences between China and Western countries, empirical evidence on teamwork from Western hospitals may have limited validity in China. This systematic review aims to advance the evidence base and understanding of teamwork in Chinese hospitals. Methods: Both English (i.e., Embase, Medline, and Web of Science) and Chinese databases (i.e., CNKI, CQVIP, and Wanfang) were searched for relevant articles until February 6, 2020. We included the studies that empirically researched teamwork in Chinese hospitals. Studies were excluded if they (1) were not conducted in hospitals in Mainland China, (2) did not research teamwork on team interventions, (3) were not empirical, (4) were not written in English or Chinese, (5) were not published in peer-reviewed journals, and (6) were not conducted in teams that provide direct patient care. Both deductive and inductive approaches were used to analyze data. The Mixed Methods Appraisal Tool (MMAT) was used to assess their methodological quality. Results: A total of 70 articles (i.e., 39 English articles and 31 Chinese articles) were included. The results are presented in two main categories: Teamwork components and Team interventions. The evidence regarding the relationships among inputs, processes, and outcomes is scarce and mostly inconclusive. The only conclusive evidence shows that females perceive better team processes than males. Similar types of training and tools were introduced as can be found in Western literature, all showing positive effects. In line with the Chinese health reforms, many of the intervention studies regard the introduction of multidisciplinary teams (MDTs). The evidence on the implementation of MDTs reveals that they have led to lower complication rates, shorter hospital stays, higher diagnosis accuracy, efficiency improvement, and a variety of better disease-specific clinical outcomes. Evidence on the effect on patient survival is inconclusive. Conclusion: The Chinese studies on teamwork components mainly focus on the input-process relationship. The evidence provided on this relationship is, however, mostly inconclusive. The intervention studies in Chinese hospitals predominantly focus on patient outcomes rather than organizational and employee outcomes. The introduction of training, tools, and MDTs generally shows promising results. The evidence from primary hospitals and rural areas, which are prioritized in the health reforms, is especially scarce. Advancing the evidence base on teamwork, especially in primary hospitals and rural areas, is needed and can inform policy and management to promote the health reform implementation. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020175069, identifier CRD42020175069.

Perspectives of Dental Patients About Safety Incident Reporting: A Qualitative Pilot Study

OBJECTIVES

Patient reporting of safety incidents is one of the hallmarks of an effective patient safety protocol in any health care setting. However, very little is known about safety reporting among dental patients or effective strategies for engaging them in activities that promote safety. The goal of this study was to understand the perceptions of dental patients about the barriers and benefits of reporting safety incidents. We also sought to identify strategies for improving patient reporting of safety incidents in the dental care setting.

METHODS

We conducted 3 focus group sessions with adult dental patients (n = 16) attending an academic dental center from November 2017 to February 2018. Audio recordings were transcribed and analyzed using a hybrid thematic analysis approach with NVivo software.

RESULTS

Dental patients mainly attributed safety incidents to provider-related and systemic factors. They were most concerned about the financial implications, inconvenience of multiple visits, and the absence of an apology when an incident occurred. The major recommended strategies for engaging patients in safety-related activities included the following: proactive solicitation of patient feedback, what-to-expect checklists, continuous communication during visits/procedures, after-visit summary reports, clear incident reporting protocols, use of technology, independent third-party safety incident reporting platforms, and a closed feedback loop.

CONCLUSIONS

This study offers a roadmap for proactively working with dental patients as vigilant partners in promoting quality and safety. If properly engaged, dental patients are prepared to work with dental professionals to identify threats to safety and reduce the occurrence of harm.

Realizing the Power of Text Mining and Natural Language Processing for Analyzing Patient Safety Event Narratives: The Challenges and Path Forward

ABSTRACT

Patient safety event (PSE) reports are a useful lens to understand hazards and patient safety risks in healthcare systems. However, patient safety officers and analysts in healthcare systems and safety organizations are challenged to make sense of the ever-increasing volume of PSE reports, including the free-text narratives. As a result, there is a growing emphasis on applying text mining and natural language processing (NLP) approaches to assist in the processing and understanding of these narratives. Although text mining and NLP in healthcare have advanced significantly over the past decades, the utility of the resulting models, ontologies, and algorithms to analyze PSE narratives are limited given the unique difference and challenges in content and language between PSE narratives and clinical documentation. To promote the application of text mining and NLP for PSE narratives, these unique challenges must be addressed. Improving data access, developing NLP resources to practically use contributing factor taxonomies, and developing and adopting shared specifications for interoperability will help create an infrastructure and environment that unlocks the collaborative potential between patient safety, research, and machine learning communities, in the development of reproducible and generalizable methods and models to better understand and improve patient safety and patient care.

Developing an Analytical Pipeline to Classify Patient Safety Event Reports Using Optimized Predictive Algorithms

BACKGROUND

 Patient safety event reports provide valuable insight into systemic safety issues but deriving insights from these reports requires computational tools to efficiently parse through large volumes of qualitative data. Natural language processing (NLP) combined with predictive learning provides an automated approach to evaluating these data and supporting the work of patient safety analysts.

OBJECTIVES

 The objective of this study was to use NLP and machine learning techniques to develop a generalizable, scalable, and reliable approach to classifying event reports for the purpose of driving improvements in the safety and quality of patient care.

METHODS

 Datasets for 14 different labels (themes) were vectorized using a bag-of-words, tf-idf, or document embeddings approach and then applied to a series of classification algorithms via a hyperparameter grid search to derive an optimized model. Reports were also analyzed for terms strongly associated with each theme using an adjusted F-score calculation.

RESULTS

 F₁ score for each optimized model ranged from 0.951 ("Fall") to 0.544 ("Environment"). The bag-of-words approach proved optimal for 12 of 14 labels, and the naïve Bayes algorithm performed best for nine labels. Linear support vector machine was demonstrated as optimal for three labels and XGBoost for four of the 14 labels. Labels with more distinctly associated terms performed better than less distinct themes, as shown by a Pearson's correlation coefficient of 0.634.

CONCLUSIONS

 We were able to demonstrate an analytical pipeline that broadly applies NLP and predictive modeling to categorize patient safety reports from multiple facilities. This pipeline allows analysts to more rapidly identify and structure information contained in patient safety data, which can enhance the evaluation and the use of this information over time.

Making Patient Safety Event Data Actionable: Understanding Patient Safety Analyst Needs

OBJECTIVES

The increase in patient safety reporting systems has led to the challenge of effectively analyzing these data to identify and mitigate safety hazards. Patient safety analysts, who manage reports, may be ill-equipped to make sense of report data. We sought to understand the cognitive needs of patient safety analysts as they work to leverage patient safety reports to mitigate risk and improve patient care.

METHODS

Semistructured interviews were conducted with 21 analysts, from 11 hospitals across 3 healthcare systems. Data were parsed into utterances and coded to extract major themes.

RESULTS

From 21 interviews, 516 unique utterances were identified and categorized into the following 4 stages of data analysis: input (15.1% of utterances), transformation (14.1%), extrapolation (30%), and output (14%). Input utterances centered on the source (35.9% of inputs) and preprocessing of data. Transformation utterances centered on recategorizing patient safety events (57.5% of transformations) or integrating external data sources (42.5% of transformations). The focus of interviews was on extrapolation and trending data (56.1% of extrapolations); alarmingly, 16.1% of trend utterances explicitly mentioned a reliance on memory. The output was either a report (56.9% of outputs) or an action (43.1% of outputs).

CONCLUSIONS

Major gaps in the analysis of patient safety report data were identified. Despite software to support reporting, many reports come from other sources. Transforming data are burdensome because of recategorization of events and integration with other data sources, processes that can be automated. Surprisingly, trend identification was mostly based on patient analyst memory, highlighting a need for new tools that better support analysts.

Safety Culture: Identifying a Healthcare Organization’s Approach to Safety Event Review and Response Through the Analysis of Event Recommendations

A nonpunitive approach to safety event reporting and analysis is an important dimension of healthcare organization safety culture. A system-based safety event review process, one focused on understanding and improving the conditions in which individuals do their work, generally leads to more effective and sustainable safety solutions. On the contrary, the more typical person-based approach, that blames individuals for errors, often results in unsustainable and ineffective safety solutions, but these solutions can be faster and less resource intensive to implement. We sought to determine the frequency of system-based and person-based approaches to adverse event reviews through analysis of the recommendation text provided by a healthcare organization in response to an event report. Human factors and clinical safety science experts developed a taxonomy to describe the content of the recommendation text, reviewed 8,546 event report recommendations, and assigned one or more taxonomy category labels to each recommendation. The taxonomy categories aligned with a system-based approach, aligned with a person-based approach, did not provide an indicator of the approach, or indicated the review/analysis was pending. A total of 9,848 category labels were assigned to the 8,546 event report recommendations. The most frequently used category labels did not provide an indicator of the approach to event review (4,145 of 9,848 category labels, 42.1%), followed by a person-based approach (2,327, 23.6%), review/analysis pending (1,862 ,18.9%), and a system-based approach (1,514, 15.4%). Analyzing the data at the level of each recommendation, 23.2% (1,979 of 8,546) had at least one person-based and no system-based category, 13.3% (1,133) had at least one system-based and no person-based category, and 3% (254) had at least one person-based and one system-based category. There was variability in the event review approach based on the general event type assigned to the safety event (e.g., medication, transfusion, etc.) as well as harm severity. Results suggest improvements in applying system-based approaches are needed, especially for certain general event type categories. Recommendations for improving safety event reviews are provided.

Investigating the Impact of Intensive Care Unit Interruptions on Patient Safety Events and Electronic Health Records Use: An Observational Study

BACKGROUND

Constant interruptions and continual data flow result in information overload for clinicians and become barriers to identification and extraction of relevant patient data and its correct interpretation. The aim of the study was to describe the types, frequencies, and impact of intensive care unit (ICU) interruptions on patient safety event occurrences and electronic health records (EHR) use.

METHODS

We conducted a live observational study for 6 weeks, observing critical care physicians' and other providers' communication while recording interruptions, patient safety events, and EHR use.

RESULTS

Across 55 hours, the researchers observed 7515 ICU tasks, 15.7% of which were interrupted. We found that technological interruptions directly influences the occurrence of patient safety events: an increase in technological interruptions directly contributes to patient safety event occurrence (P = 0.004). Technological interruptions had a direct effect on human interruptions, as the frequency of technological interruptions increase, human interruptions also increase (P = 0.02).

CONCLUSIONS

A prospective, observational study was conducted to understand the relationship between interruptions and patient safety events and EHR use, in a time-sensitive, activity-based study in a large academic medical center with a certified EHR system. We found that technological interruptions were statistically correlated to the occurrence of patient safety events, and human interruptions significantly affected the level of EHR use. This study recommends that ICUs adopt a safety culture that promotes minimizing unnecessary interruptions, such as side conversations during rounds, for improved quality of care.

The nature, severity and causes of medication incidents from an Australian community pharmacy incident reporting system: The QUMwatch study

AIMS

Most research into medication safety has been conducted in hospital settings with less known about primary care. The aim of this study was to characterise the nature and causes of medication incidents (MIs) in the community using a pharmacy incident reporting programme.

METHODS

Thirty community pharmacies participated in an anonymous or confidential MI spontaneous reporting programme in Sydney, Australia. The Advanced Incident Management System was used to record and classify incident characteristics, contributing factors, severity and frequency ratings.

RESULTS

In total, 1013 incidents were reported over 30 months, 831 of which were near misses while 165 reports involved patient harm. The largest proportion of cases pertained to patients aged >65 years (35.7%). Most incidents involved errors during the prescribing stage (61.1%), followed by dispensing (25.7%) and administration (23.5%), while some errors occurred at multiple stages (17.9%). Systemic antibacterials (12.2%), analgesics (11.8%) and renin-angiotensin medicines (11.7%) formed the majority of implicated classes. Participants identified diverse and interrelating contributing factors: those concerning healthcare providers included violations to procedures/guidelines (75.6%), rule-based mistakes (55.6%) and communication (50.6%); those concerning patients included cognitive factors (31.9%), communication (25.5%) and behaviour (6.1%). Organisational safety culture and inadequate risk management processes were rated as suboptimal.

CONCLUSION

An MI reporting programme can capture and characterise medication safety problems in the community and identify the human and system factors that contribute to errors. Since medicine use is ubiquitous in the community, morbidity and mortality from MIs may be reduced by addressing the prioritised risks and contributing factors identified in this study.

Improving Pediatric Resident Safety Event Reporting Using Quality Improvement Methods

BACKGROUND AND OBJECTIVES

Safety event reporting systems facilitate identification of system-level targets to improve patient safety. Resident physicians report few safety events despite their role as frontline providers and the frequent occurrence of events. The objective of this study is to increase the number of pediatric resident safety event submissions from <1 to 4 submissions per 14-day period within 12 months.

METHODS

We conducted an iterative quality improvement process with 39 pediatric residents at a children's hospital. Interventions focused on 4 key drivers: user-friendly event submission process, resident buy-in, nonpunitive safety culture, and data transparency. The primary outcome measure of number of pediatric resident event submissions was analyzed by using statistical process control. Balancing measures included time from submission to feedback, duplicate submissions, and nonevent submissions. As a control, the primary outcome measure was monitored for nonpediatric residents during the same period.

RESULTS

The mean number of pediatric resident event submissions increased from 0.9 to 5.7 submissions per 14 days. Impactful interventions included a designated space in the resident workroom to list safety events to submit, monthly project updates, and an interresident competition. There were no duplicate submissions or nonevent submissions in the postintervention period. Time to feedback in the postintervention period had both upward and downward shifts, with >8 consecutive points above and below the baseline period's centerline. The control group showed no sustained change in event submissions.

CONCLUSIONS

Our improvement process was associated with significant increase in pediatric resident safety event submissions without an increase in the number of submissions categorized as duplicates or nonevents.

Benefits of collaborative patient care rounds in the intensive care unit

BACKGROUND

Improving care of critically ill patients requires using an interprofessional care model and care standardisation.

OBJECTIVES

Determine whether collaborative patient care rounds in the intensive care unit increases practice consistency with respect to common considerations such as delirium prevention, device use, and indicated prophylaxis, among others. Secondary objective to assess whether collaborative interprofessional format improved nursing perceptions of collaboration.

METHODS

Single centre, pre- and post- intervention design. collaborative patient care rounding format implemented in three intensive care units in an academic tertiary care centre. format consisted of scripted nursing presentation, provider checklist of additional practice considerations, and daily priority goals documentation. measurements included nursing participation, consideration of selected practice items, daily goal verbalisation, and nursing perception of collaboration.

RESULTS

Pre- and post-intervention measurements indicate gains in consideration of eight of thirteen bundle items (p < 0.05), with the greatest gains seen in nurse-presented items. Increases were observed in verbalisation of daily goals (59.8% versus 89.1%, p < 0.0001), nurse participation (83.9% versus 91.8%, p = 0.056), and nurse collaboration ratings (p < 0.0001).

CONCLUSION

This study describes implementation of collaborative patient care rounds with corresponding increases in consideration of selected practice items, verbalisation of daily goals, and perceptions of collaboration.

La cirugía como una sinfonía. Un proyecto para el trabajo en equipo y coordinado

La seguridad del paciente es uno de los aspectos de mayor relevancia en la atención en un quirófano. El trabajo en equipo y coordinado, sumado al liderazgo, permite que los errores sean menos. Mantener un equipo estable en el quirófano, que conozca bien los procedimientos, y donde cada participante sabe el rol que juega, es uno de los factores más importantes para lograr un trabajo eficiente, con disminución de las complicaciones y del tiempo quirúrgico. Comparar el trabajo en el quirófano con una orquesta sinfónica, nos ayuda a entender la importancia del trabajo coordinado.

Patient Safety Concerns in COVID-19–Related Events: A Study of 343 Event Reports From 71 Hospitals in Pennsylvania

COVID-19 (i.e., coronavirus disease 2019) was declared a pandemic and has had a profound impact on healthcare systems, which may increase the risk of patient harm. We conducted a query of the Pennsylvania Patient Safety Reporting System (PA-PSRS) database to identify COVID-19–related events submitted by acute care hospitals between January 1 and April 15, 2020. We identified 343 relevant event reports from 71 hospitals and conducted a descriptive study to identify the prevalence of and relationships between 13 categories of associated factors and 6 categories of event outcomes. We found that 36% (124 of 343) of events had more than one associated factor and 24% (83 of 343) had more than one outcome. The most frequently identified factors were Laboratory Testing (47%; 161 of 343), Process/Protocol (25%; 87 of 343), and Isolation Integrity (22%; 74 of 343). The two most frequent outcomes were Exposure to COVID-19 Positive or Suspected Positive Patient (50%; 173 of 343) and Missed/Delayed Test or Result (31%; 108 of 343). Finally, the findings showed that seven of the associated factors had a notable impact on the frequency of Exposure to COVID-19 Positive or Suspected Positive Patient outcome. Overall, we anticipate that the results can be used to identify areas of greatest need and risk, which could help to guide allocation of resources to mitigate risk of patient harm.

Patient Safety Event Reporting and Opportunities for Emergency Medicine Resident Education

Introduction

Healthcare systems often expose patients to significant, preventable harm causing an estimated 44,000 to 98,000 deaths or more annually. This has propelled patient safety to the forefront, with reporting systems allowing for the review of local events to determine their root causes. As residents engage in a substantial amount of patient care in academic emergency departments, it is critical to use these safety event reports for resident-focused interventions and educational initiatives. This study analyzes reports from the Virginia Commonwealth University Health System to understand how the reports are categorized and how it relates to opportunities for resident education.

Methods

Identifying categories from the literature, three subject matter experts (attending physician, nursing director, registered nurse) categorized an initial 20 reports to resolve category gaps and then 100 reports to determine inter-rater reliability. Given sufficient agreement, the remaining 400 reports were coded individually for type of event and education among other categories.

Results

After reviewing 513 events, we found that the most common event types were issues related to staff and resident training (25%) and communication (18%), with 31% requiring no education, 46% requiring directed educational feedback to an individual or group, 20% requiring education through monthly safety updates or meetings, 3% requiring urgent communication by email or in-person, and <1% requiring simulation.

Conclusion

Twenty years after the publication of To Err is Human, gains have been made integrating quality assurance and patient safety within medical education and hospital systems, but there remains extensive work to be done. Through a review and analysis of our patient safety event reporting system, we were able to gain a better understanding of the events that are submitted, including the types of events and their severity, and how these relate to the types of educational interventions provided (eg, feedback, simulation). We also determined that these events can help inform resident education and learning using various types of education. Additionally, incorporating residents in the review process, such as through root cause analyses, can provide residents with high-quality, engaging learning opportunities and useful, lifelong skills, which is invaluable to our learners and future physicians.

The Potential of Twitter as a Data Source for Patient Safety

BACKGROUND

Error-reporting systems are widely regarded as critical components to improving patient safety, yet current systems do not effectively engage patients. We sought to assess Twitter as a source to gather patient perspective on errors in this feasibility study.

METHODS

We included publicly accessible tweets in English from any geography. To collect patient safety tweets, we consulted a patient safety expert and constructed a set of highly relevant phrases, such as "doctor screwed up." We used Twitter's search application program interface from January to August 2012 to identify tweets that matched the set of phrases. Two researchers used criteria to independently review tweets and choose those relevant to patient safety; a third reviewer resolved discrepancies. Variables included source and sex of tweeter, source and type of error, emotional response, and mention of litigation.

RESULTS

Of 1006 tweets analyzed, 839 (83%) identified the type of error: 26% of which were procedural errors, 23% were medication errors, 23% were diagnostic errors, and 14% were surgical errors. A total of 850 (84%) identified a tweet source, 90% of which were by the patient and 9% by a family member. A total of 519 (52%) identified an emotional response, 47% of which expressed anger or frustration, 21% expressed humor or sarcasm, and 14% expressed sadness or grief. Of the tweets, 6.3% mentioned an intent to pursue malpractice litigation.

CONCLUSIONS

Twitter is a relevant data source to obtain the patient perspective on medical errors. Twitter may provide an opportunity for health systems and providers to identify and communicate with patients who have experienced a medical error. Further research is needed to assess the reliability of the data.

The nature of patient complaints: a resource for healthcare improvements

OBJECTIVE

The aim of this study was to explore the nature, potential usefulness and meaning of complaints lodged by patients and their relatives.

DESIGN

A retrospective, descriptive design was used.

SETTING

The study was based on a sample of formal patient complaints made through a patient complaint reporting system for publicly funded healthcare services in Sweden.

PARTICIPANTS

A systematic random sample of 170 patient complaints was yielded from a total of 5689 patient complaints made in a Swedish county in 2015.

MAIN OUTCOME MEASURE

Themes emerging from patient complaints analysed using a qualitative thematic method.

RESULTS

The patient complaints reported patients' or their relatives' experiences of disadvantages and problems faced when seeking healthcare services. The meanings of the complaints reflected six themes regarding access to healthcare services, continuity and follow-up, incidents and patient harm, communication, attitudes and approaches, and healthcare options pursued against the patient's wishes.

CONCLUSIONS

The patient complaints analysed in this study clearly indicate a number of specific areas that commonly give rise to dissatisfaction; however, the key findings point to the significance of patients' exposure and vulnerability. The findings suggest that communication needs to be improved overall and that patient vulnerability could be successfully reduced with a strong interpersonal focus. Prerequisites for meeting patients' needs include accounting for patients' preferences and views both at the individual and organizational levels.

Evaluation of a Measurement System to Assess ICU Team Performance

OBJECTIVE

Measuring teamwork is essential in critical care, but limited observational measurement systems exist for this environment. The objective of this study was to evaluate the reliability and validity of a behavioral marker system for measuring teamwork in ICUs.

DESIGN

Instances of teamwork were observed by two raters for three tasks: multidisciplinary rounds, nurse-to-nurse handoffs, and retrospective videos of medical students and instructors performing simulated codes. Intraclass correlation coefficients were calculated to assess interrater reliability. Generalizability theory was applied to estimate systematic sources of variance for the three observed team tasks that were associated with instances of teamwork, rater effects, competency effects, and task effects.

SETTING

A 15-bed surgical ICU at a large academic hospital.

SUBJECTS

One hundred thirty-eight instances of teamwork were observed. Specifically, we observed 88 multidisciplinary rounds, 25 nurse-to-nurse handoffs, and 25 simulated code exercises.

INTERVENTIONS

No intervention was conducted for this study.

MEASUREMENTS AND MAIN RESULTS

Rater reliability for each overall task ranged from good to excellent correlation (intraclass correlation coefficient, 0.64-0.81), although there were seven cases where reliability was fair and one case where it was poor for specific competencies. Findings from generalizability studies provided evidence that the marker system dependably distinguished among teamwork competencies, providing evidence of construct validity.

CONCLUSIONS

Teamwork in critical care is complex, thereby complicating the judgment of behaviors. The marker system exhibited great potential for differentiating competencies, but findings also revealed that more context specific guidance may be needed to improve rater reliability.

Quality Improvement Program Outcomes for Endotracheal Intubation in the Emergency Department

OBJECTIVES

We describe our 3-year experience with endotracheal intubation (ETI) outcomes during a multidisciplinary emergency department (ED)-based quality improvement (QI) program.

METHODS

This was a single-center, observational study taking place during a QI program. We used a registry for airway management performed in the ED from April 2014 to February 2017. The QI program focused on procedural standardization, airway management education, and comprehensive preparation of airway equipment. The primary outcome was first-pass success (FPS) rate. The secondary outcomes were multiple-attempts rate and overall rate of complications.

RESULTS

A total of 1087 emergent ETIs were included. The FPS rate significantly increased from 68% in the first year to 74% in the second year and 79% in the third year (P for trend <0.01). The multiple-attempts rate in the first year was 12%, followed by 7% and 6% in the second and third years, respectively (P for trend <0.01). The overall complication rate was 16% in the first year, 8% in the second year, and 8% in the third year (P for trend <0.01).

CONCLUSIONS

We observed improved ETI outcomes in the ED, including increased FPS rate and decrease in multiple-attempt rate and overall complication rate during the multidisciplinary QI program to enhance patient safety.

Health professionals' views on maternity care for women with physical disabilities: a qualitative study

BACKGROUND

During pregnancy, childbirth and puerperium, women receive care from a range of health professionals, particularly midwives. To assess the current situation of maternity care for women with physical disabilities in Austria, this study investigated the perceptions and experiences of health professionals who have provided care for women with disabilities during pregnancy, childbirth and postpartum.

METHODS

The viewpoints of the participating health professionals were evaluated by means of semistructured interviews followed by an inductive qualitative content analysis of the interview transcripts, as proposed by Mayring.

RESULTS

Four main categories emerged from the inductive content analysis: (i) structural conditions and accessibility, (ii) interprofessional teamwork and cooperation, (iii) action competence, and (iv) diversity-sensitive attitudes. According to the participating health professionals, the structural conditions were frequently not suitable for providing targeted group-oriented care services. Additionally, a shortage of time and staff resources also limited the necessary flexibility of treatment measures in the care of mothers with physical disabilities. The importance of interprofessional teamwork for providing adequate care was highlighted. The health professionals regarded interprofessionalism as an instrument of quality assurance and team meetings as an elementary component of high-quality care. On the other hand, the interviewees perceived a lack of action competence that was attributed to a low number of cases and a corresponding lack of experience and routine. Regarding diversity-sensitive attitudes, it became apparent that the topic of mothers with physical disabilities in care posed challenges to health professionals that influenced their natural handling of the interactions.

CONCLUSION

The awareness of one's own attitudes towards diversity, in the perinatal context in particular, influences professional security and sovereignty as well as the quality of care of women with disabilities. There is a need for optimization in the support and care of women with physical disabilities during pregnancy, childbirth and puerperium.

Team talk and team decision processes: a qualitative discourse analytical approach to 10 real-life medical emergency team encounters

OBJECTIVES

Explore the function of three specific modes of talk (discourse types) in decision-making processes.

DESIGN

Ten real-life admissions of patients with critical illness were audio/video recorded and transcribed. Activity-type analysis (a qualitative discourse analytical method) was applied.

SETTING

Interdisciplinary emergency teams admitting patients with critical illness in a Norwegian university hospital emergency department (ED).

PARTICIPANTS

All emergency teams consisted of at least two internal medicine physicians, two ED nurses, one anaesthetist and one nurse anaesthetist. The number of healthcare professionals involved in each emergency team varied between 11 and 20, and some individuals were involved with more than one team.

RESULTS

The three discourse types played significant roles in team decision-making processes when negotiating meaning. Online commentaries (ONC) and metacommentaries (MC) created progression while offline commentaries (OFC) temporarily placed decisions on hold. Both ONC and MC triggered action and distributed tasks, resources and responsibility in the team. OFC sought mutual understanding and created a broader base for decisions.

CONCLUSION

A discourse analytical perspective on team talk in medical emergencies illuminates both the dynamics and complexity of teamwork. Here, we draw attention to the way specific modes of talk function in negotiating mutual understanding and distributing tasks and responsibilities in non-algorithm-driven activities. The analysis uncovers a need for an enhanced focus on how language can trigger safe team practice and integrate this knowledge in teamwork training to improve communication skills in ad hoc emergency teams.

Patient-Centered Insights: Using Health Care Complaints to Reveal Hot Spots and Blind Spots in Quality and Safety

Policy Points: Health care complaints contain valuable data on quality and safety; however, there is no reliable method of analysis to unlock their potential. We demonstrate a method to analyze health care complaints that provides reliable insights on hot spots (where harm and near misses occur) and blind spots (before admissions, after discharge, systemic and low-level problems, and errors of omission). Systematic analysis of health care complaints can improve quality and safety by providing patient-centered insights that localize issues and shed light on difficult-to-monitor problems.

CONTEXT

The use of health care complaints to improve quality and safety has been limited by a lack of reliable analysis tools and uncertainty about the insights that can be obtained. The Healthcare Complaints Analysis Tool, which we developed, was used to analyze a benchmark national data set, conceptualize a systematic analysis, and identify the added value of complaint data.

METHODS

We analyzed 1,110 health care complaints from across England. "Hot spots" were identified by mapping reported harm and near misses onto stages of care and underlying problems. "Blind spots" concerning difficult-to-monitor aspects of care were analyzed by examining access and discharge problems, systemic problems, and errors of omission.

FINDINGS

The tool showed moderate to excellent reliability. There were 1.87 problems per complaint (32% clinical, 32% relationships, and 34% management). Twenty-three percent of problems entailed major or catastrophic harm, with significant regional variation (17%-31%). Hot spots of serious harm were safety problems during examination, quality problems on the ward, and institutional problems during admission and discharge. Near misses occurred at all stages of care, with patients and family members often being involved in error detection and recovery. Complaints shed light on 3 blind spots: (1) problems arising when entering and exiting the health care system; (2) systemic failures pertaining to multiple distributed and often low-level problems; and (3) errors of omission, especially failure to acknowledge and listen to patients raising concerns.

CONCLUSIONS

The analysis of health care complaints reveals valuable and uniquely patient-centered insights on quality and safety. Hot spots of harm and near misses provide an alternative data source on adverse events and critical incidents. Analysis of entry-exit, systemic, and omission problems provides insight on blind spots that may otherwise be difficult to monitor. Benchmark data and analysis scripts are downloadable as supplementary files.

Safety considerations for performing robotic surgery in the presence of a permanent pacemaker

With increasing experience, more complex patients are undergoing robotic surgery but the patient safety during these procedures remains paramount. Being a relatively recent technique of minimal access surgery, the safety and feasibility of robotic surgery is still under scrutiny. We recently performed two robotic procedures in patients who have permanent cardiac pacemaker. We believe this is the first published report through which it is shared and discussed, the preoperative and intraoperative management for these patients along with the importance of WHO checklist for safely performing robotic procedures. The importance of pre-procedure planning and briefing cannot be emphasised enough as these along with intraoperative management remain the key step in dealing with an adverse cardiac event due to permanent pacemaker malfunction.

Redesigning Rounds in the ICU: Standardizing Key Elements Improves Interdisciplinary Communication

BACKGROUND

Daily multidisciplinary rounds (MDR) in the ICU represent a mechanism by which health care professionals from different disciplines and specialties can meet to synthesize data, think collectively, and form complete patient care plans. It was hypothesized that providing a standardized, structured approach to the daily rounds process would improve communication and collaboration in seven distinct ICUs in a single academic medical center.

METHODS

Lean-inspired methodology and information provided by frontline staff regarding inefficiencies and barriers to optimal team functioning were used in designing a toolkit for standardization of rounds in the ICUs. Staff perceptions about communication were measured, and direct observations of rounds were conducted before and after implementation of the intervention.

RESULTS

After implementation of the intervention, nurse participation during presentation of patient data increased from 17/47 (36.2%) to 56/78 (71.8%) (p < 0.0002) in the surgical ICUs and from 8/23 (34.8%) to 107/107 (100%) (p <0.0001) in the medical ICUs. Nurse participation during generation of the daily plan increased in the surgical ICUs from 24/47 (51.1%) to 63/78 (80.8%) (p = 0.0005) and from 7/23 (30.4%) to 106/107 (99.1%) (p < 0.0001) in the medical ICUs. Miscommunications and errors were corrected in nearly half of the rounding episodes observed.

CONCLUSION

This study demonstrated that the implementation of a simple toolkit that can be incorporated into existing work flow and rounding culture in several different types of ICUs can result in improvements in engagement of nursing staff and in overall communication.

10,000 Good Catches: Increasing Safety Event Reporting In A Pediatric Health Care System

Background:

In 2014, Children’s National Health System’s executive leadership team challenged the organization to double the number of voluntary safety event reports submitted over a 3-year period; the intent was to increase reliability and promote our safety culture by hardwiring employee event reporting.

Methods:

Following a Donabedian quality improvement framework of structure, process, and outcomes, a multidisciplinary team was formed and areas for improvement were identified. The multidisciplinary team focused on 3 major areas: the perceived ease of reporting (ie, how difficult is it to report an event?); the perceived safety of reporting (ie, will I get in trouble for reporting?); and the perceived impact of reporting (ie, does my report make a difference?) technology, making it safe to report, and how reporting makes a difference. The team developed a key driver diagram and implemented interventions designed to impact the key drivers and to increase reporting.

Results:

Children’s National increased the number of safety event reports from 4,668 in fiscal year 2014 to 10,971 safety event reports in fiscal year 2017. Median event report submission time was decreased by nearly 30%, anonymous reporting decreased by 69%, the number of submitting departments increased by 94%, and the number of reports submitted as “other” decreased from a baseline of 6% to 2%.

Conclusions:

Children’s National Health System’s focus on increasing safety event reporting resulted in increased organizational engagement and attention. This initiative served as a tangible step to improve organizational reliability and the culture of safety and is readily generalizable to other hospitals.

Nurse-Technology Interactions and Patient Safety

Nurses are the end-users of most technology in intensive care units, and the ways in which they interact with technology affect quality of care and patient safety. Nurses' interactions include the processes of ensuring proper input of data into the technology as well as extracting and interpreting the output (clinical data, technical data, alarms). Current challenges in nurse-technology interactions for physiologic monitoring include issues regarding alarm management, workflow interruptions, and monitor surveillance. Patient safety concepts, like high reliability organizations and human factors, can advance efforts to enhance nurse-technology interactions.

Culture, silence and voice: The implications for patient safety in the operating theatre

Team culture is an important antecedent to safety behaviours such as speaking up. A positive safety culture in the operating theatre has been linked to fewer adverse events. Psychological safety, a component of safety culture, is the belief that the team is safe to take risks such as raising concerns. Power dynamics can influence active speaking up behaviour or 'voice'. When theatre team members chose to remain silent rather than voice concerns this can be a protective or defensive strategy rather than passive inactivity.

Iterative co-creation for improved hand hygiene and aseptic techniques in the operating room: experiences from the safe hands study

BACKGROUND

Hand hygiene and aseptic techniques are essential preventives in combating hospital-acquired infections. However, implementation of these strategies in the operating room remains suboptimal. There is a paucity of intervention studies providing detailed information on effective methods for change. This study aimed to evaluate the process of implementing a theory-driven knowledge translation program for improved use of hand hygiene and aseptic techniques in the operating room.

METHODS

The study was set in an operating department of a university hospital. The intervention was underpinned by theories on organizational learning, culture and person centeredness. Qualitative process data were collected via participant observations and analyzed using a thematic approach.

RESULTS

Doubts that hand-hygiene practices are effective in preventing hospital acquired infections, strong boundaries and distrust between professional groups and a lack of psychological safety were identified as barriers towards change. Facilitated interprofessional dialogue and learning in "safe spaces" worked as mechanisms for motivation and engagement. Allowing for the free expression of different opinions, doubts and viewing resistance as a natural part of any change was effective in engaging all professional categories in co-creation of clinical relevant solutions to improve hand hygiene.

CONCLUSION

Enabling nurses and physicians to think and talk differently about hospital acquired infections and hand hygiene requires a shift from the concept of one-way directed compliance towards change and learning as the result of a participatory and meaning-making process. The present study is a part of the Safe Hands project, and is registered with ClinicalTrials.gov (ID: NCT02983136 ). Date of registration 2016/11/28, retrospectively registered.

Examining the implementation of collaborative competencies in a critical care setting: Key challenges for enacting competency-based education

Interprofessional collaboration is recognised as an important factor in improving patient care in intensive care units (ICUs). Competency frameworks, and more specifically interprofessional competency frameworks, are a key strategy being used to support the development of attitudes, knowledge, skills, and behaviours needed for an interprofessional approach to care. However, evidence for the application of competencies is limited. This study aimed to extend our empirically based understanding of the significance of interprofessional competencies to actual clinical practice in an ICU. An ethnographic approach was employed to obtain an in-depth insight into healthcare providers' perspectives, behaviours, and interactions of interprofessional collaboration in a medical surgical ICU in a community teaching hospital in Canada. Approximately 160 hours of observations were undertaken and 24 semi-structured interviews with healthcare workers were conducted over a period of 6 months. Data were analysed using a directed content approach where two national competency frameworks were used to help generate an understanding of the practice of interprofessional collaboration. Healthcare professionals demonstrated numerous instances of interprofessional communication, role understandings, and teamwork in the ICU setting, which supported a number of key collaborative competencies. However, organisational factors such as pressures for discharge and patient flow, staffing, and lack of prioritisation for interprofessional learning undermined competencies designed to improve collaboration and teamwork. The findings demonstrate that interprofessional competencies can play an important role in promoting knowledge, attitudes, skills, and behaviours needed. However, competencies that promote interprofessional collaboration are dependent on a range of contextual factors that enable (or impede) individuals to actually enact these competencies.

Comparison of awareness of patient parameters between two groups of caregivers in intensive care unit

Aim of the Study:

Materials and Methods:

Results:

Conclusions:

Bullying and Sexual Discrimination in the Greek Health Care System

INTRODUCTION

Modern medicine is based on teamwork and communication. Bullying and discrimination can have a serious effect on these, affecting the standard of medical training and patient care.

AIM

To determine the incidence of bullying and sex discrimination in the Greek health care system.

METHODS

An online questionnaire was designed and circulated among Greek medical professionals.

RESULTS

We received 1349 completed questionnaires with a response rate of 48% and with 45% of them being female. Equal opportunities in specialty training were reported by 55% of the participants. Female doctors in medicine and in surgery reported no equal opportunities at an incidence of 15% and 30%, respectively (p < 0.001). Family obligations and lack of family support were considered as the main obstacles in female doctors' professional development by 92% and 59% of the participants, respectively. Both sexes appeared to have suffered from various forms of abusive behavior with characteristics that vary between them. Verbal abuse, threatening behavior, and sexual harassment were reported by 50%, 38%, and 20%, respectively, with women being 3 times more likely to be victims of sexual harassment (34% vs. 9%, p < 0.001). Finally, the availability of official support mechanisms was reported in only 15% of the cases, whereas friends and colleagues were the main support for 46.17% of the cases.

CONCLUSION

This is the first study attempting to preliminary describe the extent of bullying and sexual discrimination in the Greek national health care system. Despite the limitations of this study, it is imperative that more research is performed on this issue from the appropriate national authorities.