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Schmied M, Buchberger W, Perkhofer D, Kvitsaridze I, Brunner W, Kapferer O, Siebert U. Detection of Adverse Events With the Austrian Inpatient Quality Indicators. J Patient Saf 2024; 20:426-433. [PMID: 38771664 DOI: 10.1097/pts.0000000000001235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/23/2024]
Abstract
OBJECTIVES Indicators based on routine data are considered a readily available and cost-effective method for assessing health care quality and safety. The Austrian Inpatient Quality Indicators (A-IQI) have been introduced in all Austrian public hospitals as a mandatory quality measurement. The purpose of this study was to assess the value of conspicuous A-IQI in predicting the presence of adverse events (AEs). METHODS We conducted an exploratory study comparing all indicator-positive patient cases contributing to 18 conspicuous A-IQI indicators to randomly selected indicator-negative control cases regarding the prevalence and severity of AEs. Structured medical record review using the Institute for Healthcare Improvement Global Trigger Tool was used as the gold standard. RESULTS In 421 chart reviews, we identified 158 AEs. 70.9% (n = 112) of the AEs were found in cases with a positive indicator. The relative risk of an AE occurring was 3.47 (95% confidence interval: 2.30, 5.24) in indicator-positive cases compared to indicator-negatives. The proportion of severe events (National Coordination Council for Medication Error Reporting and Prevention Index categories H and I) was 54.5% (n = 61) in indicator-positive cases and only 15.3% (n = 7) in indicator-negative cases. Overall sensitivity of the A-IQI was 68.2%, specificity 69.4%, positive predictive value 36.0%, and negative predictive value 89.6%. CONCLUSIONS Our study shows that significantly more AEs and more severe AEs were found in cases with positive A-IQI than in indicator-negative control cases. However, studies with larger numbers of cases and with larger numbers of conspicuous indicators are needed for the validation of the entire A-IQI indicator set.
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Affiliation(s)
| | - Wolfgang Buchberger
- Research Unit for Quality and Efficiency in Medicine, Institute of Public Health, Medical Decision Making and Health Technology Assessment, UMIT TIROL-University for Health Sciences and Technology, Hall in Tirol, Austria
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Sexton JR, Kelly-Weeder S. The Role of Pediatric Nurses During Preventable Adverse Event Disclosure: A Scoping Review. J Patient Saf 2024; 20:381-387. [PMID: 38747504 DOI: 10.1097/pts.0000000000001239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/21/2024]
Abstract
OBJECTIVES Preventable adverse events (PAEs) occur across the healthcare spectrum; and, unfortunately, errors, adverse events, and PAEs are common in pediatric care. Historically, the role of disclosure of PAEs to patients and their families occurred between the dyad of physician and patient, with physicians assuming the responsibility of disclosure. In recent years, a trend toward a multidisciplinary team-based approach has emerged in some institutions, yet the role of pediatric nurses within the team disclosing a PAE is not fully understood. Given the unique relationship between pediatric nurses and their patients and their families, it is essential to understand does the literature tell us about the role of pediatric nurses during PAE disclosure? METHODS The Arksey and O'Malley scoping review method guided this study protocol and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews framework guided reporting. RESULTS The final sample included five articles for synthesis: none reported or described a specific role for pediatric nurses during PAE disclosure. CONCLUSIONS There is a gap in the literature on the role of pediatric nurses during PAE disclosure. Two themes emerged from this review: the use of a team-based approach to disclosure, and the need to provide emotional support to the pediatric patient and their family. There is a need for additional investigation into the role of pediatric nurses as part of a team-based disclosure process and how pediatric nurses currently provide, or desire to provide, emotional support to the patient and their family.
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Fan R, Yan Z, Wang A, Gao S, Wang L, Mao S. The influence of adverse events on inpatient outcomes in a tertiary hospital using a diagnosis-related group database. Sci Rep 2024; 14:18114. [PMID: 39103554 PMCID: PMC11300589 DOI: 10.1038/s41598-024-69283-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Accepted: 08/02/2024] [Indexed: 08/07/2024] Open
Abstract
Adverse events (AEs) are a significant concern for healthcare systems. However, it is difficult to evaluate their influence because of the complexity of various medical services. This study aimed to assess the influence of AEs on the outcomes of hospitalized patients using a diagnosis-related group (DRG) database. We conducted a case-control study of hospitalized patients at a multi-district tertiary hospital with 2200 beds in China, using data from a DRG database. An AE refers to an unintended physical injury caused or contributed to by medical care that requires additional hospitalization, monitoring, treatment, or even death. Relative weight (RW), a specific indicator of DRG, was used to measure the difficulty of diagnosis and treatment, disease severity, and medical resources utilized. The primary outcomes were hospital length of stay (LOS) and hospitalization costs. The secondary outcome was discharge to home. This study applied DRG-based matching, Hodges-Lehmann estimate, regression analysis, and subgroup analysis to evaluate the influence of AEs on outcomes. Two sensitivity analyses by excluding short LOS and changing adjustment factors were performed to assess the robustness of the results. We identified 2690 hospitalized patients who had been divided into 329 DRGs, including 1345 patients who experienced AEs (case group) and 1345 DRG-matched normal controls. The Hodges-Lehmann estimate and generalized linear regression analysis showed AEs led to prolonged LOS (unadjusted difference, 7 days, 95% confidence interval [CI] 6-8 days; adjusted difference, 8.31 days, 95% CI 7.16-9.52 days) and excess hospitalization costs (unadjusted difference, $2186.40, 95% CI: $1836.87-$2559.16; adjusted difference, $2822.67, 95% CI: $2351.25-$3334.88). Logistic regression analysis showed AEs were associated with lower odds of discharge to home (unadjusted odds ratio [OR] 0.66, 95% CI 0.54-0.82; adjusted OR 0.75, 95% CI 0.61-0.93). The subgroup analyses showed that the results for each subgroup were largely consistent. LOS and hospitalization costs increased significantly after AEs in complex diseases (RW ≥ 2) and in relation to high degrees of harm subgroups (moderate harm and above groups). Similar results were obtained in sensitivity analyses. The burden of AEs, especially those related to complex diseases and severe harm, is significant in China. The DRG database serves as a valuable source of information that can be utilized for the evaluation and management of AEs.
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Affiliation(s)
- Rui Fan
- Medical Quality Management Office, Ningbo Medical Center Lihuili Hospital, Xingning Road 57, Yinzhou District, Ningbo, 315000, China
| | - Zhiyu Yan
- Medical Quality Management Office, Ningbo Medical Center Lihuili Hospital, Xingning Road 57, Yinzhou District, Ningbo, 315000, China.
| | - Anshi Wang
- School of Public Health, Wannan Medical College, Wuhu, China
| | - Shang Gao
- Medical Quality Management Office, Ningbo Medical Center Lihuili Hospital, Xingning Road 57, Yinzhou District, Ningbo, 315000, China
| | - Lili Wang
- Shanghai Fifth People's Hospital, Fudan University, Shanghai, China
- Nursing Department, Ningbo Medical Center Lihuili Hospital, Ningbo, Zhejiang, China
| | - Shuqi Mao
- Department of Hepatopancreatobiliary Surgery, Ningbo Medical Center Lihuili Hospital, Xingning Road 57, Yinzhou District, Ningbo, 315000, China.
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Meulman MD, Merten H, van Munster B, Wagner C. Comparing Guidelines to Daily Practice When Screening Older Patients for the Risk of Functional Decline in Hospitals: Outcomes of a Functional Resonance Analysis Method (FRAM) Study. J Patient Saf 2024:01209203-990000000-00248. [PMID: 39087795 DOI: 10.1097/pts.0000000000001263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2024]
Abstract
OBJECTIVES Dutch hospitals are required to screen older patients for functional decline using 4 indicators: malnutrition, delirium, physical impairment, and falls, to recognize frail older patients promptly. The Functional Resonance Analysis Method was employed to deepen the understanding of work according to the protocols (work-as-imagined [WAI]) in contrast to the realities of daily practice (work-as-done [WAD]). METHODS Data have been collected from 3 hospitals (2 tertiary and 1 general) and 4 different wards: an internal medicine ward, surgical ward, neurology ward, and a trauma geriatric ward. WAI models were based on national guidelines and hospital protocols. Data on WAD were collected through semistructured interviews with involved nurses (n = 30). RESULTS Hospital protocols were more extensive than national guidelines for all screening indicators. Additional activities mainly comprised specific preventive interventions or follow-up assessments after adequate measurements. Key barriers identified to work according to protocols included time constraints, ambiguity regarding task ownership, nurses' perceived limitations in applying their clinical expertise due to time constraints, insufficient understanding of freedom-restricted interventions, and the inadequacy of the Delirium Observation Scale Score in patients with neurological and cognitive problems. Performance variability stemmed from timing issues, frequently attributable to time constraints. CONCLUSIONS The most common reasons for deviating from the protocol are related to time constraints, lack of knowledge, and/or patient-related factors. Also, collaboration among relevant disciplines appears important to ensure good health outcomes. Future research endeavors could shed a light on the follow-up procedures of the screening process and roles of other disciplines, such as physiotherapists.
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Affiliation(s)
- Meggie D Meulman
- From the Netherlands Institute for Health Services Research (Nivel), Utrecht
| | - Hanneke Merten
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam
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Waltzman M, Ozonoff A, Fournier KA, Welcher J, Milliren C, Landschaft A, Bulis J, Kimia AA. Surveillance of Health Care-Associated Violence Using Natural Language Processing. Pediatrics 2024; 154:e2023063059. [PMID: 38973359 PMCID: PMC11291961 DOI: 10.1542/peds.2023-063059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 03/14/2024] [Accepted: 03/18/2024] [Indexed: 07/09/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Patient and family violent outbursts toward staff, caregivers, or through self-harm, have increased during the ongoing behavioral health crisis. These health care-associated violence (HAV) episodes are likely under-reported. We sought to assess the feasibility of using nursing notes to identify under-reported HAV episodes. METHODS We extracted nursing notes across inpatient units at 2 hospitals for 2019: a pediatric tertiary care center and a community-based hospital. We used a workflow for narrative data processing using a natural language processing (NLP) assisted manual review process performed by domain experts (a nurse and a physician). We trained the NLP models on the tertiary care center data and validated it on the community hospital data. Finally, we applied these surveillance methods to real-time data for 2022 to assess reporting completeness of new cases. RESULTS We used 70 981 notes from the tertiary care center for model building and internal validation and 19 332 notes from the community hospital for external validation. The final community hospital model sensitivity was 96.8% (95% CI 90.6% to 100%) and a specificity of 47.1% (39.6% to 54.6%) compared with manual review. We identified 31 HAV episodes in July to December 2022, of which 26 were reportable in accordance with the hospital internal criteria. Only 7 of 26 cases were reported by employees using the self-reporting system, all of which were identified by our surveillance process. CONCLUSIONS NLP-assisted review is a feasible method for surveillance of under-reported HAV episodes, with implementation and usability that can be achieved even at a low information technology-resourced hospital setting.
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Affiliation(s)
- Mark Waltzman
- Boston Children’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Al Ozonoff
- Boston Children’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | | | | | | | | | | | - Amir A Kimia
- Boston Children’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
- Connecticut Children’s Hospital, Hartford, Connecticut
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Miller S, Stockwell DC. Patient Harm Events and Associated Cost Outcomes Reported to a Patient Safety Organization. J Patient Saf 2024:01209203-990000000-00240. [PMID: 39038074 DOI: 10.1097/pts.0000000000001254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/24/2024]
Abstract
OBJECTIVES The aims of the study were to describe inpatient harm events detected via an automatic electronic trigger system (ETS) and to consider their financial consequences. METHODS Over a 27-month period, inpatient harm events were identified and documented in 1 healthcare system with 37 acute care facilities. Patients who experienced harm (all harm or preventable harm only) were compared with similar patients who did not. Clinical, financial, and demographic data were used to identify labor-adjusted direct variable costs (DVC) and potential differences in length of stay (LOS) associated with all-harm, preventable-harm, and nonharmed cohorts. Age-adjusted Charlson Comorbidity Index, case mix index, diagnosis-related groups, major diagnostic category, sex, age, location, diagnosis, adverse event category and subcategory, preventability, and harm severity were used to compare cohorts. Total harm events reported via the ETS and the health system's voluntary event reporting system were compared. RESULTS Nearly 93,000 encounters for all-harm (n = 25,665) and nonharmed cohorts (n = 67,217) were compared by random sampling of diagnosis-related group-matched all-harm and nonharmed groups to ensure similar clinical conditions, as measured by Charlson Comorbidity Index and case mix index. Sampling (2 groups, n = 100 and n = 200) showed that increased LOS was associated with harm; yet other clinical comparators were similar across groups. the preventable-harm subcohort had longer LOS (10.7 versus 5.9 days) and higher DVC ($13,442 versus $8024) than the nonharmed cohort. Identification of harm events was nearly 6-fold higher with the ETS than with the voluntary event reporting system. CONCLUSIONS Patients with preventable harm had increased LOS that was associated with higher DVC per preventable-harm encounter in a large US healthcare system.
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Affiliation(s)
- Susanne Miller
- From the Pascal Metrics PSO, Washington, District of Columbia
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Adamovic I, Dahlem P, Brachmann J. Measuring the overall development of patient safety in a new hospital using trigger tools. Int J Qual Health Care 2024; 36:mzae064. [PMID: 38978150 DOI: 10.1093/intqhc/mzae064] [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: 10/28/2023] [Revised: 04/26/2024] [Accepted: 07/03/2024] [Indexed: 07/10/2024] Open
Abstract
The new building of the Hospital in Lichtenfels (Germany) was put into operation in mid-July 2018. Neither the medical personnel nor medical departments have been changed. We want to evaluate how 'safe' or 'insecure' the new hospital or department in the beginning might have been. Our objective is to investigate if safety decreases at the beginning in a new hospital, despite modern environments and conditions. Adverse events (AEs) associated with treatment were included to evaluate the total number of AEs resulting from medical care and medications. Patients' records had to be closed and completed, the length of stay had to be at least 24 h, and the patient had to have been formally admitted to the hospital [Institute for Healthcare Improvement (IHI) 'Global Trigger Tool' (GTT) recommendation]. The identified AEs were grouped into 27 categories of the IHI 'GTT'. We randomly reviewed 40 patient records per month 6 months before and 6 months after moving to the new hospital. Statistical analysis showed that there was no significant difference in individual AEs. The sum of AEs was statistically higher after moving into a new hospital. A complete number of harms did reach statistical significance (χ2 = 6.62; df = 1; P < .05; Cramer's V = 0.12), indicating that new environments 'trigger' significantly more potential errors (50%) in comparison to the old environments (38.33%). According to our findings, the new hospital appears to be slightly insecure in the first 6 months after opening.
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Affiliation(s)
- Ivan Adamovic
- Department of Surgery, ASANA Spital Leuggern, Kommendeweg 12, Leuggern 5316, Switzerland
| | - Peter Dahlem
- Department of Pediatrics, REGIOMED Klinikum, Ketschendorfer Str. 33, Coburg 96450, Germany
| | - Johannes Brachmann
- Department of Cardiology, REGIOMED Klinikum, Ketschendorfer Str. 33, Coburg 96450, Germany
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Zerillo JA, Tardiff SA, Flood D, Sokol-Hessner L, Weiss A. Putting the "Action" in RCA 2: An Analysis of Intervention Strength After Adverse Events. Jt Comm J Qual Patient Saf 2024; 50:492-499. [PMID: 38705745 DOI: 10.1016/j.jcjq.2024.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 03/19/2024] [Accepted: 03/20/2024] [Indexed: 05/07/2024]
Abstract
BACKGROUND Safety event reporting and review is well established within US hospitals, but systems to ensure implementation of changes to improve patient safety are less developed. METHODS Contributing factors and corrective actions for events brought to a tertiary care academic medical center's multidisciplinary hospital-level safety event review meeting were prospectively collected from 2020 to 2021. Corrective actions were tracked to completion through 2023. The authors retrospectively coded corrective actions by category and strength using the US Department of Veterans Affairs/Institute for Healthcare Improvement Action Hierarchy Tool. RESULTS In the analysis of 67 events, 15 contributing factor themes were identified and resulted in 148 corrective actions. Of these events, 85.1% (57/67) had more than one corrective action. Of the 148 corrective actions, 84 (56.8%) were rated as weak, 36 (24.3%) as intermediate, 15 (10.1%) strong, and 13 (8.8%) needed more information. The completion rate was 97.6% (for weak corrective actions), 80.6% (intermediate), and 73.3% (strong) (p < 0.0001). CONCLUSION Safety events were often addressed with multiple corrective actions. There was an inverse relationship between intervention strength and completion, the strongest interventions with the lowest rate of completion. By integrating action strength and completion status into corrective action follow-up, health care organizations may more effectively identify and address those barriers to completing the strongest interventions that ultimately achieve high reliability.
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Jacobsen HK, Ballangrud R, Birkeli GH. Learning from patient safety incidents: The Green Cross method. Nurs Crit Care 2024. [PMID: 38923706 DOI: 10.1111/nicc.13114] [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: 02/08/2023] [Revised: 05/31/2024] [Accepted: 06/05/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND Hospitals can improve how they learn from patient safety incidents. The Green Cross method, a proactive reporting and learning method, is one strategy to meet this challenge. In it, nurses play a key role. However, describing its impact on learning from the users' perspective is important. AIM This study aimed to describe nurses' experiences of learning from patient safety incidents before and 3 months after implementing the Green Cross method in a postanaesthesia care unit. STUDY DESIGN A qualitative study with an inductive descriptive design with focus group interviews was conducted before and 3 months after implementing the Green Cross method to assess its impact. The data were analysed using qualitative content analysis. The study was conducted in a postanaesthesia care unit in a Norwegian hospital trust. RESULTS Before implementing the Green Cross method, participants indicated limited openness and learning, including the subcategories 'Lack of openness hampers learning', 'Adverse events were taken seriously' and 'Insufficient visible improvements'. After implementing the Green Cross method, participants indicated the emergence of a learning environment, including the subcategories 'Transparency increases learning', 'Increased patient safety awareness' and 'Committed to quality improvements'. CONCLUSIONS Implementing the Green Cross method in a postanaesthesia care unit positively impacted openness and nurses' patient safety awareness, which is crucial for learning and improving quality. RELEVANCE TO CLINICAL PRACTICE The Green Cross method could be useful for organizational learning and facilitating learning from patient safety incidents through transparency, discussion and involvement of nursing staff.
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Affiliation(s)
| | - Randi Ballangrud
- Department of Health Science Gjøvik, Norwegian University of Science and Technology, Gjøvik, Norway
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Griffey RT, Schneider RM, Kocher KE, Kwok ESH, Salmo E, Malone N, Smith C, Guarnacia C, Rick A, Clavet T, Asaro P, Medlin R, Todorov AA. The emergency department trigger tool: Multicenter trigger query validation. Acad Emerg Med 2024; 31:564-575. [PMID: 38497320 DOI: 10.1111/acem.14873] [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: 08/10/2023] [Revised: 12/11/2023] [Accepted: 12/27/2023] [Indexed: 03/19/2024]
Abstract
OBJECTIVES We previously described derivation and validation of the emergency department trigger tool (EDTT) for adverse event (AE) detection. As the first step in our multicenter study of the tool, we validated our computerized screen for triggers against manual review, establishing our use of this automated process for selecting records to review for AEs. METHODS This is a retrospective observational study of visits to three urban, academic EDs over 18 months by patients ≥ 18 years old. We reviewed 912 records: 852 with at least one of 34 triggers found by the query and 60 records with none. Two first-level reviewers per site each manually screened for triggers. After completion, computerized query results were revealed, and reviewers could revise their findings. Second-level reviewers arbitrated discrepancies. We compare automated versus manual screening by positive and negative predictive values (PPVs, NPVs), present population trigger frequencies, proportions of records triggered, and how often manual ratings were changed to conform with the query. RESULTS Trigger frequencies ranged from common (>25%) to rare (1/1000) were comparable at U.S. sites and slightly lower at the Canadian site. Proportions of triggered records ranged from 31% to 49.4%. Overall query PPV was 95.4%; NPV was 99.2%. PPVs for individual trigger queries exceeded 90% for 28-31 triggers/site and NPVs were >90% for all but three triggers at one site. Inter-rater reliability was excellent, with disagreement on manual screening results less than 5% of the time. Overall, reviewers amended their findings 1.5% of the time when discordant with query findings, more often when the query was positive than when negative (47% vs. 23%). CONCLUSIONS The EDTT trigger query performed very well compared to manual review. With some expected variability, trigger frequencies were similar across sites and proportions of triggered records ranged 31%-49%. This demonstrates the feasibility and generalizability of implementing the EDTT query, providing a solid foundation for testing the triggers' utility in detecting AEs.
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Affiliation(s)
- Richard T Griffey
- Department of Emergency Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Ryan M Schneider
- Department of Emergency Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Keith E Kocher
- Department of Emergency Medicine and Learning Health Sciences, University of Michigan, Ann Arbor, Michigan, USA
| | - Edmund S H Kwok
- Department of Emergency Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Ellen Salmo
- Department of Emergency Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Nora Malone
- Department of Emergency Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Carrie Smith
- Department of Emergency Medicine and Learning Health Sciences, University of Michigan, Ann Arbor, Michigan, USA
| | - Catie Guarnacia
- Department of Emergency Medicine and Learning Health Sciences, University of Michigan, Ann Arbor, Michigan, USA
| | - April Rick
- Department of Emergency Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Tamara Clavet
- Department of Emergency Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Phil Asaro
- Department of Emergency Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Rich Medlin
- Department of Emergency Medicine and Learning Health Sciences, University of Michigan, Ann Arbor, Michigan, USA
| | - Alexandre A Todorov
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
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Morales FL, Xu F, Lee HA, Navarro HT, Bechel MA, Cameron EL, Kelso J, Weiss CH, Nunes Amaral LA. Open-source machine learning pipeline automatically flags instances of acute respiratory distress syndrome from electronic health records. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.05.21.24307715. [PMID: 38826348 PMCID: PMC11142283 DOI: 10.1101/2024.05.21.24307715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2024]
Abstract
Physicians could greatly benefit from automated diagnosis and prognosis tools to help address information overload and decision fatigue. Intensive care physicians stand to benefit greatly from such tools as they are at particularly high risk for those factors. Acute Respiratory Distress Syndrome (ARDS) is a life-threatening condition affecting >10% of critical care patients and has a mortality rate over 40%. However, recognition rates for ARDS have been shown to be low (30-70%) in clinical settings. In this work, we present a reproducible computational pipeline that automatically adjudicates ARDS on retrospective datasets of mechanically ventilated adult patients. This pipeline automates the steps outlined by the Berlin Definition through implementation of natural language processing tools and classification algorithms. We train an XGBoost model on chest imaging reports to detect bilateral infiltrates, and another on a subset of attending physician notes labeled for the most common ARDS risk factor in our data. Both models achieve high performance-a minimum area under the receiver operating characteristic curve (AUROC) of 0.86 for adjudicating chest imaging reports in out-of-bag test sets, and an out-of-bag AUROC of 0.85 for detecting a diagnosis of pneumonia. We validate the entire pipeline on a cohort of MIMIC-III encounters and find a sensitivity of 93.5% - an extraordinary improvement over the 22.6% ARDS recognition rate reported for these encounters - along with a specificity of 73.9%. We conclude that our reproducible, automated diagnostic pipeline exhibits promising accuracy, generalizability, and probability calibration, thus providing a valuable resource for physicians aiming to enhance ARDS diagnosis and treatment strategies. We surmise that proper implementation of the pipeline has the potential to aid clinical practice by facilitating the recognition of ARDS cases at scale.
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Studenmund C, Lyndon A, Stotts JR, Peralta-Neel C, Sharma AE, Bardach NS. What do patients and families observe about pediatric safety?: A thematic analysis of real-time narratives. J Hosp Med 2024. [PMID: 38741257 DOI: 10.1002/jhm.13388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 03/04/2024] [Accepted: 04/18/2024] [Indexed: 05/16/2024]
Abstract
OBJECTIVES Data on inpatient safety are documented by hospital staff through incident reporting (IR) systems. Safety observations from families or patients are rarely captured. The Family Input for Quality and Safety (FIQS) study created a mobile health tool for pediatric patients and their families to anonymously report safety observations in real time during hospitalization. The study objectives were to describe these observations and identify domains salient to safety. METHODS In this observational study, we analyzed pediatric patient safety reports from June 2017 to April 2018. Participants were: English-speaking family members and hospitalized patients ≥13 years old. The analysis had two stages: 1) assessment of whether narratives met established safety event criteria and whether there were companion IRs; 2) thematic analysis to identify domains. RESULTS Of 248 enrolled participants, 58 submitted 120 narrative reports. Of the narratives, 68 (57%) met safety event criteria, while only one (0.8%) corresponded to a staff-reported IR. 25% of narratives shared positive feedback about patient safety efforts; 75% shared constructive feedback. We identified domains particularly salient to safety: 1) patients and families as safety actors; 2) emotional safety; 3) system-centered care; and 4) shared safety domains, including medication, communication, and environment of care. Some domains capture data that is otherwise difficult to obtain (#1-3), while others fit within standard healthcare safety domains (#4). CONCLUSIONS Patients and families observe and report salient safety events that can fill gaps in IR data. Healthcare leaders should consider incorporating patient and family observations-collected with an option for anonymity and eliciting both positive and constructive comments.
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Affiliation(s)
- Christine Studenmund
- Department of Pediatrics, School of Medicine, University of California, San Francisco, California, USA
| | - Audrey Lyndon
- Rory Meyers College of Nursing, New York University, New York, New York, USA
| | - James R Stotts
- Department of Quality and Patient Safety, University of California, San Francisco, California, USA
| | - Caroline Peralta-Neel
- Department of Pediatrics, Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, California, USA
| | - Anjana E Sharma
- Department of Family & Community Medicine, University of California, San Francisco, California, USA
| | - Naomi S Bardach
- Department of Pediatrics, Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, California, USA
- Department of Pediatrics, University of California, San Francisco, California, USA
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Higgins M, Tevis S, Glasheen JJ. First, Do No Harm. Second, Measure It. Am J Med 2024:S0002-9343(24)00281-X. [PMID: 38735355 DOI: 10.1016/j.amjmed.2024.04.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Accepted: 04/17/2024] [Indexed: 05/14/2024]
Affiliation(s)
- Madeline Higgins
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora.
| | - Sarah Tevis
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora
| | - Jeffrey J Glasheen
- Department of Medicine, Institute of Healthcare Quality, Safety, and Efficiency, University of Colorado Anschutz Medical Campus, Aurora
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14
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Ghanmi N, Bondok M, Etherington C, Saddiki Y, Lefebvre I, Berthelot P, Dion PM, Raymond B, Seguin J, Sekhavati P, Islam S, Boet S. Optimizing Teamwork in the Operating Room: A Scoping Review of Actionable Teamwork Strategies. Cureus 2024; 16:e60522. [PMID: 38883070 PMCID: PMC11180536 DOI: 10.7759/cureus.60522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2024] [Indexed: 06/18/2024] Open
Abstract
Suboptimal teamwork in the operating room (OR) is a contributing factor in a significant proportion of preventable complications for surgical patients. Specifying behaviour is fundamental to closing evidence-practice gaps in healthcare. Current teamwork interventions, however, have yet to be synthesized in this way. This scoping review aimed to identify actionable strategies for use during surgery by mapping the existing literature according to the Action, Actor, Context, Target, Time (AACTT) framework. The databases MEDLINE (Medical Literature Analysis and Retrieval System Online), Embase, Cumulated Index to Nursing and Allied Health Literature (CINAHL), Education Resources Information Center (ERIC), Cochrane, Scopus, and PsycINFO were searched from inception to April 5, 2022. Screening and data extraction were conducted in duplicate by pairs of independent reviewers. The search identified 9,289 references after the removal of duplicates. Across 249 studies deemed eligible for inclusion, eight types of teamwork interventions could be mapped according to the AACTT framework: bundle/checklists, protocols, audit and feedback, clinical practice guidelines, environmental change, cognitive aid, education, and other), yet many were ambiguous regarding the actors and actions involved. The 101 included protocol interventions appeared to be among the most actionable for the OR based on the clear specification of ACCTT elements, and their effectiveness should be evaluated and compared in future work.
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Affiliation(s)
- Nibras Ghanmi
- Faculty of Medicine, University of Ottawa, Ottawa, CAN
| | - Mostafa Bondok
- Department of Anesthesiology, University of British Columbia, Faculty of Medicine, Vancouver, CAN
| | - Cole Etherington
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, CAN
| | | | | | | | | | | | - Jeanne Seguin
- Faculty of Medicine, University of Ottawa, Ottawa, CAN
| | | | - Sindeed Islam
- Faculty of Medicine, University of Ottawa, Ottawa, CAN
| | - Sylvain Boet
- Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, The University of Ottawa, Ottawa, CAN
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15
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Brünn R, Basten J, Lemke D, Piotrowski A, Söling S, Surmann B, Greiner W, Grandt D, Kellermann-Mühlhoff P, Harder S, Glasziou P, Perera R, Köberlein-Neu J, Ihle P, van den Akker M, Timmesfeld N, Muth C. Digital Medication Management in Polypharmacy. DEUTSCHES ARZTEBLATT INTERNATIONAL 2024; 121:243-250. [PMID: 38377330 DOI: 10.3238/arztebl.m2024.0007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 01/11/2024] [Accepted: 01/11/2024] [Indexed: 02/22/2024]
Abstract
BACKGROUND Inappropriate drug prescriptions for patients with polypharmacy can have avoidable adverse consequences. We studied the effects of a clinical decision-support system (CDSS) for medication management on hospitalizations and mortality. METHODS This stepped-wedge, cluster-randomized, controlled trial involved an open cohort of adult patients with polypharmacy in primary care practices (=clusters) in Westphalia-Lippe, Germany. During the period of the intervention, their medication lists were checked annually using the CDSS. The CDSS warns against inappropriate prescriptions on the basis of patient-related health insurance data. The combined primary endpoint consisted of overall mortality and hospitalization for any reason. The secondary endpoints were mortality, hospitalizations, and high-risk prescription. We analyzed the quarterly health insurance data of the intention- to-treat population with a mixed logistic model taking account of clustering and repeated measurements. Sensitivity analyses addressed effects of the COVID-19 pandemic and other effects. RESULTS 688 primary care practices were randomized, and data were obtained on 42 700 patients over 391 994 quarter years. No significant reduction was found in either the primary endpoint (odds ratio [OR] 1.00; 95% confidence interval [0.95; 1.04]; p = 0.8716) or the secondary endpoints (hospitalizations: OR 1.00 [0.95; 1.05]; mortality: OR 1.04 [0.92; 1.17]; high-risk prescription: OR 0.98 [0.92; 1.04]). CONCLUSION The planned analyses did not reveal any significant effect of the intervention. Pandemicadjusted analyses yielded evidence that the mortality of adult patients with polypharmacy might potentially be lowered by the CDSS. Controlled trials with appropriate follow-up are needed to prove that a CDSS has significant effects on mortality in patients with polypharmacy.
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Affiliation(s)
- Robin Brünn
- Institute of General Practice, Goethe University Frankfurt am Main; Pharmacy of University Hospital Frankfurt; Department of Medical Informatics, Biometry and Epidemiology, Ruhr University Bochum; Department of Medical Informatics, Biometry and Epidemiology, Ruhr University Bochum; Institute of General Practice, Goethe University Frankfurt am Main; Working Group General and Family Medicine, Medical Faculty East Westphalia-Lippe, University of Bielefeld; Institute of General Practice, Goethe University Frankfurt am Main; Bergisch Competence Center for Health Economics and Health Services Research, Bergische University Wuppertal; Chair of General Medicine II and Patient Orientation in Primary Care, Institute of General Medicine and Ambulatory Health Care (iamag), University Witten/Herdecke; Working Group for Health Economics and Health Management, Faculty of ; Health Sciences, Bielefeld University; Chairman of the Drug Therapy Management and Drug Therapy Safety Commission, German Society for Internal Medicine (DGIM); Barmer, Wuppertal; Institute of Clinical Pharmacology, University Hospital and Faculty of Medicine, Goethe University Frankfurt, Frankfurt am Main; Institute for Evidence-Based Healthcare, Faculty of Health Sciences & Medicine, Bond University, Gold Coast, Queensland, 4229, Australia; Nuffield Department of Primary Care Health Sciences, University of Oxford, UK; PMV Research Group, Faculty of Medicine, University Hospital Cologne, University of Cologne; Institute of General Practice, Goethe-University Frankfurt am Main; Department of Family Medicine, Care and Public Health Research Institute, Maastricht University; Department of Public Health and Primary Care, Academic Centre of General Practice, KU Leuven
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16
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Buchberger W, Schmied M, Schomaker M, Del Rio A, Siebert U. Implementation of a comprehensive clinical risk management system in a university hospital. ZEITSCHRIFT FUR EVIDENZ, FORTBILDUNG UND QUALITAT IM GESUNDHEITSWESEN 2024; 184:18-25. [PMID: 38199940 DOI: 10.1016/j.zefq.2023.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 11/20/2023] [Accepted: 11/22/2023] [Indexed: 01/12/2024]
Abstract
BACKGROUND Adverse events during hospital treatment are common and can lead to serious harm. This study reports the implementation of a comprehensive clinical risk management system in a university hospital and assesses the impact of clinical risk management on patient harms. METHODS The clinical risk management system was rolled out over a period of eight years and consisted of a training of interdisciplinary risk management teams, external and internal risk audits, and the implementation of a critical incident reporting system (CIRS). The risks identified during the audits were analyzed according to the type, severity, and implementation of preventive measures. Other key figures of the risk management system were obtained from the annual risk reports. The number of liability cases was used as primary outcome measurement. RESULTS Of the 1,104 risks identified during the risk audits, 56.2% were related to organization, 21.3% to documentation, 15.3% to treatment, and 7.2% to patient information and consent. The highest proportion of serious risks was found in the category organization (22.7%), the lowest in the category documentation (13.6%). Critical incident reporting identified between 241 and 370 critical incidents per year, for which in 79.5% to 83% preventive measures were implemented within twelve months. The frequency of incident reports per department correlated with the number of active risk managers and risk team meetings. Compared with the years prior to the introduction of the clinical risk management system, an average annual reduction of harms by 60.1% (95% CI: 57.1; 63.1) was observed two years after the implementation was completed. On average, the rate of harms dropped by 5% per year for each 10% increase in roll-out of the clinical risk management system (incidence rate ratio: 0.95; 95% CI: 0.93; 0.97) . CONCLUSION The results of this project demonstrate the effectiveness of clinical risk management in detecting treatment-related risks and in reducing harm to patients.
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Affiliation(s)
- Wolfgang Buchberger
- UMIT TIROL- University for Health Sciences and Technology, Institute of Public Health, Medical Decision Making and HTA, Hall in Tirol, Austria.
| | - Marten Schmied
- UMIT TIROL- University for Health Sciences and Technology, Institute of Nursing Science, Hall in Tirol, Austria
| | - Michael Schomaker
- Ludwig-Maximilians-Universität München, Department of Statistics, Munich, Germany; University of Cape Town, Centre of Infectious Disease Epidemiology and Research, Cape Town, South Africa
| | - Anca Del Rio
- Strategy and Global Development Advisor, EIT Health Germany-Switzerland, Munich, Germany
| | - Uwe Siebert
- UMIT TIROL- University for Health Sciences and Technology, Institute of Public Health, Medical Decision Making and HTA, Hall in Tirol, Austria; Harvard T.H. Chan School of Public Health, Center for Health Decision Science and Departments of Epidemiology and Health Policy & Management, Boston, MA, USA; Massachusetts General Hospital, Harvard Medical School, Institute for Technology Assessment and Department of Radiology, Boston, MA, USA
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17
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Shahab O, El Kurdi B, Shaukat A, Nadkarni G, Soroush A. Large language models: a primer and gastroenterology applications. Therap Adv Gastroenterol 2024; 17:17562848241227031. [PMID: 38390029 PMCID: PMC10883116 DOI: 10.1177/17562848241227031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 01/02/2024] [Indexed: 02/24/2024] Open
Abstract
Over the past year, the emergence of state-of-the-art large language models (LLMs) in tools like ChatGPT has ushered in a rapid acceleration in artificial intelligence (AI) innovation. These powerful AI models can generate tailored and high-quality text responses to instructions and questions without the need for labor-intensive task-specific training data or complex software engineering. As the technology continues to mature, LLMs hold immense potential for transforming clinical workflows, enhancing patient outcomes, improving medical education, and optimizing medical research. In this review, we provide a practical discussion of LLMs, tailored to gastroenterologists. We highlight the technical foundations of LLMs, emphasizing their key strengths and limitations as well as how to interact with them safely and effectively. We discuss some potential LLM use cases for clinical gastroenterology practice, education, and research. Finally, we review critical barriers to implementation and ongoing work to address these issues. This review aims to equip gastroenterologists with a foundational understanding of LLMs to facilitate a more active clinician role in the development and implementation of this rapidly emerging technology.
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Affiliation(s)
- Omer Shahab
- Division of Gastroenterology, Department of Medicine, VHC Health, Arlington, VA, USA
| | - Bara El Kurdi
- Division of Gastroenterology and Hepatology, Department of Medicine, Virginia Tech Carilion School of Medicine, Roanoke, VA, USA
| | - Aasma Shaukat
- Division of Gastroenterology, Department of Medicine, NYU Grossman School of Medicine, New York, NY, USA VA
- New York Harbor Veterans Affairs Healthcare System New York City, New York, NY, USA
| | - Girish Nadkarni
- Division of Data-Driven and Digital Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- The Charles Bronfman Institute of Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ali Soroush
- Division of Data-Driven and Digital Medicine, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY 10029-6574, USA
- The Charles Bronfman Institute of Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Henry D. Janowitz Division of Gastroenterology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Auerbach AD, Lee TM, Hubbard CC, Ranji SR, Raffel K, Valdes G, Boscardin J, Dalal AK, Harris A, Flynn E, Schnipper JL. Diagnostic Errors in Hospitalized Adults Who Died or Were Transferred to Intensive Care. JAMA Intern Med 2024; 184:164-173. [PMID: 38190122 PMCID: PMC10775080 DOI: 10.1001/jamainternmed.2023.7347] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 11/07/2023] [Indexed: 01/09/2024]
Abstract
Importance Diagnostic errors contribute to patient harm, though few data exist to describe their prevalence or underlying causes among medical inpatients. Objective To determine the prevalence, underlying cause, and harms of diagnostic errors among hospitalized adults transferred to an intensive care unit (ICU) or who died. Design, Setting, and Participants Retrospective cohort study conducted at 29 academic medical centers in the US in a random sample of adults hospitalized with general medical conditions and who were transferred to an ICU, died, or both from January 1 to December 31, 2019. Each record was reviewed by 2 trained clinicians to determine whether a diagnostic error occurred (ie, missed or delayed diagnosis), identify diagnostic process faults, and classify harms. Multivariable models estimated association between process faults and diagnostic error. Opportunity for diagnostic error reduction associated with each fault was estimated using the adjusted proportion attributable fraction (aPAF). Data analysis was performed from April through September 2023. Main Outcomes and Measures Whether or not a diagnostic error took place, the frequency of underlying causes of errors, and harms associated with those errors. Results Of 2428 patient records at 29 hospitals that underwent review (mean [SD] patient age, 63.9 [17.0] years; 1107 [45.6%] female and 1321 male individuals [54.4%]), 550 patients (23.0%; 95% CI, 20.9%-25.3%) had experienced a diagnostic error. Errors were judged to have contributed to temporary harm, permanent harm, or death in 436 patients (17.8%; 95% CI, 15.9%-19.8%); among the 1863 patients who died, diagnostic error was judged to have contributed to death in 121 (6.6%; 95% CI, 5.3%-8.2%). In multivariable models examining process faults associated with any diagnostic error, patient assessment problems (aPAF, 21.4%; 95% CI, 16.4%-26.4%) and problems with test ordering and interpretation (aPAF, 19.9%; 95% CI, 14.7%-25.1%) had the highest opportunity to reduce diagnostic errors; similar ranking was seen in multivariable models examining harmful diagnostic errors. Conclusions and Relevance In this cohort study, diagnostic errors in hospitalized adults who died or were transferred to the ICU were common and associated with patient harm. Problems with choosing and interpreting tests and the processes involved with clinician assessment are high-priority areas for improvement efforts.
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Affiliation(s)
- Andrew D. Auerbach
- Division of Hospital Medicine, Department of Medicine, University of California San Francisco
| | - Tiffany M. Lee
- Division of Hospital Medicine, Department of Medicine, University of California San Francisco
| | - Colin C. Hubbard
- Division of Hospital Medicine, Department of Medicine, University of California San Francisco
| | - Sumant R. Ranji
- Division of Hospital Medicine, Zuckerberg San Francisco General Hospital, San Francisco, California
| | - Katie Raffel
- Department of Medicine, University of Colorado School of Medicine, Denver
| | - Gilmer Valdes
- Department of Radiation Oncology, University of California San Francisco
| | - John Boscardin
- Division of Geriatrics, Department of Medicine, University of California San Francisco
| | - Anuj K. Dalal
- Hospital Medicine Unit, Division of General Internal Medicine and Primary Care, Brigham and Women’s Hospital, and Harvard Medical School, Boston, Massachusetts
| | | | | | - Jeffrey L. Schnipper
- Hospital Medicine Unit, Division of General Internal Medicine and Primary Care, Brigham and Women’s Hospital, and Harvard Medical School, Boston, Massachusetts
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19
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Scarpis E, Beorchia Y, Moretti V, Favero B, Farneti F, Cocconi R, Quattrin R, Castriotta L. Second Victim Symptoms and Desired Support Strategies Among Italian Health Care Workers in Friuli-Venezia Giulia: Cross-Sectional Survey and Latent Profile Analysis. J Patient Saf 2024; 20:66-75. [PMID: 38099853 DOI: 10.1097/pts.0000000000001182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
BACKGROUND AND OBJECTIVE The second victim (SV) phenomenon concerns health care workers (HCWs) whose involvement in a medical error, as well as non-error patient safety events, has affected their well-being. Its prevalence ranges from 10% to 75% and can predispose HCWs to burnout, increasing the probability of committing errors. The primary aim of our study was to determine the prevalence of HCWs involved in an adverse patient safety event in Friuli Venezia Giulia Region (Italy). The secondary aims were to use latent profile analysis to identify profiles of SVs and factors influencing profile membership, and to evaluate the relationship between the severity of symptoms and desired support options. METHODS A cross-sectional survey through the Italian version of the Second Victim Experience and Support Tool tool was conducted in 5 local health authorities. Descriptive statistics were conducted for all variables. Associations and correlations were assessed with statistical tests, as appropriate. Latent profile analysis was based on the scores of dimensions measuring SVs' symptoms. Factors affecting profile membership were assessed through multinomial logistic regression. RESULTS A total of 733 HCWs participated. Of them, 305 (41.6%) experienced at least 1 adverse event. Among dimensions measuring SVs' symptoms, psychological distress had the highest percentage of agreement (30.2%). Three latent profiles were identified: mild (58.7%), moderate (24.3%), and severe (17.0%) symptoms. Severe symptoms profile was positively associated with the agreement for extraoccupational support and negatively associated with the agreement for organizational support. A respected colleague with whom to discuss the details of the incident (78.7%) and free counseling outside of work (71.2%) were the support options most desired by HCWs. The severity of symptoms was directly associated with the desire for support strategies. CONCLUSIONS The prevalence of HCWs involved in adverse events is consistent with the literature. Three latent profiles have been identified according to SV symptoms, and the higher the severity of symptoms, the greater the reliance on extraoccupational support.
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Affiliation(s)
- Enrico Scarpis
- From the Dipartimento di Area Medica, Università degli Studi di Udine
| | | | - Valentina Moretti
- From the Dipartimento di Area Medica, Università degli Studi di Udine
| | - Beatrice Favero
- From the Dipartimento di Area Medica, Università degli Studi di Udine
| | - Federico Farneti
- SOC Rischio Clinico, Qualità e Accreditamento, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Roberto Cocconi
- SOC Rischio Clinico, Qualità e Accreditamento, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Rosanna Quattrin
- SOC Rischio Clinico, Qualità e Accreditamento, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
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20
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Kaplan HC, Goldstein SL, Rubinson C, Daraiseh N, Zhang F, Rodgers IM, Dahale DS, Askenazi DJ, Somers MJG, Zaritsky JJ, Misurac J, Chadha V, Yonekawa KE, Sutherland SM, Weng PL, Walsh KE. Prospective Study of the Multisite Spread of a Medication Safety Intervention: Factors Common to Hospitals With Improved Outcomes. Am J Med Qual 2024; 39:21-32. [PMID: 38127682 DOI: 10.1097/jmq.0000000000000161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
Context and implementation approaches can impede the spread of patient safety interventions. The objective of this article is to characterize factors associated with improved outcomes among 9 hospitals implementing a medication safety intervention. Nephrotoxic Injury Negated by Just-in-Time Action (NINJA) is a pharmacist-driven intervention that led to a sustained reduction in nephrotoxic medication-associated acute kidney injury (NTMx-AKI) at 1 hospital. Using qualitative comparative analysis, the team prospectively assessed the association between context and implementation factors and NTMx-AKI reduction during NINJA spread to 9 hospitals. Five hospitals reduced NTMx-AKI. These 5 had either (1) a pharmacist champion and >2 pharmacists working on NINJA (Scon 1.0, Scov 0.8) or (2) a nephrologist-implementing NINJA with minimal competing organizational priorities (Scon 1.0, Scov 0.2). Interviews identified ways NINJA team leaders obtained pharmacist support or successfully implemented without that support. In conclusion, these findings have implications for future spread of NINJA and suggest an approach to study spread of safety interventions more broadly.
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Affiliation(s)
- Heather C Kaplan
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
- Division of Neonatology, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Stuart L Goldstein
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Claude Rubinson
- Department of Social Sciences, University of Houston-Downtown, Houston, TX
| | - Nancy Daraiseh
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
- Patient Services, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Fang Zhang
- Division of Health Policy and Insurance Research, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA
| | | | - Devesh S Dahale
- Operational Effectiveness Department, Southeast Health, Dothan, AL
| | - David J Askenazi
- Division of Nephrology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL
| | | | | | - Jason Misurac
- Department of Pediatrics, University of Iowa, Stead Family Children's Hospital, Iowa City, IA
| | - Vimal Chadha
- Division of Nephrology, Children's Mercy Hospital, Kansas City, MO
- Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, MO
| | - Karyn E Yonekawa
- Division of Nephrology, Seattle Children's Hospital, Seattle, WA
| | - Scott M Sutherland
- Division of Nephrology, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA
- Division of Nephrology, Lucille Packard Stanford Children's Hospital, Palo Alto, CA
| | - Patricia L Weng
- Division of Nephrology, Department of Pediatrics, UCLA Mattel Children's Hospital, Los Angeles, CA
| | - Kathleen E Walsh
- Division of General Pediatrics, Boston Children's Hospital, Boston, MA
- Department of General Pediatrics, Harvard Medical School, Boston, MA
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21
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Kashani KB, Awdishu L, Bagshaw SM, Barreto EF, Claure-Del Granado R, Evans BJ, Forni LG, Ghosh E, Goldstein SL, Kane-Gill SL, Koola J, Koyner JL, Liu M, Murugan R, Nadkarni GN, Neyra JA, Ninan J, Ostermann M, Pannu N, Rashidi P, Ronco C, Rosner MH, Selby NM, Shickel B, Singh K, Soranno DE, Sutherland SM, Bihorac A, Mehta RL. Digital health and acute kidney injury: consensus report of the 27th Acute Disease Quality Initiative workgroup. Nat Rev Nephrol 2023; 19:807-818. [PMID: 37580570 PMCID: PMC11285755 DOI: 10.1038/s41581-023-00744-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2023] [Indexed: 08/16/2023]
Abstract
Acute kidney injury (AKI), which is a common complication of acute illnesses, affects the health of individuals in community, acute care and post-acute care settings. Although the recognition, prevention and management of AKI has advanced over the past decades, its incidence and related morbidity, mortality and health care burden remain overwhelming. The rapid growth of digital technologies has provided a new platform to improve patient care, and reports show demonstrable benefits in care processes and, in some instances, in patient outcomes. However, despite great progress, the potential benefits of using digital technology to manage AKI has not yet been fully explored or implemented in clinical practice. Digital health studies in AKI have shown variable evidence of benefits, and the digital divide means that access to digital technologies is not equitable. Upstream research and development costs, limited stakeholder participation and acceptance, and poor scalability of digital health solutions have hindered their widespread implementation and use. Here, we provide recommendations from the Acute Disease Quality Initiative consensus meeting, which involved experts in adult and paediatric nephrology, critical care, pharmacy and data science, at which the use of digital health for risk prediction, prevention, identification and management of AKI and its consequences was discussed.
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Affiliation(s)
- Kianoush B Kashani
- Division of Nephrology and Hypertension, Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA.
| | - Linda Awdishu
- Clinical Pharmacy, San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, La Jolla, CA, USA
| | - Sean M Bagshaw
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta and Alberta Health Services, Edmonton, Canada
| | | | - Rolando Claure-Del Granado
- Division of Nephrology, Hospital Obrero No 2 - CNS, Cochabamba, Bolivia
- Universidad Mayor de San Simon, School of Medicine, Cochabamba, Bolivia
| | - Barbara J Evans
- Intelligent Critical Care Center, University of Florida, Gainesville, FL, USA
| | - Lui G Forni
- Department of Critical Care, Royal Surrey Hospital NHS Foundation Trust & Department of Clinical & Experimental Medicine, University of Surrey, Guildford, UK
| | - Erina Ghosh
- Philips Research North America, Cambridge, MA, USA
| | - Stuart L Goldstein
- Center for Acute Care Nephrology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Sandra L Kane-Gill
- Biomedical Informatics and Clinical Translational Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jejo Koola
- UC San Diego Health Department of Biomedical Informatics, Department of Medicine, La Jolla, CA, USA
| | - Jay L Koyner
- Section of Nephrology, Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Mei Liu
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, FL, USA
| | - Raghavan Murugan
- The Program for Critical Care Nephrology, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- The Clinical Research, Investigation, and Systems Modelling of Acute Illness Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Girish N Nadkarni
- Division of Data-Driven and Digital Medicine (D3M), Department of Medicine, Icahn School of Medicine at Mount Sinai; Mount Sinai Clinical Intelligence Center, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Javier A Neyra
- Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jacob Ninan
- Division of Pulmonary, Critical Care and Sleep Medicine, Mayo Clinic, Rochester, MN, USA
| | - Marlies Ostermann
- Department of Critical Care, King's College London, Guy's & St Thomas' Hospital, London, UK
| | - Neesh Pannu
- Division of Nephrology, University of Alberta, Edmonton, Canada
| | - Parisa Rashidi
- Intelligent Critical Care Center, University of Florida, Gainesville, FL, USA
| | - Claudio Ronco
- Università di Padova; Scientific Director Foundation IRRIV; International Renal Research Institute; San Bortolo Hospital, Vicenza, Italy
| | - Mitchell H Rosner
- Department of Medicine, University of Virginia Health, Charlottesville, VA, USA
| | - Nicholas M Selby
- Centre for Kidney Research and Innovation, Academic Unit of Translational Medical Sciences, University of Nottingham, Nottingham, UK
- Department of Renal Medicine, Royal Derby Hospital, Derby, UK
| | - Benjamin Shickel
- Intelligent Critical Care Center, University of Florida, Gainesville, FL, USA
| | - Karandeep Singh
- Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Danielle E Soranno
- Section of Nephrology, Department of Pediatrics, Indiana University, Riley Hospital for Children, Indianapolis, IN, USA
| | - Scott M Sutherland
- Division of Nephrology, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Azra Bihorac
- Intelligent Critical Care Center, University of Florida, Gainesville, FL, USA.
| | - Ravindra L Mehta
- Division of Nephrology-Hypertension, Department of Medicine, University of California San Diego, La Jolla, CA, USA.
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22
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Stockwell DC. Scientific Progress and a Diagnostic Dilemma. Crit Care Med 2023; 51:1597-1599. [PMID: 37902345 DOI: 10.1097/ccm.0000000000006011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2023]
Affiliation(s)
- David C Stockwell
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
- The Johns Hopkins Children's Center, Baltimore, MD
- Armstrong Institute of Patient Safety and Quality, Johns Hopkins University, Baltimore, MD
- Pascal Metrics, a Patient Safety Organization, Washington, DC
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Beauvais B, Dolezel D, Ramamonjiarivelo Z. An Exploratory Analysis of the Association between Hospital Quality Measures and Financial Performance. Healthcare (Basel) 2023; 11:2758. [PMID: 37893832 PMCID: PMC10606508 DOI: 10.3390/healthcare11202758] [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: 10/01/2023] [Revised: 10/10/2023] [Accepted: 10/16/2023] [Indexed: 10/29/2023] Open
Abstract
Hospitals are perpetually challenged by concurrently improving the quality of healthcare and maintaining financial solvency. Both issues are among the top concerns for hospital executives across the United States, yet some have questioned if the efforts to enhance quality are financially sustainable. Thus, the aim of this study is to examine if efforts to improve quality in the hospital setting have a corresponding association with hospital profitability. Recent and directly relevant research on this topic is very limited, leaving practitioners uncertain about the wisdom of their investments in interventions which enhance quality and patient safety. We assessed if eight different quality measures were associated with our targeted measure of hospital profitability: the net patient revenue per adjusted discharge. Using multivariate regression, we found that improving quality was significantly associated with our targeted measure of hospital profitability: the net patient revenue per adjusted discharge. Significant findings were reported for seven of eight quality measures tested, including the HCAHPS Summary Star Rating (p < 0.001), Hospital Compare Overall Rating (p < 0.001), All-Cause Hospital-Wide Readmission Rate (p < 0.01), Total Performance Score (p < 0.001), Safety Domain Score (p < 0.01), Person and Community Engagement Domain Score (p < 0.001), and the Efficiency and Cost Reduction Score (p < 0.001). Failing to address quality and patient safety issues is costly for US hospitals. We believe our findings support the premise that increased attention to the quality of care delivered as well as patients' perceptions of care may allow hospitals to accentuate profitability and advance a hospital's financial position.
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Affiliation(s)
- Brad Beauvais
- School of Health Administration, Texas State University, Encino Hall, Room 250A, 601 University Drive, San Marcos, TX 78666, USA;
| | - Diane Dolezel
- Health Informatics & Information Management Department, Texas State University, Round Rock, TX 78665, USA;
| | - Zo Ramamonjiarivelo
- School of Health Administration, Texas State University, Encino Hall, Room 250A, 601 University Drive, San Marcos, TX 78666, USA;
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24
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Florentino SA. What's Important: Patient Voices Matter: A Place for Patient-Reported Outcomes in Medical Education. J Bone Joint Surg Am 2023; 105:1647-1648. [PMID: 37167365 DOI: 10.2106/jbjs.23.00154] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Affiliation(s)
- Samuel A Florentino
- Department of Orthopaedic Surgery, School of Medicine & Dentistry, University of Rochester, Rochester, New York
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25
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Milliren CE, Denhoff ER, Hahn PD, Ozonoff A. Incidence of Hospital-Acquired Conditions During Pediatric Clinical Research Inpatient Hospitalizations: A Matched Cohort Study. J Patient Saf 2023; 19:469-477. [PMID: 37678187 DOI: 10.1097/pts.0000000000001159] [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] [Indexed: 09/09/2023]
Abstract
OBJECTIVES In this matched cohort study using data from pediatric hospitals, we compared the incidence of hospital-acquired conditions (HACs) during clinical research hospitalizations to nonresearch hospitalizations. METHODS Using Pediatric Health Information System data for inpatient discharges January 2017-June 2022, we matched research hospitalizations (identified by International Classification of Diseases, Tenth Revision, diagnosis code) to nonresearch hospitalizations within hospital on age (±3 y), sex, discharge year (±2), and All Patients Refined Diagnosis Related Groups classification, severity of illness (±1), and risk of mortality (±1). We calculated the incidence (per 1000 discharges) and incidence rate (per 10,000 patient days) of HAC identified by International Classification of Diseases, Tenth Revision, codes and compare research versus nonresearch using logistic and Poisson regression, accounting for matching using generalized estimating equations and adjusting for sociodemographic factors and hospital utilization. RESULTS We matched 7000 research hospitalizations to 26,447 nonresearch from 28 hospitals. Median age was 6.0 years (interquartile range, 10.6 y). Median length of stay was 4.0 days (interquartile range, 11.0 days) with longer stays among research hospitalizations ( P < 0.001). Incidence of HAC among research hospitalizations was 13.1 versus 7.2 per 1000 for nonresearch ( P < 0.001) and incidence rate 6.7 versus 4.5 per 10,000 patient days. Adjusting for sociodemographic and clinical factors, research stays had 1.65 times the odds of any HAC (95% confidence interval, 1.27-2.16; P < 0.001) and 1.38 times the incidence rate (95% confidence interval, 1.09-1.75; P = 0.009). CONCLUSIONS Our findings indicate that pediatric research hospitalizations are more likely to experience HACs compared with nonresearch hospitalizations. These findings have important safety implications for pediatric inpatient clinical research that warrant further study.
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Affiliation(s)
- Carly E Milliren
- From the Institutional Centers for Clinical and Translational Research
| | - Erica R Denhoff
- From the Institutional Centers for Clinical and Translational Research
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26
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Kavanagh KT, Cormier LE. Viewpoint: Patient safety in primary care - patients are not just a beneficiary but a critical component in its achievement. Medicine (Baltimore) 2023; 102:e35095. [PMID: 37713815 PMCID: PMC10508386 DOI: 10.1097/md.0000000000035095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 08/15/2023] [Indexed: 09/17/2023] Open
Abstract
Promoting and maintaining patient safety in primary care requires different strategies and monitoring than utilized in large healthcare delivery systems. Maintenance of a culture of safety is key to providing patient safety but has been difficult to measure in primary care. This is particularly true in rural settings where practice size is a major barrier to measurement reliability. Primary care evaluates a wide range of patients, including those who are immunocompromised and others who have infectious diseases. Providing a safe environment with proper wearing of N95 masks, clean examination rooms, and adequate ventilation is important. Patients with infectious diseases should be separated from other patient populations. Primary care is often less bureaucratic than hospitals, but also has fewer resources to implement patient safety initiatives, along with detecting safety lapses and adverse events. However, monitoring the practice's safety practices and the culture of safety is of utmost importance and should be performed using both outcome and process measures. Because of the small size of many rural practices, effective monitoring of adverse events and maintenance of safety protocols should include patients. Patients are an important resource for reporting of adverse events and medical treatment outcomes. The aim of this manuscript is to underscore the importance of patient safety in primary care and to stimulate future research in developing a metric for the culture of safety in primary care, which also incorporates the patient perspective. Patients should be viewed not only as beneficiaries of patient safety but also as a critical component of its maintenance.
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Immonen H, Raekallio M, Holmström AR. Promoting veterinary medication safety - Exploring the competencies of community pharmacy professionals in veterinary pharmacotherapy. Vet Anim Sci 2023; 21:100310. [PMID: 37664413 PMCID: PMC10468355 DOI: 10.1016/j.vas.2023.100310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2023] Open
Abstract
The science of veterinary medicine is currently lacking studies on medication safety, although its importance in protecting animals from medication errors is central. Pharmacy professionals have an important role in ensuring medication safety of both prescription and over-the-counter medications of animals. However, this requires adequate competencies of pharmacy professionals in veterinary pharmacotherapy. The present study aimed to explore the competencies of pharmaceutical staff in community pharmacies in veterinary pharmacotherapy, which factors influence these competencies and what kind of information sources they typically use on veterinary pharmacotherapy. The study was conducted as a cross-sectional online survey targeted to pharmacy professionals in the Finnish community pharmacies, providing 596 responses. Less than half of the respondents (41%, n = 246) are considered to possess good competencies in veterinary pharmacotherapy. A third of the respondents (35%, n = 211) would dispense an anti-inflammatory drug for an animal off-label, whereas 24% (n = 145) would not interview the pet owner to discover the need for internal parasite medication before dispensing the drug. A small proportion (<1%, n = 5) would have dispensed a broad-spectrum internal parasite medication. Approximately a quarter of the respondents (27%, n = 159) stated that they acquired information on pharmacotherapy only from the material produced by the manufacturers of veterinary drugs. The competencies of pharmacy professionals in veterinary pharmacotherapy need to be strengthened in many areas to better promote veterinary medication safety. It should also be ensured that pharmacy professionals can access and use independent, high-quality information on veterinary pharmacotherapy.
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Affiliation(s)
- H. Immonen
- Faculty of Pharmacy, Division of pharmacology and pharmacotherapy, University of Helsinki, Viikinkaari 5 E, 00014, Finland
| | - M.R. Raekallio
- Faculty of Veterinary Medicine, Department of Equine and Small Animal Medicine, University of Helsinki, Koetilantie 2, 00014, Finland
| | - A-R. Holmström
- Faculty of Pharmacy, Division of pharmacology and pharmacotherapy, University of Helsinki, Viikinkaari 5 E, 00014, Finland
- Faculty of Veterinary Medicine, Department of Equine and Small Animal Medicine, University of Helsinki, Koetilantie 2, 00014, Finland
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28
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Youssef C, Houchens N, Gupta A. Quality and safety in the literature: July 2023. BMJ Qual Saf 2023; 32:426-430. [PMID: 37336557 DOI: 10.1136/bmjqs-2023-016272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 04/21/2023] [Indexed: 06/21/2023]
Affiliation(s)
- Christie Youssef
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Nathan Houchens
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
- Medicine Service, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
| | - Ashwin Gupta
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
- Medicine Service, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
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29
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Wong CI, Vannatta K, Gilleland Marchak J, Quade EV, Rodgers IM, Reid CM, Dandoy CE, Billett AL, Miller TP, Vaughn S, Daraiseh NM, Liu S, Carle AC, Walsh KE. Preventable harm because of outpatient medication errors among children with leukemia and lymphoma: A multisite longitudinal assessment. Cancer 2023; 129:1064-1074. [PMID: 36704995 DOI: 10.1002/cncr.34651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 07/27/2022] [Accepted: 08/01/2022] [Indexed: 01/28/2023]
Abstract
BACKGROUND There is little longitudinal information about the type and frequency of harm resulting from medication errors among outpatient children with cancer. We aimed to characterize rates and types of medication errors and harm to outpatient children with leukemia and lymphoma over 7 months of treatment. METHODS We recruited children taking medications at home for leukemia or lymphoma from three pediatric cancer centers. Errors were identified by chart review, in-home medication review, observation of administration, and interviews. Physician reviewers confirmed error (Fleiss' κ = 0.95), harm (Fleiss' κ = 0.82), and suggested interventions. Generalized linear mixed models with random effects were used to account for clustering by site. RESULTS Among 131 children taking 1669 medications with 367 home visits, 408 errors were identified, including 242 with potential for harm and 39 with harm (1.0 harm per 1000 patient-days [95% CI, 0.1-9.8]). Ten percent of children were injured by errors and 42% had errors with potential for harm. Twenty-six percent of caregivers reported that miscommunication led to missed doses or overdoses at home. Children on >13 medications had significantly more serious medication errors than those on fewer medications (77% vs 61%; p = .05). Physician reviewers judged that improved communication among caregivers and between caregivers and clinicians may have prevented the most harm (66%). CONCLUSIONS In this longitudinal study, 10% children with leukemia or lymphoma experienced adverse drug events because of outpatient medication errors. Improvements addressing communication with and among caregivers should be codeveloped with families and based on human-factors engineering. PLAIN LANGUAGE SUMMARY In this longitudinal study, medication errors in the clinic, pharmacy, or at home among children with leukemia or lymphoma over a 7-month period were common, and 10% suffered harm because of errors. Children on >13 medications had significantly more serious medication errors than those on fewer medications (77% vs 61%; p = .05). Physician reviewers judged that improved communication among caregivers and between caregivers and clinicians may have prevented the most harm (66%). Improvements addressing communication with and among caregivers should be codeveloped with families and based on human-factors engineering.
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Affiliation(s)
- Chris I Wong
- Pediatric Hematology-Oncology, University Hospitals Rainbow Babies and Children's Hospital, Cleveland, Ohio, USA
- Medical Oncology, University Hospitals Seidman Cancer Center, Cleveland, Ohio, USA
| | - Kathryn Vannatta
- Center for Biobehavioral Health, Nationwide Children's Hospital, Columbus, Ohio, USA
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Jordan Gilleland Marchak
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
- Aflac Cancer and Blood Disorders Center at Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Emeric V Quade
- Center for Biobehavioral Health, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Isabelle M Rodgers
- Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Christine M Reid
- Department of Pediatrics, James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Christopher E Dandoy
- Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Cancer and Blood Disease Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Amy L Billett
- Quality and Safety Program, Nemours Children's Health, Delaware Valley, Wilmington, Delaware, USA
| | - Tamara P Miller
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
- Aflac Cancer and Blood Disorders Center at Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Shelley Vaughn
- Department of Otolaryngology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Nancy M Daraiseh
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Shanshan Liu
- Biostatistics and Research Design Center, Boston Children's Hospital, Boston, Massachusetts, USA
- Institutional Centers for Clinical Translational Research, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Adam C Carle
- Department of Pediatrics, James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- College of Medicine University of Cincinnati, Cincinnati, Ohio, USA
- Department of Psychology, College of Arts and Sciences, University of Cincinnati, Cincinnati, Ohio, USA
| | - Kathleen E Walsh
- Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
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Ahmed FA, Asif F, Munir T, Halim MS, Feroze Ali Z, Belgaumi A, Zafar H, Latif A. Measuring the patient safety culture at a tertiary care hospital in Pakistan using the Hospital Survey on Patient Safety Culture (HSOPSC). BMJ Open Qual 2023; 12:bmjoq-2022-002029. [PMID: 36931633 PMCID: PMC10030877 DOI: 10.1136/bmjoq-2022-002029] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 03/04/2023] [Indexed: 03/19/2023] Open
Abstract
BACKGROUND Patient safety is a top priority for many healthcare organisations worldwide. However, most of the initiatives aimed at the measurement and improvement of patient safety culture have been undertaken in developed countries. The purpose of this study was to measure the patient safety culture at a tertiary care hospital in Pakistan using the Hospital Survey on Patient Safety Culture (HSOPSC). METHODS The HSOPSC was used to measure the patient safety culture across 12 dimensions at Aga Khan University Hospital, Karachi. 2,959 individuals, who had been working at the hospital, were administered the HSOPSC in paper form between June and September 2019. RESULTS The response rate of the survey was 50%. In the past 12 months, 979 respondents (33.1%) had submitted at least one event report. Results showed that the personnel viewed the patient safety culture at their hospital favourably. Overall, respondents scored highest in the following dimensions: 'feedback and communication on error' (91%), 'organisational learning and continuous improvement' (85%), 'teamwork within units' (83%), 'teamwork across units' (76%). The dimensions with the lowest positive per cent scores included 'staffing' (40%) and 'non-punitive response to error' (41%). Only the reliability of the 'handoffs and transitions', 'frequency of events reported', 'organisational learning' and 'teamwork within units' was higher than Cronbach's alpha of 0.7. Upon regression analysis of positive responses, physicians and nurses were found to have responded less favourably than the remaining professional groups for most dimensions. CONCLUSION The measurement of safety culture is both feasible and informative in developing countries and could be broadly implemented to inform patient safety efforts. Current data suggest that it compares favourably with benchmarks from hospitals in the USA. Like the USA, high staff workload is a significant safety concern among staff. This study lays the foundation for further context-specific research on patient safety culture in developing countries.
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Affiliation(s)
- Fasih Ali Ahmed
- Division of Surgical Oncology, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
- Center for Patient Safety, Aga Khan University Medical College, Karachi, Pakistan
| | - Fozia Asif
- Center for Patient Safety, Aga Khan University Medical College, Karachi, Pakistan
| | - Tahir Munir
- Department of Anaesthesiology, Aga Khan University Medical College, Karachi, Pakistan
| | - Muhammad Sohail Halim
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, California, USA
| | - Zehra Feroze Ali
- Quality and Patient Safety Department, Aga Khan University Hospital, Karachi, Pakistan
| | - Asim Belgaumi
- Quality and Patient Safety Department, Aga Khan University Hospital, Karachi, Pakistan
- Department of Oncology, Aga Khan University, Karachi, Pakistan
| | - Hasnain Zafar
- Department of Surgery, Aga Khan University Medical College, Karachi, Pakistan
| | - Asad Latif
- Department of Anaesthesiology, Aga Khan University Medical College, Karachi, Pakistan
- Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, Maryland, USA
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Lipitz-Snyderman A, Chimonas S, Mailankody S, Kim M, Silva N, Kriplani A, Saltz LB, Sihag S, Tan CR, Widmar M, Zauderer M, Weingart S, Perchick W, Roman BR. Clinical value of second opinions in oncology: A retrospective review of changes in diagnosis and treatment recommendations. Cancer Med 2023; 12:8063-8072. [PMID: 36737878 PMCID: PMC10134380 DOI: 10.1002/cam4.5598] [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: 04/27/2022] [Revised: 12/08/2022] [Accepted: 12/17/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Data on the clinical value of second opinions in oncology are limited. We examined diagnostic and treatment changes resulting from second opinions and the expected impact on morbidity and prognosis. METHODS This retrospective cohort study included patients presenting in 2018 to a high-volume cancer center for second opinions about newly diagnosed colorectal, head and neck, lung, and myeloma cancers or abnormal results. Two sub-specialty physicians from each cancer type reviewed 30 medical records (120 total) using a process and detailed data collection guide meant to mitigate institutional bias. The primary outcome measure was the rate of treatment changes that were "clinically meaningful", i.e., expected to impact morbidity and/or prognosis. Among those with treatment changes, another outcome measure was the rate of clinically meaningful diagnostic changes that led to treatment change. RESULTS Of 120 cases, forty-two had clinically meaningful changes in treatment with positive expected outcomes (7 colorectal, 17 head and neck, 11 lung, 7 myeloma; 23-57%). Two patients had negative expected outcomes from having sought a second opinion, with worse short-term morbidity and unchanged long-term morbidity and prognosis. All those with positive expected outcomes had improved expected morbidity (short- and/or long-term); 11 (0-23%) also had improved expected prognosis. Nine involved a shift from treatment to observation; 21 involved eliminating or reducing the extent of surgery, compared to 6 adding surgery or increasing its extent. Of the 42 with treatment changes, 13 were due to clinically meaningful diagnostic changes (1 colorectal, 5 head and neck, 3 lung, 4 myeloma; 3%-17%) . CONCLUSIONS Second-opinion consultations sometimes add clinical value by improving expected prognoses; more often, they offer treatment de-escalations, with corresponding reductions in expected short- and/or long-term morbidity. Future research could identify subgroups of patients most likely to benefit from second opinions.
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Affiliation(s)
- Allison Lipitz-Snyderman
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Susan Chimonas
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Sham Mailankody
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Michelle Kim
- Strategy and Innovation, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Nicholas Silva
- Strategy and Innovation, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Anuja Kriplani
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Leonard B Saltz
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Smita Sihag
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Carlyn Rose Tan
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Maria Widmar
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Marjorie Zauderer
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Saul Weingart
- Rhode Island Hospital and Hasbro Children's Hospital, Providence, Rhode Island, USA
| | - Wendy Perchick
- Strategy and Innovation, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Benjamin R Roman
- Strategy and Innovation, Memorial Sloan Kettering Cancer Center, New York, New York, USA.,Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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Weaver MD, Landrigan CP, Sullivan JP, O'Brien CS, Qadri S, Viyaran N, Czeisler CA, Barger LK. National improvements in resident physician-reported patient safety after limiting first-year resident physicians' extended duration work shifts: a pooled analysis of prospective cohort studies. BMJ Qual Saf 2023; 32:81-89. [PMID: 35537821 PMCID: PMC9887355 DOI: 10.1136/bmjqs-2021-014375] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 04/13/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND The Accreditation Council for Graduate Medical Education (ACGME) enacted a policy in 2011 that restricted first-year resident physicians in the USA to work no more than 16 consecutive hours. This was rescinded in 2017. METHODS We conducted a nationwide prospective cohort study of resident physicians for 5 academic years (2002-2007) before and for 3 academic years (2014-2017) after implementation of the 16 hours 2011 ACGME work-hour limit. Our analyses compare trends in resident physician-reported medical errors between the two cohorts to evaluate the impact of this policy change. RESULTS 14 796 residents provided data describing 78 101 months of direct patient care. After adjustment for potential confounders, the work-hour policy was associated with a 32% reduced risk of resident physician-reported significant medical errors (rate ratio (RR) 0.68; 95% CI 0.64 to 0.72), a 34% reduced risk of reported preventable adverse events (RR 0.66; 95% CI 0.59 to 0.74) and a 63% reduced risk of reported medical errors resulting in patient death (RR 0.37; 95% CI 0.28 to 0.49). CONCLUSIONS These findings have broad relevance for those who work in and receive care from academic hospitals in the USA. The decision to lift this work hour policy in 2017 may expose patients to preventable harm.
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Affiliation(s)
- Matthew D Weaver
- Brigham and Women's Hospital, Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Boston, Massachusetts, USA
- Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Christopher P Landrigan
- Brigham and Women's Hospital, Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Boston, Massachusetts, USA
- Division of General Pediatrics, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
- Departments of Pediatrics and Medicine, and Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Jason P Sullivan
- Brigham and Women's Hospital, Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Boston, Massachusetts, USA
| | - Conor S O'Brien
- Brigham and Women's Hospital, Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Boston, Massachusetts, USA
| | - Salim Qadri
- Brigham and Women's Hospital, Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Boston, Massachusetts, USA
| | - Natalie Viyaran
- Brigham and Women's Hospital, Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Boston, Massachusetts, USA
| | - Charles A Czeisler
- Brigham and Women's Hospital, Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Boston, Massachusetts, USA
- Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Laura K Barger
- Brigham and Women's Hospital, Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Boston, Massachusetts, USA
- Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts, USA
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Bates DW, Levine DM, Salmasian H, Syrowatka A, Shahian DM, Lipsitz S, Zebrowski JP, Myers LC, Logan MS, Roy CG, Iannaccone C, Frits ML, Volk LA, Dulgarian S, Amato MG, Edrees HH, Sato L, Folcarelli P, Einbinder JS, Reynolds ME, Mort E. The Safety of Inpatient Health Care. N Engl J Med 2023; 388:142-153. [PMID: 36630622 DOI: 10.1056/nejmsa2206117] [Citation(s) in RCA: 72] [Impact Index Per Article: 72.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Adverse events during hospitalization are a major cause of patient harm, as documented in the 1991 Harvard Medical Practice Study. Patient safety has changed substantially in the decades since that study was conducted, and a more current assessment of harm during hospitalization is warranted. METHODS We conducted a retrospective cohort study to assess the frequency, preventability, and severity of patient harm in a random sample of admissions from 11 Massachusetts hospitals during the 2018 calendar year. The occurrence of adverse events was assessed with the use of a trigger method (identification of information in a medical record that was previously shown to be associated with adverse events) and from review of medical records. Trained nurses reviewed records and identified admissions with possible adverse events that were then adjudicated by physicians, who confirmed the presence and characteristics of the adverse events. RESULTS In a random sample of 2809 admissions, we identified at least one adverse event in 23.6%. Among 978 adverse events, 222 (22.7%) were judged to be preventable and 316 (32.3%) had a severity level of serious (i.e., caused harm that resulted in substantial intervention or prolonged recovery) or higher. A preventable adverse event occurred in 191 (6.8%) of all admissions, and a preventable adverse event with a severity level of serious or higher occurred in 29 (1.0%). There were seven deaths, one of which was deemed to be preventable. Adverse drug events were the most common adverse events (accounting for 39.0% of all events), followed by surgical or other procedural events (30.4%), patient-care events (which were defined as events associated with nursing care, including falls and pressure ulcers) (15.0%), and health care-associated infections (11.9%). CONCLUSIONS Adverse events were identified in nearly one in four admissions, and approximately one fourth of the events were preventable. These findings underscore the importance of patient safety and the need for continuing improvement. (Funded by the Controlled Risk Insurance Company and the Risk Management Foundation of the Harvard Medical Institutions.).
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Affiliation(s)
- David W Bates
- From the Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital (D.W.B., D.M.L., H.S., A.S., S.L., C.I., M.L.F., S.D., M.G.A., H.H.E., L.S.), the Department of Health Care Policy (E.M.), Harvard Medical School (D.W.B., D.M.L., H.S., A.S., D.M.S., S.L., J.P.Z., M.S.L., H.H.E., L.S., E.M.), the Department of Health Policy and Management, Harvard T.H. Chan School of Public Health (D.W.B.), the Edward P. Lawrence Center for Quality and Safety (D.M.S., J.P.Z., E.M.), the Division of Cardiac Surgery, Department of Surgery (D.M.S.), the Department of Psychiatry (J.P.Z.), the Division of Nephrology (M.S.L.), and the Division of General Internal Medicine (E.M.), Massachusetts General Hospital, and the Controlled Risk Insurance Company and the Risk Management Foundation of the Harvard Medical Institutions (L.S., P.F., J.S.E., M.E.R.) - all in Boston; the Kaiser Permanente Northern California Division of Research, Oakland (L.C.M.); Maine Medical Center, Portland (C.G.R.); and Mass General Brigham, Somerville, MA (L.A.V.)
| | - David M Levine
- From the Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital (D.W.B., D.M.L., H.S., A.S., S.L., C.I., M.L.F., S.D., M.G.A., H.H.E., L.S.), the Department of Health Care Policy (E.M.), Harvard Medical School (D.W.B., D.M.L., H.S., A.S., D.M.S., S.L., J.P.Z., M.S.L., H.H.E., L.S., E.M.), the Department of Health Policy and Management, Harvard T.H. Chan School of Public Health (D.W.B.), the Edward P. Lawrence Center for Quality and Safety (D.M.S., J.P.Z., E.M.), the Division of Cardiac Surgery, Department of Surgery (D.M.S.), the Department of Psychiatry (J.P.Z.), the Division of Nephrology (M.S.L.), and the Division of General Internal Medicine (E.M.), Massachusetts General Hospital, and the Controlled Risk Insurance Company and the Risk Management Foundation of the Harvard Medical Institutions (L.S., P.F., J.S.E., M.E.R.) - all in Boston; the Kaiser Permanente Northern California Division of Research, Oakland (L.C.M.); Maine Medical Center, Portland (C.G.R.); and Mass General Brigham, Somerville, MA (L.A.V.)
| | - Hojjat Salmasian
- From the Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital (D.W.B., D.M.L., H.S., A.S., S.L., C.I., M.L.F., S.D., M.G.A., H.H.E., L.S.), the Department of Health Care Policy (E.M.), Harvard Medical School (D.W.B., D.M.L., H.S., A.S., D.M.S., S.L., J.P.Z., M.S.L., H.H.E., L.S., E.M.), the Department of Health Policy and Management, Harvard T.H. Chan School of Public Health (D.W.B.), the Edward P. Lawrence Center for Quality and Safety (D.M.S., J.P.Z., E.M.), the Division of Cardiac Surgery, Department of Surgery (D.M.S.), the Department of Psychiatry (J.P.Z.), the Division of Nephrology (M.S.L.), and the Division of General Internal Medicine (E.M.), Massachusetts General Hospital, and the Controlled Risk Insurance Company and the Risk Management Foundation of the Harvard Medical Institutions (L.S., P.F., J.S.E., M.E.R.) - all in Boston; the Kaiser Permanente Northern California Division of Research, Oakland (L.C.M.); Maine Medical Center, Portland (C.G.R.); and Mass General Brigham, Somerville, MA (L.A.V.)
| | - Ania Syrowatka
- From the Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital (D.W.B., D.M.L., H.S., A.S., S.L., C.I., M.L.F., S.D., M.G.A., H.H.E., L.S.), the Department of Health Care Policy (E.M.), Harvard Medical School (D.W.B., D.M.L., H.S., A.S., D.M.S., S.L., J.P.Z., M.S.L., H.H.E., L.S., E.M.), the Department of Health Policy and Management, Harvard T.H. Chan School of Public Health (D.W.B.), the Edward P. Lawrence Center for Quality and Safety (D.M.S., J.P.Z., E.M.), the Division of Cardiac Surgery, Department of Surgery (D.M.S.), the Department of Psychiatry (J.P.Z.), the Division of Nephrology (M.S.L.), and the Division of General Internal Medicine (E.M.), Massachusetts General Hospital, and the Controlled Risk Insurance Company and the Risk Management Foundation of the Harvard Medical Institutions (L.S., P.F., J.S.E., M.E.R.) - all in Boston; the Kaiser Permanente Northern California Division of Research, Oakland (L.C.M.); Maine Medical Center, Portland (C.G.R.); and Mass General Brigham, Somerville, MA (L.A.V.)
| | - David M Shahian
- From the Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital (D.W.B., D.M.L., H.S., A.S., S.L., C.I., M.L.F., S.D., M.G.A., H.H.E., L.S.), the Department of Health Care Policy (E.M.), Harvard Medical School (D.W.B., D.M.L., H.S., A.S., D.M.S., S.L., J.P.Z., M.S.L., H.H.E., L.S., E.M.), the Department of Health Policy and Management, Harvard T.H. Chan School of Public Health (D.W.B.), the Edward P. Lawrence Center for Quality and Safety (D.M.S., J.P.Z., E.M.), the Division of Cardiac Surgery, Department of Surgery (D.M.S.), the Department of Psychiatry (J.P.Z.), the Division of Nephrology (M.S.L.), and the Division of General Internal Medicine (E.M.), Massachusetts General Hospital, and the Controlled Risk Insurance Company and the Risk Management Foundation of the Harvard Medical Institutions (L.S., P.F., J.S.E., M.E.R.) - all in Boston; the Kaiser Permanente Northern California Division of Research, Oakland (L.C.M.); Maine Medical Center, Portland (C.G.R.); and Mass General Brigham, Somerville, MA (L.A.V.)
| | - Stuart Lipsitz
- From the Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital (D.W.B., D.M.L., H.S., A.S., S.L., C.I., M.L.F., S.D., M.G.A., H.H.E., L.S.), the Department of Health Care Policy (E.M.), Harvard Medical School (D.W.B., D.M.L., H.S., A.S., D.M.S., S.L., J.P.Z., M.S.L., H.H.E., L.S., E.M.), the Department of Health Policy and Management, Harvard T.H. Chan School of Public Health (D.W.B.), the Edward P. Lawrence Center for Quality and Safety (D.M.S., J.P.Z., E.M.), the Division of Cardiac Surgery, Department of Surgery (D.M.S.), the Department of Psychiatry (J.P.Z.), the Division of Nephrology (M.S.L.), and the Division of General Internal Medicine (E.M.), Massachusetts General Hospital, and the Controlled Risk Insurance Company and the Risk Management Foundation of the Harvard Medical Institutions (L.S., P.F., J.S.E., M.E.R.) - all in Boston; the Kaiser Permanente Northern California Division of Research, Oakland (L.C.M.); Maine Medical Center, Portland (C.G.R.); and Mass General Brigham, Somerville, MA (L.A.V.)
| | - Jonathan P Zebrowski
- From the Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital (D.W.B., D.M.L., H.S., A.S., S.L., C.I., M.L.F., S.D., M.G.A., H.H.E., L.S.), the Department of Health Care Policy (E.M.), Harvard Medical School (D.W.B., D.M.L., H.S., A.S., D.M.S., S.L., J.P.Z., M.S.L., H.H.E., L.S., E.M.), the Department of Health Policy and Management, Harvard T.H. Chan School of Public Health (D.W.B.), the Edward P. Lawrence Center for Quality and Safety (D.M.S., J.P.Z., E.M.), the Division of Cardiac Surgery, Department of Surgery (D.M.S.), the Department of Psychiatry (J.P.Z.), the Division of Nephrology (M.S.L.), and the Division of General Internal Medicine (E.M.), Massachusetts General Hospital, and the Controlled Risk Insurance Company and the Risk Management Foundation of the Harvard Medical Institutions (L.S., P.F., J.S.E., M.E.R.) - all in Boston; the Kaiser Permanente Northern California Division of Research, Oakland (L.C.M.); Maine Medical Center, Portland (C.G.R.); and Mass General Brigham, Somerville, MA (L.A.V.)
| | - Laura C Myers
- From the Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital (D.W.B., D.M.L., H.S., A.S., S.L., C.I., M.L.F., S.D., M.G.A., H.H.E., L.S.), the Department of Health Care Policy (E.M.), Harvard Medical School (D.W.B., D.M.L., H.S., A.S., D.M.S., S.L., J.P.Z., M.S.L., H.H.E., L.S., E.M.), the Department of Health Policy and Management, Harvard T.H. Chan School of Public Health (D.W.B.), the Edward P. Lawrence Center for Quality and Safety (D.M.S., J.P.Z., E.M.), the Division of Cardiac Surgery, Department of Surgery (D.M.S.), the Department of Psychiatry (J.P.Z.), the Division of Nephrology (M.S.L.), and the Division of General Internal Medicine (E.M.), Massachusetts General Hospital, and the Controlled Risk Insurance Company and the Risk Management Foundation of the Harvard Medical Institutions (L.S., P.F., J.S.E., M.E.R.) - all in Boston; the Kaiser Permanente Northern California Division of Research, Oakland (L.C.M.); Maine Medical Center, Portland (C.G.R.); and Mass General Brigham, Somerville, MA (L.A.V.)
| | - Merranda S Logan
- From the Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital (D.W.B., D.M.L., H.S., A.S., S.L., C.I., M.L.F., S.D., M.G.A., H.H.E., L.S.), the Department of Health Care Policy (E.M.), Harvard Medical School (D.W.B., D.M.L., H.S., A.S., D.M.S., S.L., J.P.Z., M.S.L., H.H.E., L.S., E.M.), the Department of Health Policy and Management, Harvard T.H. Chan School of Public Health (D.W.B.), the Edward P. Lawrence Center for Quality and Safety (D.M.S., J.P.Z., E.M.), the Division of Cardiac Surgery, Department of Surgery (D.M.S.), the Department of Psychiatry (J.P.Z.), the Division of Nephrology (M.S.L.), and the Division of General Internal Medicine (E.M.), Massachusetts General Hospital, and the Controlled Risk Insurance Company and the Risk Management Foundation of the Harvard Medical Institutions (L.S., P.F., J.S.E., M.E.R.) - all in Boston; the Kaiser Permanente Northern California Division of Research, Oakland (L.C.M.); Maine Medical Center, Portland (C.G.R.); and Mass General Brigham, Somerville, MA (L.A.V.)
| | - Christopher G Roy
- From the Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital (D.W.B., D.M.L., H.S., A.S., S.L., C.I., M.L.F., S.D., M.G.A., H.H.E., L.S.), the Department of Health Care Policy (E.M.), Harvard Medical School (D.W.B., D.M.L., H.S., A.S., D.M.S., S.L., J.P.Z., M.S.L., H.H.E., L.S., E.M.), the Department of Health Policy and Management, Harvard T.H. Chan School of Public Health (D.W.B.), the Edward P. Lawrence Center for Quality and Safety (D.M.S., J.P.Z., E.M.), the Division of Cardiac Surgery, Department of Surgery (D.M.S.), the Department of Psychiatry (J.P.Z.), the Division of Nephrology (M.S.L.), and the Division of General Internal Medicine (E.M.), Massachusetts General Hospital, and the Controlled Risk Insurance Company and the Risk Management Foundation of the Harvard Medical Institutions (L.S., P.F., J.S.E., M.E.R.) - all in Boston; the Kaiser Permanente Northern California Division of Research, Oakland (L.C.M.); Maine Medical Center, Portland (C.G.R.); and Mass General Brigham, Somerville, MA (L.A.V.)
| | - Christine Iannaccone
- From the Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital (D.W.B., D.M.L., H.S., A.S., S.L., C.I., M.L.F., S.D., M.G.A., H.H.E., L.S.), the Department of Health Care Policy (E.M.), Harvard Medical School (D.W.B., D.M.L., H.S., A.S., D.M.S., S.L., J.P.Z., M.S.L., H.H.E., L.S., E.M.), the Department of Health Policy and Management, Harvard T.H. Chan School of Public Health (D.W.B.), the Edward P. Lawrence Center for Quality and Safety (D.M.S., J.P.Z., E.M.), the Division of Cardiac Surgery, Department of Surgery (D.M.S.), the Department of Psychiatry (J.P.Z.), the Division of Nephrology (M.S.L.), and the Division of General Internal Medicine (E.M.), Massachusetts General Hospital, and the Controlled Risk Insurance Company and the Risk Management Foundation of the Harvard Medical Institutions (L.S., P.F., J.S.E., M.E.R.) - all in Boston; the Kaiser Permanente Northern California Division of Research, Oakland (L.C.M.); Maine Medical Center, Portland (C.G.R.); and Mass General Brigham, Somerville, MA (L.A.V.)
| | - Michelle L Frits
- From the Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital (D.W.B., D.M.L., H.S., A.S., S.L., C.I., M.L.F., S.D., M.G.A., H.H.E., L.S.), the Department of Health Care Policy (E.M.), Harvard Medical School (D.W.B., D.M.L., H.S., A.S., D.M.S., S.L., J.P.Z., M.S.L., H.H.E., L.S., E.M.), the Department of Health Policy and Management, Harvard T.H. Chan School of Public Health (D.W.B.), the Edward P. Lawrence Center for Quality and Safety (D.M.S., J.P.Z., E.M.), the Division of Cardiac Surgery, Department of Surgery (D.M.S.), the Department of Psychiatry (J.P.Z.), the Division of Nephrology (M.S.L.), and the Division of General Internal Medicine (E.M.), Massachusetts General Hospital, and the Controlled Risk Insurance Company and the Risk Management Foundation of the Harvard Medical Institutions (L.S., P.F., J.S.E., M.E.R.) - all in Boston; the Kaiser Permanente Northern California Division of Research, Oakland (L.C.M.); Maine Medical Center, Portland (C.G.R.); and Mass General Brigham, Somerville, MA (L.A.V.)
| | - Lynn A Volk
- From the Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital (D.W.B., D.M.L., H.S., A.S., S.L., C.I., M.L.F., S.D., M.G.A., H.H.E., L.S.), the Department of Health Care Policy (E.M.), Harvard Medical School (D.W.B., D.M.L., H.S., A.S., D.M.S., S.L., J.P.Z., M.S.L., H.H.E., L.S., E.M.), the Department of Health Policy and Management, Harvard T.H. Chan School of Public Health (D.W.B.), the Edward P. Lawrence Center for Quality and Safety (D.M.S., J.P.Z., E.M.), the Division of Cardiac Surgery, Department of Surgery (D.M.S.), the Department of Psychiatry (J.P.Z.), the Division of Nephrology (M.S.L.), and the Division of General Internal Medicine (E.M.), Massachusetts General Hospital, and the Controlled Risk Insurance Company and the Risk Management Foundation of the Harvard Medical Institutions (L.S., P.F., J.S.E., M.E.R.) - all in Boston; the Kaiser Permanente Northern California Division of Research, Oakland (L.C.M.); Maine Medical Center, Portland (C.G.R.); and Mass General Brigham, Somerville, MA (L.A.V.)
| | - Sevan Dulgarian
- From the Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital (D.W.B., D.M.L., H.S., A.S., S.L., C.I., M.L.F., S.D., M.G.A., H.H.E., L.S.), the Department of Health Care Policy (E.M.), Harvard Medical School (D.W.B., D.M.L., H.S., A.S., D.M.S., S.L., J.P.Z., M.S.L., H.H.E., L.S., E.M.), the Department of Health Policy and Management, Harvard T.H. Chan School of Public Health (D.W.B.), the Edward P. Lawrence Center for Quality and Safety (D.M.S., J.P.Z., E.M.), the Division of Cardiac Surgery, Department of Surgery (D.M.S.), the Department of Psychiatry (J.P.Z.), the Division of Nephrology (M.S.L.), and the Division of General Internal Medicine (E.M.), Massachusetts General Hospital, and the Controlled Risk Insurance Company and the Risk Management Foundation of the Harvard Medical Institutions (L.S., P.F., J.S.E., M.E.R.) - all in Boston; the Kaiser Permanente Northern California Division of Research, Oakland (L.C.M.); Maine Medical Center, Portland (C.G.R.); and Mass General Brigham, Somerville, MA (L.A.V.)
| | - Mary G Amato
- From the Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital (D.W.B., D.M.L., H.S., A.S., S.L., C.I., M.L.F., S.D., M.G.A., H.H.E., L.S.), the Department of Health Care Policy (E.M.), Harvard Medical School (D.W.B., D.M.L., H.S., A.S., D.M.S., S.L., J.P.Z., M.S.L., H.H.E., L.S., E.M.), the Department of Health Policy and Management, Harvard T.H. Chan School of Public Health (D.W.B.), the Edward P. Lawrence Center for Quality and Safety (D.M.S., J.P.Z., E.M.), the Division of Cardiac Surgery, Department of Surgery (D.M.S.), the Department of Psychiatry (J.P.Z.), the Division of Nephrology (M.S.L.), and the Division of General Internal Medicine (E.M.), Massachusetts General Hospital, and the Controlled Risk Insurance Company and the Risk Management Foundation of the Harvard Medical Institutions (L.S., P.F., J.S.E., M.E.R.) - all in Boston; the Kaiser Permanente Northern California Division of Research, Oakland (L.C.M.); Maine Medical Center, Portland (C.G.R.); and Mass General Brigham, Somerville, MA (L.A.V.)
| | - Heba H Edrees
- From the Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital (D.W.B., D.M.L., H.S., A.S., S.L., C.I., M.L.F., S.D., M.G.A., H.H.E., L.S.), the Department of Health Care Policy (E.M.), Harvard Medical School (D.W.B., D.M.L., H.S., A.S., D.M.S., S.L., J.P.Z., M.S.L., H.H.E., L.S., E.M.), the Department of Health Policy and Management, Harvard T.H. Chan School of Public Health (D.W.B.), the Edward P. Lawrence Center for Quality and Safety (D.M.S., J.P.Z., E.M.), the Division of Cardiac Surgery, Department of Surgery (D.M.S.), the Department of Psychiatry (J.P.Z.), the Division of Nephrology (M.S.L.), and the Division of General Internal Medicine (E.M.), Massachusetts General Hospital, and the Controlled Risk Insurance Company and the Risk Management Foundation of the Harvard Medical Institutions (L.S., P.F., J.S.E., M.E.R.) - all in Boston; the Kaiser Permanente Northern California Division of Research, Oakland (L.C.M.); Maine Medical Center, Portland (C.G.R.); and Mass General Brigham, Somerville, MA (L.A.V.)
| | - Luke Sato
- From the Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital (D.W.B., D.M.L., H.S., A.S., S.L., C.I., M.L.F., S.D., M.G.A., H.H.E., L.S.), the Department of Health Care Policy (E.M.), Harvard Medical School (D.W.B., D.M.L., H.S., A.S., D.M.S., S.L., J.P.Z., M.S.L., H.H.E., L.S., E.M.), the Department of Health Policy and Management, Harvard T.H. Chan School of Public Health (D.W.B.), the Edward P. Lawrence Center for Quality and Safety (D.M.S., J.P.Z., E.M.), the Division of Cardiac Surgery, Department of Surgery (D.M.S.), the Department of Psychiatry (J.P.Z.), the Division of Nephrology (M.S.L.), and the Division of General Internal Medicine (E.M.), Massachusetts General Hospital, and the Controlled Risk Insurance Company and the Risk Management Foundation of the Harvard Medical Institutions (L.S., P.F., J.S.E., M.E.R.) - all in Boston; the Kaiser Permanente Northern California Division of Research, Oakland (L.C.M.); Maine Medical Center, Portland (C.G.R.); and Mass General Brigham, Somerville, MA (L.A.V.)
| | - Patricia Folcarelli
- From the Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital (D.W.B., D.M.L., H.S., A.S., S.L., C.I., M.L.F., S.D., M.G.A., H.H.E., L.S.), the Department of Health Care Policy (E.M.), Harvard Medical School (D.W.B., D.M.L., H.S., A.S., D.M.S., S.L., J.P.Z., M.S.L., H.H.E., L.S., E.M.), the Department of Health Policy and Management, Harvard T.H. Chan School of Public Health (D.W.B.), the Edward P. Lawrence Center for Quality and Safety (D.M.S., J.P.Z., E.M.), the Division of Cardiac Surgery, Department of Surgery (D.M.S.), the Department of Psychiatry (J.P.Z.), the Division of Nephrology (M.S.L.), and the Division of General Internal Medicine (E.M.), Massachusetts General Hospital, and the Controlled Risk Insurance Company and the Risk Management Foundation of the Harvard Medical Institutions (L.S., P.F., J.S.E., M.E.R.) - all in Boston; the Kaiser Permanente Northern California Division of Research, Oakland (L.C.M.); Maine Medical Center, Portland (C.G.R.); and Mass General Brigham, Somerville, MA (L.A.V.)
| | - Jonathan S Einbinder
- From the Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital (D.W.B., D.M.L., H.S., A.S., S.L., C.I., M.L.F., S.D., M.G.A., H.H.E., L.S.), the Department of Health Care Policy (E.M.), Harvard Medical School (D.W.B., D.M.L., H.S., A.S., D.M.S., S.L., J.P.Z., M.S.L., H.H.E., L.S., E.M.), the Department of Health Policy and Management, Harvard T.H. Chan School of Public Health (D.W.B.), the Edward P. Lawrence Center for Quality and Safety (D.M.S., J.P.Z., E.M.), the Division of Cardiac Surgery, Department of Surgery (D.M.S.), the Department of Psychiatry (J.P.Z.), the Division of Nephrology (M.S.L.), and the Division of General Internal Medicine (E.M.), Massachusetts General Hospital, and the Controlled Risk Insurance Company and the Risk Management Foundation of the Harvard Medical Institutions (L.S., P.F., J.S.E., M.E.R.) - all in Boston; the Kaiser Permanente Northern California Division of Research, Oakland (L.C.M.); Maine Medical Center, Portland (C.G.R.); and Mass General Brigham, Somerville, MA (L.A.V.)
| | - Mark E Reynolds
- From the Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital (D.W.B., D.M.L., H.S., A.S., S.L., C.I., M.L.F., S.D., M.G.A., H.H.E., L.S.), the Department of Health Care Policy (E.M.), Harvard Medical School (D.W.B., D.M.L., H.S., A.S., D.M.S., S.L., J.P.Z., M.S.L., H.H.E., L.S., E.M.), the Department of Health Policy and Management, Harvard T.H. Chan School of Public Health (D.W.B.), the Edward P. Lawrence Center for Quality and Safety (D.M.S., J.P.Z., E.M.), the Division of Cardiac Surgery, Department of Surgery (D.M.S.), the Department of Psychiatry (J.P.Z.), the Division of Nephrology (M.S.L.), and the Division of General Internal Medicine (E.M.), Massachusetts General Hospital, and the Controlled Risk Insurance Company and the Risk Management Foundation of the Harvard Medical Institutions (L.S., P.F., J.S.E., M.E.R.) - all in Boston; the Kaiser Permanente Northern California Division of Research, Oakland (L.C.M.); Maine Medical Center, Portland (C.G.R.); and Mass General Brigham, Somerville, MA (L.A.V.)
| | - Elizabeth Mort
- From the Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital (D.W.B., D.M.L., H.S., A.S., S.L., C.I., M.L.F., S.D., M.G.A., H.H.E., L.S.), the Department of Health Care Policy (E.M.), Harvard Medical School (D.W.B., D.M.L., H.S., A.S., D.M.S., S.L., J.P.Z., M.S.L., H.H.E., L.S., E.M.), the Department of Health Policy and Management, Harvard T.H. Chan School of Public Health (D.W.B.), the Edward P. Lawrence Center for Quality and Safety (D.M.S., J.P.Z., E.M.), the Division of Cardiac Surgery, Department of Surgery (D.M.S.), the Department of Psychiatry (J.P.Z.), the Division of Nephrology (M.S.L.), and the Division of General Internal Medicine (E.M.), Massachusetts General Hospital, and the Controlled Risk Insurance Company and the Risk Management Foundation of the Harvard Medical Institutions (L.S., P.F., J.S.E., M.E.R.) - all in Boston; the Kaiser Permanente Northern California Division of Research, Oakland (L.C.M.); Maine Medical Center, Portland (C.G.R.); and Mass General Brigham, Somerville, MA (L.A.V.)
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Liu C, Talaei-Khoei A, Storey VC, Peng G. A Review of the State of the Art of Data Quality in Healthcare. JOURNAL OF GLOBAL INFORMATION MANAGEMENT 2023. [DOI: 10.4018/jgim.316236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Effective implementation of strategic data-driven health analysis initiatives is heavily dependent on the quality of the electronic medical records that serve as the foundation from which to improve clinical decisions and, in turn, the quality of care. Although there is a large body of research on the quality of healthcare data, a systematical understanding of the methods used to address the issues of data quality is missing. This study analyzes research articles in health information systems/healthcare informatics on data quality to derive a set of dimensions for understanding data quality. Issues related to each dimension are identified and methods used to address them summarized. The issues and methods can inform healthcare professionals of how to improve data practices.
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Affiliation(s)
- Caihua Liu
- Guilin University of Electronic Technology, China
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Yesilyaprak T, Demir Korkmaz F. The relationship between surgical intensive care unit nurses' patient safety culture and adverse events. Nurs Crit Care 2023; 28:63-71. [PMID: 33655626 DOI: 10.1111/nicc.12611] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 02/01/2021] [Accepted: 02/11/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Adverse events are often encountered in surgical intensive care units (ICUs), and most of them occur due to preventable errors. Establishment of a patient safety culture is recommended for preventing and reducing these errors. AIMS This study was performed to investigate the relationship between surgical ICU nurses' patient safety culture and adverse events. DESIGN This was a cross-sectional descriptive study. METHODS The study was performed in the surgical ICUs of four university hospitals in Izmir province, Turkey and was conducted in accordance with the Declaration of Helsinki and approved by an Ethics Committee. The sample comprised 113 nurses working in the surgical ICUs of the hospitals between November 2018 and February 2019. Data were collected using a questionnaire that comprised a demographic form, adverse events form, and patient safety culture hospital questionnaire. Student's t test, one-way analysis of variance, and logistic regression analyses were used to evaluate the data. P values <.05 were considered significant. RESULTS At the end of the study, nurses' level of patient safety culture was found to be intermediate (65.5%), with the highest average positive response rate (PRR) obtained for teamwork within the units (65.5%) and the lowest average PRR obtained for the frequency of adverse event reporting (25.3%). There was a significant correlation between patient safety culture and adverse events (r = 0.027, P < .05). CONCLUSIONS Surgical ICUs nurses' level of patient safety culture was average, and there was a significant correlation between patient safety culture and adverse events. RELEVANCE TO CLINICAL PRACTICE Managers should establish a reliable system for reporting adverse events and encourage ICU nurses to report them. It is very important to adopt a non-punitive approach at instances when an adverse event is reported.
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Affiliation(s)
| | - Fatma Demir Korkmaz
- Faculty of Nursing, Department of Surgical Nursing, Ege University, Izmir, Turkey
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Brady PW, Marshall TL, Walsh KE. Promoting Action on Diagnostic Safety: The Safer Dx Checklist. Jt Comm J Qual Patient Saf 2022; 48:559-560. [PMID: 36155177 DOI: 10.1016/j.jcjq.2022.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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An Asset-Based Quality Improvement Tool for Health Care Organizations: Cultivating Organizationwide Quality Improvement and Health Care Professional Engagement. Jt Comm J Qual Patient Saf 2022; 48:599-608. [PMID: 36123296 DOI: 10.1016/j.jcjq.2022.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 08/04/2022] [Accepted: 08/15/2022] [Indexed: 12/30/2022]
Abstract
In the United States, health care organizations are often biased toward deficit-based quality and safety improvement techniques, such as incident reporting and peer review. However, deficit-based techniques may elicit negative sentiments from frontline health care professionals, causing disengagement and adverse event underreporting. To complement deficit-based quality improvement, our institution developed an organizationwide asset-based quality improvement tool. Inspired by asset-based quality improvement methodologies such as appreciative inquiry, Safety-II, and positive deviance, this tool facilitates the identification and analysis of clinical excellence. Resultant best practices and quality improvement projects are then propagated throughout our organization. Ultimately, asset-based quality improvement tools are logistically and technologically feasible for organizationwide deployment, and they potentially improve care quality and team culture. Health care organizations should consider adding these tools to their quality and safety improvement initiatives.
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Draganović Š, Offermanns G. Patient safety culture in Austria and recommendations of evidence-based instruments for improving patient safety. PLoS One 2022; 17:e0274805. [PMID: 36251643 PMCID: PMC9576070 DOI: 10.1371/journal.pone.0274805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 09/03/2022] [Indexed: 11/05/2022] Open
Abstract
This study aimed to investigate the patient safety culture in Austria. We identified factors that contributed to a higher degree of patient safety and subsequently developed evidence-based suggestions on how to improve patient safety culture in hospitals. Moreover, we examined differences in the perception of patient safety culture among different professional groups. This study used a cross-sectional design in ten Austrian hospitals (N = 1,525). We analyzed the correlation between ten patient safety culture factors, three background characteristics (descriptive variables), and three outcome variables (patient safety grade, number of adverse events reported, and influence on patient safety). We also conducted an analysis of variance to determine the differences in patient safety culture factors among the various professional groups in hospitals. The findings revealed that all ten factors have considerable potential for improvement. The most highly rated patient safety culture factors were communication openness and supervisor/manager’s expectations and actions promoting safety; whereas, the lowest rated factor was non-punitive response to error. A comparison of the various professional groups showed significant differences in the perception of patient safety culture between nurses, doctors, and other groups. Patient safety culture in Austria seems to have considerable potential for improvement, and patient safety culture factors significantly contribute to patient safety. We determined evidence-based practices as recommendations for improving each of the patient safety factors.
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Affiliation(s)
- Šehad Draganović
- Department of Organization, Human Resources, and Service Management, Faculty of Management and Economics, University of Klagenfurt, Klagenfurt am Wörthersee, Austria
- * E-mail:
| | - Guido Offermanns
- Department of Organization, Human Resources, and Service Management, Faculty of Management and Economics, University of Klagenfurt, Klagenfurt am Wörthersee, Austria
- Karl Landsteiner Society, Institute for Hospital Organization, Vienna, Austria
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Schmidt M, Lambert SI, Klasen M, Sandmeyer B, Lazarovici M, Jahns F, Trefz LC, Hempel G, Sopka S. Safety management in times of crisis: Lessons learned from a nationwide status-analysis on German intensive care units during the COVID-19 pandemic. Front Med (Lausanne) 2022; 9:988746. [PMID: 36275792 PMCID: PMC9583873 DOI: 10.3389/fmed.2022.988746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 09/02/2022] [Indexed: 01/08/2023] Open
Abstract
Background The status of Safety Management is highly relevant to evaluate an organization's ability to deal with unexpected events or errors, especially in times of crisis. However, it remains unclear to what extent Safety Management was developed and sufficiently implemented within the healthcare system during the COVID-19 pandemic. Providing insights of potential for improvement is expected to be directional for ongoing Safety Management efforts, in times of crisis and beyond. Method A nationwide survey study was conducted among healthcare professionals and auxiliary staff on German Intensive Care Units (ICUs) evaluating their experiences during the first wave of the COVID-19 pandemic. Error Management and Patient Safety Culture (PSC) measures served to operationalize Safety Management. Data were analyzed descriptively and by using quantitative content analysis (QCA). Results Results for n = 588 participants from 53 hospitals show that there is a gap between errors occurred, reported, documented, and addressed. QCA revealed that low quality of safety culture (27.8%) was the most mentioned reason for errors not being addressed. Overall, ratings of PSC ranged from 26.7 to 57.9% positive response with Staffing being the worst and Teamwork Within Units being the best rated dimension. While assessments showed a similar pattern, medical staff rated PSC on ICUs more positively in comparison to nursing staff. Conclusion The status-analysis of Safety Management in times of crisis revealed relevant potential for improvement. Human Factor plays a crucial role in the occurrence and the way errors are dealt with on ICUs, but systemic factors should not be underestimated. Further intensified efforts specifically in the fields of staffing and error reporting, documentation and communication are needed to improve Safety Management on ICUs. These findings might also be applicable across nations and sectors beyond the medical field.
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Affiliation(s)
- Michelle Schmidt
- AIXTRA — Competence Center for Training and Patient Safety, Medical Faculty, RWTH Aachen University, Aachen, Germany,Department of Anaesthesiology, University Hospital RWTH Aachen, Medical Faculty, RWTH Aachen University, Aachen, Germany,*Correspondence: Michelle Schmidt
| | - Sophie Isabelle Lambert
- AIXTRA — Competence Center for Training and Patient Safety, Medical Faculty, RWTH Aachen University, Aachen, Germany,Department of Anaesthesiology, University Hospital RWTH Aachen, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Martin Klasen
- AIXTRA — Competence Center for Training and Patient Safety, Medical Faculty, RWTH Aachen University, Aachen, Germany,Department of Anaesthesiology, University Hospital RWTH Aachen, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Benedikt Sandmeyer
- Institut für Notfallmedizin und Medizinmanagement (INM), Klinikum der Universität München, LMU München, München, Germany
| | - Marc Lazarovici
- Institut für Notfallmedizin und Medizinmanagement (INM), Klinikum der Universität München, LMU München, München, Germany
| | - Franziska Jahns
- Department of Anaesthesiology and Intensive Care, University Medical Centre Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Lara Charlott Trefz
- Department of Anaesthesiology and Intensive Care, University Medical Centre Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Gunther Hempel
- Department of Anaesthesiology and Intensive Care, University of Leipzig Medical Centre, Leipzig, Germany
| | - Saša Sopka
- AIXTRA — Competence Center for Training and Patient Safety, Medical Faculty, RWTH Aachen University, Aachen, Germany,Department of Anaesthesiology, University Hospital RWTH Aachen, Medical Faculty, RWTH Aachen University, Aachen, Germany
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Oura P, Sajantila A. A recent two-fold increase in medical adverse event deaths among US inpatients. J Public Health Res 2022; 11:22799036221139935. [PMID: 36457900 PMCID: PMC9706070 DOI: 10.1177/22799036221139935] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 11/02/2022] [Indexed: 10/20/2023] Open
Abstract
Inpatients have a particular risk of sustaining medical adverse events (MAEs). This analysis aimed to identify patterns of change in deaths due to MAEs among US inpatients. The analysis was based on nationwide cause-of-death data from 1999 to 2019. To adjust for secular trends in overall mortality, MAE deaths were examined proportional to total deaths. Statistical analysis was performed by means of joinpoint regression modeling. Over the analysis period, a total of 18,126,135 certified deaths occurred among inpatients. MAEs were used as the underlying cause of death in 43,899 cases (0.24%). MAE deaths showed a significant increase from mid-2010s onwards; the estimated increase in MAE deaths was up to 15.6% per year (95% confidence interval 11.3-20.1) from 2014 to 2019. Procedure-related events mainly drove the trend. As the present data are insufficient to substantiate and disentangle underlying factors, future analyses are warranted.
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Affiliation(s)
- Petteri Oura
- Department of Forensic Medicine,
University of Helsinki, Helsinki, Finland
- Forensic Medicine Unit, Finnish
Institute for Health and Welfare, Helsinki, Finland
| | - Antti Sajantila
- Department of Forensic Medicine,
University of Helsinki, Helsinki, Finland
- Forensic Medicine Unit, Finnish
Institute for Health and Welfare, Helsinki, Finland
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41
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Landrigan CP. Pediatric Patient Safety-First Steps Forward. JAMA Pediatr 2022; 176:850-851. [PMID: 35877110 DOI: 10.1001/jamapediatrics.2022.2500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Christopher P Landrigan
- Division of General Pediatrics, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts.,Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, Massachusetts.,Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts
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Eggenschwiler LC, Rutjes AWS, Musy SN, Ausserhofer D, Nielen NM, Schwendimann R, Unbeck M, Simon M. Variation in detected adverse events using trigger tools: A systematic review and meta-analysis. PLoS One 2022; 17:e0273800. [PMID: 36048863 PMCID: PMC9436152 DOI: 10.1371/journal.pone.0273800] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 08/15/2022] [Indexed: 11/19/2022] Open
Abstract
Background Adverse event (AE) detection is a major patient safety priority. However, despite extensive research on AEs, reported incidence rates vary widely. Objective This study aimed: (1) to synthesize available evidence on AE incidence in acute care inpatient settings using Trigger Tool methodology; and (2) to explore whether study characteristics and study quality explain variations in reported AE incidence. Design Systematic review and meta-analysis. Methods To identify relevant studies, we queried PubMed, EMBASE, CINAHL, Cochrane Library and three journals in the patient safety field (last update search 25.05.2022). Eligible publications fulfilled the following criteria: adult inpatient samples; acute care hospital settings; Trigger Tool methodology; focus on specialty of internal medicine, surgery or oncology; published in English, French, German, Italian or Spanish. Systematic reviews and studies addressing adverse drug events or exclusively deceased patients were excluded. Risk of bias was assessed using an adapted version of the Quality Assessment Tool for Diagnostic Accuracy Studies 2. Our main outcome of interest was AEs per 100 admissions. We assessed nine study characteristics plus study quality as potential sources of variation using random regression models. We received no funding and did not register this review. Results Screening 6,685 publications yielded 54 eligible studies covering 194,470 admissions. The cumulative AE incidence was 30.0 per 100 admissions (95% CI 23.9–37.5; I2 = 99.7%) and between study heterogeneity was high with a prediction interval of 5.4–164.7. Overall studies’ risk of bias and applicability-related concerns were rated as low. Eight out of nine methodological study characteristics did explain some variation of reported AE rates, such as patient age and type of hospital. Also, study quality did explain variation. Conclusion Estimates of AE studies using trigger tool methodology vary while explaining variation is seriously hampered by the low standards of reporting such as the timeframe of AE detection. Specific reporting guidelines for studies using retrospective medical record review methodology are necessary to strengthen the current evidence base and to help explain between study variation.
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Affiliation(s)
- Luisa C. Eggenschwiler
- Institute of Nursing Science (INS), Department Public Health (DPH), Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Anne W. S. Rutjes
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | - Sarah N. Musy
- Institute of Nursing Science (INS), Department Public Health (DPH), Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Dietmar Ausserhofer
- Institute of Nursing Science (INS), Department Public Health (DPH), Faculty of Medicine, University of Basel, Basel, Switzerland
- College of Health Care-Professions Claudiana, Bozen-Bolzano, Italy
| | - Natascha M. Nielen
- Institute of Nursing Science (INS), Department Public Health (DPH), Faculty of Medicine, University of Basel, Basel, Switzerland
| | - René Schwendimann
- Institute of Nursing Science (INS), Department Public Health (DPH), Faculty of Medicine, University of Basel, Basel, Switzerland
- Patient Safety Office, University Hospital Basel, Basel, Switzerland
| | - Maria Unbeck
- School of Health and Welfare, Dalarna University, Falun, Sweden
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Michael Simon
- Institute of Nursing Science (INS), Department Public Health (DPH), Faculty of Medicine, University of Basel, Basel, Switzerland
- * E-mail:
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Ahmed FA, Asif F, Mubashir A, Aboumatar HJ, Hameed M, Haider A, Latif A. Incorporating Patient Safety and Quality Into the Medical School Curriculum: An Assessment of Student Gains. J Patient Saf 2022; 18:637-644. [PMID: 35532980 PMCID: PMC9422755 DOI: 10.1097/pts.0000000000001010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Global efforts are being made to improve health care standards and the quality of care provided. It has been shown through research that the introduction of patient safety (PS) and quality improvement (QI) concepts in the medical curriculum prepares medical students to face future challenges in their professional careers. PURPOSE This study aimed to evaluate how a brief course on QI and PS affects the knowledge, efficacy, and system thinking of medical students. METHODS A 5-day QI and PS intervention course was implemented at the Aga Khan University medical college for 98 third-year medical students in March 2021. This weeklong course of lectures, interactive sessions, and hands-on skill workshops was conducted before the students began their clinical rotations. Students' knowledge, self-efficacy, and system thinking were assessed with pretest and posttest. Students were also asked to write personal reflections and fill out a satisfaction survey at the end of the intervention. RESULTS Comparisons of pretest and posttest scores showed that the course significantly improved students' knowledge by a mean of 2.92 points (95% confidence interval, 2.30-3.53; P < 0.001) and system thinking by 0.16 points (95% confidence interval, 0.03-0.29; P = 0.018) of the maximum scores of 20 and 5 points, respectively. The students' self-assessment of PS knowledge also reflected statistically significant increases in all 9 domains ( P < 0.001). Students reported positive experiences with this course in their personal reflections. CONCLUSIONS The medical students exhibited increases in knowledge, self-efficacy, and system thinking after this weeklong intervention. The design of the course can be modified as needed and implemented at other institutions in low- and middle-income countries. A targeted long-term assessment of knowledge and attitudes is needed to fully evaluate the impact of this course.
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Affiliation(s)
- Fasih Ali Ahmed
- From the Center for Patient Safety, Aga Khan University, Karachi, Pakistan
| | - Fozia Asif
- From the Center for Patient Safety, Aga Khan University, Karachi, Pakistan
| | - Ayesha Mubashir
- From the Center for Patient Safety, Aga Khan University, Karachi, Pakistan
| | - Hanan J. Aboumatar
- Johns Hopkins University School of Medicine
- Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, Maryland
| | - Malika Hameed
- Department of Anaesthesiology, Aga Khan University, Karachi, Pakistan
| | - Adil Haider
- Medical College, Aga Khan University, Karachi, Pakistan
| | - Asad Latif
- Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, Maryland
- Department of Anaesthesiology, Aga Khan University, Karachi, Pakistan
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Kalenderian E, Hebballi NB, Franklin A, Yansane A, Ibarra Noriega AM, White J, Walji MF. Development of a Quality Improvement Dental Chart Review Training Program. J Patient Saf 2022; 18:e883-e888. [PMID: 35067625 PMCID: PMC9300767 DOI: 10.1097/pts.0000000000000965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Chart review is central to understanding adverse events (AEs) in medicine. In this article, we describe the process and results of educating chart reviewers assigned to evaluate dental AEs. METHODS We developed a Web-based training program, "Dental Patient Safety Training," which uses both independent and consensus-based curricula, for identifying AEs recorded in electronic health records in the dental setting. Training included (1) didactic education, (2) skills training using videos and guided walkthroughs, (3) quizzes with feedback, and (4) hands-on learning exercises. In addition, novice reviewers were coached weekly during consensus review discussions. TeamExpert was composed of 2 experienced reviewers, and TeamNovice included 2 chart reviewers in training. McNemar test, interrater reliability, sensitivity, specificity, positive predictive value, and negative predictive value were calculated to compare accuracy rates on the identification of charts containing AEs at the start of training and 7 months after consensus building discussions between the 2 teams. RESULTS TeamNovice completed independent and consensus development training. Initial chart reviews were conducted on a shared set of charts (n = 51) followed by additional training including consensus building discussions. There was a marked improvement in overall percent agreement, prevalence and bias-adjusted κ correlation, and diagnostic measures (sensitivity, specificity, positive predictive value, and negative predictive value) of reviewed charts between both teams from the phase I training program to phase II consensus building. CONCLUSIONS This study detailed the process of training new chart reviewers and evaluating their performance. Our results suggest that standardized training and continuous coaching improves calibration between experts and trained chart reviewers.
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Affiliation(s)
- Elsbeth Kalenderian
- University of California at San Francisco, School of Dentistry, Department of Preventive and Restorative Dental Sciences, CA, USA
- Harvard School of Dental Medicine, Boston, MA, USA
- University of Pretoria, School of Dentistry, South Africa
| | - Nutan B. Hebballi
- University of Texas Health Science Center, School of Dentistry at Houston, Houston, TX, USA
| | - Amy Franklin
- University of Texas Health Science Center, School of Dentistry at Houston, Houston, TX, USA
| | - Alfa Yansane
- University of California at San Francisco, School of Dentistry, Department of Preventive and Restorative Dental Sciences, CA, USA
| | - Ana M. Ibarra Noriega
- University of Texas Health Science Center, School of Dentistry at Houston, Houston, TX, USA
| | - Joel White
- University of California at San Francisco, School of Dentistry, Department of Preventive and Restorative Dental Sciences, CA, USA
| | - Muhammad F. Walji
- University of Texas Health Science Center, School of Dentistry at Houston, Houston, TX, USA
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Stockwell DC, Kayes DC, Thomas EJ. Patient Safety: Where to Aim When Zero Harm Is Not the Target-A Case for Learning and Resilience. J Patient Saf 2022; 18:e877-e882. [PMID: 35067622 DOI: 10.1097/pts.0000000000000967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- David C Stockwell
- From the Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, School of Medicine, Baltimore, Maryland
| | - D Christopher Kayes
- The George Washington University, School of Business, Washington, District of Columbia
| | - Eric J Thomas
- The McGovern Medical School at the University of Texas Health Science Houston and the University of Texas at Houston-Memorial Hermann Center for Healthcare Quality and Safety, University of Texas Medical School, Houston, Texas
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Eldridge N, Wang Y, Metersky M, Eckenrode S, Mathew J, Sonnenfeld N, Perdue-Puli J, Hunt D, Brady PJ, McGann P, Grace E, Rodrick D, Drye E, Krumholz HM. Trends in Adverse Event Rates in Hospitalized Patients, 2010-2019. JAMA 2022; 328:173-183. [PMID: 35819424 PMCID: PMC9277501 DOI: 10.1001/jama.2022.9600] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
IMPORTANCE Patient safety is a US national priority, yet lacks a comprehensive assessment of progress over the past decade. OBJECTIVE To determine the change in the rate of adverse events in hospitalized patients. DESIGN, SETTING, AND PARTICIPANTS This serial cross-sectional study used data from the Medicare Patient Safety Monitoring System from 2010 to 2019 to assess in-hospital adverse events in patients. The study included 244 542 adult patients hospitalized in 3156 US acute care hospitals across 4 condition groups from 2010 through 2019: acute myocardial infarction (17%), heart failure (17%), pneumonia (21%), and major surgical procedures (22%); and patients hospitalized from 2012 through 2019 for all other conditions (22%). EXPOSURES Adults aged 18 years or older hospitalized during each included calendar year. MAIN OUTCOMES AND MEASURES Information on adverse events (abstracted from medical records) included 21 measures across 4 adverse event domains: adverse drug events, hospital-acquired infections, adverse events after a procedure, and general adverse events (hospital-acquired pressure ulcers and falls). The outcomes were the total change over time for the observed and risk-adjusted adverse event rates in the subpopulations. RESULTS The study sample included 190 286 hospital discharges combined in the 4 condition-based groups of acute myocardial infarction, heart failure, pneumonia, and major surgical procedures (mean age, 68.0 [SD, 15.9] years; 52.6% were female) and 54 256 hospital discharges for the group including all other conditions (mean age, 57.7 [SD, 20.7] years; 59.8% were female) from 3156 acute care hospitals across the US. From 2010 to 2019, the total change was from 218 to 139 adverse events per 1000 discharges for acute myocardial infarction, from 168 to 116 adverse events per 1000 discharges for heart failure, from 195 to 119 adverse events per 1000 discharges for pneumonia, and from 204 to 130 adverse events per 1000 discharges for major surgical procedures. From 2012 to 2019, the rate of adverse events for all other conditions remained unchanged at 70 adverse events per 1000 discharges. After adjustment for patient and hospital characteristics, the annual change represented by relative risk in all adverse events per 1000 discharges was 0.94 (95% CI, 0.93-0.94) for acute myocardial infarction, 0.95 (95% CI, 0.94-0.96) for heart failure, 0.94 (95% CI, 0.93-0.95) for pneumonia, 0.93 (95% CI, 0.92-0.94) for major surgical procedures, and 0.97 (95% CI, 0.96-0.99) for all other conditions. The risk-adjusted adverse event rates declined significantly in all patient groups for adverse drug events, hospital-acquired infections, and general adverse events. For patients in the major surgical procedures group, the risk-adjusted rates of events after a procedure declined significantly. CONCLUSIONS AND RELEVANCE In the US between 2010 and 2019, there was a significant decrease in the rates of adverse events abstracted from medical records for patients admitted for acute myocardial infarction, heart failure, pneumonia, and major surgical procedures and there was a significant decrease in the adjusted rates of adverse events between 2012 and 2019 for all other conditions. Further research is needed to understand the extent to which these trends represent a change in patient safety.
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Affiliation(s)
- Noel Eldridge
- Agency for Healthcare Research and Quality, US Department of Health and Human Services, Rockville, Maryland
- Now with Defense Health Agency, Falls Church, Virginia
| | - Yun Wang
- Richard and Susan Smith Center for Outcomes Research in Cardiology, Division of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
- Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut
| | - Mark Metersky
- Division of Pulmonary and Critical Care Medicine, University of Connecticut School of Medicine, Farmington
| | - Sheila Eckenrode
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut
| | - Jasie Mathew
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut
| | - Nancy Sonnenfeld
- Centers for Medicare & Medicaid Services, US Department of Health and Human Services, Baltimore, Maryland
| | - Jade Perdue-Puli
- Agency for Healthcare Research and Quality, US Department of Health and Human Services, Rockville, Maryland
| | - David Hunt
- Office of the National Coordinator for Health Information Technology, US Department of Health and Human Services, Rockville, Maryland
| | - P. Jeffrey Brady
- Agency for Healthcare Research and Quality, US Department of Health and Human Services, Rockville, Maryland
- Now with Highmark Health, Pittsburgh, Pennsylvania
| | - Paul McGann
- Centers for Medicare & Medicaid Services, US Department of Health and Human Services, Baltimore, Maryland
| | - Erin Grace
- Agency for Healthcare Research and Quality, US Department of Health and Human Services, Rockville, Maryland
| | - David Rodrick
- Agency for Healthcare Research and Quality, US Department of Health and Human Services, Rockville, Maryland
| | - Elizabeth Drye
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut
- Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut
- Now with the National Quality Forum, Washington, DC
| | - Harlan M. Krumholz
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
- Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut
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Reime MH, Molloy MA, Blodgett TJ, Telnes KI. Why an IPE Team Matters… Improvement in Identification of Hospital Hazards: A Room of Horrors Pilot Study. J Multidiscip Healthc 2022; 15:1349-1360. [PMID: 35757786 PMCID: PMC9216206 DOI: 10.2147/jmdh.s368363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 05/23/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose To evaluate student performance in a simulation-based interprofessional learning activity that focused on identifying patient safety hazards in a simulated patient's hospital room. Participants and Methods Students from nursing, occupational therapy, physiotherapy, radiography, social education, social work, biomedical laboratory science, dental hygiene, and medicine participated in this two-phased study. In the first phase, students worked alone to identify safety hazards. In the second phase, students worked in interprofessional teams. Following each phase, students completed a structured questionnaire to report their findings. In addition, following the first phase, each student wrote down the hazards they identified in an unstructured essay format. Results Out of 48 intended hazards, individual students identified 10.7% on the open essay and 42.6% on the questionnaire, and interprofessional teams identified 90.1%. Conclusion The number of hospital hazards identified increased considerably when working in interprofessional teams. A room of horrors exercise expands participants' observational skills. With some modifications, this pilot study can be implemented on a wider scale with the goal of increasing interprofessional students' awareness of hospital hazards.
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Affiliation(s)
- Marit Hegg Reime
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | | | | | - Kirsten Irene Telnes
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
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Oura P. Educational Gradients Behind Medical Adverse Event Deaths in the US—A Time Series Analysis of Nationwide Mortality Data 2010–2019. Front Public Health 2022; 10:797379. [PMID: 35784232 PMCID: PMC9240395 DOI: 10.3389/fpubh.2022.797379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 05/23/2022] [Indexed: 12/04/2022] Open
Abstract
Background Deaths due to medical care appear common. Individuals with low socioeconomic position seem to be at a higher risk for sustaining a medical adverse event and premature death. This time series analysis aimed to assess educational gradients behind adverse event deaths in the US over the period 2010–2019. Methods Publicly available mortality and census data were retrieved from official sources. The data included age, sex, educational attainment, and underlying cause of death. Adverse event deaths were identified by ICD-10 codes Y40—Y84 and Y88. Four education categories were created in accordance with the International Standard Classification of Education 2011 coding scheme [No high school or General Educational Development (GED); High school or GED; Some college; Bachelor's degeree or higher]. To capture also highly educated individuals, the analysis was delimited to ≥30-year-olds. Age-adjusted mortality rates (AMRs) were compared between education categories by means of mortality plots and linear mixed models. Results A total of 25,897,334 certified deaths occurred among ≥30-year-olds during the study period. The underlying cause of death was an adverse event in a rarity of cases (0.12%, n = 31,997). Individuals with Bachelor's degeree or higher had the lowest adverse event AMRs (6.1–12.4 per million per year), followed by the Some college category (9.6–18.6), the High school or GED category (17.1–35.4), and finally the No high school or GED category (20.0–36.0). AMRs showed a gradual increase as education level decreased (p ≤ 0.001 against those with Bachelor's degeree or higher). Moreover, the temporal increase in adverse event AMRs was more pronounced among individuals with low than high education; the contrasts between categories were greatest toward the end of the study period. Conclusion The findings of this study suggest that the widening socioeconomic gradients in mortality extend also to fatal adverse events. Future studies should aim to analyze whether access to care, severity of the condition at presentation, quality of care, and social determinants of health may drive the gradients.
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Affiliation(s)
- Petteri Oura
- Department of Forensic Medicine, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Forensic Medicine Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
- Center for Life Course Health Research, Faculty of Medicine, University of Oulu, Oulu, Finland
- *Correspondence: Petteri Oura
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dos Santos Alves DF, da Silva SO, Ullman A, Maia FDOM. Effectiveness of checklists in multidisciplinary rounds for improving patient safety in the pediatric intensive care unit: a systematic review protocol. JBI Evid Synth 2022; 20:1835-1841. [DOI: 10.11124/jbies-21-00180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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50
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Bardach NS, Stotts JR, Fiore DM, Sarkar U, Sharma AE, Boscardin WJ, Avina L, Peralta-Neel C, Rosenbluth G. Family Input for Quality and Safety (FIQS): Using mobile technology for in-hospital reporting from families and patients. J Hosp Med 2022; 17:456-465. [PMID: 35535946 DOI: 10.1002/jhm.2777] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Accepted: 12/29/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Despite three decades of effort, ensuring inpatient safety remains elusive. Patients and family members are a potential source of safety observations, but systems gathering these are limited. Our goal was to test a system to gather safety observations from hospitalized patients and their family members via a real-time mobile health tool. METHODS We developed a mobile-responsive website for reporting safety observations. We piloted the tool during June 2017-April 2018 on the medical-surgical unit of a children's hospital. Participants were English-speaking family members and patients ≥13 years. We sent a daily text with a website link. We assessed: (1) face validity by comparing observations to incident reporting (IR) criteria and to hospital IRs and (2) associations between the number of safety observations/100 patient-days and participant characteristics using Poisson regression. RESULTS We enrolled 235 patients (43.8% of 537 reviewed for eligibility), resulting in 8.15 safety reports/100 patient-days, most frequently regarding medications (29% of reports) and communication (20% of reports). Fifty-one (40% of 125) met IR criteria; only one (1.1%) had been reported via the IR system. Latinx participants submitted fewer observations than White participants (3.9 vs. 10.1, p = .002); participants with more prior hospitalizations submitted more observations (p < .001). In adjusted analyses, including measures of preference in decision making, and patient activation, the difference between Latinx and White participants diminished substantially (6.4 vs. 11.3, p = .16). CONCLUSIONS We demonstrated the feasibility of real-time patient and family-member technology-enabled safety observation reporting and elicited reports not otherwise identified. Variation in reporting may potentially exacerbate disparities in safety if not addressed.
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Affiliation(s)
- Naomi S Bardach
- Department of Pediatrics, University of California San Francisco, San Francisco, California, USA
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California, USA
| | - Jim R Stotts
- Department of Patient Safety and Regulatory Affairs, University of California San Francisco, San Francisco, California, USA
| | - Darren M Fiore
- Department of Pediatrics, University of California San Francisco, San Francisco, California, USA
| | - Urmimala Sarkar
- Division of General Internal Medicine, University of California San Francisco, San Francisco, California, USA
- Department of Medicine, UCSF Center for Vulnerable Populations, University of California San Francisco, San Francisco, California, USA
| | - Anjana E Sharma
- Department of Medicine, UCSF Center for Vulnerable Populations, University of California San Francisco, San Francisco, California, USA
- Department of Family and Community Medicine, University of California San Francisco, San Francisco, California, USA
| | - W John Boscardin
- Departments of Medicine and Epidemiology & Biostatistics, University of California San Francisco, San Francisco, California, USA
| | - Lizette Avina
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California, USA
| | - Caroline Peralta-Neel
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California, USA
| | - Glenn Rosenbluth
- Department of Pediatrics, University of California San Francisco, San Francisco, California, USA
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