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O'Malley R, O'Connor P, Lydon S. Strategies that facilitate the delivery of exceptionally good patient care in general practice: a qualitative study with patients and primary care professionals. BMC PRIMARY CARE 2024; 25:141. [PMID: 38678200 PMCID: PMC11055247 DOI: 10.1186/s12875-024-02352-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 03/27/2024] [Indexed: 04/29/2024]
Abstract
BACKGROUND In recent years, proactive strengths-based approaches to improving quality of care have been advocated. The positive deviance approach seeks to identify and learn from those who perform exceptionally well. Central to this approach is the identification of the specific strategies, behaviours, tools and contextual strategies used by those positive deviants to perform exceptionally well. This study aimed to: identify and collate the specific strategies, behaviours, processes and tools used to support the delivery of exceptionally good care in general practice; and to abstract the identified strategies into an existing framework pertaining to excellence in general practice; the Identifying and Disseminating the Exceptional to Achieve Learning (IDEAL) framework. METHODS This study comprised a secondary analysis of data collected during semi-structured interviews with 33 purposively sampled patients, general practitioners, practice nurses, and practice managers. Discussions explored the key factors and strategies that support the delivery of exceptional care across five levels of the primary care system; the patient, provider, team, practice, and external environment. For analysis, a summative content analysis approach was undertaken whereby data were inductively analysed and summated to identify the key strategies used to achieve the delivery of exceptionally good general practice care, which were subsequently abstracted as a new level of the IDEAL framework. RESULTS In total, 222 individual factors contributing to exceptional care delivery were collated and abstracted into the framework. These included specific behaviours (e.g., patients providing useful feedback and personal history to the provider), structures (e.g., using technology effectively to support care delivery (e.g., electronic referrals & prescriptions)), processes (e.g., being proactive in managing patient flow and investigating consistently delayed wait times), and contextual factors (e.g., valuing and respecting contributions of every team member). CONCLUSION The addition of concrete and contextual strategies to the IDEAL framework has enhanced its practicality and usefulness for supporting improvement in general practices. Now, a multi-level systems approach is needed to embed these strategies and create an environment where excellence is supported. The refined framework should be developed into a learning tool to support teams in general practice to measure, reflect and improve care within their practice.
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Affiliation(s)
- Roisin O'Malley
- Discipline of General Practice, University of Galway, Newcastle, 1 Distillery Road, Galway, H91TK33, Ireland.
| | - Paul O'Connor
- Discipline of General Practice, University of Galway, Newcastle, 1 Distillery Road, Galway, H91TK33, Ireland
| | - Sinéad Lydon
- Discipline of General Practice, University of Galway, Newcastle, 1 Distillery Road, Galway, H91TK33, Ireland
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Péculo-Carrasco JA, Rodríguez-Ruiz HJ, Puerta-Córdoba A, Rodríguez-Bouza M, De La Fuente-Rodríguez JM, Failde I. Factors influencing witnesses' perception of patient safety during pre-hospital health care from emergency medical services: A multi-center cross-sectional study. Int Emerg Nurs 2024; 72:101383. [PMID: 38086283 DOI: 10.1016/j.ienj.2023.101383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 10/16/2023] [Accepted: 10/29/2023] [Indexed: 01/28/2024]
Abstract
AIM To determine the factors related with the perception of feeling safe during pre-hospital emergency care. METHODS A multi-centred, cross-sectional study. Data collection from April 2021 to March 2022, in the Centro de Emergencias Sanitarias 061 (Andalusia, Spain). INCLUSION CRITERIA witnesses of health care by emergency medical services. EXCLUSION CRITERIA minors, or communication barriers. OUTCOME VARIABLE Witness Perceived Safety Scale ESPT10. The variables studied were related with sociodemographic data, the request for health care, the patient, the hospital transfer and patient safety incidents. A multivariate linear regression model was constructed for the dependent variable. The study followed STROBE statement. RESULTS Responses were obtained from 1400 witnesses. The linear regression model showed that the score on the scale increased as the witnesses felt more satisfied (B = 1.302; p < 0.001). On the contrary, the score was lower when the witness reported a patient safety incident (B = -2.856; p < 0.001 and B = -3.166; p < 0.001), or when the assistance took place in a public space (B = -0.722; p = 0.017). CONCLUSIONS The level of satisfaction, the occurrence of a patient safety incident, and the place of health care are related factors with the perception of the witnesses. The Witness Perceived Safety Scale ESPT10 could be considered a valid and useful patient safety indicator.
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Affiliation(s)
- Juan-Antonio Péculo-Carrasco
- Centro de Emergencias Sanitarias 061, Andalusian Health Service, Provincial Service 061 in Cádiz. Regional Government of Andalusia, Spain.
| | - Hugo-José Rodríguez-Ruiz
- Centro de Emergencias Sanitarias 061, Andalusian Health Service, Provincial Service 061 in Cádiz. Regional Government of Andalusia, Spain
| | - Antonio Puerta-Córdoba
- Centro de Emergencias Sanitarias 061, Andalusian Health Service, Provincial Service 061 in Cádiz. Regional Government of Andalusia, Spain
| | - Mónica Rodríguez-Bouza
- Centro de Emergencias Sanitarias 061, Andalusian Health Service, Provincial Service 061 in Cádiz. Regional Government of Andalusia, Spain
| | | | - Inmaculada Failde
- Institute of Research and Innovation of Biomedical Sciences of the Province of Cádiz (INiBICA), Spain; Preventive Medicine and Public Health, University of Cádiz, Spain
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Krugliak N, Gagnon K, Sawadsky B, Lewell M, McGowan M, Nolan B. The Role of Paramedics in Disclosure of Patient Safety Incidents: A Mixed Methods Study. Air Med J 2024; 43:66-68. [PMID: 38154845 DOI: 10.1016/j.amj.2023.11.010] [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: 10/16/2023] [Accepted: 11/14/2023] [Indexed: 12/30/2023]
Abstract
OBJECTIVE Critical care transport is a high-risk environment ripe for patient safety incidents (PSIs). Disclosure is the process by which a PSI is communicated to a patient or substitute decision maker. Little is known on paramedic perceptions on disclosure PSIs. This study evaluated the impact of a disclosure training program on the perceptions of paramedics on disclosing PSIs. METHODS This was a before-and-after mixed methods survey study on paramedic disclosure training at Ornge, the provincial critical care transport organization for Ontario, Canada. A paramedic disclosure training program was implemented at Ornge between 2020 and 2022. All paramedics were eligible for participation through pre- and posttraining surveys. RESULTS In total, 54 and 69 paramedics completed the pretraining and posttraining surveys, respectively, representing 25% to 30% of all active paramedics. All of the paramedics (100%) expressed a moral and professional responsibility to disclose PSIs. All paramedics felt disclosure training was somewhat to extremely useful. After training, more paramedics felt comfortable disclosing PSIs, and more paramedics felt disclosure could occur at the time of transport. CONCLUSION A training program on PSIs can improve paramedics' perceptions on disclosure. This study shows its feasible for paramedics to feel comfortable and participate in disclosure of PSIs within a critical care environment.
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Affiliation(s)
| | | | - Bruce Sawadsky
- Ornge, Mississauga, Ontario, Canada; Department of Emergency Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | | | - Melissa McGowan
- Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Ontario, Canada
| | - Brodie Nolan
- Ornge, Mississauga, Ontario, Canada; Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Ontario, Canada; Department of Emergency Medicine, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada; Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
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O’Malley R, Lydon S, Faherty A, O’Connor P. Identifying Factors that Support the Delivery of Exceptional Care in General Practice and Development of the IDEAL Framework: A Qualitative Study. QUALITATIVE HEALTH RESEARCH 2023; 33:1232-1248. [PMID: 37694934 PMCID: PMC10626987 DOI: 10.1177/10497323231197387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
The positive deviance approach seeks to identify and learn from those that perform exceptionally well. Positive deviance as an approach to quality improvement is gaining traction in general practice. This study aimed to explore and compare stakeholders' perceptions of the factors that support the delivery of exceptional care in general practice and to refine a previously developed theoretical framework of factors associated with positively deviant care in general practice: the Identifying and Disseminating the Exceptional to Achieve Learning (IDEAL) framework. Semi-structured interviews were conducted with 33 purposively sampled patients, general practitioners, practice nurses, and practice managers in Irish general practice. Subsequently, a directed content analysis approach was employed to deductively analyse interview data using the IDEAL framework, and newly emerging factors were inductively analysed and abstracted into the framework. Several distinct strategies (e.g. patient activation and team collaboration), structures (e.g. facilities and staffing), and contextual factors (e.g. communication and rapport, and culture) were found to support the delivery of exceptional care, and differences in perceptions, values, and expectations emerged between patients and practice staff. Interview data largely supported the pre-determined factors posited by the IDEAL framework, and new factors were abstracted into the framework (e.g. facilities and infrastructure). Stakeholder engagement regarding the factors supporting exceptional care in general practice supported and extended the IDEAL framework, contributing to a more comprehensive understanding of how exceptional care is delivered in general practice. The refined framework will support researchers, policymakers, and teams looking to support, measure, and achieve exceptionally good patient care in general practice.
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Affiliation(s)
- Roisin O’Malley
- Discipline of General Practice, University of Galway, Galway, Ireland
| | - Sinéad Lydon
- School of Medicine, Clinical Science Institute, University of Galway, Galway, Ireland
| | - Aileen Faherty
- Discipline of General Practice, University of Galway, Galway, Ireland
| | - Paul O’Connor
- Discipline of General Practice, University of Galway, Galway, Ireland
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Venesoja A, Tella S, Castrén M, Lindström V. Finnish emergency medical services managers' and medical directors' perceptions of collaborating with patients concerning patient safety issues: a qualitative study. BMJ Open 2023; 13:e067754. [PMID: 37037618 PMCID: PMC10111928 DOI: 10.1136/bmjopen-2022-067754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/12/2023] Open
Abstract
OBJECTIVES This study aimed to describe emergency medical services (EMS) managers' and medical directors' perceptions of collaborating with patients concerning patient safety issues in the EMS. DESIGN The study used a descriptive qualitative approach. Five focus groups and two individuals were interviewed using a semi-structured guide with open-ended questions. The data were analysed using reflexive thematic analysis. Consolidated criteria for Reporting Qualitative research was used to guide the reporting of this study. SETTING EMS organisations from Finland's five healthcare districts. PARTICIPANTS EMS medical directors (n=5) and EMS managers (n=14). Purposive sampling was used. RESULTS Two main themes, 'Patient safety considered an organisational responsibility' and 'EMS patients' opportunities and obstacles to speaking up', were generated from the data. Under the main theme, 'Patient safety considered an organisational responsibility', were three subthemes: patient safety considered part of the quality in EMS, system-level models for handling and observing patient safety in EMS, and management's ability to find a balance when using patients' feedback for patient safety development. Under the other main theme were four subthemes: 'social and feedback skills of EMS personnel and management', 'managements' assumptions of patients' reasons for not speaking up', 'EMS organisations' different but unsystematic ways of collecting feedback' and 'management's openness to develop patient participation'. CONCLUSIONS The nature of the EMS organisations and EMS assignments could affect a patient's participation in developing patient safety in EMS. However, EMS managers and medical directors are receptive to collaborating with patients concerning patient safety issues if they have sufficient resources and a coherent way to collect patient safety concerns. The management is open to collaborating with patients, but there is a need to develop a systematic method with enough resources to facilitate the management's collaborating with patients.
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Affiliation(s)
- Anu Venesoja
- Department of Emergency Care Services, South Karelia Social and Health Care District, Lappeenranta, Finland
- Department of Emergency Medicine and Services, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Health & Wellbeing, LAB University of Applied Sciences - Lappeenrannan Kampus, Lappeenranta, Finland
| | - Susanna Tella
- Health & Wellbeing, LAB University of Applied Sciences - Lappeenrannan Kampus, Lappeenranta, Finland
- Department of Nursing Science, University of Eastern Finland, Faculty of Health Sciences, Kuopio, Finland
| | - Maaret Castrén
- Department of Emergency Medicine and Services, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Veronica Lindström
- Department of Neurobiology, Care Sciences, and Society Division of Nursing, Karolinska Institutet, Stockholm, Sweden
- Samariten Ambulance, Stockholm, Sweden
- Department of Nursing, Umeå University, Umeå, Sweden
- Department of Health Promotion Science, Sophiahemmet University, Stockholm, Sweden
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Petersen JAD, Blomberg SN, Lippert F, Christensen HC. Characteristics of low acuity prehospital emergency patients with 48-h mortality, an observational cohort study. Scand J Trauma Resusc Emerg Med 2022; 30:64. [PMID: 36482471 PMCID: PMC9730555 DOI: 10.1186/s13049-022-01048-8] [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] [Received: 04/25/2022] [Accepted: 11/10/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Every year an emergency medical technician or paramedic treats and transports up to several hundred patients. Only some patients are acutely seriously ill, and a few of these show only discrete signs and symptoms of their condition. This study aims to describe patients who died within 48 h of being admitted non-emergently to hospital by ambulance, examine the extent to which critically ill patients are recognized prehospitally, and identify clinical warning signs that might be frequently overlooked. METHOD Registry based follow-up study on patients receiving an ambulance from the Copenhagen EMS in 2018. Data was included regarding the dispatch of the ambulance from the emergency services disposition system, ICD-10 hospital admission diagnoses from the National Patient Register, 48-h mortality from the Central Person Register and assessment and treatment in the ambulance by reviewing the electronic pre-hospital patient record. RESULTS In 2018 2279 patients died within 48 h after contact with the EMS, 435 cases met inclusion criteria. The patients' median age was 83 years (IQR 75-90), and 374 (86.0%) had one or more underlying serious medical conditions. A triage category based on vitals and presentation was not assigned by the EMS in 286 (68.9%) cases, of which 38 (13.3%) would meet red and 126 (44.1%) orange criteria. For 409 (94.0%) patients, it was estimated that death within 48 h could not have been avoided prehospitally, and for 26 (6.0%) patients it was uncertain. We found 27 patients with acute aortic syndrome as admission diagnosis, of these nine (33.3%) had not been admitted urgently to a hospital with vascular surgery specialty. CONCLUSIONS It was estimated that death within 48 h could generally not be avoided prehospitally. The patients' median age was 83 years, and they often had serious comorbidity. Patients whose vital parameters met red or orange triage criteria were to a lesser degree triaged prehospitally, compared to patients in the yellow or green categories. Patients with acute aortic syndrome were not recognized by EMS 33.3% of the time.
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Affiliation(s)
- Jesper A. Dyhring Petersen
- grid.5254.60000 0001 0674 042XDepartment of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Stig Nikolaj Blomberg
- grid.5254.60000 0001 0674 042XDepartment of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark ,grid.512919.7Copenhagen Emergency Medical Services, Copenhagen, Denmark
| | - Freddy Lippert
- grid.5254.60000 0001 0674 042XDepartment of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark ,grid.512919.7Copenhagen Emergency Medical Services, Copenhagen, Denmark
| | - Helle Collatz Christensen
- grid.5254.60000 0001 0674 042XDepartment of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark ,grid.512919.7Copenhagen Emergency Medical Services, Copenhagen, Denmark ,Danish Clinical Quality Program (RKKP), National Clinical Registries, Copenhagen, Denmark
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Péculo‐Carrasco J, Luque‐Hernández MJ, Rodríguez‐Ruiz H, Chacón‐Manzano C, Failde I. Factors influencing the perception of feeling safe in pre‐hospital emergency care: A mixed‐methods systematic review. J Clin Nurs 2022. [DOI: 10.1111/jocn.16595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 11/09/2022] [Accepted: 11/14/2022] [Indexed: 12/02/2022]
Affiliation(s)
- Juan‐Antonio Péculo‐Carrasco
- Centro de Emergencias Sanitarias 061, Andalusian Health Service Provincial Service 061 in Cádiz, Regional Government of Andalusia Cádiz Spain
| | - María José Luque‐Hernández
- Centro de Emergencias Sanitarias 061, Andalusian Health Service Central Headquaters, Regional Government of Andalusia Málaga Spain
| | - Hugo‐José Rodríguez‐Ruiz
- Centro de Emergencias Sanitarias 061, Andalusian Health Service Provincial Service 061 in Cádiz, Regional Government of Andalusia Cádiz Spain
| | - Coral Chacón‐Manzano
- Centro de Emergencias Sanitarias 061, Andalusian Health Service Provincial Service 061 in Córdoba, Regional Government of Andalusia Córdoba Spain
| | - Inmaculada Failde
- Institute of Research and Innovation of Biomedical Sciences of the Province of Cádiz (INiBICA) Preventive Medicine and Public Health University of Cádiz Cádiz Spain
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