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Hackmann C, Komashie A, Handley M, Murdoch J, Wagner AP, Grünwald LM, Waller S, Kaminskiy E, Zeilig H, Jones J, Bray J, Bagge S, Simpson A, Dalkin SM, Clarkson J, Borghini G, Kipouros T, Rohricht F, Taousi Z, Haighton C, Rae S, Wilson J. Codesigning a systemic discharge intervention for inpatient mental health settings (MINDS): a protocol for integrating realist evaluation and an engineering-based systems approach. BMJ Open 2023; 13:e071272. [PMID: 37709323 PMCID: PMC10503342 DOI: 10.1136/bmjopen-2022-071272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 04/26/2023] [Indexed: 09/16/2023] Open
Abstract
INTRODUCTION Transition following discharge from mental health hospital is high risk in terms of relapse, readmission and suicide. Discharge planning supports transition and reduces risk. It is a complex activity involving interacting systemic elements. The codesigning a systemic discharge intervention for inpatient mental health settings (MINDS) study aims to improve the process for people being discharged, their carers/supporters and staff who work in mental health services, by understanding, co-designing and evaluating implementation of a systemic approach to discharge planning. METHODS AND ANALYSIS The MINDS study integrates realist research and an engineering-informed systems approach across three stages. Stage 1 applies realist review and evaluation using a systems approach to develop programme theories of discharge planning. Stage 2 uses an Engineering Better Care framework to codesign a novel systemic discharge intervention, which will be subjected to process and economic evaluation in stage 3. The programme theories and resulting care planning approach will be refined throughout the study ready for a future clinical trial. MINDS is co-led by an expert by experience, with researchers with lived experience co-leading each stage. ETHICS AND DISSEMINATION MINDS stage 1 has received ethical approval from Yorkshire & The Humber-Bradford Leeds (Research Ethics Committee (22/YH/0122). Findings from MINDS will be disseminated via high-impact journal publications and conference presentations, including those with service user and mental health professional audiences. We will establish routes to engage with public and service user communities and National Health Service professionals including blogs, podcasts and short videos. TRIAL REGISTRATION NUMBER MINDS is funded by the National Institute of Health Research (NIHR 133013) https://fundingawards.nihr.ac.uk/award/NIHR133013. The realist review protocol is registered on PROSPERO. PROSPERO REGISTRATION NUMBER CRD42021293255.
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Affiliation(s)
- Corinna Hackmann
- Research and Development, Norfolk and Suffolk NHS Foundation Trust, Norwich, UK
- Noriwch Medical School, The University of East Anglia, Norwich, UK
| | - Alexander Komashie
- Department of Enginering, University of Cambridge School of Technology, Cambridge, UK
| | - Melanie Handley
- Centre for Research in Public Health and Community Care, University of Hertfordshire, Hatfield, UK
| | - Jamie Murdoch
- School of Life Course and Population Sciences, King's College London, London, UK
| | - Adam P Wagner
- NIHR Collaboration for Leadership in Applied Health Research & Care (CLAHRC) East of England, Cambridge, UK
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Lisa Marie Grünwald
- Research and Development, Norfolk and Suffolk NHS Foundation Trust, Norwich, UK
| | - Sam Waller
- Engineering Design Centre, University of Cambridge, Cambridge, UK
| | - Emma Kaminskiy
- School of Psychology and Sports Science, Anglia Ruskin University, Chelmsford, UK
| | - Hannah Zeilig
- London College of Fashion, University of the Arts London, London, UK
| | - Julia Jones
- Centre for Research in Primary & Community Care, University of Hertfordshire, Hatfield, UK
| | | | - Sophie Bagge
- Norfolk and Suffolk NHS Foundation Trust, Norwich, UK
| | - Alan Simpson
- Health Services and Population Research, King's College London, London, UK
| | - Sonia Michelle Dalkin
- Department of Social Work, Education & Community Wellbeing, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
| | - John Clarkson
- Engineering Design Centre, University of Cambridge, Cambridge, UK
| | | | | | - Frank Rohricht
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
- East London NHS Foundation Trust, London, UK
| | - Zohra Taousi
- Hertfordshire and Peterborough NHS Foundation Trust, St Albans, UK
| | - Catherine Haighton
- Department of Social Work, Education & Community Wellbeing, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
| | | | - Jon Wilson
- Research and Development, Norfolk and Suffolk NHS Foundation Trust, Norwich, UK
- Noriwch Medical School, The University of East Anglia, Norwich, UK
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Woodier N, Burnett C, Moppett I. The Value of Learning From Near Misses to Improve Patient Safety: A Scoping Review. J Patient Saf 2023; 19:42-47. [PMID: 36538339 DOI: 10.1097/pts.0000000000001078] [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: 12/24/2022]
Abstract
OBJECTIVES For years, health care has recognized that learning from near misses offers potential opportunities to reduce unintended harm to patients. However, these benefits have yet to be realized. It is assumed that effective actions are being implemented as a result of learning from healthcare near misses, leading to improvements in patient safety. A scoping review of the healthcare literature was undertaken to explore the value of learning from near misses in the improvement of patient safety. METHODS The scoping review was conducted on Ovid MEDLINE, Embase, and CINAHL. Eligible articles published since 2000 were included. RESULTS A total of 4745 articles were identified through the searches, with 19 included in the final review. The articles included one randomized control trial. All the included articles had evidence of action after reporting or investigation of near misses, with the majority showing evaluation of impact. Actions were human, administrative, and engineering focused. Impact evaluation focused on the reduction of near misses, but without consideration of patient safety outcome measures, such as harm. The review also noted limited availability of experimental research and variability in near-miss definitions and that actions are not just the result of near misses. CONCLUSIONS Currently, health care assumes that reporting and learning from near misses improves patient safety. The literature provides limited evidence supporting these assumptions and shows that actions as a result of near misses are commonly aimed at the human. There is a need to prove the benefits of focusing on near misses in health care and for more system-level actions.
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Affiliation(s)
- Nick Woodier
- From the Faculty of Medicine and Health Sciences, School of Medicine, University of Nottingham, Nottingham, United Kingdom
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MacFarlane E, Carson‐Stevens A, North R, Ryan B, Acton J. A mixed-methods characterisation of patient safety incidents by primary eye care practitioners. Ophthalmic Physiol Opt 2022; 42:1304-1315. [PMID: 35908186 PMCID: PMC9796726 DOI: 10.1111/opo.13030] [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: 03/18/2022] [Revised: 06/28/2022] [Accepted: 06/28/2022] [Indexed: 01/07/2023]
Abstract
PURPOSE Patient safety in eye health care is an underdeveloped field of research. A patient safety incident occurs when an unintended incident happens that could have (or did) lead to harm. To enable learning from patient safety incidents in optometry, a characterisation of commonly experienced safety incidents is needed to identify options to improve the quality of care. This study aimed to characterise eye health-related patient safety incidents from the perspective of eye care practitioners. METHODS At a national conference in Wales, 56 eye care practitioners participated in a stakeholder workshop on eye care-related patient safety incidents. Participants were asked to suggest patient safety incidents that have occurred, or based on their experience, could occur in optometric practice. Using the nominal group technique, participants voted on the incident they perceived could cause the most harm and the incident observed most frequently in practice. Framework analysis supported identification of themes about the nature and outcomes of incidents in eye care. RESULTS Diagnostic incidents were perceived to be the most severe (highest number of 'severity votes', n = 38), whilst administration-related incidents were most frequent (highest number of 'frequency votes' n = 39). Four themes were identified which are as follows: inappropriate clinical decision-making; delayed or missed referral of patients to general medical practitioners or ophthalmologists; compromised communication with other practitioners or patients and delays in receiving eye care. The results suggest that incidents relating to inappropriate clinical decision-making could result in the most severe harm to patients but may not occur frequently. CONCLUSIONS Diagnostic- and administrative-related incidents pose clear challenges for improvement in quality and safety of care. The breadth of themes reflecting the nature and outcomes from unsafe eye care highlights the complexity underpinning incidents and the burden to patients. This work has informed the content of an all-Wales incident report form for primary eye care practitioners.
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Affiliation(s)
- Elinor MacFarlane
- School of Optometry and Vision SciencesCardiff UniversityCardiffUK,PRIME Centre Wales, Division of Population Medicine, School of MedicineCardiff UniversityCardiffUK
| | - Andrew Carson‐Stevens
- PRIME Centre Wales, Division of Population Medicine, School of MedicineCardiff UniversityCardiffUK
| | - Rachel North
- School of Optometry and Vision SciencesCardiff UniversityCardiffUK,PRIME Centre Wales, Division of Population Medicine, School of MedicineCardiff UniversityCardiffUK
| | - Barbara Ryan
- School of Optometry and Vision SciencesCardiff UniversityCardiffUK
| | - Jennifer Acton
- School of Optometry and Vision SciencesCardiff UniversityCardiffUK
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Komashie A, Ward J, Bashford T, Dickerson T, Kaya GK, Liu Y, Kuhn I, Günay A, Kohler K, Boddy N, O'Kelly E, Masters J, Dean J, Meads C, Clarkson PJ. Systems approach to health service design, delivery and improvement: a systematic review and meta-analysis. BMJ Open 2021; 11:e037667. [PMID: 33468455 PMCID: PMC7817809 DOI: 10.1136/bmjopen-2020-037667] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 10/02/2020] [Accepted: 11/18/2020] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES To systematically review the evidence base for a systems approach to healthcare design, delivery or improvement. DESIGN Systematic review with meta-analyses. METHODS Included were studies in any patients, in any healthcare setting where a systems approach was compared with usual care which reported quantitative results for any outcomes for both groups. We searched Medline, Embase, HMIC, Health Business Elite, Web of Science, Scopus, PsycINFO and CINAHL from inception to 28 May 2019 for relevant studies. These were screened, and data extracted independently and in duplicate. Study outcomes were stratified by study design and whether they reported patient and/or service outcomes. Meta-analysis was conducted with Revman software V.5.3 using ORs-heterogeneity was assessed using I2 statistics. RESULTS Of 11 405 records 35 studies were included, of which 28 (80%) were before-and-after design only, five were both before-and-after and concurrent design, and two were randomised controlled trials (RCTs). There was heterogeneity of interventions and wide variation in reported outcome types. Almost all results showed health improvement where systems approaches were used. Study quality varied widely. Exploratory meta-analysis of these suggested favourable effects on both patient outcomes (n=14, OR=0.52 (95% CI 0.38 to 0.71) I2=91%), and service outcomes (n=18, OR=0.40 (95% CI 0.31 to 0.52) I2=97%). CONCLUSIONS This study suggests that a systems approaches to healthcare design and delivery results in a statistically significant improvement to both patient and service outcomes. However, better quality studies, particularly RCTs are needed.PROSPERO registration numberCRD42017065920.
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Affiliation(s)
- Alexander Komashie
- Department of Engineering, University of Cambridge, Cambridge, Cambridgeshire, UK
- The Healthcare Improvement Studies (THIS) Institute, University of Cambridge, Cambridge, Cambridgeshire, UK
- NIHR Global Health Research Group on Neurotrauma, Cambridge University Hospitals NHS Foundation Trust, Cambridge, Cambridgeshire, UK
| | - James Ward
- Department of Engineering, University of Cambridge, Cambridge, Cambridgeshire, UK
| | - Tom Bashford
- Department of Engineering, University of Cambridge, Cambridge, Cambridgeshire, UK
- NIHR Global Health Research Group on Neurotrauma, Cambridge University Hospitals NHS Foundation Trust, Cambridge, Cambridgeshire, UK
- Division of Anaesthesia, Cambridge University Hospitals NHS Foundation Trust, Cambridge, Cambridgeshire, UK
| | - Terry Dickerson
- Department of Engineering, University of Cambridge, Cambridge, Cambridgeshire, UK
| | - Gulsum Kubra Kaya
- Faculty of Engineering and Natural Sciences, Istanbul Medeniyet University, Istanbul, Turkey
| | - Yuanyuan Liu
- Department of Engineering, University of Cambridge, Cambridge, Cambridgeshire, UK
| | - Isla Kuhn
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Aslι Günay
- Department of Engineering, University of Cambridge, Cambridge, Cambridgeshire, UK
- Media and Visual Arts, Koc University, Istanbul, Turkey
| | - Katharina Kohler
- Department of Engineering, University of Cambridge, Cambridge, Cambridgeshire, UK
- Division of Anaesthesia, Cambridge University Hospitals NHS Foundation Trust, Cambridge, Cambridgeshire, UK
| | - Nicholas Boddy
- Department of Engineering, University of Cambridge, Cambridge, Cambridgeshire, UK
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Eugenia O'Kelly
- Department of Engineering, University of Cambridge, Cambridge, Cambridgeshire, UK
| | - Joseph Masters
- Major Trauma Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, Cambridgeshire, UK
| | - John Dean
- Department of Care Quality Improvement, Royal College of Physicians, London, London, UK
| | - Catherine Meads
- School of Nursing and Midwifery, Anglia Ruskin University - Cambridge Campus, Cambridge, Cambridgeshire, UK
| | - P John Clarkson
- Department of Engineering, University of Cambridge, Cambridge, Cambridgeshire, UK
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Salahuddin L, Ismail Z, Abd Ghani MK, Mohd Aboobaider B, Hasan Basari AS. Exploring the contributing factors to workarounds to the hospital information system in Malaysian hospitals. J Eval Clin Pract 2020; 26:1416-1424. [PMID: 31863517 DOI: 10.1111/jep.13326] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 11/10/2019] [Accepted: 11/13/2019] [Indexed: 01/28/2023]
Abstract
OBJECTIVES The objective of this study was to identify the factors influencing workarounds to the Hospital Information System (HIS) in Malaysian government hospitals. METHODS Semi-structured interviews were conducted among 31 medical doctors in three Malaysian government hospitals on the implementation of the Total Hospital Information System (THIS) between March and May 2015. A thematic qualitative analysis was performed on the resultant data to deduce the relevant themes. RESULTS Five themes emerged as the factors influencing workarounds to the HIS: (a) typing skills, (b) system usability, (c) computer resources, (d) workload, and (e) time. CONCLUSIONS This study provided the key factors as to why doctors were involved in workarounds during the implementation of the HIS. It is important to understand these factors in order to help mitigate work practices that can pose a threat to patient safety.
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Affiliation(s)
- Lizawati Salahuddin
- Centre for Advanced Computing Technology (C-ACT), Fakulti Teknologi Maklumat dan Komunikasi (FTMK), Universiti Teknikal Malaysia Melaka, Melaka, Malaysia
| | - Zuraini Ismail
- Advanced Informatics Department, Razak Faculty of Technology and Informatics, Universiti Teknologi Malaysia Kuala Lumpur, Kuala Lumpur, Malaysia
| | - Mohd Khanapi Abd Ghani
- Centre for Advanced Computing Technology (C-ACT), Fakulti Teknologi Maklumat dan Komunikasi (FTMK), Universiti Teknikal Malaysia Melaka, Melaka, Malaysia
| | - Burhanuddin Mohd Aboobaider
- Centre for Advanced Computing Technology (C-ACT), Fakulti Teknologi Maklumat dan Komunikasi (FTMK), Universiti Teknikal Malaysia Melaka, Melaka, Malaysia
| | - Abd Samad Hasan Basari
- Centre for Advanced Computing Technology (C-ACT), Fakulti Teknologi Maklumat dan Komunikasi (FTMK), Universiti Teknikal Malaysia Melaka, Melaka, Malaysia
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Schneider DSDS, Magalhães AMMD, Glanzner CH, Thomé EGDR, Oliveira JLCD, Anzanello MJ. Management of ophthalmic surgical instruments and processes optimization: mixed method study. ACTA ACUST UNITED AC 2020; 41:e20190111. [PMID: 32294725 DOI: 10.1590/1983-1447.2020.20190111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Accepted: 05/30/2019] [Indexed: 11/22/2022]
Abstract
AIM Analysis of the use of ophthalmic instruments during surgical procedures in order to propose a material management method. METHOD Mixed method study, sequential exploratory design, performed from January to June 2015, at a university hospital in southern Brazil. First, a qualitative approach was held from brainstorming and field observation. Themes were grouped into thematic categories. By connection, the quantitative stage happened through matrix arrangement and linear programming, culminating in the instrument management proposal. RESULTS Given categories - instruments reorganization according to the time of the surgical procedure and the need surgical instruments for in each procedure - guided the definition of existing restrictions and application of mathematical models. There was an average reduction of 13.10% in the number of surgical instruments per tray and an increase of 17.88% in surgical production. FINAL CONSIDERATIONS This proposal allowed the rationalization and optimization of ophthalmic instruments, favoring sustainability of the organization.
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Affiliation(s)
- Daniela Silva Dos Santos Schneider
- Hospital de Clínicas de Porto Alegre (HCPA). Porto Alegre, Rio Grande do Sul, Brasil.,Universidade Federal do Rio Grande do Sul(UFRGS), Escola de Enfermagem, Programa de Pós-Graduação em Enfermagem. Porto Alegre, Rio Grande do Sul, Brasil
| | - Ana Maria Müller de Magalhães
- Hospital de Clínicas de Porto Alegre (HCPA). Porto Alegre, Rio Grande do Sul, Brasil.,Universidade Federal do Rio Grande do Sul(UFRGS), Escola de Enfermagem, Programa de Pós-Graduação em Enfermagem. Porto Alegre, Rio Grande do Sul, Brasil
| | - Cecilia Helena Glanzner
- Hospital de Clínicas de Porto Alegre (HCPA). Porto Alegre, Rio Grande do Sul, Brasil.,Universidade Federal do Rio Grande do Sul(UFRGS), Escola de Enfermagem, Departamento Enfermagem Médico-Cirúrgica. Porto Alegre, Rio Grande do Sul, Brasil
| | - Elisabeth Gomes da Rocha Thomé
- Universidade Federal do Rio Grande do Sul(UFRGS), Escola de Enfermagem, Departamento Enfermagem Médico-Cirúrgica. Porto Alegre, Rio Grande do Sul, Brasil
| | - João Lucas Campos de Oliveira
- Universidade Federal do Rio Grande do Sul(UFRGS), Escola de Enfermagem, Departamento de Assistência e Orientação Profissional. Porto Alegre, Rio Grande do Sul, Brasil
| | - Michel José Anzanello
- Universidade Federal do Rio Grande do Sul(UFRGS), Escola de Engenharia, Departamento de Engenharia de Produção e Transportes. Porto Alegre, Rio Grande do Sul, Brasil
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Vision to improve: quality improvement in ophthalmology. Can J Ophthalmol 2019; 55:107-115. [PMID: 31712012 DOI: 10.1016/j.jcjo.2019.07.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 06/27/2019] [Accepted: 07/21/2019] [Indexed: 12/25/2022]
Abstract
Improving quality of care and patient outcomes is a professional duty of all health care workers. Quality improvement is a part of health policy, an accreditation requirement of residency programs, and a recognized sub-specialty in academic medicine. Given the increasing need for ophthalmological services with our aging population, it is critical for ophthalmologists and their staff to develop the necessary skills in quality improvement to ensure access to care that is safe, patient-centered, effective, efficient, equitable, and timely. This narrative review outlines tools that are used in a recognized framework, including the creation of an aim statement, Ishikawa diagram, Pareto analysis, process maps, Plan-Do-Study-Act cycles, and run charts. We also discuss common challenges that occur when conducting quality initiatives. Two quality improvement projects conducted in the Department of Ophthalmology at University of Toronto are used as examples to illustrate these tools. The aim of the first project was to improve visual field test reliability and the aim of the second was to ensure secure email communication between residents and staff in caring for emergency patients. This primer provides the foundations ophthalmologists and their staff can use to support and guide their quality improvement efforts.
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Stolk-Vos AC, van der Steen JJ, Drossaert CH, Braakman-Jansen A, Zijlmans BL, Kranenburg LW, de Korne DF. A Digital Patient-Led Hospital Checklist for Enhancing Safety in Cataract Surgery: Qualitative Study. JMIR Perioper Med 2018; 1:e3. [PMID: 33401370 PMCID: PMC7709842 DOI: 10.2196/periop.9463] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Revised: 05/11/2018] [Accepted: 05/12/2018] [Indexed: 11/13/2022] Open
Abstract
Background Surgery holds high risk for iatrogenic patient harm. Correct and sufficient communication and information during the surgical process is a root solution for preventing patient harm. Information technology may substantially contribute to engaging patients in this process. Objective To explore the feasibility of a digital patient-led checklist for cataract surgery, we evaluated the experiences of patients and nurses who have used this novel tool with a focus on use, appreciation, and impact. Methods A multidisciplinary team, including cataract surgeons, nurses, pharmacists and administrative representatives developed a 19-item digital patient-led checklist for cataract patients who underwent surgery in an ambulatory setting. This “EYEpad” checklist was distributed to patients and their companions during their hospital visit via an application on a tablet. It contained necessary information the patient should have received before or during the surgical preparation (8 items), before anesthesia (2 items), and before discharge (9 items). Patients and their companions were invited to actively indicate the information they received, or information discussed with them, by ticking on the EYEpad. Our qualitative research design included semi-structured individual interviews with 17 patients and a focus group involving 6 nurses. The transcripts were analyzed by 2 independent coders using both deductive and inductive coding. Results All but one of the 17 patients used the EYEpad, occasionally assisted by his or her companion (usually the partner). In several cases, the checklist was completed by the companion. Most patients felt positively about the usability of the EYEpad. Yet, for most of the patients, it was not clear why they received the checklist. Only 4 of them indicated that they understood that the EYEpad was used to determine if there were sufficient and correct information discussed or checked by the nurses. Although most nurses agreed the EYEpad was easy to use and could be a useful tool for improving patient engagement for improving safety, they felt that not all elderly patients were willing or capable of using it and it interfered with the existing surgical process. They also anticipated the need to spend more time explaining the purpose and use of the EYEpad. Conclusions Our results showed that a digital patient-led checklist is a potentially valid way to increase patient participation in safety improvement efforts, even among elderly patients. It also illustrates the crucial role nurses play in the implementation and diffusion of technological innovations. Increased patient participation will only improve safety when both healthcare workers and patients feel empowered to share responsibility and balance their power.
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Affiliation(s)
- Aline C Stolk-Vos
- Rotterdam Ophthalmic Institute, Rotterdam, Netherlands.,Section Health Services, Management and Organisation, Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, Netherlands.,Section Medical Psychology and Psychotherapy, Department of Psychiatry, Erasmus Medical Center, Rotterdam, Netherlands
| | | | - Constance Hc Drossaert
- Vakgroep Psychologie, Gezondheid & Technologie, University of Twente, Enschede, Netherlands
| | | | | | - Leonieke W Kranenburg
- Section Medical Psychology and Psychotherapy, Department of Psychiatry, Erasmus Medical Center, Rotterdam, Netherlands
| | - Dirk F de Korne
- Section Health Services, Management and Organisation, Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, Netherlands.,Duke-NUS Medical School, Singapore, Singapore.,KK Women's & Children's Hospital, SingHealth Duke-NUS Academic Medical Centre, Singapore, Singapore
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