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Graber ML, Castro GM, Danforth M, Tilly JL, Croskerry P, El-Kareh R, Hemmalgarn C, Ryan R, Tozier MP, Trowbridge B, Wright J, Zwaan L. Root cause analysis of cases involving diagnosis. Diagnosis (Berl) 2024:dx-2024-0102. [PMID: 39238228 DOI: 10.1515/dx-2024-0102] [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: 06/13/2024] [Accepted: 07/04/2024] [Indexed: 09/07/2024]
Abstract
Diagnostic errors comprise the leading threat to patient safety in healthcare today. Learning how to extract the lessons from cases where diagnosis succeeds or fails is a promising approach to improve diagnostic safety going forward. We present up-to-date and authoritative guidance on how the existing approaches to conducting root cause analyses (RCA's) can be modified to study cases involving diagnosis. There are several diffierences: In cases involving diagnosis, the investigation should begin immediately after the incident, and clinicians involved in the case should be members of the RCA team. The review must include consideration of how the clinical reasoning process went astray (or succeeded), and use a human-factors perspective to consider the system-related contextual factors in the diagnostic process. We present detailed instructions for conducting RCA's of cases involving diagnosis, with advice on how to identify root causes and contributing factors and select appropriate interventions.
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Affiliation(s)
| | | | | | | | - Pat Croskerry
- Emergency Medicine, Dalhousie University, Halifax, NS, Canada
| | | | | | | | | | | | | | - Laura Zwaan
- Institute of Medical Education Research Rotterdam, Rotterdam, The Netherlands
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2
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Russell J, Boswell L, Ip A, Harris J, Singh H, Meyer AND, Giardina TD, Bhuiya A, Whitaker KL, Black GB. How is diagnostic uncertainty communicated and managed in real world primary care settings? BMC PRIMARY CARE 2024; 25:296. [PMID: 39135159 PMCID: PMC11318185 DOI: 10.1186/s12875-024-02526-x] [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: 02/14/2024] [Accepted: 07/16/2024] [Indexed: 08/15/2024]
Abstract
BACKGROUND Managing diagnostic uncertainty is a major challenge in primary care due to factors such as the absence of definitive tests, variable symptom presentations and disease evolution. Maintaining patient trust during a period of investigative uncertainty, whilst minimising scope for diagnostic error is a challenge. Mismanagement can lead to diagnostic errors, treatment delays, and suboptimal patient outcomes. OBJECTIVE Our aim was to explore how UK primary care physicians (GPs) address and communicate diagnostic uncertainty in practice. DESIGN This qualitative study used video and audio-recordings. Verbatim transcripts were coded with a modified, validated tool to capture GPs' actions and communication in primary care consultations that included diagnostic uncertainty. The tool includes items relating to advice regarding new symptoms or symptom deterioration (sometimes called 'safety netting'). Video data was analysed to identify GP and patient body postures during and after the delivery of the management plan. PARTICIPANTS All patient participants had a consultation with a GP, were over the age of 50 and had (1) at least one new presenting problem or (2) one persistent problem that was undiagnosed. APPROACH Data collection occurred in GP-patient consultations during 2017-2018 across 7 practices in UK during 2017-2018. KEY RESULTS GPs used various management strategies to address diagnostic uncertainty, including (1) symptom monitoring without treatment, (2) prescribed treatment with symptom monitoring, and (3) addressing risks that could arise from administrative tasks. GPs did not make management plans for potential treatment side effects. Specificity of uncertainty management plans varied among GPs, with only some offering detailed actions and timescales. The transfer of responsibility for the management plan to patients was usually delivered rather than negotiated, with most patients confirming acceptance before concluding the discussion. CONCLUSIONS We offer guidance to healthcare professionals, improving awareness of using and communicating management plans for diagnostic uncertainty.
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Affiliation(s)
- Jessica Russell
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK.
| | - Laura Boswell
- School of Health Sciences, The University of Surrey, Surrey, UK
| | - Athena Ip
- School of Health Sciences, The University of Surrey, Surrey, UK
| | - Jenny Harris
- School of Health Sciences, The University of Surrey, Surrey, UK
| | - Hardeep Singh
- Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey VA Medical Center, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Ashley N D Meyer
- Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey VA Medical Center, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Traber D Giardina
- Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey VA Medical Center, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Afsana Bhuiya
- General Practitioner, Cancer GP lead for North Central London Cancer Alliance, London, UK
| | | | - Georgia B Black
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
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Kovic Ž, Kobua M, Fogarty M, Donohoe CL, Kelly ME, Fitzmaurice GJ, Fitzgerald M, Zambra P, Geary U, Ward ME. Valid consent in the acute hospital setting: perspectives of patients and members of the public. Ir J Med Sci 2024; 193:1703-1714. [PMID: 38578384 PMCID: PMC11294267 DOI: 10.1007/s11845-024-03658-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: 12/14/2023] [Accepted: 02/29/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND People who interact with healthcare services have an ethical and legal right to control their own lives, to make informed decisions, and to consent to what happens to them. For consent to be considered ethically and legally valid, three key criteria must be met: consent must be given voluntarily; people must be sufficiently informed of all options; and people should have capacity to make the decision to give or withhold their consent. AIM This study set out to explore, through the use of surveys, the perspectives of patients and public in relation to consent. METHOD Surveys were developed for patients and the public and administered paper based (patients) and through social media (public). RESULTS One hundred and forty surveys were posted to patients, with a 38% response rate; 104 responses were received from the public. Ninety-six percent of patients were satisfied that the decision they made was informed; 100% felt they had made a voluntary decision; 98% felt the clinician seemed knowledgeable about the procedure. What matters most to the public were being informed about the risks associated with the proposed procedure and being assured that whatever choice they make they will receive the best care possible. CONCLUSIONS The results highlight interesting similarities and differences in relation to consent between members of the public thinking about a possible treatment, surgery, or procedure and those patients who have actually been through the process in the past 12 months. Recommendations have been developed on the basis of these findings to co-design improvements in consent practices.
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Affiliation(s)
- Živa Kovic
- School of Medicine, Trinity College, The University of Dublin, Dublin 2, Ireland
| | - Motheo Kobua
- School of Medicine, Trinity College, The University of Dublin, Dublin 2, Ireland
| | - Mary Fogarty
- Quality and Safety Improvement Directorate, St James's Hospital, Dublin 8, Ireland
| | - Claire L Donohoe
- Gastrointestinal and General Surgery, St James's Hospital, Dublin 8, Ireland
| | | | | | | | - Paul Zambra
- Quality and Safety Improvement Directorate, St James's Hospital, Dublin 8, Ireland
| | - Una Geary
- Quality and Safety Improvement Directorate, St James's Hospital, Dublin 8, Ireland
| | - Marie E Ward
- Quality and Safety Improvement Directorate, St James's Hospital, Dublin 8, Ireland.
- Centre for Innovative Human Systems, School of Psychology, Trinity College, The University of Dublin, Dublin 2, Ireland.
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Al Zoubi S, Gharaibeh L, Amaireh EA, AlSalamat H, Deameh MG, Almansi A, Al Asoufi YM, Alshahwan H, Al-Zoubi Z. Unveiling the factors influencing public knowledge and behaviours towards medication errors in Jordan: a cross-sectional study. BMC Health Serv Res 2024; 24:798. [PMID: 38987809 PMCID: PMC11238437 DOI: 10.1186/s12913-024-11230-6] [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: 03/29/2024] [Accepted: 06/20/2024] [Indexed: 07/12/2024] Open
Abstract
BACKGROUND Medication errors are preventable incidents resulting from improper use of drugs that may cause harm to patients. They thus endanger patient safety and offer a challenge to the efficiency and efficacy of the healthcare system. Both healthcare professionals and patients may commit medication errors. METHODS AND OBJECTIVES A cross-sectional, observational study was designed using a self-developed, self-administered online questionnaire. A sample was collected using convenience sampling followed by snowball sampling. Adult participants from the general population were recruited regardless of age, gender, area of residence, medical history, or educational background in order to explore their practice, experience, knowledge, and fear of medication error, and their understanding of this drug-related problem. RESULTS Of the 764 participants who agreed to complete the questionnaire, 511 (66.9%) were females and 295 (38.6%) had a medical background. One-fifth of participants had experienced medication errors, with 37.7% of this segment reporting these medication errors. More than half of all medication errors (84, 57.5%) were minor and thus did not require any intervention. The average anxiety score for all attributes was 21.2 (The highest possible mean was 36, and the lowest possible was 0). The highest level of anxiety was seen regarding the risk of experiencing drug-drug interactions and the lowest levels were around drug costs and shortages. Being female, having no medical background, and having experience with medication errors were the main predictors of high anxiety scores. Most participants (between 67% and 92%) were able to recognise medication errors committed by doctors or pharmacists. However, only 21.2 to 27.5% of participants could recognise medication errors committed by patients. Having a medical background was the strongest predictor of knowledge in this study (P < 0.001). CONCLUSION The study revealed that the prevalence of self-reported medication errors was significantly high in Jordan, some of which resulted in serious outcomes such as lasting impairment, though most were minor. Raising awareness about medication errors and implementing preventive measures is thus critical, and further collaboration between healthcare providers and policymakers is essential to educate patients and establish effective safety protocols.
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Affiliation(s)
- Sura Al Zoubi
- Department of Basic Medical Sciences, Faculty of Medicine, Al-Balqa Applied University, As-Salt, Jordan.
| | - Lobna Gharaibeh
- Pharmacological and Diagnostic Research Center, Biopharmaceutics and Clinical Pharmacy Department, Faculty of Pharmacy, Al-Ahliyya Amman University, Amman, Jordan
| | | | - Husam AlSalamat
- Department of Basic Medical Sciences, Faculty of Medicine, Al-Balqa Applied University, As-Salt, Jordan
| | - Mohammad Ghassab Deameh
- Department of Basic Medical Sciences, Faculty of Medicine, Al-Balqa Applied University, As-Salt, Jordan
| | | | - Yaqeen Majed Al Asoufi
- Department of Basic Medical Sciences, Faculty of Medicine, Al-Balqa Applied University, As-Salt, Jordan
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Black GB, Moreland J, Fulop NJ, Lyratzopoulos G, Nicholson BD, Whitaker KL. Personal and organisational health literacy in the non-specific symptom pathway for cancer: An ethnographic study. Health Expect 2024; 27:e14062. [PMID: 38704822 PMCID: PMC11070181 DOI: 10.1111/hex.14062] [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: 10/10/2023] [Revised: 04/17/2024] [Accepted: 04/18/2024] [Indexed: 05/07/2024] Open
Abstract
INTRODUCTION People being investigated for cancer face a wealth of complex information. Non-specific symptom pathways (NSS) were implemented in the United Kingdom in 2017 to address the needs of patients experiencing symptoms such as weight loss, fatigue or general practitioner 'gut feeling', who did not have streamlined pathways for cancer investigation. This study aimed to explore the health literacy skills needed by patients being investigated for cancer in NSS pathways. METHODS This study employed ethnographic methods across four hospitals in England, including interviews, patient shadowing and clinical care observations, to examine NSS pathways for cancer diagnosis. We recruited 27 patients who were shadowed and interviewed during their care. We also interviewed 27 professionals. The analysis focused on patient communication and understanding, drawing on the concepts of personal and organisational health literacy. RESULTS Our analysis derived six themes highlighting the considerable informational demands of the NSS pathway. Patients were required to understand complex blood tests and investigations in primary care and often did not understand why they were referred. The NSS pathway itself was difficult to understand with only a minority of patients appreciating that multiple organs were being investigated for cancer. The process of progressing through the pathway was also difficult to understand, particularly around who was making decisions and what would happen next. The results of investigations were complex, often including incidental findings. Patients whose persistent symptoms were not explained were often unsure of what to do following discharge. CONCLUSION We have identified several potential missed opportunities for organisations to support patient understanding of NSS pathways which could lead to inappropriate help-seeking post-discharge. Patients' difficulties in comprehending previous investigations and findings could result in delays, overtesting or inadequately targeted investigations, hindering the effective use of their medical history. Third, patients' limited understanding of their investigations and results may impede their ability to engage in patient safety by reporting potential care errors. PATIENT OR PUBLIC CONTRIBUTION Patient, public, clinical and policy representatives contributed to developing the research objectives through a series of meetings and individual conversations in preparation for the study. We have held several events in which patients and the public have had an opportunity to give feedback about our results, such as local interest groups in North London and academic conferences. A clinical contributor (J.-A. M.) was involved in data analysis and writing the manuscript.
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Affiliation(s)
- Georgia B. Black
- Centre for Cancer Screening, Prevention and Early Diagnosis, Wolfson Institute of Population HealthQueen Mary University of LondonLondonUK
- Department of Applied Health ResearchUniversity College LondonLondonUK
| | - Julie‐Ann Moreland
- Department of RadiologyOxford University Hospitals NHS Foundation TrustOxfordUK
| | - Naomi J. Fulop
- Department of Applied Health ResearchUniversity College LondonLondonUK
| | | | - Brian D. Nicholson
- Nuffield Department of Primary Care Health SciencesUniversity of OxfordOxfordUK
| | - Katriina L. Whitaker
- Department of Cancer Care, School of Health SciencesUniversity of SurreyGuildfordUK
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Ayre MJ, Lewis PJ, Phipps DL, Morgan KM, Keers RN. Towards understanding and improving medication safety for patients with mental illness in primary care: A multimethod study. Health Expect 2024; 27:e14095. [PMID: 38817038 PMCID: PMC11139968 DOI: 10.1111/hex.14095] [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: 03/13/2024] [Revised: 04/17/2024] [Accepted: 05/17/2024] [Indexed: 06/01/2024] Open
Abstract
INTRODUCTION Medication safety incidents have been identified as an important target to improve patient safety in mental healthcare. Despite this, the causes of preventable medication safety incidents affecting patients with mental illness have historically been poorly understood, with research now addressing this knowledge gap through a healthcare professional lens. However, patients and carers can also provide complimentary insight into safety issues, and as key stakeholders in healthcare, it is vital to consider their needs when designing effective interventions. METHODS A two-stage approach was adopted by (i) conducting three focus groups (FG) comprising 13 patients with mental illness and their carers to develop a holistic picture of medication safety in primary care with extraction of themes guided by the P-MEDS framework; (ii) conducting two separate nominal group consensus workshops with seven patients with mental illness/carers and seven healthcare professionals to identify priority areas for targeted interventions. RESULTS Seven themes were identified in the FGs: communication; trust, involvement and respect; continuity and support; access; the healthcare professional; the patient and carer; and the organisation. Priority areas identified for intervention by key stakeholders included improving communication within and between clinical services, enhancing patient support with holistic continuity of care, maximising shared decision-making and empowerment, ensuring timely access to medicines and services, strengthening healthcare professional knowledge regarding mental illnesses and associated medications, and increasing patient dignity and respect. CONCLUSION This study has developed a holistic picture of contributors to medication safety incidents affecting patients with mental illness in primary care. This theory was then used by key stakeholders to inform and generate priority recommendations for targeted interventions. These findings can be used to inform future intervention research, as they consider the needs of those who access or work within primary care services. PATIENT OR PUBLIC CONTRIBUTION An advisory group consisting of three expert patients with lived experience of mental illness was consulted on the design of both stages of this study. Patients with mental illness and/or their carers were recruited and participated in both stages of this study. Patients/carers aided with data analysis and interpretation during the patient/carer nominal group consensus workshop.
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Affiliation(s)
- Matthew J. Ayre
- Division of Pharmacy and Optometry, Faculty of Biology, Medicine and Health, School of Health SciencesThe University of ManchesterManchesterUK
| | - Penny J. Lewis
- Division of Pharmacy and Optometry, Faculty of Biology, Medicine and Health, School of Health SciencesThe University of ManchesterManchesterUK
- NIHR Greater Manchester Patient Safety Research Collaboration, Manchester Academic Health Science Centre (MAHSC)The University of ManchesterManchesterUK
- Manchester University NHS Foundation TrustManchesterUK
| | - Denham L. Phipps
- Division of Pharmacy and Optometry, Faculty of Biology, Medicine and Health, School of Health SciencesThe University of ManchesterManchesterUK
- NIHR Greater Manchester Patient Safety Research Collaboration, Manchester Academic Health Science Centre (MAHSC)The University of ManchesterManchesterUK
| | - Kathy M. Morgan
- Division of Pharmacy and Optometry, Faculty of Biology, Medicine and Health, School of Health SciencesThe University of ManchesterManchesterUK
- Pharmacy DepartmentPennine Care NHS Foundation TrustManchesterUK
| | - Richard N. Keers
- Division of Pharmacy and Optometry, Faculty of Biology, Medicine and Health, School of Health SciencesThe University of ManchesterManchesterUK
- NIHR Greater Manchester Patient Safety Research Collaboration, Manchester Academic Health Science Centre (MAHSC)The University of ManchesterManchesterUK
- Pharmacy DepartmentPennine Care NHS Foundation TrustManchesterUK
- Optimising Outcomes With Medicines (OptiMed) Research UnitPennine Care NHS Foundation TrustManchesterUK
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Marsall M, Hornung T, Bäuerle A, Weigl M. Quality of care transition, patient safety incidents, and patients' health status: a structural equation model on the complexity of the discharge process. BMC Health Serv Res 2024; 24:576. [PMID: 38702719 PMCID: PMC11069201 DOI: 10.1186/s12913-024-11047-3] [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: 04/15/2023] [Accepted: 04/25/2024] [Indexed: 05/06/2024] Open
Abstract
BACKGROUND The transition of patients between care contexts poses patient safety risks. Discharges to home from inpatient care can be associated with adverse patient outcomes. Quality in discharge processes is essential in ensuring safe transitions for patients. Current evidence relies on bivariate analyses and neglects contextual factors such as treatment and patient characteristics and the interactions of potential outcomes. This study aimed to investigate the associations between the quality and safety of the discharge process, patient safety incidents, and health-related outcomes after discharge, considering the treatments' and patients' contextual factors in one comprehensive model. METHODS Patients at least 18 years old and discharged home after at least three days of inpatient treatment received a self-report questionnaire. A total of N = 825 patients participated. The assessment contained items to assess the quality and safety of the discharge process from the patient's perspective with the care transitions measure (CTM), a self-report on the incidence of unplanned readmissions and medication complications, health status, and sociodemographic and treatment-related characteristics. Statistical analyses included structural equation modeling (SEM) and additional analyses using logistic regressions. RESULTS Higher quality of care transition was related to a lower incidence of medication complications (B = -0.35, p < 0.01) and better health status (B = 0.74, p < 0.001), but not with lower incidence of readmissions (B = -0.01, p = 0.39). These effects were controlled for the influences of various sociodemographic and treatment-related characteristics in SEM. Additional analyses showed that these associations were only constant when all subscales of the CTM were included. CONCLUSIONS Quality and safety in the discharge process are critical to safe patient transitions to home care. This study contributes to a better understanding of the complex discharge process by applying a model in which various contextual factors and interactions were considered. The findings revealed that high quality discharge processes are associated with a lower likelihood of patient safety incidents and better health status at home even, when sociodemographic and treatment-related characteristics are taken into account. This study supports the call for developing individualized, patient-centered discharge processes to strengthen patient safety in care transitions.
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Affiliation(s)
- Matthias Marsall
- Institute for Patient Safety (IfPS), University Hospital Bonn, Bonn, Germany.
| | | | - Alexander Bäuerle
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University of Duisburg-Essen, Essen, Germany
| | - Matthias Weigl
- Institute for Patient Safety (IfPS), University Hospital Bonn, Bonn, Germany
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Obadan-Udoh E, Sundararajan V, Sanchez GA, Howard R, Chandrupatla S, Worley D. Dental patients as partners in promoting quality and safety: a qualitative exploratory study. BMC Oral Health 2024; 24:438. [PMID: 38600495 PMCID: PMC11005277 DOI: 10.1186/s12903-024-04030-1] [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: 08/14/2023] [Accepted: 02/14/2024] [Indexed: 04/12/2024] Open
Abstract
OBJECTIVE Active patient involvement in promoting quality and safety is a priority for healthcare. We investigated how dental patients perceive their role as partners in promoting quality and safety across various dental care settings. METHODS Focus group sessions were conducted at three dental practice settings: an academic dental center, a community dental clinic, and a large group private practice, from October 2018-July 2019. Patients were recruited through flyers or word-of-mouth invitations. Each session lasted 2.5 h and patients completed a demographic and informational survey at the beginning. Audio recordings were transcribed, and a hybrid thematic analysis was performed by two independent reviewers using Dedoose. RESULTS Forty-seven participants took part in eight focus group sessions; 70.2% were females and 38.3% were aged 45-64 years. Results were organized into three major themes: patients' overall perception of dental quality and safety; patients' reaction to an adverse dental event; and patients' role in promoting quality and safety. Dental patients were willing to participate in promoting quality and safety by careful provider selection, shared decision-making, self-advocacy, and providing post-treatment provider evaluations. Their reactions towards adverse dental events varied based on the type of dental practice setting. Some factors that influenced a patient's overall perception of dental quality and safety included provider credentials, communication skills, cleanliness, and durability of dental treatment. CONCLUSION The type of dental practice setting affected patients' desire to work as partners in promoting dental quality and safety. Although patients acknowledged having an important role to play in their care, their willingness to participate depended on their relationship with their provider and their perception of provider receptivity to patient feedback.
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Affiliation(s)
- Enihomo Obadan-Udoh
- Department of Preventive and Restorative Dental Sciences, University of California San Francisco, School of Dentistry, 707 Parnassus Avenue, D3214, Box #1361, San Francisco, CA, 94143, USA.
| | - Vyshiali Sundararajan
- Department of Preventive and Restorative Dental Sciences, University of California San Francisco, School of Dentistry, 707 Parnassus Avenue, D3214, Box #1361, San Francisco, CA, 94143, USA
| | - Gustavo A Sanchez
- Department of Preventive and Restorative Dental Sciences, University of California San Francisco, School of Dentistry, 707 Parnassus Avenue, D3214, Box #1361, San Francisco, CA, 94143, USA
| | - Rachel Howard
- Department of Preventive and Restorative Dental Sciences, University of California San Francisco, School of Dentistry, 707 Parnassus Avenue, D3214, Box #1361, San Francisco, CA, 94143, USA
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Fiol-deRoque MA, Mansilla GV, Maderuelo-Fernández JA, Tamayo-Morales O, Martín-Luján F, Astier-Peña P, Chacón-Docampo M, Orrego C, Gens-Barberà M, Andreu-Rodrigo P, Ricci-Cabello I. Evaluation of SINERGIAPS, an intervention to improve patient safety in primary healthcare centers in Spain based on patients' perceptions and experiences: a protocol for a hybrid type I randomized clinical trial. Front Public Health 2024; 12:1324940. [PMID: 38596515 PMCID: PMC11003190 DOI: 10.3389/fpubh.2024.1324940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 03/05/2024] [Indexed: 04/11/2024] Open
Abstract
Background Adverse events in the primary care setting result in a direct cost equivalent to at least 2.5% of total healthcare spending. Across OECD countries, they lead to more than seven million avoidable hospital admissions annually. In this manuscript, we describe the protocol of a trial aimed at evaluating the effectiveness of SinergiAPS (a patient-centered audit and feedback intervention) in reducing avoidable hospital admission and explore the factors that may affect its implementation. Methods We will conduct a 24-month, parallel, open-label, multicenter, pragmatic, hybrid type 1 randomized clinical trial. 118 primary healthcare centers with wide geographical distribution in Spain will be randomly assigned (ratio 1:1) to two groups. The intervention group will receive two audits (baseline and intermediate at 12 months) based on information collected through the administration of the PREOS-PC questionnaire (a measure of patient-reported patient safety) to a convenience sample of 100 patients per center. The intervention group will receive reports on the results of both audits, along with educational resources aimed at facilitating the design and implementation of safety improvement plans. The control group will receive care as usual. The primary outcome will be the rate of avoidable hospitalizations (administrative data). Secondary outcomes: patient-reported patient safety experiences and outcomes (PREOS-PC questionnaire); patient safety culture as perceived by professionals (MOSPSC questionnaire); adverse events reported by healthcare professionals (ad hoc questionnaire); the number of safety improvement actions which the re has implemented (ad hoc questionnaire). Outcome data will be collected at baseline and 24 months follow-up. For the evaluation of the implementation of the SinergiAPS intervention, we will draw on the Consolidated Framework for Implementation Research (CFIR). We will collect and analyze qualitative and quantitative data (30 individual interviews, implementation logbooks; questionnaires for professionals from intervention centers, and level of use of the SinergiAPS web tool). Discussion This study will expand the scarce body of evidence existing regarding the effects and implementation of interventions aimed at promoting patient and family engagement in primary healthcare, specifically for enhancing patient safety. The study has the potential to produce an impact on clinical practice, healthcare systems, and population health.Clinical Trial Registration: https://clinicaltrials.gov/study/NCT05958108?term=sinergiAPS&rank=1 (NCT05958108).
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Affiliation(s)
- Maria A. Fiol-deRoque
- Health Research Institute of the Balearic Islands (IdISBa), Hospital Universitari Son Espases, Palma, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Spain
| | - Georgina Vidal Mansilla
- Unitat de Qualitat i Seguretat dels Pacients, Gerència Territorial Camp de Tarragona, Institut Català de la Salut, Tarragona, Spain
| | - José A. Maderuelo-Fernández
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Spain
- Unidad de Investigación en Atención Primaria de Salamanca (APISAL), Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
- Gerencia de Atención Primaria de Salamanca, Gerencia Regional de Salud de Castilla y León (SACyL), Avenida de Portugal, Salamanca, Spain
| | - Olaya Tamayo-Morales
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Spain
- Unidad de Investigación en Atención Primaria de Salamanca (APISAL), Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
| | - Francisco Martín-Luján
- Unitat de Suport a la Recerca de Tarragona, Institut de d'investigació en l'Atenció Primària Jordi Gol (IDIAP Jordi Gol), Institut Català de la Salut, Tarragona, Spain
| | - Pilar Astier-Peña
- Unitat de Qualitat i Seguretat dels Pacients, Gerència Territorial Camp de Tarragona, Institut Català de la Salut, Tarragona, Spain
- Unitat de Suport a la Recerca de Tarragona, Institut de d'investigació en l'Atenció Primària Jordi Gol (IDIAP Jordi Gol), Institut Català de la Salut, Tarragona, Spain
| | - Macarena Chacón-Docampo
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Spain
- I-Saude Group, Galicia Sur Health Research Institute (IIS Galicia Sur), Vigo, Spain
| | - Carola Orrego
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Spain
- Avedis Donabedian Research Institute (FAD) – Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Montserrat Gens-Barberà
- Unitat de Qualitat i Seguretat dels Pacients, Gerència Territorial Camp de Tarragona, Institut Català de la Salut, Tarragona, Spain
- Unitat de Suport a la Recerca de Tarragona, Institut de d'investigació en l'Atenció Primària Jordi Gol (IDIAP Jordi Gol), Institut Català de la Salut, Tarragona, Spain
| | - Pilar Andreu-Rodrigo
- Health Research Institute of the Balearic Islands (IdISBa), Hospital Universitari Son Espases, Palma, Spain
| | - Ignacio Ricci-Cabello
- Health Research Institute of the Balearic Islands (IdISBa), Hospital Universitari Son Espases, Palma, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
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Gemmete JJ. Learning from medical errors. CVIR Endovasc 2024; 7:8. [PMID: 38197983 PMCID: PMC10781906 DOI: 10.1186/s42155-023-00406-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 11/15/2023] [Indexed: 01/11/2024] Open
Affiliation(s)
- Joseph J Gemmete
- Department of Radiology, Neurology, Neurosurgery, and Otolaryngology, University of Michigan Hospitals, UH B1D 328, 1500 E Medical Center Drive, Ann Arbor, MI, 48109, USA.
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Busch IM, Mazzi MA, Berti L, Wu AW, Cosci F, Marinelli V, Moretti F, Rimondini M. Screening Second Victims for Emotional Distress: Assessment of the Clinimetric Properties of the WITHSTAND-PSY Questionnaire. PSYCHOTHERAPY AND PSYCHOSOMATICS 2023; 92:399-409. [PMID: 38118426 PMCID: PMC10794969 DOI: 10.1159/000535006] [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: 08/09/2023] [Accepted: 10/31/2023] [Indexed: 12/22/2023]
Abstract
INTRODUCTION Adverse events (AEs) are a leading cause of patient morbidity and mortality, greatly impacting healthcare providers' well-being (second victim (SV) phenomenon). Since it is not accurately captured by existing psychometric instruments, we developed a clinimetric instrument for assessing SVs' emotional distress before and after an AE. METHODS Content validity and clinical utility of the WITHSTAND-PSY Questionnaire (WS-PSY-Q) were examined using cognitive interviews. Rasch analysis (n = 284) was applied for clinimetric assessment (i.e., construct, concurrent, and clinical validity, internal consistency), considering two crucial psychological facets of the SV phenomenon (1st: emotional impact of the AE, 2nd: current emotional state). RESULTS The Rasch partial credit model was used. The 1st facet demonstrated overall acceptable clinimetric properties with the subscale anxiety meeting clinimetric threshold values (e.g., all items with ordered thresholds, Loevinger's coefficient h ≥ 0.40; Person Separation Reliability Index (PSI) = 0.7). The 2nd facet showed overall better clinimetric properties for both subscales (e.g., h ≥ 0.40, PSI = 0.82 and 0.79, respectively; receiver operating characteristic area of 0.80 and 0.86, respectively). For both datasets, item fit statistics, except those for item 19, were within the critical range (z-score < ±2.5), and meaningful differential functioning analysis was observed for only 4 (out of 24) items. Local dependency was not observed, except for two item couples in the depression subscales. CONCLUSIONS The WS-PSY-Q is the first clinimetric tool assessing SVs' emotional distress. It should be regarded as part of the armamentarium used by clinicians to assess in-depth healthcare providers' psychological reactions in the aftermath of an AE to mitigate burnout and allostatic overload.
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Affiliation(s)
- Isolde Martina Busch
- Department of Neuroscience, Biomedicine and Movement Sciences, Section of Clinical Psychology, University of Verona, Verona, Italy
| | - Maria Angela Mazzi
- Department of Neuroscience, Biomedicine and Movement Sciences, Section of Clinical Psychology, University of Verona, Verona, Italy
| | - Loretta Berti
- Department of Neuroscience, Biomedicine and Movement Sciences, Section of Clinical Psychology, University of Verona, Verona, Italy
| | - Albert W. Wu
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Fiammetta Cosci
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Veronica Marinelli
- Department of Surgery, Dentistry, Paediatrics and Gynaecology, Section of General and Pancreatic Surgery, University of Verona, Verona, Italy
| | - Francesca Moretti
- Department of Neuroscience, Biomedicine and Movement Sciences, Section of Movement Sciences, University of Verona, Verona, Italy
| | - Michela Rimondini
- Department of Neuroscience, Biomedicine and Movement Sciences, Section of Clinical Psychology, University of Verona, Verona, Italy
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Guraya SS, Umair Akhtar M, Sulaiman N, David LR, Jirjees FJ, Awad M, Al Kawas S, Hassan Taha M, Haider M, Maria Dias J, Kodumayil SA, Dash NR, Al-Qallaf A, Hasswan A, Salmanpour VA, Guraya SY. Embedding patient safety in a scaffold of interprofessional education; a qualitative study with thematic analysis. BMC MEDICAL EDUCATION 2023; 23:968. [PMID: 38110914 PMCID: PMC10729414 DOI: 10.1186/s12909-023-04934-6] [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: 09/27/2023] [Accepted: 12/04/2023] [Indexed: 12/20/2023]
Abstract
BACKGROUND Regardless of a proliferation of interest in reducing unsafe practices in healthcare, threats to patient safety (PS) remain high. Moreover, little attention has been paid towards the role of interprofessional education (IPE) in enhancing PS. This qualitative study was conducted to unfold the insights of the senior medical, dental and health sciences students at the University of Sharjah (UoS) in the United Arab Emirates (UAE) about PS in an online IPE-based workshop. METHODS This inductive thematic analysis study was conducted on senior medical and health students at the Colleges of Medicine, Dental Medicine, Health Sciences, and Pharmacy of UoS. During an online workshop, students discussed plausible solutions for four real practice-based clinical scenarios with elements of unsafe healthcare practices. During the breakout rooms, the students exhibited high level of articulation and proactively participated in discussions. The data from the online workshop were transcribed and then coding, categorizing, and labelling of recurrent themes were carried out. Multiple individual deliberations, consolidation, incorporation of the identified preliminary themes, and merging and reorganizing sub-themes led to a final thematic framework. RESULTS This work delved into the perspectives of 248 students regarding teamwork, communication, problem-solving, and other aspects concerning PS in interprofessional settings in an online workshop. The iterative process of data transcription, curating and qualitative analysis surfaced 32 codes. Later, the inductive themaric analysis yielded five themes with distinct yet interconnected nested subthemes in the context of PS in IPE settings. These themes of information sharing and grounding (problem-solving, social skills), maintaining communication (clinical reasoning, shared mental model), executing interprofessional activities (collaborative practice, collaboration scripts), professional cognitive abilities (cognitive maturity, metacognition), and negotiating professional identities (systematic change, socio-economic scaffolding) emerged as fundamental pillars for enhancing PS in healthcare. CONCLUSION Our study demonstrated the outcome of an innovative and team-based workshop which embedded PS within a scaffold of IPE environment. This research calls for incorporation of the emerging areas of clinical reasoning, problem solving, collaborative practice, and shared mental model into medical curricula for structured IPE in improving PS domains in medical education. These findings underscore the need for multifaceted dimensions of IPE imperatives for cultivating collaborative competence.
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Affiliation(s)
- Shaista Salman Guraya
- Royal College of Surgeons Ireland, Medical University of Bahrain, Busaiteen, Bahrain
| | - Muhammad Umair Akhtar
- Royal College of Surgeons Ireland, Medical University of Bahrain, Busaiteen, Bahrain
| | - Nabil Sulaiman
- College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Leena R David
- College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | | | - Manal Awad
- College of Dental Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Sausan Al Kawas
- College of Dental Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | | | - Mohamed Haider
- College of Pharmacy, University of Sharjah, Sharjah, United Arab Emirates
| | | | - Shada Aysha Kodumayil
- Royal College of Surgeons Ireland, Medical University of Bahrain, Busaiteen, Bahrain
| | - Nihar Ranjan Dash
- College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Amal Al-Qallaf
- Royal College of Surgeons Ireland, Medical University of Bahrain, Busaiteen, Bahrain
| | - Ahmed Hasswan
- College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
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Marsall M, Hornung T, Bäuerle A, Weigl M. Measuring transitional patient safety: Adaptation and validation of the German version of the Care Transitions Measure. ZEITSCHRIFT FUR EVIDENZ, FORTBILDUNG UND QUALITAT IM GESUNDHEITSWESEN 2023; 182-183:17-25. [PMID: 37951720 DOI: 10.1016/j.zefq.2023.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 09/30/2023] [Accepted: 10/03/2023] [Indexed: 11/14/2023]
Abstract
INTRODUCTION The transition between different care contexts, especially during discharge from inpatient treatment to home, is associated with risks for patient safety. Internationally established, the Care Transitions Measure (CTM) is used to assess the quality and safety of this transition from the patients' perspective. A systematic and standardized assessment of quality and safety in the discharge process from the patients' perspective has not been possible in German-speaking countries due to the lack of a German adaptation and validation of the CTM. This study aims to translate, adapt, and validate the CTM for use in German-speaking countries METHODS: The German version of the CTM was developed based on internationally accepted recommendations for translating and adapting questionnaires. Patients of all departments (except pediatric departments) of a German university hospital who were discharged home after at least three days of inpatient treatment received the questionnaire by mail between May and August 2022. A total of 806 patients participated in the survey. The validity of the CTM was tested by factor analyses. For this purpose, different factor models were compared. In addition, the measurement invariance of the instrument was examined. RESULTS The construct validity of the long version of the CTM (15items) with a two-factorial model structure was confirmed with good model fit indices. The two subscales had excellent internal consistency. In addition, the one short version with four items achieved excellent model fit indices and high internal consistency. For the long version of the CTM, measurement invariance was confirmed for all sociodemographic, care-related, and survey response characteristics examined. The measurement invariance of the short version was only partially confirmed. DISCUSSION The validity and reliability of the German version of the CTM were confirmed. In its long version, the instrument is measurement invariant across various characteristics and thus allows valid interpretation of group differences. The short version is partially measurement invariant and is suitable as a screening instrument for assessing the quality and safety of discharge processes due to its high validity and reliability. CONCLUSIONS With a validated and standardized German version of the CTM, an instrument is now available to assess the quality and safety of the discharge process from the patients' perspective. Thus, this study provides an essential tool for systematically investigating and optimizing patient safety in the discharge process.
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Affiliation(s)
- Matthias Marsall
- Institute for Patient Safety (IfPS), University Hospital Bonn, Bonn, Germany.
| | | | - Alexander Bäuerle
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Matthias Weigl
- Institute for Patient Safety (IfPS), University Hospital Bonn, Bonn, Germany
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Okkenhaug A, Tritter JQ, Landstad BJ. Developing a research tool to detect iatrogenic adverse events in psychiatric health care by involving service users and health professionals. J Psychiatr Ment Health Nurs 2023. [PMID: 37947248 DOI: 10.1111/jpm.12994] [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: 08/03/2022] [Revised: 09/30/2023] [Accepted: 10/15/2023] [Indexed: 11/12/2023]
Abstract
WHAT IS KNOWN ON THE SUBJECT Most health professionals working in psychiatric care will experience adverse events (AE) such as service user suicide or violence, during their career Norway lacks measures to capture potential iatrogenic injuries, such as risk assessment measures, to evaluate patient records for AEs in both inpatient and outpatient psychiatric clinics in hospitals WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE: We have described an approach to the validation of a research tool between different national contexts; a process that went beyond language translation We have incorporated the understanding of health professionals and service users; to bring together the lifeworld of the patient with the professional definition of AEs, triggers and risk areas of AEs in a psychiatric context. The service users' experiences resulted in modifications to the tool. WHAT ARE THE IMPLICATIONS FOR NURSES Applying the 'Global Trigger Tool-Psychiatry' in Norway and Sweden can help mental health nurses to prevent iatrogenic harm and reduce the occurrence of AEs through the identification of potential triggers. Implementing 'Global Trigger Tool-Psychiatry' might help mental health nurses to improve patient safety in Norway and Sweden. ABSTRACT INTRODUCTION: There is little consensus on cross-cultural and cross-national adaptation of research instruments. AIM/QUESTION To translate and validate a Swedish research tool (GTT-P) to detect iatrogenic adverse events in psychiatric health care by involving service users and health professionals in the process. METHOD The GTT-P, designed to identify events in patient records that were triggers for adverse events, was translated to Norwegian using a cross-cultural adaptation approach. This involved two focus groups with clinical staff, one of which involved service users, and a joint discussion at a Dialogue Conference to generate consensus on the definition of the triggers of potential adverse events identifiable in patient records. RESULTS We highlight both the differences and commonalities in defining the nature of risks, the adverse events and the triggers of such events. The Dialogue Conference resulted in three modifications of the tool, based on service users' experiences. Service user involvement and co-production was essential for both the translation and adaptation of the research instrument. DISCUSSION We have described an approach to the validation of a research tool between different national contexts; a process that went beyond language translation. This approach enables a more nuanced understanding of potential risks within a psychiatric context as it engages differences in the care delivery. Applying the GTT-P in hospital-based psychiatric care might help to identify processes that need to be changed in order to promote patient safety and a safer work environment for mental health nurses. IMPLICATIONS FOR PRACTICE When translating and validating the GTT-P from Swedish to Norwegian, we have considered the knowledge and experiences of both service users and health professionals. The application of the GTT-P can promote greater patient safety in hospital settings.
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Affiliation(s)
- Arne Okkenhaug
- Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- Nord Trøndelag Hospital Trust, Levanger Hospital, Levanger, Norway
| | - Jonathan Q Tritter
- School of Humanities and Social Sciences, Aston University, Birmingham, UK
| | - Bodil J Landstad
- Faculty of Human Sciences, Mid Sweden University, Östersund, Sweden
- Unit of Research, Education and Development, Östersund Hospital, Östersund, Sweden
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Bie Bogh S, Fryd Birkeland S, Maj-Britt Hansen S, Alexandrovna Tchijevitch O, Hallas J, Morsø L. Harnessing patient complaints to systematically monitoring healthcare concerns through disproportionality analysis. Int J Qual Health Care 2023; 35:mzad062. [PMID: 37556110 DOI: 10.1093/intqhc/mzad062] [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: 04/24/2023] [Revised: 07/12/2023] [Accepted: 08/07/2023] [Indexed: 08/10/2023] Open
Abstract
Staff observations are the most common source of data for driving improvements in care. However, the patient perspective should also be considered, and healthcare complaints offer concrete details that health organizations might otherwise overlook and that can highlight areas for learning and improvement in the healthcare system. However, because of the diverse nature of patient complaints, systematic analyses can be challenging. This study aimed to identify and prioritize areas for improvement using a data-driven approach to analysing patient complaints. The Danish version of the Healthcare Complaints Analysis Tool was used to categorize the content of complaint letters. All complaints managed by the national complaints authority, compensation claims to the Patient Compensation Association, and locally managed complaints that were filed directly at Odense University Hospital from 2017 to 2021 were included. Proportional reporting ratios (PRRs) were used to measure and display the top five signals of disproportionality and rank them by excess complaints at the hospital level and when divided into department types. The study included 6366 complaints containing 13 156 problems (on average, 2.1 problems mentioned per complaint letter). Surgical departments had the highest number of complaints (3818), followed by medical (1059), service (439), and emergency departments (239). Signal 1 of disproportionality, relating to quality problems during ward procedures, had the highest excess reporting of 1043 complaints at the hospital level and a PRR of 1.61 and was present in all department types. Signal 2, relating to safety problems during the examination and diagnosis stage, had an excess reporting of 699 problems and a PRR of 1.86 and was also present in all department types. Signal 3, relating to institutional problems during admission, had the highest PRR of 3.54 and was found in most department types. Signals 4 and 5, relating to environmental problems during ward procedures and care on the ward, respectively, had PRRs of 1.5 and 1.84 and were present in most department types. The study found that analysing patient complaints can identify potential areas for hospital improvement. The study identified recurring issues in multiple departments, including quality problems during ward procedures, safety problems during the examination, institutional problems during admission, and environmental problems on the ward. The study highlights disproportionality analysis of complaints as a valuable tool to monitor patient concerns systematically.
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Affiliation(s)
- Søren Bie Bogh
- Research Unit OPEN, Department of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 19,3, Odense, Syddanmark 5000, Denmark
- Odense University Hospital, Region of Southern Denmark, J.B. Winsløws Vej 19,3, 5000, Denmark
| | - Søren Fryd Birkeland
- Odense University Hospital, Region of Southern Denmark, J.B. Winsløws Vej 19,3, 5000, Denmark
- Department of Regional Health Research, Faculty of Health Science, Forensic Mental Health Research Unit Middelfart (RFM), University of Southern Denmark, J.B. Winsløws Vej 19,3, Odense 5000, Denmark
- Psychiatric Department Middelfart, Mental Health Services in the Region of Southern Denmark, Østre Hougvej 70, Middelfart 5500, Denmark
| | - Sebrina Maj-Britt Hansen
- Research Unit OPEN, Department of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 19,3, Odense, Syddanmark 5000, Denmark
| | - Olga Alexandrovna Tchijevitch
- Research Unit OPEN, Department of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 19,3, Odense, Syddanmark 5000, Denmark
| | - Jesper Hallas
- Department of Clinical Pharmacology, Pharmacy and Environmental Medicine, University of Southern Denmark, J.B. Winsløws Vej 19,3, Odense, Denmark
| | - Lars Morsø
- Research Unit OPEN, Department of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 19,3, Odense, Syddanmark 5000, Denmark
- Odense University Hospital, Region of Southern Denmark, J.B. Winsløws Vej 19,3, 5000, Denmark
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Pedrosa AJ, van Munster M, Timmermann L, Pedrosa DJ. Safety perception in patients with advanced idiopathic Parkinson's disease - a qualitative study. Front Aging Neurosci 2023; 15:1200143. [PMID: 37744397 PMCID: PMC10513089 DOI: 10.3389/fnagi.2023.1200143] [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: 04/04/2023] [Accepted: 08/18/2023] [Indexed: 09/26/2023] Open
Abstract
Background A fundamental cornerstone of quality of healthcare is patient safety, which many people with life-limiting illnesses feel is being compromised. Perceptions of impaired safety are associated with the occurrence of psychological distress and healthcare utilization. However, little is known about how people with idiopathic Parkinson's disease (iPD) perceive their own safety toward the end of life. The aim of our study was therefore to investigate factors that influence the perception of safety of patients with advanced iPD. Methods We conducted semi-structured interviews with a purposeful sample of 21 patients with advanced iPD. Participants were recruited at the neurology department of a tertiary care hospital in Germany between August 2021 and June 2022. Data were analyzed using reflexive thematic analysis. Results iPD-patients reported relevant impairment of their safety. While most participants expressed safety concerns based on the manifestation of disease, our analysis identified enablers and barriers to establishing safety in patients with advanced iPD, in 10 additional domains: relationship to the disease, informedness, self-perception, utilization of support and care structures, healthcare professionals and structures, treatment, social interaction, social security, spirituality, and environment. Conclusion This study provides new insights into safety perceptions of patients with advanced iPD, which extend well beyond the physical realm. The findings suggest that clinicians and policy makers should consider a holistic and multidisciplinary approach to assessing and improving patients' safety taking into account the enablers and barriers identified in this study.
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Affiliation(s)
- Anna J. Pedrosa
- Department of Neurology, University Hospital Giessen and Marburg, Marburg, Germany
| | - Marlena van Munster
- Department of Neurology, University Hospital Giessen and Marburg, Marburg, Germany
- Department of International Health, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
| | - Lars Timmermann
- Department of Neurology, University Hospital Giessen and Marburg, Marburg, Germany
- Centre for Mind, Brain and Behaviour, Philipps-University Marburg, Marburg, Germany
| | - David J. Pedrosa
- Department of Neurology, University Hospital Giessen and Marburg, Marburg, Germany
- Centre for Mind, Brain and Behaviour, Philipps-University Marburg, Marburg, Germany
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Chirinos Muñoz MS, Orrego C, Montoya C, Sunol R. Relationship between adverse events prevalence, patient safety culture and patient safety perception in a single sample of patients: a cross-sectional and correlational study. BMJ Open 2023; 13:e060695. [PMID: 37620259 PMCID: PMC10450132 DOI: 10.1136/bmjopen-2021-060695] [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: 03/09/2022] [Accepted: 04/24/2023] [Indexed: 08/26/2023] Open
Abstract
OBJECTIVE To assess the relationship between adverse events prevalence (AEP), patient safety culture (PSC) and patient safety perception (PSP). DESIGN Cross-sectional, ex post facto comparative study on a single sample of patients. SETTING Four medium-high-level hospitals were included in the study-two public and two private from Zulia State in Venezuela. PARTICIPANTS 556 medical records and patients were studied for the prevalence and PSP study, and 397 of the healthcare providers involved in the care of these patients were surveyed for the PSC study, at two public and two private hospitals. OUTCOME MEASUREMENT The primary outcome of this study was the association between AEP, PSC and PSP, and according to hospital funding type, private and public. RESULTS An inverse association was observed between AEP and its severity and Patient Safety Culture Index (rho=-0.8, p=0.5) (95% CI 0.26-0.10) and Patient Safety Perception Index (rho=-0.6, p=0.18) (95% CI 0.10-0.28), which were protective factors for patient safety. No association was identified between PSC and PSP (rho=0.0001). No statistical differences were identified by hospital type (p=0.93) (95% CI 0.70-1.2). CONCLUSIONS The analysis of the variable correlations studied (AEP, PSC and PSP) within the same sample offers an interesting and useful perspective. In this sample, although no correlation was observed between the three variables as an interacting set, some correlation patterns were observed between pairs of variables that could guide further studies.
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Affiliation(s)
- Mónica Susana Chirinos Muñoz
- Health Sector Administration Program, University of Zulia, Maracaibo, Zulia, Bolivarian Republic of Venezuela
- Doctorate, Autonomous University of Barcelona, Barcelona, Spain
- Scientific and Humanistic Development Council of the University of Zulia, University of Zulia, Maracaibo, Zulia, Bolivarian Republic of Venezuela
| | - Carola Orrego
- Avedis Donabedian Research Institute (FAD) - Universitat Autonoma de Barcelona, Barcelona, Spain
- RICAPPS, Network for Research on Chronicity, Primary Care, and Health Promotion, Barcelona, Spain
| | - Cesar Montoya
- Data Analysis Center, Rafael Belloso Chacin University, Maracaibo, Zulia, Bolivarian Republic of Venezuela
| | - Rosa Sunol
- Avedis Donabedian Research Institute (FAD) - Universitat Autonoma de Barcelona, Barcelona, Spain
- RICAPPS, Network for Research on Chronicity, Primary Care, and Health Promotion, Barcelona, Spain
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Pedrosa Carrasco AJ, Bezmenov A, Sibelius U, Berthold D. How Safe Do Dying People Feel at Home? Patients' Perception of Safety While Receiving Specialist Community Palliative Care. Am J Hosp Palliat Care 2023; 40:829-836. [PMID: 36396608 PMCID: PMC10333965 DOI: 10.1177/10499091221140075] [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: 07/20/2023] Open
Abstract
BACKGROUND There is a research gap regarding safety concerns of patients at the end of life. The aim of this study was, therefore, to explore whether patients under specialist community palliative care feel safe at home and which factors affect the perceived safety. Furthermore, we investigated if perception of safety is associated with different aspects of subsequent care. METHODS Using a standardized questionnaire, a cross-sectional survey was conducted among 100 specialist community palliative care patients. Logistic regression was used to examine the strength of the association between clinical and socio-demographic variables and the perception of safety. After a 6-month follow-up period, we analyzed differences in various care-related outcomes between patients with unaffected and impaired perceptions of safety. RESULTS In our study, one in five patients receiving specialist community palliative care expressed safety concerns. Subdomains of safety that were reported most frequently were physical disability (60%), physical symptoms (30%), psychological symptoms (26%), and side effects/complications of drug therapy (19%). Of the participants surveyed after the initial COVID-19 lockdown, 35.1% reported that they felt their safety had been adversely affected by the pandemic. Compromised safety perception was associated with higher levels of palliative care-related problems, and proximity to death. CONCLUSIONS Our study uncovered relevant safety concerns of palliative care patients receiving specialist community palliative care. The insights gained into patient-reported problems may help healthcare professionals to identify situations where patients feel unsafe. Further research should address primary and secondary prevention measures to improve the quality of end-of-life care in the home environment.
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Affiliation(s)
- Anna J Pedrosa Carrasco
- Research Group Medical Ethics, Philipps-University Marburg, Marburg, Germany
- Department of Medical Oncology and Palliative Care, University Hospital of Giessen and Marburg, Giessen Site, Germany
| | - Alexandra Bezmenov
- Department of Medical Oncology and Palliative Care, University Hospital of Giessen and Marburg, Giessen Site, Germany
| | - Ulf Sibelius
- Department of Medical Oncology and Palliative Care, University Hospital of Giessen and Marburg, Giessen Site, Germany
| | - Daniel Berthold
- Department of Medical Oncology and Palliative Care, University Hospital of Giessen and Marburg, Giessen Site, Germany
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Espinoza Suarez NR, Hargraves I, Singh Ospina N, Sivly A, Majka A, Brito JP. Collaborative Diagnostic Conversations Between Clinicians, Patients, and Their Families: A Way to Avoid Diagnostic Errors. Mayo Clin Proc Innov Qual Outcomes 2023; 7:291-300. [PMID: 37457857 PMCID: PMC10344690 DOI: 10.1016/j.mayocpiqo.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023] Open
Abstract
Objective To identify the components of the collaborative diagnostic conversations between clinicians, patients, and their families and how deficiencies in these conversations can lead to diagnostic errors. Patients and Methods We purposively selected 60 video recordings of clinical encounters that included diagnosis conversations. These videos were obtained from the internal medicine, and family medicine services at Mayo Clinic's campus in Rochester, Minnesota. These clinical encounters were recorded between November 2017, and December 2021, during the conduct of studies aiming at developing or testing shared decision-making interventions. We followed a critically reflective approach model for data analysis. Results We identified 3 components of diagnostic conversations as follows: (1) recognizing diagnostic situations, (2) setting priorities, and (3) creating and reconciling a diagnostic plan. Deficiencies in diagnostic conversations could lead to framing issues in a way that sets diagnostic activities off in an incorrect or undesirable direction, incorrect prioritization of diagnostic concerns, and diagnostic plans of care that are not feasible, desirable, or productive. Conclusion We identified 3 clinician-and-patient diagnostic conversation components and mapped them to potential diagnostic errors. This information may inform additional research to identify areas of intervention to decrease the frequency and harm associated with diagnostic errors in clinical practice.
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Affiliation(s)
- Nataly R Espinoza Suarez
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN
| | - Ian Hargraves
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN
| | - Naykky Singh Ospina
- Division of Endocrinology, Department of Medicine, University of Florida, Gainesville, FL
| | - Angela Sivly
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN
| | - Andrew Majka
- Mayo Clinic Emeritus consultant, Mayo Clinic, Rochester, MN
| | - Juan P Brito
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN
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Barrow E, Lear RA, Morbi A, Long S, Darzi A, Mayer E, Archer S. How do hospital inpatients conceptualise patient safety? A qualitative interview study using constructivist grounded theory. BMJ Qual Saf 2023; 32:383-393. [PMID: 36198506 DOI: 10.1136/bmjqs-2022-014695] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 09/18/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Efforts to involve patients in patient safety continue to revolve around professionally derived notions of minimising clinical risk, yet evidence suggests that patients hold perspectives on patient safety that are distinct from clinicians and academics. This study aims to understand how hospital inpatients across three different specialties conceptualise patient safety and develop a conceptual model that reflects their perspectives. METHODS A qualitative semi-structured interview study was conducted with 24 inpatients across three clinical specialties (medicine for the elderly, elective surgery and maternity) at a large central London teaching hospital. An abbreviated form of constructivist grounded theory was employed to analyse interview transcripts. Constant comparative analysis and memo-writing using the clustering technique were used to develop a model of how patients conceptualise patient safety. RESULTS While some patients described patient safety using terms consistent with clinical/academic definitions, patients predominantly conceptualised patient safety in the context of what made them 'feel safe'. Patients' feelings of safety arose from a range of care experiences involving specific actors: hospital staff, the patient, their friends/family/carers, and the healthcare organisation. Four types of experiences contributed to how patients conceptualise safety: actions observed by patients; actions received by patients; actions performed by patients themselves; and shared actions involving patients and other actors in their care. CONCLUSIONS Our findings support the need for a patient safety paradigm that is meaningful to all stakeholders, incorporating what matters to patients to feel safe in hospital. Additional work should explore and test how the proposed conceptual model can be practically applied and implemented to incorporate the patient conceptualisation of patient safety into everyday clinical practice.
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Affiliation(s)
- Emily Barrow
- NIHR Imperial Patient Safety Translational Research Centre, Institute of Global Health Innovation, Imperial College London, London, UK
| | - Rachael A Lear
- NIHR Imperial Patient Safety Translational Research Centre, Institute of Global Health Innovation, Imperial College London, London, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
- Imperial College Healthcare NHS Trust, London, UK
| | - Abigail Morbi
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Susannah Long
- NIHR Imperial Patient Safety Translational Research Centre, Institute of Global Health Innovation, Imperial College London, London, UK
- Imperial College Healthcare NHS Trust, London, UK
| | - Ara Darzi
- NIHR Imperial Patient Safety Translational Research Centre, Institute of Global Health Innovation, Imperial College London, London, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Erik Mayer
- NIHR Imperial Patient Safety Translational Research Centre, Institute of Global Health Innovation, Imperial College London, London, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
- Imperial College Healthcare NHS Trust, London, UK
| | - Stephanie Archer
- NIHR Imperial Patient Safety Translational Research Centre, Institute of Global Health Innovation, Imperial College London, London, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Department of Psychology, University of Cambridge, Cambridge, UK
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21
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Morris RL, Giles S, Campbell S. Involving patients and carers in patient safety in primary care: A qualitative study of a co-designed patient safety guide. Health Expect 2023; 26:630-639. [PMID: 36645147 PMCID: PMC10010084 DOI: 10.1111/hex.13673] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 10/28/2022] [Accepted: 11/06/2022] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Involving patients is a key premise of national and international policies on patient safety, which requires understanding how patients or carers want to be involved and developing resources to support this. This paper examines patients' and carers' views of being involved in patient safety in primary care and their views of potentially using a co-designed patient safety guide for primary care (PSG-PC) to foster both involvement and their safety. METHODS A qualitative study using semistructured face-to-face interviews with 18 patients and/or carers in primary care. Interviews were transcribed and analysis was conducted using an inductive thematic approach. RESULTS Overall participants expressed enthusiasm for the PSG-PC as a tool to support patients and carers to be involved in patient safety in primary care. However, for some participants being involved in patient safety was seen as taking on the role of General Practitioner and had the potential to add an additional workload for patients. Participants' willingness or ability to be involved in patient safety was influenced by a range of factors including an invisible, often underacknowledged role of everyday safety for patients' interactions with primary care; the levels of involvement that patients wanted in their care and safety and the work of embedding the PSG-PC for patients into their routine interactions with primary care. Participants identified components of the PSG-PC that would be useful to them, in particular, if they had a responsibility for caring for a family member if they had more complex care or long-term conditions. CONCLUSION Involving patients and carers in patient safety needs a tailored and personalized approach that enables patients and carers to use resources like the PSG-PC routinely and helps challenge assumptions about their willingness and ability to be involved in patient safety. Doing so would raise awareness of opportunities to be involved in safety in line with personal preference. PATIENT OR PUBLIC CONTRIBUTION Patient and public involvement were central to the research study. This included working in partnership to develop the PSG-PC with patients and carers and throughout our study including in the design of the study, recruiting participants, interpretation of findings.
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Affiliation(s)
- Rebecca L Morris
- NIHR Greater Manchester Patient Safety Translational Research Centre, Centre for Primary Care and Health Services Research, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Sally Giles
- NIHR Greater Manchester Patient Safety Translational Research Centre, Centre for Primary Care and Health Services Research, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Stephen Campbell
- NIHR Greater Manchester Patient Safety Translational Research Centre, Centre for Primary Care and Health Services Research, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
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22
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Adams M, Hartley J, Sanford N, Heazell AE, Iedema R, Bevan C, Booker M, Treadwell M, Sandall J. Strengthening open disclosure after incidents in maternity care: a realist synthesis of international research evidence. BMC Health Serv Res 2023; 23:285. [PMID: 36973796 PMCID: PMC10041808 DOI: 10.1186/s12913-023-09033-2] [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: 03/22/2022] [Accepted: 01/04/2023] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND Open Disclosure (OD) is open and timely communication about harmful events arising from health care with those affected. It is an entitlement of service-users and an aspect of their recovery, as well as an important dimension of service safety improvement. Recently, OD in maternity care in the English National Health Service has become a pressing public issue, with policymakers promoting multiple interventions to manage the financial and reputational costs of communication failures. There is limited research to understand how OD works and its effects in different contexts. METHODS Realist literature screening, data extraction, and retroductive theorisation involving two advisory stakeholder groups. Data relevant to families, clinicians, and services were mapped to theorise the relationships between contexts, mechanisms, and outcomes. From these maps, key aspects for successful OD were identified. RESULTS After realist quality appraisal, 38 documents were included in the synthesis (22 academic, 2 training guidance, and 14 policy report). 135 explanatory accounts were identified from the included documents (with n = 41 relevant to families; n = 37 relevant to staff; and n = 37 relevant to services). These were theorised as five key mechanism sets: (a) meaningful acknowledgement of harm, (b) opportunity for family involvement in reviews and investigations, (c) possibilities for families and staff to make sense of what happened, (d) specialist skills and psychological safety of clinicians, and (e) families and staff knowing that improvements are happening. Three key contextual factors were identified: (a) the configuration of the incident (how and when identified and classified as more or less severe); (b) national or state drivers, such as polices, regulations, and schemes, designed to promote OD; and (c) the organisational context within which these these drivers are recieived and negotiated. CONCLUSIONS This is the first review to theorise how OD works, for whom, in what circumstances, and why. We identify and examine from the secondary data the five key mechanisms for successful OD and the three contextual factors that influence this. The next study stage will use interview and ethnographic data to test, deepen, or overturn our five hypothesised programme theories to explain what is required to strengthen OD in maternity services.
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Affiliation(s)
- Mary Adams
- Department of Women and Children's Health, School of Life Course and Population Sciences, King's College London, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK.
| | - Julie Hartley
- Department of Women and Children's Health, School of Life Course and Population Sciences, King's College London, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK
| | - Natalie Sanford
- The Florence Nightingale Faculty of Nursing, Midwifery, and Palliative Care, King's College London, London, UK
| | | | - Rick Iedema
- School of Life Sciences and Medicine, King's College London, London, UK
| | - Charlotte Bevan
- The Stillbirth and Neonatal Death Charity (SANDS), London, UK
| | | | | | - Jane Sandall
- Department of Women and Children's Health, School of Life Course and Population Sciences, King's College London, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK
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Bell SK, Dong ZJ, Desroches CM, Hart N, Liu S, Mahon B, Ngo LH, Thomas EJ, Bourgeois F. Partnering with patients and families living with chronic conditions to coproduce diagnostic safety through OurDX: a previsit online engagement tool. J Am Med Inform Assoc 2023; 30:692-702. [PMID: 36692204 PMCID: PMC10018262 DOI: 10.1093/jamia/ocad003] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 12/27/2022] [Accepted: 01/10/2023] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVE Patients and families are key partners in diagnosis, but methods to routinely engage them in diagnostic safety are lacking. Policy mandating patient access to electronic health information presents new opportunities. We tested a new online tool ("OurDX") that was codesigned with patients and families, to determine the types and frequencies of potential safety issues identified by patients/families with chronic health conditions and whether their contributions were integrated into the visit note. METHODS Patients/families at 2 US healthcare sites were invited to contribute, through an online previsit survey: (1) visit priorities, (2) recent medical history/symptoms, and (3) potential diagnostic concerns. Two physicians reviewed patient-reported diagnostic concerns to verify and categorize diagnostic safety opportunities (DSOs). We conducted a chart review to determine whether patient contributions were integrated into the note. We used descriptive statistics to report implementation outcomes, verification of DSOs, and chart review findings. RESULTS Participants completed OurDX reports in 7075 of 18 129 (39%) eligible pediatric subspecialty visits (site 1), and 460 of 706 (65%) eligible adult primary care visits (site 2). Among patients reporting diagnostic concerns, 63% were verified as probable DSOs. In total, probable DSOs were identified by 7.5% of pediatric and adult patients/families with underlying health conditions, respectively. The most common types of DSOs were patients/families not feeling heard; problems/delays with tests or referrals; and problems/delays with explanation or next steps. In chart review, most clinician notes included all or some patient/family priorities and patient-reported histories. CONCLUSIONS OurDX can help engage patients and families living with chronic health conditions in diagnosis. Participating patients/families identified DSOs and most of their OurDX contributions were included in the visit note.
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Affiliation(s)
- Sigall K Bell
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Zhiyong J Dong
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Catherine M Desroches
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Nicholas Hart
- Department of Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Stephen Liu
- Department of Medicine, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Brianna Mahon
- Department of Medicine, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Long H Ngo
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Eric J Thomas
- Department of Medicine, UT Houston—Memorial Hermann Center for Healthcare Quality and Safety, Houston, Texas, USA
- McGovern Medical School at the University of Texas Health Science Center, Houston, Texas, USA
| | - Fabienne Bourgeois
- Department of Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Robberechts A, Van Loon L, Steurbaut S, De Meyer GRY, De Loof H. Patient experiences and opinions on medication review: a qualitative study. Int J Clin Pharm 2023:10.1007/s11096-023-01541-9. [PMID: 36862254 DOI: 10.1007/s11096-023-01541-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 01/11/2023] [Indexed: 03/03/2023]
Abstract
BACKGROUND Medication reviews are a structured critical evaluation of a patient's pharmacotherapy, carried out by a healthcare professional, but are not yet a routine pharmaceutical service in Belgium. A pilot project to initiate an advanced medication review (= type 3 medication review) in community pharmacies was set up by the Royal Pharmacists' Association of Antwerp. AIM To investigate the experiences and opinions of patients who participated in this pilot project. METHOD Qualitative study through semi-structured interviews with participating patients. RESULTS Seventeen patients from six different pharmacies were interviewed. The medication review process with the pharmacist was perceived as positive and instructive by fifteen interviewees. The extra attention that the patient received was highly appreciated. However, the interviews revealed that patients did not fully understand the purpose and structure of this new service or were aware of the subsequent contact and feedback with the general practitioner. Medication reviews in the home setting put patients more at ease, were highly appreciated, and enabled also to address practical problems such as drug dosing or storage requirements. CONCLUSION This qualitative study analysed patients' experiences during a pilot project on the implementation of type 3 medication review. Although most patients were enthusiastic about this new service, a lack of patients' understanding of the whole process was also observed. Therefore, better communication to patients by pharmacists and general practitioners about the goals and components of this type of medication review is needed, with the added benefit of increased efficiency.
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Affiliation(s)
- Anneleen Robberechts
- Royal Pharmacists Association of Antwerp (KAVA), Consciencestraat 41, B-2018, Antwerp, Belgium. .,Laboratory of Physiopharmacology, Department of Pharmaceutical Sciences, University of Antwerp, Universiteitsplein 1, B-2610, Antwerp, Belgium. .,Research Group Clinical Pharmacology and Clinical Pharmacy, Centre for Pharmaceutical Research, Vrije Universiteit Brussel, Laarbeeklaan 103, B-1090, Brussels, Belgium.
| | - Laura Van Loon
- Laboratory of Physiopharmacology, Department of Pharmaceutical Sciences, University of Antwerp, Universiteitsplein 1, B-2610, Antwerp, Belgium
| | - Stephane Steurbaut
- Research Group Clinical Pharmacology and Clinical Pharmacy, Centre for Pharmaceutical Research, Vrije Universiteit Brussel, Laarbeeklaan 103, B-1090, Brussels, Belgium.,Department of Hospital Pharmacy, UZ Brussel, Laarbeeklaan 101, B-1090, Brussels, Belgium
| | - Guido R Y De Meyer
- Laboratory of Physiopharmacology, Department of Pharmaceutical Sciences, University of Antwerp, Universiteitsplein 1, B-2610, Antwerp, Belgium
| | - Hans De Loof
- Laboratory of Physiopharmacology, Department of Pharmaceutical Sciences, University of Antwerp, Universiteitsplein 1, B-2610, Antwerp, Belgium
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25
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Sutton E, Martin G, Eborall H, Tarrant C. Undertaking risk and relational work to manage vulnerability: Acute medical patients' involvement in patient safety in the NHS. Soc Sci Med 2023; 320:115729. [PMID: 36736055 DOI: 10.1016/j.socscimed.2023.115729] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 12/15/2022] [Accepted: 01/25/2023] [Indexed: 02/01/2023]
Abstract
Over the last decade a wealth of studies have explored the way that patients are involved in patient safety internationally. Most begin from the premise that patients can and should take on the role of identifying and reporting safety concerns. Most give little attention, however, to the impact of the patient's health status and vulnerability on their ability to participate in their safety. Drawing on qualitative interviews with 28 acute medical patients, this article aims to show how patients' contributions to their safety in the acute medical context are less about involvement as a deliberate intervention, and more about how patients manage their own vulnerability in their interactions with staff. Our analysis is underpinned by theories of vulnerability and risk. This enables us to provide a deeper understanding of how vulnerability shapes patients' involvement in their safety. Acute medical patients engage in reassurance-seeking, relational and vigilance work to manage their vulnerability. Patients undertake reassurance seeking to obtain evidence that they can trust the organisation and the professionals who work in it and relational and vigilance work to manage the vulnerability associated with dependence on others and the unpredictability of their status as acute medical patients. Patients are made responsible for speaking up about their care but simultaneously, by virtue of the expectations of the sick role and their relational vulnerability, encouraged to remain passive, compliant or silent. We show how risk frames the extent to which patients can activate their role in creating patient safety at the point of care. Foregrounding the theory of vulnerability, the concept of the sick role and the relationship of both to risk offers new insights into the potentials and limits of patient involvement in patient safety in the acute care context.
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Affiliation(s)
- E Sutton
- Department of Health Sciences, University of Leicester, UK.
| | - G Martin
- This. Institute, University of Cambridge, UK
| | | | - C Tarrant
- Department of Health Sciences, University of Leicester, UK
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Mitchell P, Cribb A, Entwistle V. Patient Safety and the Question of Dignitary Harms. THE JOURNAL OF MEDICINE AND PHILOSOPHY 2023; 48:33-49. [PMID: 36592336 PMCID: PMC9935492 DOI: 10.1093/jmp/jhac035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Patient safety is a central aspect of healthcare quality, focusing on preventable, iatrogenic harm. Harm, in this context, is typically assumed to mean physical injury to patients, often caused by technical error. However, some contributions to the patient safety literature have argued that disrespectful behavior towards patients can cause harm, even when it does not lead to physical injury. This paper investigates the nature of such dignitary harms and explores whether they should be included within the scope of patient safety as a field of practice. We argue that dignitary harms in health care are-at least sometimes-preventable, iatrogenic harms. While we caution against including dignitary harms within the scope of patient safety just because they are relevantly similar to other iatrogenic harms, we suggest that thinking about dignitary harms can help to elucidate the value of patient safety, and to illuminate the evolving relationship between safety and quality.
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Marsall M, Bäuerle A, Hasenberg T, Schräpler L, Robitzsch A, Niedergethmann M, Teufel M, Weigl M. Quality of Care Transition During Hospital Discharge, Patient Safety, and Weight Regain After Bariatric Surgery: a Cross-Sectional Study. Obes Surg 2023; 33:1143-1153. [PMID: 36773181 PMCID: PMC10079752 DOI: 10.1007/s11695-023-06486-6] [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: 11/30/2022] [Revised: 01/21/2023] [Accepted: 01/27/2023] [Indexed: 02/12/2023]
Abstract
PURPOSE Bariatric surgery is established as the gold standard in the treatment of severe obesity. However, a significant proportion of patients experience a substantial weight regain afterwards. Previous research focused predominantly on patients' personal factors. Yet, critical discharge process factors that contribute to patient's adherence after surgical interventions are rarely examined. This study investigated whether high quality of care transitions in discharge management influences weight regain and the likelihood of experiencing adverse patient safety incidents. MATERIALS AND METHODS A cross-sectional study with 578 patients after bariatric surgery was conducted. Participants answered a standardized assessment on the quality of care transition from hospital to home-, surgery-, and nutrition-related characteristics as well as patient safety incidents. RESULTS Significant weight regain was observed 24 months after surgery. The association between time since surgery and weight regain was weaker in patients with high quality of care transitions (B = 2.27, p < .001). Higher quality of care transition was also significantly related to a lower likelihood of unplanned hospital readmissions (OR = 0.67) and fewer medication complications (OR = 0.48) after surgery. CONCLUSION This study sheds first light on the key influence of high quality of care transitions after bariatric surgery. Improvement efforts into effective discharge processes may establish smoother care transitions and help patients to assume responsibility and compliance with behavioral recommendations after surgery. Moreover, adverse patient safety incidents are less frequent after high quality care transitions indicating both high quality of health services for patients and reducing costs for the health care system.
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Affiliation(s)
- Matthias Marsall
- Institute for Patient Safety (IfPS), University Hospital Bonn, 53127, Bonn, Germany.
| | - Alexander Bäuerle
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, 45147, Essen, Germany
| | - Till Hasenberg
- Helios Obesity Center West, Helios St. Elisabeth Hospital Oberhausen, Witten/Herdecke University, Helios University Hospital Wuppertal, 42283, Wuppertal, Germany
| | - Laura Schräpler
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, 45147, Essen, Germany
| | - Anita Robitzsch
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, 45147, Essen, Germany
| | - Marco Niedergethmann
- Department of Surgery, Obesity and Metabolic Surgery Center, Alfried Krupp Hospital Essen, 45131, Essen, Germany
| | - Martin Teufel
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, 45147, Essen, Germany
| | - Matthias Weigl
- Institute for Patient Safety (IfPS), University Hospital Bonn, 53127, Bonn, Germany
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28
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Mavragani A, Sandsdalen V, Manskow US, Småbrekke L, Waaseth M. Internet Use for Obtaining Medicine Information: Cross-sectional Survey. JMIR Form Res 2023; 7:e40466. [PMID: 36729577 PMCID: PMC9936360 DOI: 10.2196/40466] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 12/23/2022] [Accepted: 12/27/2022] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND The internet is increasingly being used as a source of medicine-related information. People want information to facilitate decision-making and self-management, and they tend to prefer the internet for ease of access. However, it is widely acknowledged that the quality of web-based information varies. Poor interpretation of medicine information can lead to anxiety and poor adherence to drug therapy. It is therefore important to understand how people search, select, and trust medicine information. OBJECTIVE The objectives of this study were to establish the extent of internet use for seeking medicine information among Norwegian pharmacy customers, analyze factors associated with internet use, and investigate the level of trust in different sources and websites. METHODS This is a cross-sectional study with a convenience sample of pharmacy customers recruited from all but one community pharmacy in Tromsø, a medium size municipality in Norway (77,000 inhabitants). Persons (aged ≥16 years) able to complete a questionnaire in Norwegian were asked to participate in the study. The recruitment took place in September and October 2020. Due to COVID-19 restrictions, social media was also used to recruit medicine users. RESULTS A total of 303 respondents reported which sources they used to obtain information about their medicines (both prescription and over the counter) and to what extent they trusted these sources. A total of 125 (41.3%) respondents used the internet for medicine information, and the only factor associated with internet use was age. The odds of using the internet declined by 5% per year of age (odds ratio 0.95, 95% CI 0.94-0.97; P=.048). We found no association between internet use and gender, level of education, or regular medicine use. The main purpose reported for using the internet was to obtain information about side effects. Other main sources of medicine information were physicians (n=191, 63%), pharmacy personnel (n=142, 47%), and medication package leaflets (n=124, 42%), while 36 (12%) respondents did not obtain medicine information from any sources. Note that 272 (91%) respondents trusted health professionals as a source of medicine information, whereas 58 (46%) respondents who used the internet trusted the information they found on the internet. The most reliable websites were the national health portals and other official health information sites. CONCLUSIONS Norwegian pharmacy customers use the internet as a source of medicine information, but most still obtain medicine information from health professionals and packet leaflets. People are aware of the potential for misinformation on websites, and they mainly trust high-quality sites run by health authorities.
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Affiliation(s)
| | - Vilde Sandsdalen
- Department of Pharmacy, UiT The Artic University of Norway, Tromsø, Norway
| | - Unn Sollid Manskow
- Norwegian Centre for E-health Research, University Hospital of North Norway, Tromsø, Norway
| | - Lars Småbrekke
- Department of Pharmacy, UiT The Artic University of Norway, Tromsø, Norway
| | - Marit Waaseth
- Department of Pharmacy, UiT The Artic University of Norway, Tromsø, Norway
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Investigating the Mediating Effect of Patient Self-Efficacy on the Relationship between Patient Safety Engagement and Patient Safety in Healthcare Professionals. JOURNAL OF HEALTHCARE ENGINEERING 2023; 2023:8934444. [PMID: 36865682 PMCID: PMC9974308 DOI: 10.1155/2023/8934444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 07/25/2022] [Accepted: 11/24/2022] [Indexed: 02/23/2023]
Abstract
Patient safety and involvement of the patients in their safety engagement activities are considered the most important elements in the healthcare professions due to their impact on various individual and organizational outcomes. The study used responses of 456 patients. The simple random sampling (SRS) technique was used to collect data from the respondents. The researcher used individuals as the unit of analysis in this study. The results revealed that patient safety engagement had a positive significant effect on patient safety. When the mediating variable of self-efficacy was analyzed, it showed a significant mediated effect on patient safety. Therefore, it was concluded that self-efficacy mediated the relationship between patient safety engagement and patient safety. The findings of the current study convey that engagement of the patient in the practices for patient safety is predicted through the level of self-efficacy of the patient. The study discussed various implications for theory and practice. The study also discussed potential avenues for future research.
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Sarkhosh S, Abdi Z, Ravaghi H. Engaging patients in patient safety: a qualitative study examining healthcare managers and providers' perspectives. BMC Nurs 2022; 21:374. [PMID: 36581873 PMCID: PMC9801597 DOI: 10.1186/s12912-022-01152-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 12/19/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Patients can play an essential role in improving patient safety by becoming actively involved in their health care. The present study aimed to qualitatively explore healthcare providers' (HCPs) and managers' perceptions on patient participation in patient safety processes. METHODS This qualitative study carried out in three teaching hospitals in Tehran, Iran. The data were collected through semi-structured interviews with 31 HCPs and managers working at public teaching hospitals, medical universities and the Ministry of Health. The data were analyzed using thematic analysis. RESULTS Three main themes and 21 sub-themes emerged from the interviews. Participants believed that patients and their families can play an effective role in maintaining and improving patient safety through different roles. However, a variety of barriers were identified at patients, providers, and system levels hindering patient participation in delivering safe care. CONCLUSION The participants identified facilitators and barriers to patient engagement in safety-orientated activities at multiple patients, providers, and system levels, indicating that complex, multifaceted initiatives must be designed to address the issue. This study encourages further research to enhance the understating of the problems and solutions to patient involvement in safety initiatives in the Iranian healthcare setting.
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Affiliation(s)
- Samaneh Sarkhosh
- grid.411746.10000 0004 4911 7066Master of Health Services Administration, School of Health Management and Information Sciences, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Zhaleh Abdi
- grid.411705.60000 0001 0166 0922National Institute of Health Research (NIHR), Tehran University of Medical Sciences, Tehran (TUMS), Tehran, Iran
| | - Hamid Ravaghi
- grid.411746.10000 0004 4911 7066School of Health Management and Information Sciences, Iran University of Medical Sciences (IUMS), No. 6, Rashid Yasemi St. Vali-E-Asr Ave, P.O Box: 1996713883, Tehran, Iran
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Villar VCFL, Martins M, Rabello ET. Qualidade do cuidado e segurança do paciente: o papel dos pacientes e familiares. SAÚDE EM DEBATE 2022. [DOI: 10.1590/0103-1104202213516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
RESUMO Este ensaio procurou discutir o papel dos pacientes e das famílias na qualidade dos cuidados e na segurança do paciente. Tradicionalmente, o papel dos profissionais de saúde – especialmente, dos médicos – tem sido predominante na discussão e na definição do que constitui um cuidado de saúde de alta qualidade. Entretanto, outros atores foram reconhecidos no debate contemporâneo sobre a qualidade do atendimento e, em particular, sobre a segurança do paciente e a centralidade do atendimento. O papel dos pacientes na qualidade do atendimento e até mesmo o seu protagonismo na identificação dos principais problemas presentes na prestação de cuidados e em como contribuir para um atendimento mais seguro são destacados. Inicialmente, discute-se o papel dos pacientes e seus familiares na qualidade do atendimento e na segurança do paciente. Em seguida, são discutidos os fatores que influenciam e dificultam a sua participação. Finalmente, são propostas estratégias para aumentar a participação dos pacientes. Pacientes e familiares podem desempenhar um papel essencial na melhoria da qualidade dos cuidados de saúde e da segurança do paciente. Entretanto, eles devem estar ativamente envolvidos para que isso ocorra, com suas contribuições consideradas em um ambiente favorável a uma cultura de segurança justa.
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Malathi A, Jasim K. Validating the relationship between service quality, patient sensitivity and experience towards medical applications using SERVQUAL. Int J Med Inform 2022; 168:104883. [DOI: 10.1016/j.ijmedinf.2022.104883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 09/26/2022] [Accepted: 09/29/2022] [Indexed: 11/07/2022]
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BELL SIGALLK, BOURGEOIS FABIENNE, DONG JOE, GILLESPIE ALEX, NGO LONGH, READER TOMW, THOMAS ERICJ, DESROCHES CATHERINEM. Patient Identification of Diagnostic Safety Blindspots and Participation in "Good Catches" Through Shared Visit Notes. Milbank Q 2022; 100:1121-1165. [PMID: 36539389 PMCID: PMC9836247 DOI: 10.1111/1468-0009.12593] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 06/03/2022] [Accepted: 06/30/2022] [Indexed: 12/24/2022] Open
Abstract
Policy Points Patients and families can identify clinically relevant errors, including "blindspots"-safety hazards that are difficult for clinicians or organizations to see. Health information transparency, including patient access to electronic visit notes, now federally mandated in the US and the subject of policy debate worldwide, creates a new opportunity to engage patients in diagnostic safety. However, not all patients access notes. Patient identification of blindspots in their notes underscores the need to systematically and equitably engage willing patients in safety, promote patient "good catches," and establish routine systems for patient feedback to help avoid preventable diagnostic errors and delays. CONTEXT Policy shifts toward health information transparency provide a new opportunity for patients to contribute to diagnostic safety. We investigated whether sharing clinical notes with patients can support identification of "diagnostic safety blindspots"-potentially consequential breakdowns in the diagnostic process that may be difficult for clinical staff to observe. METHOD We used mixed methods to analyze patient-reported ambulatory documentation errors among 22,889 patients at three US health care centers who read ≥ 1 visit note(s). We identified blindspots by tailoring a previously established taxonomy. We used multiple regression analysis to identify factors associated with blindspot identification. FINDINGS 774 patients reported a total of 962 blindspots in 4 categories: (1) diagnostic misalignments (n = 421, 43.8%), including inaccurate symptoms or histories and failures or delay in diagnosis; (2) errors of omission (38.1%) including missed main concerns or next steps, and failure to listen to patients; (3) problems occurring outside visits (14.3%) such as tests, referrals, or appointment access; and (4) multiple low-level problems (3.7%) cascading into diagnostic breakdowns. Many patients acted on the blindspots they identified, resulting in "good catches" that may prevent potential negative consequences. Older, female, sicker, unemployed or disabled patients, or those who work in health care were more likely to identify a blindspot. Individuals reporting less formal education; those self-identifying as Black, Asian, other, or multiple races; and participants who deferred decision-making to providers were less likely to report a blindspot. CONCLUSION Patients who read notes have unique insight about potential errors in their medical records that could impact diagnostic reasoning but may not be known to clinicians-underscoring a critical role for patients in diagnostic safety and organizational learning. From a policy standpoint, organizations should encourage patient review of visit notes, build systems to track patient-reported blindspots, and promote equity in note access and blindspot reporting.
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Affiliation(s)
- SIGALL K. BELL
- Beth Israel Deaconess Medical Center
- Harvard Medical School
| | | | - JOE DONG
- Beth Israel Deaconess Medical Center
| | | | - LONG H. NGO
- Beth Israel Deaconess Medical Center
- Harvard Medical School
- Harvard T.H. Chan School of Public Health
| | | | - ERIC J. THOMAS
- The University of Texas ‐ Memorial Hermann Center for Healthcare Quality and Safety
- McGovern Medical School at the University of Texas Health Science Center
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O’Connor L, McAuliffe E, Casey M, Rogers L, Gallen A, Finnegan L, Glasgow ME, White M, White C, Kavanagh P, Bell M, Killeen A, Barnard M. Operationalising a modified Delphi study to progress quality care process nursing metrics for acute care. J Res Nurs 2022; 27:655-676. [PMID: 36405804 PMCID: PMC9669935 DOI: 10.1177/17449871211021138] [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: 11/03/2023] Open
Abstract
Background Despite representing the largest occupational group within the healthcare workforce, evidence suggests that due to the complexity of nursing practice, nurses' contribution remains 'invisible'. Quality Care Metrics aligned to standards can offer valuable numerical information that quantify input, output and dimensions of nursing care processes in complex clinical and interprofessional milieus. Aims and objectives Progress an evidence-based metric system to measure the quality and clinical safety of nursing care within acute care in Ireland. The objectives were to: classify quality care process nursing metrics and corresponding indicators pertinent to acute care; reach agreement on a selected set of robust metrics and corresponding indicators; and implement the findings of the study. Design A modified four-round Delphi study. Methods The modified Delphi study integrated a four-round survey of 422 nurses, face-to-face meetings with a patient representative and key stakeholders within acute services with a final consensus meeting inclusive of a panel of 26 expert nurse clinicians. Results There was consensus on 11 quality care process nursing metrics and 53 corresponding indicators for the acute care setting. Despite the rating of 'critical' in the Delphi rounds, a concern was reported by participants on the subjective nature of three of the developed metrics: 'patient experience', 'patient engagement' and 'professional and ethical approach to care' based on the absence of objective measurement tools that include patient input. Conversely, this led to the conundrum for the panel of experts at the final consensus meeting who were divided in their views on objectively observing, recording and subsequent auditing of those three developed metrics in real-time clinical practice. Conclusion This paper describes the operationalisation of a modified Delphi technique that progressed a set of 11 quality care process metrics and 53 corresponding indicators. The challenge now is the implementation of these quality care process metrics so that nurses' contribution to patient-centred care is tangible in acute care.
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Affiliation(s)
- Laserina O’Connor
- Professor, UCD School of Nursing Midwifery
& Health Systems, University College Dublin, Ireland
| | - Eilish McAuliffe
- Full Professor, UCD School of Nursing Midwifery
& Health Systems, University College Dublin, Ireland
| | - Mary Casey
- Associate Professor, UCD School of Nursing
Midwifery & Health Systems, University College Dublin, Ireland
| | - Lisa Rogers
- Lecturer, UCD School of Nursing Midwifery &
Health Systems, University College Dublin, Ireland
| | - Anne Gallen
- Director, Nursing & Midwifery Planning
Development Unit, Health Service Executive, Ireland
| | - Leonie Finnegan
- Quality Care Metrics Project Officer, Nursing
& Midwifery Planning Development Unit, Health Service Executive,
Ireland
| | | | - Mark White
- Vice-President, Department of Nursing,
Waterford Institute of Technology, Ireland
| | - Ciara White
- Assistant Lecturer, School of Nursing,
Psychotherapy, and Community Health, Dublin City University, Ireland
| | - Paula Kavanagh
- Quality care Metrics Project Officer, Nursing
& Midwifery Planning Development Unit, Health Service Executive,
Ireland
| | - Miriam Bell
- Quality Care Metrics Project Officer, Nursing
& Midwifery Planning Development Unit, Health Service Executive,
Ireland
| | - Angela Killeen
- Quality Care Metrics Project Officer, Nursing
& Midwifery Planning Development Unit, Health Service Executive,
Ireland
| | - Marlize Barnard
- Research Assistant, UCD School of Nursing
Midwifery & Health Systems, University College Dublin, Ireland
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Foster C, Kaat AJ, Shaunfield S, Lin E, Coleman C, Storey M, Morales L, Davis MM. PediHome: Development of a Family-Reported Measure of Pediatric Home Healthcare Quality. Acad Pediatr 2022; 22:1510-1519. [PMID: 35439604 DOI: 10.1016/j.acap.2022.04.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 03/11/2022] [Accepted: 04/08/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVE No validated tools exist to measure pediatric home healthcare quality. The objective of this work was to develop a family-reported survey (PediHome) to measure the quality of home healthcare for children with medical complexity (CMC). METHODS A national multidisciplinary expert panel (N = 19) was convened to develop survey content domains. Panelist were joined by 3 additional experts to rank candidate survey items for importance and evaluate relevance and structure. Cognitive interviews were conducted with English-speaking (n = 12) and Spanish-speaking (n = 4) family caregivers of CMC to revise problematic items and clarify response options. A cross-sectional survey was then fielded (6/1/20-10/31/20) to parents whose children receive healthcare at 2 regional academic medical centers. RESULTS The final measure included N = 28 total items with 4 items quantifying access, 1 evaluating overall quality rating, and 21 items assessing provider tasks (11 home nursing only, 2 certified nursing assistant/home health aide only, and 1 dual). Out of 312 caregivers of CMC, 142 (46%) responded and one-half (n = 68, 48%) reported a child receiving home nursing. They received a weekly median of 58.4% (IQR ±31.2%) of approved nursing hours with 55% reporting a missed nursing shift within the last month. Median overall quality was 75-9 (0-10 scale) and median scores on specific quality items ranged from 31-4 to 43-4 (0-4 scale). CONCLUSIONS PediHome is a new content-valid family-reported measure of home healthcare quality for CMC that is useful for evaluating healthcare quality across several domains. Future work will involve assessing PediHome's construct and predictive validity.
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Affiliation(s)
- Carolyn Foster
- Division of Advanced General Pediatrics and Primary Care, Department of Pediatrics (C Foster and MM Davis), Northwestern University Feinberg School of Medicine, Chicago, Ill; Mary Ann & J. Milburn Smith Child Health Outcomes, Research, and Evaluation Center (C Foster and MM Davis), Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Ill.
| | - Aaron J Kaat
- Department of Medical Social Sciences (AJ Kaat, S Shaunfield, L Morales and MM Davis), Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Sara Shaunfield
- Department of Medical Social Sciences (AJ Kaat, S Shaunfield, L Morales and MM Davis), Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Elaine Lin
- Division of General Pediatrics, Department of Pediatrics (E Lin), Icahn School of Medicine at Mount Sinai, New York, NY
| | - Cara Coleman
- Family Voices National (C Coleman), Lexington, Mass
| | - Margaret Storey
- Ann & Robert H. Lurie Children's Hospital of Chicago Family Advisory Board (M Storey), Chicago, Ill
| | - Luis Morales
- Department of Medical Social Sciences (AJ Kaat, S Shaunfield, L Morales and MM Davis), Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Matthew M Davis
- Division of Advanced General Pediatrics and Primary Care, Department of Pediatrics (C Foster and MM Davis), Northwestern University Feinberg School of Medicine, Chicago, Ill; Mary Ann & J. Milburn Smith Child Health Outcomes, Research, and Evaluation Center (C Foster and MM Davis), Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Ill; Department of Medical Social Sciences (AJ Kaat, S Shaunfield, L Morales and MM Davis), Northwestern University Feinberg School of Medicine, Chicago, Ill; Departments of Medicine and Preventive Medicine, Northwestern University Feinberg School of Medicine (MM Davis), Chicago, Ill
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Schmiedhofer M, Derksen C, Dietl JE, Haeussler F, Strametz R, Huener B, Lippke S. The Impact of a Communication Training on the Birth Experience: Qualitative Interviews with Mothers after Giving Birth at Obstetric University Departments in Germany. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11481. [PMID: 36141754 PMCID: PMC9517065 DOI: 10.3390/ijerph191811481] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 09/04/2022] [Accepted: 09/05/2022] [Indexed: 05/27/2023]
Abstract
(1) Background: Patient safety is a pressing issue in healthcare. Besides economical and organizational issues, human factors play a crucial role in providing safe care. Safe and clear communication on both the healthcare workers' and patients' sides contribute to the avoidance of medical errors and increase patients' and healthcare workers' satisfaction. Globally, the incidence of experiencing at least one adverse event in obstetrics is about 10%, of which half are classified as preventable. According to international research, improving communication skills may decrease preventable adverse events. The research question was to what extent communication training for pregnant women impacts the quality of communication and mutual understanding during birth. (2) Methods: Communication interventions with pregnant women were conducted in two German university obstetric departments in a mixed methods research design, based on the Health Action Process Approach. The online classes covered the awareness of personal wishes, the understanding and usage of communication strategies, self-efficacy and empathy. This study presents the qualitative results. Out of 142 mothers who answered two questionnaires before the communication training and after the birth, 24 in-depth semistructured interviews were conducted to explore the subjective impact of the communication training. The results were analyzed with qualitative content analysis. (3) Results: The majority of participants felt incentivized to be aware of their personal wishes for birth and to express them. Perceived positive experiences with sufficient competency in communication, empathy and mutual understanding outweighed negative treatments and experiences in the hospital, some of which could be attributed to structural problems. (4) Discussion: The reported positive effects of the communication training underline the need but also the potential for communication lessons to reflect and improve communication skills in obstetrics. However, negative experiences due to structural problems in the healthcare system may be buffered by communication skills but not solved.
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Affiliation(s)
- Martina Schmiedhofer
- German Coalition for Patient Safety (Aktionsbündnis Patientensicherheit), 10179 Berlin, Germany
- Department of Psychology & Methods, Jacobs University Bremen GmbH, 28759 Bremen, Germany
| | - Christina Derksen
- Department of Psychology & Methods, Jacobs University Bremen GmbH, 28759 Bremen, Germany
| | - Johanna Elisa Dietl
- German Coalition for Patient Safety (Aktionsbündnis Patientensicherheit), 10179 Berlin, Germany
- Department of Psychology & Methods, Jacobs University Bremen GmbH, 28759 Bremen, Germany
| | - Freya Haeussler
- German Coalition for Patient Safety (Aktionsbündnis Patientensicherheit), 10179 Berlin, Germany
| | - Reinhard Strametz
- German Coalition for Patient Safety (Aktionsbündnis Patientensicherheit), 10179 Berlin, Germany
- Wiesbaden Business School, Rhein Main University of Applied Science, 65183 Wiesbaden, Germany
| | - Beate Huener
- Department of Gynecology and Obstetrics, University Hospital Ulm, 89070 Ulm, Germany
| | - Sonia Lippke
- Department of Psychology & Methods, Jacobs University Bremen GmbH, 28759 Bremen, Germany
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Lee NJ, Ahn S, Lee M. The effects of a mobile application for patient participation to improve patient safety. Health Expect 2022; 25:1601-1618. [PMID: 35543141 PMCID: PMC9327837 DOI: 10.1111/hex.13503] [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: 08/26/2021] [Revised: 04/01/2022] [Accepted: 04/06/2022] [Indexed: 11/29/2022] Open
Abstract
Background Patient participation in patient safety activities in care processes is a fundamental element of safer care. Patients play an important role in preventing patient safety incidents and improving health outcomes. Therefore, healthcare providers need to develop and provide educational materials and actionable tools for patient participation. Objectives This study aimed to develop a mobile application for health consumers' participation and evaluate the effect of the mobile application on improving health consumers' participation in patient safety. Methods A quasi‐experimental design was adopted. We developed a mobile application on the basis of a needs assessment, literature review, compilation of patient safety topics, and validity testing of the application. The target population included Korean adults aged between 30 and 65 years who had visited a medical institution more than once within the most recent 6 months. The intervention group received patient participation training by using the mobile application, Application for Patient Participation in Safety Enhancement, for 2 months. The primary outcome variables were patient safety knowledge, self‐efficacy of participation, willingness to participate and experience of patient participation in patient safety activities. End‐user satisfaction was assessed using a questionnaire. To assess participants' experiences with the intervention, qualitative data were collected through a focus group interview and open‐ended responses to an end‐user satisfaction survey. Results The intervention group (n = 60) had significantly higher overall average scores than the control group (n = 37) with regard to patient safety knowledge (p < .001), self‐efficacy of participation (p = .001), willingness to participate (p = .010) and experience of participation (p = .038) in the post‐survey. The total mean end‐user satisfaction score was 3.56 ± 0.60. The participants expressed the realization that patients could play an important role in improving patient safety. Conclusions This study demonstrated that educating health consumers through a mobile application with useful information improves patient participation in patient safety activities. Educational materials and patient participation tools could motivate health consumers' health‐related behaviours. Patient or Public Contribution Patients were involved during the programme development and evaluation.
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Affiliation(s)
- Nam-Ju Lee
- College of Nursing, Seoul National University, Seoul, South Korea.,The Research Institute of Nursing Science, Seoul National University, Seoul, South Korea
| | - Shinae Ahn
- Department of Nursing, Wonkwang University, Jeonbuk, South Korea
| | - Miseon Lee
- College of Nursing, Seoul National University, Seoul, South Korea
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McQueen JM, Gibson KR, Manson M, Francis M. Adverse event reviews in healthcare: what matters to patients and their family? A qualitative study exploring the perspective of patients and family. BMJ Open 2022; 12:e060158. [PMID: 35534075 PMCID: PMC9086600 DOI: 10.1136/bmjopen-2021-060158] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 04/06/2022] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES Explore what 'good' patient and family involvement in healthcare adverse event reviews may involve. DESIGN Data was collected using semi-structured telephone interviews. Interview transcripts were analysed using an inductive thematic approach. SETTING NHS Scotland. PARTICIPANTS 19 interviews were conducted with patients who had experienced an adverse event during the provision of their healthcare or their family member. RESULTS Four key themes were derived from these interviews: trauma, communication, learning and litigation. CONCLUSIONS There are many advantages of actively involving patients and their families in adverse event reviews. An open, collaborative, person-centred approach which listens to, and involves, patients and their families is perceived to lead to improved outcomes. For the patient and their family, it can help with reconciliation following a traumatic event and help restore their faith in the healthcare system. For the health service, listening and involving people will likely enhance learning with subsequent improvements in healthcare provision with reduction in risk of similar events occurring for other patients. This study suggests eight recommendations for involving patients and families in adverse event reviews using the APICCTHS model (table 3) which includes an apology, person-centred inclusive communication, closing the loop, timeliness, putting patients and families at the heart of the review with appropriate support for staff involved. Communicating in a compassionate manner could also decrease litigation claims following an adverse event.
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Affiliation(s)
- Jean M McQueen
- Person Centred Care, NHS Education for Scotland West Region, Glasgow, UK
| | - Kyle R Gibson
- Intensive Care, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Moira Manson
- Assurance, Healthcare Improvement Scotland, Glasgow, UK
| | - Morag Francis
- Assurance, Healthcare Improvement Scotland, Edinburgh, UK
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Assiri GA, Alanazi BM, AlRuthia Y. The Prevalence of High-Risk Prescribing of Oral Non-Steroidal Anti-Inflammatory Drugs in Primary Healthcare: A Single-Centre Retrospective Chart Review Study. Healthcare (Basel) 2022; 10:healthcare10050867. [PMID: 35628004 PMCID: PMC9142064 DOI: 10.3390/healthcare10050867] [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: 02/24/2022] [Revised: 04/28/2022] [Accepted: 05/05/2022] [Indexed: 12/04/2022] Open
Abstract
The quality and safety of prescribed drugs can be assessed using prescribing safety indicators (PSIs). This study aimed to estimate the prevalence of PSIs of oral non-steroidal anti-inflammatory drugs (NSAIDs) at primary care clinics of a tertiary care hospital in Saudi Arabia and to identify the risk factors associated with positive PSIs for patients. In this retrospective chart review study, data from the medical records of 450 patients aged ≥18 years, who were prescribed oral NSAIDs, were reviewed and collected manually. Seven PSIs were chosen and defined as follows: prescription of an oral NSAID to any patient with a peptic ulcer; aged ≥75 years; aged ≥65 years with a glomerular filtration rate <60; heart failure; co-prescribed warfarin; co-prescribed aspirin or clopidogrel; or co-prescribed angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker and a diuretic. Patients with positive indicators are at risk of harm from high-risk prescribing. The overall period prevalence of PSIs is 153/450 (34%; 95% CI 29.60−38.39). The overall proportion of PSIs is 202/431 (46.9%; 95% CI 42.12−51.61). The most common safety indicators were for NSAIDs prescribed to patients with heart failure and patients aged ≥65 years with a glomerular filtration rate <60. The elderly and patients using polypharmacy are at increased risk of having at least one positive PSI (OR 5.22; 95% CI 3.32−8.21, p-value < 0.001 and OR 2.97; 95% CI 1.17−7.55, p-value 0.022, respectively). Patients at risk of harm from high-risk NSAID prescriptions are common in primary care. The elderly and patients on polypharmacy are at increased risk of having at least one positive PSI. Therefore, when NSAIDs are prescribed, it is recommended to weigh the benefits versus the risks for high-risk patients, such as the elderly and those with multiple-drug therapy.
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Abstract
Providers and health systems should use ethnic differences in risk of harm from healthcare to reimagine their role in reducing health inequalities, write Cian Wade and colleagues
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Affiliation(s)
- Cian Wade
- NHS England and NHS Improvement, London, UK
- Harvard T H Chan School of Public Health, Boston, MA, USA
| | | | | | - Charles Vincent
- Department of Experimental Psychology, University of Oxford, UK
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Brierley-Jones L, Ramsey L, Canvin K, Kendal S, Baker J. To what extent are patients involved in researching safety in acute mental healthcare? RESEARCH INVOLVEMENT AND ENGAGEMENT 2022; 8:8. [PMID: 35227330 PMCID: PMC8886877 DOI: 10.1186/s40900-022-00337-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 01/20/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND There is a growing need to involve patients in the development of patient safety interventions. Mental health services, despite their strong history of patient involvement, have been slow to develop patient safety interventions, particularly in inpatient settings. METHODS A systematic search was undertaken of both academic and grey literature. Whilst no lay member of the team worked directly on the review, they were part of the project steering group which provided oversight throughout the review process. This included people with lived experience of mental health services. From a research perspective the main focus for lay members was in co-producing the digital technology, the key project output. Smits et al.'s (Res Involv Engagem 6:1-30, 2020) Involvement Matrix was used to taxonomise levels of patient involvement. Studies were included if they were set in any inpatient mental health care context regardless of design. The quality of all selected studies was appraised using Mixed Methods Appraisal Methodology (MMAT). RESULTS Fifty-two studies were classified, synthesised and their levels of patient involvement in the research and development of patient safety interventions were taxonomised. Almost two-thirds of studies (n = 33) researched reducing restrictive practices. Only four studies reported engaging patients in the research process as decision-makers, with the remaining studies divided almost equally between engaging patients in the research process as partners, advisors and co-thinkers. Just under half of all studies engaged patients in just one stage of the research process. CONCLUSION Involvement of patients in researching patient safety and developing interventions in an inpatient mental health context seems diverse in its nature. Researchers need to both more fully consider and better describe their approaches to involving patients in safety research in inpatient mental health. Doing so will likely lead to the development of higher quality safety interventions.
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Affiliation(s)
| | - Lauren Ramsey
- Yorkshire Quality and Safety Research Group, Bradford Institute for Health Research, Bradford, UK
| | | | - Sarah Kendal
- School of Healthcare, University of Leeds, Leeds, UK
| | - John Baker
- School of Healthcare, University of Leeds, Leeds, UK.
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Madden C, Lydon S, O'Dowd E, Murphy AW, O'Connor P. A Systematic Review of Patient-Report Safety Climate Measures in Health Care. J Patient Saf 2022; 18:e51-e60. [PMID: 32345810 DOI: 10.1097/pts.0000000000000705] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Patients are a valuable, yet underutilized source of information for safety measurement and improvement in health care. The aim of this review was to identify patient-report safety climate (SC) measures described in the literature, analyze the included items to consider their alignment with previously established SC domains, evaluate their validity and reliability, and make recommendations for best practice in using patient-report measures of SC in health care. METHODS Searches were conducted, with no limit on publication year, using MEDLINE, EMBASE, CINAHL, PsycINFO, and Academic Search Complete in November 2019. Reference lists of included studies and existing reviews were also screened. English-language, peer-reviewed studies that described the development or use of a patient-report measure to assess SC in health care were included. Two researchers independently extracted data from studies and applied a quality appraisal tool. RESULTS A total of 5060 studies were screened, with 44 included. Included studies described 31 different SC measures. There was much variability in the coverage of SC domains across included measures. Poor measure quality was marked by inadequacies in the testing and reporting of validity and reliability. There was also a lack of usability testing among measures. CONCLUSIONS This review identified the extant patient-reported SC measures in health care and demonstrated significant variance in their coverage of SC domains, validity and reliability, and usability. Findings suggest a pressing need for a stand-alone measure that has a high validity and reliability, and assess core SC domains from the patient perspective, particularly in primary care.
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Wray J, Williams C, Oldham G. Testing the Healthcare Complaints Analysis Tool in a Specialist Pediatric Hospital to Assess Potential Utility for Organizational Learning from Complaints. J Patient Exp 2022; 9:23743735221106594. [PMID: 35734468 PMCID: PMC9208030 DOI: 10.1177/23743735221106594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
The importance of improving the analysis of complaints about poor healthcare experiences is recognized but often not addressed. We explored the utility of the Healthcare Complaints Assessment Tool for analyzing written complaints in a specialist pediatric hospital receiving relatively few, but complex, complaints. The scoring framework could be applied but, in contrast to previous work, the complexity of complaints was considerably greater. Responses to the complainant were also scored and we identified instances of both higher and lower levels of severity than identified by the complainant, suggesting a novel application of the tool which will be important for institutional learning.
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Affiliation(s)
- Jo Wray
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- Centre for Outcomes and Experience Research in Children’s Health, Illness and Disability, London, UK
| | - Claire Williams
- Patient Experience and Engagement, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Geralyn Oldham
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
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Hardicre N, Murray J, Shannon R, Sheard L, Birks Y, Hughes L, Cracknell A, Lawton R. Doing involvement: A qualitative study exploring the 'work' of involvement enacted by older people and their carers during transition from hospital to home. Health Expect 2021; 24:1936-1947. [PMID: 34599866 PMCID: PMC8628582 DOI: 10.1111/hex.13327] [Citation(s) in RCA: 9] [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: 02/05/2021] [Revised: 07/02/2021] [Accepted: 07/09/2021] [Indexed: 12/11/2022] Open
Abstract
CONTEXT Being involved in one's care is prioritised within UK healthcare policy to improve care quality and safety. However, research suggests that many older people struggle with this. DESIGN We present focused ethnographic research exploring older peoples' involvement in healthcare from hospital to home. RESULTS We propose that being involved in care is a dynamic form of labour, which we call 'involvement work' (IW). In hospital, many patients 'entrust' IW to others; indeed, when desired, maintaining control, or being actively involved, was challenging. Patient and professionals' expectations, alongside hospital processes, promoted delegation; staff frequently did IW on patients' behalf. Many people wanted to resume IW postdischarge, but struggled because they were out of practice. DISCUSSION Preference and capacity for involvement was dynamic, fluctuating over time, according to context and resource accessibility. The challenges of resuming IW were frequently underestimated by patients and care providers, increasing dependence on others post-discharge and negatively affecting peoples' sense and experience of (in)dependence. CONCLUSIONS A balance needs to be struck between respecting peoples' desire/capacity for non-involvement in hospital while recognising that 'delegating' IW can be detrimental. Increasing involvement will require patient and staff roles to be reframed, though this must be done acknowledging the limits of patient desire, capability,and resources. Hospital work should be (re)organised to maximise involvement where possible and desired. PATIENT/PUBLIC CONTRIBUTION Our Patient and Public Involvement and Engagement Panel contributed to research design, especially developing interview guides and patient-facing documentation. Patients were key participants within the study; it is their experiences represented.
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Affiliation(s)
- Natasha Hardicre
- Yorkshire Quality and Safety Research Group, Bradford Institute for Health Research, Temple Bank HouseBradford Royal InfirmaryBradfordUK
- School of Health and Community StudiesLeeds Beckett UniversityLeedsUK
| | - Jenni Murray
- Yorkshire Quality and Safety Research Group, Bradford Institute for Health Research, Temple Bank HouseBradford Royal InfirmaryBradfordUK
| | - Rosie Shannon
- Yorkshire Quality and Safety Research Group, Bradford Institute for Health Research, Temple Bank HouseBradford Royal InfirmaryBradfordUK
| | - Laura Sheard
- Yorkshire Quality and Safety Research Group, Bradford Institute for Health Research, Temple Bank HouseBradford Royal InfirmaryBradfordUK
- Present address:
Laura Sheard, Department of Health SciencesUniversity of YorkYorkUK
| | - Yvonne Birks
- Social Policy Research UnitUniversity of YorkYorkUK
| | - Lesley Hughes
- Yorkshire Quality and Safety Research Group, Bradford Institute for Health Research, Temple Bank HouseBradford Royal InfirmaryBradfordUK
| | - Alison Cracknell
- Leeds Centre for Older People's Medicine, St James' University HospitalLeeds Teaching Hospitals NHS TrustLeedsUK
| | - Rebecca Lawton
- School of Psychology, Faculty of Medicine and HealthUniversity of LeedsLeedsUK
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Obadan-Udoh E, Van der Berg-Cloete S, Ramoni R, Kalenderian E, White JG. Patient-Reported Dental Safety Events: A South African Perspective. J Patient Saf 2021; 17:e866-e873. [PMID: 29369072 DOI: 10.1097/pts.0000000000000464] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES In recent years, there has been an increase in research studies highlighting patients' experiences of adverse events (AEs) as well as the role of patients in promoting safety. The primary goal of the study was to assess the prevalence of dental AEs (DAEs) among dental patients in South Africa and its associated factors. The integration of the patient perspective into dental patient safety research will enhance our collective understanding of DAEs. METHODS We conducted a cross-sectional study of adult patients at a large dental academic institution in South Africa from May to June 2015, evaluating their previous experiences of DAEs at any dental clinic in South Africa. Descriptive statistics and bivariate and multivariate analyses were performed to identify the factors associated with an increased likelihood of experiencing a DAE. RESULTS A total of 440 questionnaires were returned during the 6-week study period (response rate = 97.8%). Overall, 45.5% of participants reported experiencing one or more DAEs. Two hundred participants reported a total of 717 DAEs giving us a lifetime prevalence of 1.6 DAEs per respondent. Our results suggest that respondents who were younger (18-24 y), from high-income families (>R150,000 or US $9200), dissatisfied with their last dental visit and oral health had an increased likelihood of reporting a previous experience of a DAE. CONCLUSIONS This study provides an insight into the nature of information that can be gleaned from dental patients regarding safety and helps lay the foundation for patient involvement in patient safety reporting.
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Affiliation(s)
- Enihomo Obadan-Udoh
- From the Department of Preventive and Restorative Dental Sciences, School of Dentistry, University of California San Francisco, California
| | - Sophy Van der Berg-Cloete
- Department of Dental Management Sciences, School of Dentistry, University of Pretoria, Pretoria, South Africa
| | - Rachel Ramoni
- Center for Biomedical Informatics, Harvard Medical School, Boston, Massachusetts
| | - Elsbeth Kalenderian
- From the Department of Preventive and Restorative Dental Sciences, School of Dentistry, University of California San Francisco, California
| | - John George White
- Department of Dental Management Sciences, School of Dentistry, University of Pretoria, Pretoria, South Africa
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Rollinson TJ, Furnival J, Goldberg S, Choudhury A. Learning from Lean: a quality improvement project using a Lean-based improvement approach to improve discharge for patients with frailty in an acute care hospital. BMJ Open Qual 2021; 10:bmjoq-2021-001393. [PMID: 34824143 PMCID: PMC8627410 DOI: 10.1136/bmjoq-2021-001393] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 11/09/2021] [Indexed: 11/04/2022] Open
Abstract
A Lean-based improvement approach was used to complete a quality improvement project (QIP) focused on improving speed and quality of discharge of frail patients on two wards at a large teaching hospital in the UK. This was part of a national initiative to embed continuous improvement within the trust. The aim of the QIP was to improve the proportion of prenoon discharges to 33% of total patients discharged from the ward each day. An 'improvement practice process' followed, which included seven discrete workshops that took the QIP through four distinct phases-understand, design, deliver and sustain. Several improvement methods and tools were used, including value stream mapping and plan-do-study-act (PDSA) cycles. Ten PDSA cycles were implemented across the clinical areas, including improved planning and data collection of discharge, improved communication between nursing and medical staff, and earlier referrals to community hospitals for discharge. Improved performance was identified through the outcome metric prenoon discharges on both wards, with the average increasing from 8% to 24% on ward X and from 9% to 19% on ward Y, with no other significant change seen in other measures. Pettigrew et al's context-content-process change model was used to structure the learning from the QIP, which included the impact of varying ward contexts, the format of conducting improvement with staff, the importance of organisational support, the need for qualitative measures, agreeing to an apposite aim and the power of involving service users. The original aim of 33% prenoon discharges was not achieved, yet there was clear learning from completing the QIP which could contribute to ongoing improvement work. This identified that the Lean-based improvement approach used was effective to some degree for improving discharge processes. Further focus is required on collecting qualitative data to identify the impact on staff, especially related to behaviour and culture change.
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Affiliation(s)
- Thomas James Rollinson
- Strategy and Improvement, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - Joy Furnival
- Chief of Regulatory Compliance and Improvement, North West Ambulance Service NHS Trust, Bolton, UK
| | - Sarah Goldberg
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Aklak Choudhury
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK.,Department of Respiratory Medicine, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
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Kaud Y, Lydon S, O'Connor P. Measuring and monitoring patient safety in hospitals in Saudi Arabia. BMC Health Serv Res 2021; 21:1224. [PMID: 34772409 PMCID: PMC8588732 DOI: 10.1186/s12913-021-07228-z] [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: 03/31/2021] [Accepted: 10/21/2021] [Indexed: 11/22/2022] Open
Abstract
Background There is much variability in the measurement and monitoring of patient safety across healthcare organizations. With no recognized standardized approach, this study examines how the key components outlined in Vincent et al’s Measuring and Monitoring Safety (MMS) framework can be utilized to critically appraise a healthcare safety surveillance system. The aim of this study is to use the MMS framework to evaluate the Saudi Arabian healthcare safety surveillance system for hospital care. Methods This qualitative study consisted of two distinct phases. The first phase used document analysis to review national-level guidance relevant to measuring and monitoring safety in Saudi Arabia. The second phase consisted of semi-structured interviews with key stakeholders between May and August 2020 via a video conference call and focused on exploring their knowledge of how patient safety is measured and monitored in hospitals. The MMS framework was used to support data analysis. Results Three documents were included for analysis and 21 semi-structured interviews were conducted with key stakeholders working in the Saudi Arabian healthcare system. A total of 39 unique methods of MMS were identified, with one method of MMS addressing two dimensions. Of these MMS methods: 10 (25 %) were concerned with past harm; 14 (35 %) were concerned with the reliability of safety critical processes, 3 (7.5 %) were concerned with sensitivity to operations, 2 (5 %) were concerned with anticipation and preparedness, and 11 (27.5 %) were concerned with integration and learning. Conclusions The document analysis and interviews show an extensive system of MMS is in place in Saudi Arabian hospitals. The assessment of MMS offers a useful framework to help healthcare organizations and researchers to think critically about MMS, and how the data from different methods of MMS can be integrated in individual countries or health systems. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-07228-z.
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Affiliation(s)
- Yazeed Kaud
- Discipline of General Practice, School of Medicine, National University of Ireland Galway, County Galway, H91 TK33, Galway, Ireland. .,Department of Public Health, Saudi Electronic University, Riyadh, Saudi Arabia.
| | - Sinéad Lydon
- School of Medicine, National University of Ireland Galway, 1 Distillery Road, Newcastle, Co Galway, H91 TK33, Galway, Ireland
| | - Paul O'Connor
- Discipline of General Practice, School of Medicine, National University of Ireland Galway, County Galway, H91 TK33, Galway, Ireland
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Bergholt MD, Falstie-Jensen AM, Brink Valentin J, Hibbert P, Braithwaite J, Johnsen SP, Von Plessen C. Patients experience more support, information and involvement after first-time hospital accreditation: a before and after study in the Faroe Islands. Int J Qual Health Care 2021; 33:6410636. [PMID: 34698825 DOI: 10.1093/intqhc/mzab149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 09/30/2021] [Accepted: 10/24/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The impact of hospital accreditation on the experiences of patients remains a weak point in quality improvement research. This is surprising given the time and cost of accreditation and the fact that patient experiences influence outcomes. We investigated the impact of first-time hospital accreditation on patients' experience of support from health-care professionals, information and involvement in decisions. OBJECTIVE We aimed to examine the association between first-time hospital accreditation and patient experiences. METHODS We conducted a longitudinal study in the three Faroese hospitals that, unlike hospitals on the Danish mainland and elsewhere internationally, had no prior exposure to systematic quality improvement. The hospitals were accredited in 2017 according to a modified second version of the Danish Healthcare Quality program. Study participants were 18 years or older and hospitalized for at least 24 h in 2016 before or 2018 after accreditation. We administered the National Danish Survey of Patient Experiences for acute and scheduled hospitalization. Patients rated their experiences of support, information and involvement in decision-making on a 5-point Likert scale. We calculated individual and grouped mean item scores, the percentages of scores ≥4, the mean score difference, the relative risk (RR) for high/very high scores (≥4) using Poisson regression and the risk difference. Patient experience ratings were compared using mixed effects linear regression. RESULTS In total, 400 patients before and 400 after accreditation completed the survey. After accreditation patients reported increased support from health professionals; adjusted mean score difference (adj. mean diff.) = 1.99 (95% confidence interval (CI): 1.89, 2.10), feeling better informed before and during the hospitalization; adj. mean diff. = 1.14 (95% CI: 1.07; 1.20) and more involved in decision-making; adj. mean diff. = 1.79 (95% CI: 1.76; 1.82). Additionally, the RR for a high/very high score (≥4) was significantly greater on 15 of the 16 questionnaire items. The greatest RR for a high/very high score (≥4) after accreditation, was found for the item 'Have you had a dialogue with the staff about the advantages and disadvantages of the examination/treatment options available?'; RR= 5.73 (95% CI: 4.51, 7.27). CONCLUSION Hospitalized patients experienced significantly more support from health professionals, information and involvement in decision-making after accreditation. Future research on accreditation should include the patients' perspective.
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Affiliation(s)
- Maria Daniella Bergholt
- Department of Clinical Epidemiology, Aarhus University Hospital, Oluf Palmes Allé 43-45, Aarhus N DK-8200, Denmark.,Department of Anesthesiology and Intensive Care Medicine, Copenhagen University Hospital, Gentofte Hospital, Gentofte Hospitalsvej 1, Hellerup DK-2900, Denmark
| | | | - Jan Brink Valentin
- Department of Clinical Medicine, Danish Center for Clinical Health Services Research, Aalborg University and Aalborg University Hospital, Frederik Bajers vej 5, Aalborg DK-9220, Denmark
| | - Peter Hibbert
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd, Sydney, NSW 2109, Australia.,Australian Centre for Precision Health, University of South Australia Cancer Research Institute (UniSA CRI), School of Health Sciences, University of South Australia, GPO Box 2471, Adelaide, SA 5001, Australia
| | - Jeffrey Braithwaite
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd, Sydney, NSW 2109, Australia
| | - Søren Paaske Johnsen
- Department of Clinical Medicine, Danish Center for Clinical Health Services Research, Aalborg University and Aalborg University Hospital, Frederik Bajers vej 5, Aalborg DK-9220, Denmark
| | - Christian Von Plessen
- Policlinique Médicale, Unisanté, Rue du Bugnon 44, Lausanne CH-1011, Switzerland.,Institute for Clinical Research, University of Southern Denmark, Campusvej 55, Odense M, Syddanmark DK-5230, Denmark
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Kenward L, Whiffin C, Townend M. The needs of clients coming to counselling following second harm: A Q methodology study. COUNSELLING & PSYCHOTHERAPY RESEARCH 2021. [DOI: 10.1002/capr.12475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | - Charlotte Whiffin
- College of Health, Psychology and Social Care University of Derby Derby UK
| | - Michael Townend
- College of Health, Psychology and Social Care University of Derby Derby UK
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Matharoo M, Rutter MD. Proportionate patient safety incident reviews: making them less complicated. Endosc Int Open 2021; 9:E1196-E1197. [PMID: 34447863 PMCID: PMC8383090 DOI: 10.1055/a-1495-5077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Manmeet Matharoo
- Wolfson Unit for Endoscopy, St. Mark's Hospital, Harrow, United Kingdom
| | - Matt D Rutter
- Gastroenterology, University Hospital of North Tees, Stockton-on-Tees, United Kingdom
- Faculty of Medical Sciences, Newcastle University, Newcastle-upon-Tyne, United Kingdom
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