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Jang H, Lee M, Lee NJ. Communication education regarding patient safety for registered nurses in acute hospital settings: a scoping review protocol. BMJ Open 2022; 12:e053217. [PMID: 35105581 PMCID: PMC8808417 DOI: 10.1136/bmjopen-2021-053217] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 12/22/2021] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION The importance of correct and timely communication continues to be emphasised in the area of patient safety. Nurses play a key role in communicating with a variety of healthcare personnel to deliver safe care for patients. Many attempts have been made to improve nursing professionals' communication competencies regarding patient safety. However, the scope, method and effectiveness of communication education regarding patient safety for registered nurses have not been sufficiently reviewed. In order to understand the overall status of this field, a scoping review with a systematic framework is necessary. The objective of this study is to map the extent, range and nature of literature on communication education regarding patient safety for registered nurses in acute hospital settings and identify gaps to guide future research, policy and practice. METHODS AND ANALYSIS This study will be conducted in accordance with the methodology for scoping reviews developed by Arksey and O'Malley. To strengthen its rigour, the scoping review will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines. The overall review process will involve an independent review by two reviewers to select and analyse literature. The databases to be explored are MEDLINE (Ovid), Embase, Education Resources Information Center (ERIC), the Cumulative Index to Nursing and Allied Health Literature (CINAHL) and the Korean Medical Database (KMBASE). In addition, we will endeavour to include the grey literature through manual searches on patient safety-related websites. This review will target literature on communication programmes for patient safety provided to registered nurses in acute hospital settings and will include peer-reviewed literature in English and Korean since 2000, when research in the field of patient safety started to increase rapidly. ETHICS AND DISSEMINATION Since this study is a review of previous studies, no ethics approval is required. The findings of the study will be disseminated in a peer-reviewed journal for publication.
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Affiliation(s)
- Haena Jang
- College of Nursing, Dong-A University, Busan, Republic of Korea
| | - Miseon Lee
- College of Nursing, Seoul National University, Seoul, Republic of Korea
| | - Nam-Ju Lee
- Research Institute of Nursing Science, Seoul National University, Seoul, Republic of Korea
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Liu Y, Chen H, Li H, Li L, Wu J, Li H. Effect and Safety of Adding Metformin to Insulin Therapy in Treating Adolescents With Type 1 Diabetes Mellitus: An Updated Meta-Analysis of 10 Randomized Controlled Trials. Front Endocrinol (Lausanne) 2022; 13:878585. [PMID: 35707462 PMCID: PMC9190285 DOI: 10.3389/fendo.2022.878585] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 04/20/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The role of metformin in the treatment of adolescents with type 1 diabetes mellitus (T1DM) remains controversial. We conducted this updated meta-analysis to generate a comprehensive assessment regarding the effect and safety of metformin in treating adolescents with T1DM. METHODS We systematically searched PubMed, Embase, and the Cochrane Central Registry of Controlled Trials (CENTRAL) from their inception to November 2021 to identify randomized controlled trials evaluating the efficacy of metformin in the treatment of adolescents with T1DM. The primary outcome was the HbA1c level, and secondary outcomes included the body mass index (BMI), total insulin daily dose (TIDD) (unit/kg/d), hypoglycemia events, diabetes ketoacidosis (DKA) events, and gastrointestinal adverse events (GIAEs). Statistical analysis was conducted using RevMan 5.4 and STATA 14.0. RESULTS Ten studies enrolling 539 T1DM adolescents were included. Results suggested that metformin significantly decreased the HbA1c level at 12 months (mean difference [MD])=-0.50, 95% confidence interval [CI]=-0.61 to -0.39, P < 0.01); BMI (kg/m2) at 3 months (MD=-1.05, 95%CI=-2.05 to -0.05, P=0.04); BMI z-score at 6 months (MD=-0.10, 95%CI=-0.14 to -0.06, P<0.01); and TIDD at 3 (MD=-0.13, 95%CI=-0.20 to -0.06, P<0.01), 6 (MD=-0.18, 95%CI=-0.25 to -0.11, P<0.01), and 12 (MD=-0.42, 95%CI=-0.49 to -0.35, P<0.01) months but significantly increased the risk of hypoglycemia events (risk ratio [RR]=3.13, 95%CI=1.05 to 9.32, P=0.04) and GIAEs (RR=1.64, 95%CI=1.28 to 2.10, P<0.01). For remaining outcomes at other time points, no statistical difference was identified. Sensitivity analysis confirmed the robustness of all pooled results. CONCLUSIONS The use of metformin might result in decreased BMI (kg/m2), BMI z-score, and TIDD and increased risk of hypoglycemia events and GIAEs in adolescents with T1DM. However, future studies are required to further confirm the optimal dose and duration of metformin therapy.
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Affiliation(s)
- Ying Liu
- Department of Pediatrics, West China Second Hospital, Sichuan University, Chengdu, China
- Center of Translational Medicine, Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Hongbo Chen
- Department of Pediatrics, West China Second Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Hui Li
- Department of Pediatrics, West China Second Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Liman Li
- Center of Translational Medicine, Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Jin Wu
- Department of Pediatrics, West China Second Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
- *Correspondence: Hong Li, ; Jin Wu,
| | - Hong Li
- Center of Translational Medicine, Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
- *Correspondence: Hong Li, ; Jin Wu,
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Xia M, He Q, Ying G, Fei X, Zhou W, He X. Clinical Efficacy and Safety of Massage for the Treatment of Restless Leg Syndrome in Hemodialysis Patients: A Meta-Analysis of 5 Randomized Controlled Trials. Front Psychiatry 2022; 13:843263. [PMID: 35479488 PMCID: PMC9035587 DOI: 10.3389/fpsyt.2022.843263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Accepted: 03/02/2022] [Indexed: 11/13/2022] Open
Abstract
AIM We conducted this meta-analysis to evaluate the clinical efficacy and safety of massage for the treatment of hemodialysis patients with restless leg syndrome (RLS). METHODS A comprehensive literature search was performed using the PubMed database, EMBASE database (via OVID), and the Cochrane Library in order to identify eligible randomized controlled trials (RCTs) published before August 31, 2021. After extracted essential data and assessed risk of bias of each eligible study, we calculated the pooled estimate of RLS score and safety after treatment. Statistical analysis was performed by using Review Manager 5.3. RESULTS Five studies involving 369 hemodialysis patients with RLS were analyzed. The RLS score after treatment [mean difference (MD), -12.01; 95% confidence interval (CI), -14.91 to -9.11] and mean difference of RLS score at the beginning and end of treatment [mean difference (MD), -11.94; 95% confidence interval (CI), -15.45 to -8.43] in a massage group was significantly better than that in route care group. Subgroup analysis suggested that massage with lavender oil also significantly reduced the RLS score after treatment (MD, -14.22; 95% CI, -17.81 to -10.63) and mean difference of RLS score at the beginning and end of treatment (MD, -14.87; 95% CI, -18.29 to -11.45) compared with route care. Meanwhile, massage regime significantly relieved RLS severity compared with route care but did not increase adverse events. CONCLUSION Massage may be a preferred treatment modality for hemodialysis patients with RLS because it effectively reduces RLS symptoms, relieves RLS severity, and does not increase the risk of adverse events. However, future study with a larger sample size is warranted due to the fact that only limited number of eligible studies with small sample size are enrolled.
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Affiliation(s)
- Min Xia
- Department of Nephrology, Beilun People's Hospital, Ningbo, China
| | - Qien He
- Department of Nephrology, Beilun People's Hospital, Ningbo, China
| | - Guanghui Ying
- Department of Nephrology, Beilun People's Hospital, Ningbo, China
| | - Xiapei Fei
- Department of Nephrology, Beilun People's Hospital, Ningbo, China
| | - Wenjing Zhou
- Department of Nephrology, Beilun People's Hospital, Ningbo, China
| | - Xuelin He
- Department of Nephrology, Beilun People's Hospital, Ningbo, China.,Kidney Disease Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Kidney Disease Immunology Laboratory, The Third Grade Laboratory, State Administration of Traditional Chinese Medicine of China, Hangzhou, China
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Subbe CP, Tellier G, Barach P. Impact of electronic health records on predefined safety outcomes in patients admitted to hospital: a scoping review. BMJ Open 2021; 11:e047446. [PMID: 33441368 PMCID: PMC7812113 DOI: 10.1136/bmjopen-2020-047446] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES Review available evidence for impact of electronic health records (EHRs) on predefined patient safety outcomes in interventional studies to identify gaps in current knowledge and design interventions for future research. DESIGN Scoping review to map existing evidence and identify gaps for future research. DATA SOURCES PubMed, the Cochrane Library, EMBASE, Trial registers. STUDY SELECTION Eligibility criteria: We conducted a scoping review of bibliographic databases and the grey literature of randomised and non-randomised trials describing interventions targeting a list of fourteen predefined areas of safety. The search was limited to manuscripts published between January 2008 and December 2018 of studies in adult inpatient settings and complemented by a targeted search for studies using a sample of EHR vendors. Studies were categorised according to methodology, intervention characteristics and safety outcome.Results from identified studies were grouped around common themes of safety measures. RESULTS The search yielded 583 articles of which 24 articles were included. The identified studies were largely from US academic medical centres, heterogeneous in study conduct, definitions, treatment protocols and study outcome reporting. Of the 24 included studies effective safety themes included medication reconciliation, decision support for prescribing medications, communication between teams, infection prevention and measures of EHR-specific harm. Heterogeneity of the interventions and study characteristics precluded a systematic meta-analysis. Most studies reported process measures and not patient-level safety outcomes: We found no or limited evidence in 13 of 14 predefined safety areas, with good evidence limited to medication safety. CONCLUSIONS Published evidence for EHR impact on safety outcomes from interventional studies is limited and does not permit firm conclusions regarding the full safety impact of EHRs or support recommendations about ideal design features. The review highlights the need for greater transparency in quality assurance of existing EHRs and further research into suitable metrics and study designs.
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Affiliation(s)
- Christian Peter Subbe
- School of Medical Sciences, Bangor University, Bangor, UK
- Medicine, Ysbyty Gwynedd, Bangor, UK
| | | | - Paul Barach
- Pediatrics, Wayne State University, Detroit, Michigan, USA
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Lee M, Lee NJ, Seo HJ, Jang H, Kim SM. Interventions to Engage Patients and Families in Patient Safety: A Systematic Review. West J Nurs Res 2020; 43:972-983. [PMID: 33353509 DOI: 10.1177/0193945920980770] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The involvement of patients and families is essential for improving patient safety. However, the role of patients and caregivers in patient safety has recently been receiving attention, and programs and interventions have been implemented for patients and caregivers. The objective of this systematic review was to identify the types of interventions to improve patient safety that focused on engaging patients and their families, and the effectiveness of these interventions. Searching four electronic databases, 2019 articles were obtained; of these, 15 articles met the inclusion criteria. The studies used intervention strategies at the "information" and "involvement" engagement levels. Interventions with strategies only at the information level mostly measured safety perception and were mostly found to be effective. Interventions with both information and involvement strategies measured more diverse outcomes, but their effectiveness was inconsistent. Further studies using a range of intervention strategies and outcomes with more rigorous methodologies are needed.PROSPERO registration number CRD42018096162.
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Affiliation(s)
- Miseon Lee
- College of Nursing, Seoul National University, Jongno-gu, Seoul, South Korea
| | - Nam-Ju Lee
- College of Nursing, Seoul National University, Jongno-gu, Seoul, South Korea.,The Research Institute of Nursing Science, Seoul National University, Jongno-gu, Seoul, South Korea
| | - Hyun-Ju Seo
- College of Nursing, Chungnam National University, Jung-gu, Daejeon, South Korea
| | - Haena Jang
- Department of Nursing, College of Medicine, Inje University, Busanjin-gu, Busan, South Korea
| | - Seong Min Kim
- Department of Nursing, Donggang University, Buk-gu, Kwangju, South Korea
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Zhang Z, Inman C, Waters D, Dee P. Effectiveness of application of carbon-fibre polymer-fabric resistive heating compared with forced-air warming to prevent unintentional intraoperative hypothermia in patients undergoing elective abdominal operations: A systematic review and meta-analysis of randomised controlled trials. J Clin Nurs 2020; 29:4429-4439. [PMID: 32841437 DOI: 10.1111/jocn.15463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 07/22/2020] [Accepted: 07/25/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Unintentional intraoperative hypothermia was regarded as a common intraoperative symptom with serious complications. The active warming strategies of forced-air warming (FAW) and carbon-fibre polymer-fabric resistive heating were considered to be effective interventions for preventing hypothermia. However, the effectiveness of them was not reported consistently. AIM To evaluate the effectiveness of carbon-fibre polymer-fabric resistive heating compared with FAW in preventing hypothermia in patients undergoing elective surgeries. DESIGN Systematic review and meta-analysis. METHODS A rigorous systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis reporting checklist. Searching strategy was undertaken on the electronic databases of Cumulative Index to Nursing and Allied Health Literature, MEDLINE, PubMed, EMBASE and Medical Literature Retrieval Service. The assessment of study quality was performed through risk of bias of Cochrane handbook of systematic review of interventions. Data synthesis was conducted through meta-analysis with sensitive analysis. The quality of evidence was graded using Grading of Recommendations Assessment, Development and Evaluation approach. RESULTS A total of five randomised controlled trials with 282 patients undergoing elective surgeries were included in the quantitative synthesis. Four studies concluded that FAW was as effective as carbon-fibre polymer-fabric resistive heating in preventing hypothermia. However, one study yielded a different conclusion that the efficacy of FAW was superior to carbon-fibre polymer-fabric resistive heating with small incidence of hypothermia. Meta-analysis found that FAW was more effective than carbon-fibre polymer-fabric resistive heating in preventing hypothermia. CONCLUSIONS In the elective abdominal surgery, carbon-fibre polymer-fabric resistive heating was less effective than FAW on the prevention of hypothermia. However, hypothermia still occurred in the FAW group. It was more objective to assess the efficacy of warming technology combining the incidence of hypothermia and the core body temperature together, which was suggested for further research.
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Affiliation(s)
- Zhihui Zhang
- Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | | | | | - Philip Dee
- Birmingham City University, Birmingham, UK
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Integrated Care Search: development and validation of a PubMed search filter for retrieving the integrated care research evidence. BMC Med Res Methodol 2020; 20:12. [PMID: 31964347 PMCID: PMC6971984 DOI: 10.1186/s12874-020-0901-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 01/07/2020] [Indexed: 11/10/2022] Open
Abstract
Background Integrated care is an increasingly important principle for organising healthcare. Integrated care models show promise in reducing resource wastage and service fragmentation whilst improving the accessibility, patient-centredness and quality of care for patients. Those needing reliable access to the growing research evidence base for integrated care can be frustrated by search challenges reflective of the topic’s complexity. The aim of this study is to report the empirical development and validation of two search filters for rapid and effective retrieval of integrated care evidence in PubMed. One filter is optimised for recall and the other for precision. Methods An Expert Advisory Group comprising international integrated care experts guided the study. A gold standard test set of citations was formed from screening Handbook Integrated Care chapter references for relevance. This set was divided into a Term Identification Set (20%) for determining candidate terms using frequency analysis; a Filter Development Set (40%) for testing performance of term combinations; and a Filter Validation Set (40%) reserved for confirming final filter performance. In developing the high recall filter, recall was steadily increased while maintaining precision at ≥50%. Similarly, the high precision filter sought to maximise precision while keeping recall ≥50%. For each term combination tested, an approximation of precision was obtained by reviewing the first 100 citations retrieved in Medline for relevance. Results The gold standard set comprised 534 citations. The search filter optimised for recall (‘Broad Integrated Care Search’) achieved 86.0–88.3% recall with corresponding low precision (47–53%). The search filter optimised for precise searching (‘Narrow Integrated Care Search’) demonstrated precision of 73–95% with recall reduced to between 55.9 and 59.8%. These filters are now available as one-click URL hyperlinks in the website of International Foundation for Integrated Care. Conclusions The Broad and Narrow Integrated Care Search filters provide potential users, such as policy makers and researchers, seamless, reliable and ongoing access to integrated care evidence for decision making. These filters were developed according to a rigorous and transparent methodology designed to circumvent the challenges of information retrieval posed by this complex, multifaceted topic.
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van Melle MA, van Stel HF, Poldervaart JM, de Wit NJ, Zwart DLM. Measurement tools and outcome measures used in transitional patient safety; a systematic review. PLoS One 2018; 13:e0197312. [PMID: 29864119 PMCID: PMC5986135 DOI: 10.1371/journal.pone.0197312] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 04/29/2018] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Patients are at risk for harm when treated simultaneously by healthcare providers from different healthcare organisations. To assess current practice and improvements of transitional patient safety, valid measurement tools are needed. AIM AND METHODS To identify and appraise all measurement tools and outcomes that measure aspects of transitional patient safety, PubMed, Cinahl, Embase and Psychinfo were systematically searched. Two researchers performed the title and abstract and full-text selection. First, publications about validation of measurement tools were appraised for quality following COSMIN criteria. Second, we inventoried all measurement tools and outcome measures found in our search that assessed current transitional patient safety or the effect of interventions targeting transitional patient safety. RESULTS The initial search yielded 8288 studies, of which 18 assessed validity of measurement tools of different aspects of transitional safety, and 191 assessed current transitional patient safety or effect of interventions. In the validated measurement tools, the overall quality of content and structural validity was acceptable; other COSMIN criteria, such as reliability, measurement error and responsiveness, were mostly poor or not reported. In our outcome inventory, the most frequently used validated outcome measure was the Care Transition Measure (n = 9). The most frequently used non-validated outcome measures were: medication discrepancies (n = 98), hospital readmissions (n = 55), adverse events (n = 34), emergency department visits (n = 33), (mental or physical) health status (n = 28), quality and timeliness of discharge summary, and patient satisfaction (n = 23). CONCLUSIONS Although no validated measures exist that assess all aspects of transitional patient safety, we found validated measurement tools on specific aspects. Reporting of validity of transitional measurement tools was incomplete. Numerous outcome measures with unknown measurement properties are used in current studies on safety of care transitions, which makes interpretation or comparison of their results uncertain.
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Affiliation(s)
- Marije A van Melle
- Julius Center for Health Sciences and Primary care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Henk F van Stel
- Julius Center for Health Sciences and Primary care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Judith M Poldervaart
- Julius Center for Health Sciences and Primary care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Niek J de Wit
- Julius Center for Health Sciences and Primary care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Dorien L M Zwart
- Julius Center for Health Sciences and Primary care, University Medical Center Utrecht, Utrecht, the Netherlands
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Zegers M, Hesselink G, Geense W, Vincent C, Wollersheim H. Evidence-based interventions to reduce adverse events in hospitals: a systematic review of systematic reviews. BMJ Open 2016; 6:e012555. [PMID: 27687901 PMCID: PMC5051502 DOI: 10.1136/bmjopen-2016-012555] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE To provide an overview of effective interventions aimed at reducing rates of adverse events in hospitals. DESIGN Systematic review of systematic reviews. DATA SOURCES PubMed, CINAHL, PsycINFO, the Cochrane Library and EMBASE were searched for systematic reviews published until October 2015. STUDY SELECTION English-language systematic reviews of interventions aimed at reducing adverse events in hospitals, including studies with an experimental design and reporting adverse event rates, were included. Two reviewers independently assessed each study's quality and extracted data on the study population, study design, intervention characteristics and adverse patient outcomes. RESULTS Sixty systematic reviews with moderate to high quality were included. Statistically significant pooled effect sizes were found for 14 types of interventions, including: (1) multicomponent interventions to prevent delirium; (2) rapid response teams to reduce cardiopulmonary arrest and mortality rates; (3) pharmacist interventions to reduce adverse drug events; (4) exercises and multicomponent interventions to prevent falls; and (5) care bundle interventions, checklists and reminders to reduce infections. Most (82%) of the significant effect sizes were based on 5 or fewer primary studies with an experimental study design. CONCLUSIONS The evidence for patient-safety interventions implemented in hospitals worldwide is weak. The findings address the need to invest in high-quality research standards in order to identify interventions that have a real impact on patient safety. Interventions to prevent delirium, cardiopulmonary arrest and mortality, adverse drug events, infections and falls are most effective and should therefore be prioritised by clinicians.
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Affiliation(s)
- Marieke Zegers
- Radboud university medical center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands
| | - Gijs Hesselink
- Radboud university medical center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands
| | - Wytske Geense
- Radboud university medical center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands
| | - Charles Vincent
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Hub Wollersheim
- Radboud university medical center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands
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Brenner SK, Kaushal R, Grinspan Z, Joyce C, Kim I, Allard RJ, Delgado D, Abramson EL. Effects of health information technology on patient outcomes: a systematic review. J Am Med Inform Assoc 2016; 23:1016-36. [PMID: 26568607 PMCID: PMC6375119 DOI: 10.1093/jamia/ocv138] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Revised: 07/28/2015] [Accepted: 07/29/2015] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To systematically review studies assessing the effects of health information technology (health IT) on patient safety outcomes. MATERIALS AND METHODS The authors employed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement methods. MEDLINE, Cumulative Index to Nursing Allied Health (CINAHL), EMBASE, and Cochrane Library databases, from 2001 to June 2012, were searched. Descriptive and comparative studies were included that involved use of health IT in a clinical setting and measured effects on patient safety outcomes. RESULTS Data on setting, subjects, information technology implemented, and type of patient safety outcomes were all abstracted. The quality of the studies was evaluated by 2 independent reviewers (scored from 0 to 10). A total of 69 studies met inclusion criteria. Quality scores ranged from 1 to 9. There were 25 (36%) studies that found benefit of health IT on direct patient safety outcomes for the primary outcome measured, 43 (62%) studies that either had non-significant or mixed findings, and 1 (1%) study for which health IT had a detrimental effect. Neither the quality of the studies nor the rate of randomized control trials performed changed over time. Most studies that demonstrated a positive benefit of health IT on direct patient safety outcomes were inpatient, single-center, and either cohort or observational trials studying clinical decision support or computerized provider order entry. DISCUSSION AND CONCLUSION Many areas of health IT application remain understudied and the majority of studies have non-significant or mixed findings. Our study suggests that larger, higher quality studies need to be conducted, particularly in the long-term care and ambulatory care settings.
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Affiliation(s)
- Samantha K Brenner
- Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, NY, USA Center for Healthcare Informatics and Policy, New York, NY, USA Department of Medicine, Stanford School of Medicine, Palo Alto, CA, USA Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Rainu Kaushal
- Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, NY, USA Center for Healthcare Informatics and Policy, New York, NY, USA Department of Medicine, Weill Cornell Medical College, New York, NY, USA Department of Pediatrics, Weill Cornell Medical College, New York, NY, USA New York-Presbyterian Hospital, New York, NY, USA
| | - Zachary Grinspan
- Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, NY, USA Center for Healthcare Informatics and Policy, New York, NY, USA Department of Pediatrics, Weill Cornell Medical College, New York, NY, USA New York-Presbyterian Hospital, New York, NY, USA
| | - Christine Joyce
- Department of Pediatrics, Weill Cornell Medical College, New York, NY, USA New York-Presbyterian Hospital, New York, NY, USA
| | - Inho Kim
- New York-Presbyterian Hospital, New York, NY, USA Department of Emergency Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Rhonda J Allard
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Diana Delgado
- Samuel J. Wood Library & C.V. Starr Biomedical Information Center, Weill Cornell Medical College, New York, NY, USA
| | - Erika L Abramson
- Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, NY, USA Center for Healthcare Informatics and Policy, New York, NY, USA Department of Pediatrics, Weill Cornell Medical College, New York, NY, USA New York-Presbyterian Hospital, New York, NY, USA
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Fisher JD, Freeman K, Clarke A, Spurgeon P, Smyth M, Perkins GD, Sujan MA, Cooke MW. Patient safety in ambulance services: a scoping review. HEALTH SERVICES AND DELIVERY RESEARCH 2015. [DOI: 10.3310/hsdr03210] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BackgroundThe role of ambulance services has changed dramatically over the last few decades with the introduction of paramedics able to provide life-saving interventions, thanks to sophisticated equipment and treatments available. The number of 999 calls continues to increase, with adverse events theoretically possible with each one. Most patient safety research is based on hospital data, but little is known concerning patient safety when using ambulance services, when things can be very different. There is an urgent need to characterise the evidence base for patient safety in NHS ambulance services.ObjectiveTo identify and map available evidence relating to patient safety when using ambulance services.DesignMixed-methods design including systematic review and review of ambulance service documentation, with areas for future research prioritised using a Delphi process.Setting and participantsAmbulance services, their staff and service users in UK.Data sourcesA wide range of data sources were explored. Multiple databases, reference lists from key papers and citations, Google and the NHS Confederation website were searched, and experts contacted to ensure that new data were included in the review. The databases MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science, Science Direct, Emerald, Education Resources Information Center (ERIC), Applied Social Sciences Index and Abstracts, Social Services Abstracts, Sociological Abstracts, International Bibliography of the Social Sciences (IBSS), PsycINFO, PsycARTICLES, Health Management Information Consortium (HMIC), NHS Evidence, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects (DARE), NHS Economic Evaluation Database (NHS EED),Health Technology Assessment, the FADE library, Current Awareness Service for Health (CASH), OpenDOAR (Directory of Open Access Repositories) and Open System for Information on Grey Literature in Europe (OpenSIGLE) and Zetoc (The British Library's Electronic Table of Contents) were searched from 1 January 1980 to 12 October 2011. Publicly available documents and issues identified by National Patient Safety Agency (NPSA), NHS Litigation Authority (NHSLA) and coroners’ reports were considered. Opinions and perceptions of senior managers, ambulance staff and service users were solicited.Review methodsData were extracted from annual reports using two-stage thematic analysis, data from quality accounts were collated with safety priorities tabulated and considered using thematic analysis, NPSA incident report data were collated and displayed comparatively using descriptive statistics, claims reported to NHSLA were analysed to identify number and cost of claims from mistakes and/or poor service, and summaries of coroners’ reports were assessed using thematic analysis to identify underlying safety issues. The depth of analysis is limited by the remit of a scoping exercise and availability of data.ResultsWe identified studies exploring different aspects of safety, which were of variable quality and with little evidence to support activities currently undertaken by ambulance services. Adequately powered studies are required to address issues of patient safety in this service, and it appeared that national priorities were what determined safety activities, rather than patient need. There was inconsistency of information on attitudes and approaches to patient safety, exacerbated by a lack of common terminology.ConclusionPatient safety needs to become a more prominent consideration for ambulance services, rather than operational pressures, including targets and driving the service. Development of new models of working must include adequate training and monitoring of clinical risks. Providers and commissioners need a full understanding of the safety implications of introducing new models of care, particularly to a mobile workforce often isolated from colleagues, which requires a body of supportive evidence and an inherent critical evaluation culture. It is difficult to extrapolate findings of clinical studies undertaken in secondary care to ambulance service practice and current national guidelines often rely on consensus opinion regarding applicability to the pre-hospital environment. Areas requiring further work include the safety surrounding discharging patients, patient accidents, equipment and treatment, delays in transfer/admission to hospital, and treatment and diagnosis, with a clear need for increased reliability and training for improving handover to hospital.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Joanne D Fisher
- Department of Health Sciences, Warwick Medical School, Coventry, UK
| | - Karoline Freeman
- Department of Health Sciences, Warwick Medical School, Coventry, UK
| | - Aileen Clarke
- Department of Health Sciences, Warwick Medical School, Coventry, UK
| | - Peter Spurgeon
- Department of Health Sciences, Warwick Medical School, Coventry, UK
| | - Mike Smyth
- West Midlands Ambulance Service, Millennium Point, Waterfront Business Park, Brierley Hill, West Midlands, UK
| | - Gavin D Perkins
- Department of Health Sciences, Warwick Medical School, Coventry, UK
| | | | - Matthew W Cooke
- Department of Health Sciences, Warwick Medical School, Coventry, UK
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Abstract
OBJECTIVES To review the empirical literature to identify the activities, time spent and engagement of hospital managers in quality of care. DESIGN A systematic review of the literature. METHODS A search was carried out on the databases MEDLINE, PSYCHINFO, EMBASE, HMIC. The search strategy covered three facets: management, quality of care and the hospital setting comprising medical subject headings and key terms. Reviewers screened 15,447 titles/abstracts and 423 full texts were checked against inclusion criteria. Data extraction and quality assessment were performed on 19 included articles. RESULTS The majority of studies were set in the USA and investigated Board/senior level management. The most common research designs were interviews and surveys on the perceptions of managerial quality and safety practices. Managerial activities comprised strategy, culture and data-centred activities, such as driving improvement culture and promotion of quality, strategy/goal setting and providing feedback. Significant positive associations with quality included compensation attached to quality, using quality improvement measures and having a Board quality committee. However, there is an inconsistency and inadequate employment of these conditions and actions across the sample hospitals. CONCLUSIONS There is some evidence that managers' time spent and work can influence quality and safety clinical outcomes, processes and performance. However, there is a dearth of empirical studies, further weakened by a lack of objective outcome measures and little examination of actual actions undertaken. We present a model to summarise the conditions and activities that affect quality performance.
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Affiliation(s)
- Anam Parand
- Department of Surgery & Cancer, Imperial College London, London, UK
| | - Sue Dopson
- Said Business School, University of Oxford, Oxford, UK
| | - Anna Renz
- Department of Surgery & Cancer, Imperial College London, London, UK
| | - Charles Vincent
- Department of Experimental Psychology, University of Oxford, Oxford, UK
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Golder S, Loke YK. Sensitivity and precision of adverse effects search filters in MEDLINE and EMBASE: a case study of fractures with thiazolidinediones. Health Info Libr J 2012; 29:28-38. [PMID: 22335287 DOI: 10.1111/j.1471-1842.2011.00972.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Search filters have been developed in MEDLINE and EMBASE to help overcome the challenges of searching electronic databases for information on adverse effects. However, little evaluation of their effectiveness has been carried out. OBJECTIVES To measure the sensitivity and precision of available adverse effects search filters in MEDLINE and EMBASE. METHODS A case study systematic review of fracture related adverse effects associated with the use of thiazolidinediones was used. Twelve MEDLINE search strategies and three EMBASE search strategies were tested. RESULTS Nineteen relevant references from MEDLINE and 24 from EMBASE were included in the review. Four search filters in MEDLINE achieved high sensitivity (95 or 100%) with an improved level of precision from searches without any adverse effects filter. High precision in MEDLINE could also be achieved (up to 53%) using search filters that rely on Medical Subject Headings. No search filter in EMBASE achieved high precision (all were under 5%) and the highest sensitivity in EMBASE was 83%. CONCLUSIONS Adverse effects search filters appear to be effective in MEDLINE for achieving either high sensitivity or high precision. Search filters in EMBASE, however, do not appear as effective, particularly in improving precision.
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Affiliation(s)
- Su Golder
- Centre for Reviews and Dissemination (CRD), University of York, York, UK.
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