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Brook K, Agarwala AV, Tewfik GL. Reframing the Morbidity and Mortality Conference: The Impact of a Just Culture. J Patient Saf 2024; 20:280-287. [PMID: 38470962 DOI: 10.1097/pts.0000000000001224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2024]
Abstract
ABSTRACT Morbidity and mortality (M&M) conferences are prevalent in all fields of medicine. Historically, they arose out a desire to improve medical care. Nevertheless, the goals of M&M conferences are often poorly defined, at odds with one another, and do not support a just culture. We differentiate among the various possible goals of an M&M and review the literature for strategies that have been shown to achieve these goals. Based on the literature, we outline an ideal M&M structure within the context of just culture: The process starts with robust adverse event and near miss reporting, followed by careful case selection, excluding cases solely attributable to individual error. Prior to the M&M, the case should be openly discussed with involved members and should be reviewed using a selected framework. The goal of the M&M should be selected and clearly defined, and the presentation format and rules of conduct should all conform to the selected presentation goal. The audience should ideally be multidisciplinary and multispecialty. The M&M should conclude with concrete tasks and assigned follow-up. The entire process should be conducted in a peer review protected format within an environment promoting psychological safety. We conclude with future directions for M&Ms.
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Affiliation(s)
| | - Aalok V Agarwala
- Department of Anaesthesia, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts
| | - George L Tewfik
- Department of Anesthesiology, Rutgers-New Jersey Medical School, Newark, New Jersey
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2
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Chau M. Enhancing safety culture in radiology: Key practices and recommendations for sustainable excellence. Radiography (Lond) 2024; 30 Suppl 1:9-16. [PMID: 38797116 DOI: 10.1016/j.radi.2024.04.025] [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: 01/27/2024] [Revised: 04/25/2024] [Accepted: 04/26/2024] [Indexed: 05/29/2024]
Abstract
OBJECTIVES This review aims to explore and thematically synthesize the existing literature on safety culture within the context of radiology. The primary objective is to identify key practices that effectively strengthen safety culture, highlighting the pivotal roles of leadership, effective teamwork, and interprofessional collaboration in these efforts. The review intends to showcase actionable recommendations that are particularly relevant to the radiology setting. KEY FINDINGS The study highlights that effective leadership is fundamental in establishing and nurturing a safety-first approach within radiology departments. Key practices for promoting a safety culture include safety huddles, leadership walkarounds, quality learning boards, intentional patient rounding (frequent patient-care provider interactions), morbidity and mortality meetings, and multidisciplinary team rounds. These practices have been found to facilitate open communication and transparency, which are crucial elements in creating a sustainable safety culture. Additionally, the study underscores the significant role of radiology managers in driving these safety initiatives and acting as facilitators for a culture of safety, focused on long-term excellence and continuous improvement. CONCLUSION The study concludes that a multifaceted and comprehensive approach is vital for fostering a safety culture in radiology departments, with a focus on sustainable excellence in patient care. The leadership role is critical in this process, with radiology managers being instrumental in implementing and maintaining effective safety practices. IMPLICATIONS FOR PRACTICE This study provides best practices for sustainable safety culture in radiology departments. It advocates for healthcare managers to adopt and integrate these identified practices into their operational strategies. Continuous professional development, focusing on safety and quality in patient care, and fostering a collaborative environment for open discussion and learning from safety incidents are essential for the continued advancement and excellence of healthcare services.
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Affiliation(s)
- M Chau
- Faculty of Science and Health, Charles Sturt University, Level 5, 250 Boorooma St, NSW 2678, Australia; South Australia Medical Imaging, Flinders Medical Centre, 1 Flinders Drive, Bedford Park, SA 5042, Australia.
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3
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Bisset CN, Moug SJ, Oliphant R, Dames N, Parson S, Cleland J. Influencing factors in surgical decision-making: a qualitative analysis of colorectal surgeons' experiences of postoperative complications. Colorectal Dis 2024; 26:987-993. [PMID: 38485203 DOI: 10.1111/codi.16943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 01/25/2024] [Accepted: 02/21/2024] [Indexed: 05/26/2024]
Abstract
AIM When making anastomotic decisions in rectal cancer surgery, surgeons must consider the risk of anastomotic leakage, which bears implications for the patient's quality of life, cancer recurrence and, potentially, death. The aim of this study was to investigate the views of colorectal surgeons on how their individual attributes (e.g. experience, personality traits) may influence their decision-making and experience of complications. METHOD This qualitative study used individual interviews for data collection. Purposive sampling was used to invite certified UK-based colorectal surgeons to participate. Participants were recruited until ongoing data review indicated no new codes were generated, suggesting data sufficiency. Data were analysed thematically following Braun and Clarke's six-step framework. RESULTS Seventeen colorectal surgeons (eight female, nine male) participated. Two key themes with relevant subthemes were identified: (1) personal attributes influencing variation in decision-making (e.g. demographics, personality) and (2) the influence of complications on decision-making. Surgeons described variation in the management of complications based upon their personal attributes, which included factors such as gender, experience and subspeciality interests. Surgeons described the detrimental impact of anastomotic leakage on their mental and physical health. Experience of anastomotic leakage influences future decision-making and is associated with changes in practice even when a technical error is not identified. CONCLUSION Colorectal surgeons consider anastomotic leaks to be personal 'failures', which has a negative impact on surgeon welfare. Better understanding of how surgeons make difficult decisions, and how surgeons respond to and learn from complications, is necessary to identify 'personalized' methods of supporting surgeons at all career stages, which may improve patient outcomes.
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Affiliation(s)
- Carly N Bisset
- Department of General Surgery, Royal Alexandra Hospital, Paisley, UK
- University of Aberdeen, Aberdeen, UK
| | - Susan J Moug
- Department of General Surgery, Royal Alexandra Hospital, Paisley, UK
- Department of General Surgery, Golden Jubilee University National Hospital, Clydebank, UK
- University of Glasgow, Glasgow, UK
| | - Raymond Oliphant
- University of Aberdeen, Aberdeen, UK
- Department of Colorectal Surgery, Raigmore Hospital, Inverness, UK
| | - Nicola Dames
- Association of Coloproctology of Great Britain & Ireland Patient Liaison Group, Oxford, UK
| | | | - Jennifer Cleland
- Medical Education Research and Scholarship Unit, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
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Zloto O, Shah P, Paiusco V, Singh B, Kang S, Verity D, Fabiola M. The Outcomes of Involutional Ptosis Surgeries in a Single Tertiary Center. Curr Eye Res 2024; 49:325-329. [PMID: 37921352 DOI: 10.1080/02713683.2023.2277137] [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: 09/04/2023] [Accepted: 10/25/2023] [Indexed: 11/04/2023]
Abstract
PURPOSE To report the surgical outcome of anterior approach primary ptosis surgery in a tertiary center and to compare redo surgical rates between different grades of surgeons. METHODS This is a Retrospective review of series of annual audits. All involutional/aponeurosis-disinsertion ptosis surgeries performed at Moorfields Eye-hospital (MEH) between January 01, 2016 and December 31, 2019 were included. Only primary surgery was included. The following data were collected; number of surgeries per year, number of patients, demographics data, grades of surgeons, success rate, redo surgery rate from different grades of surgeons, complications rate and patients' satisfaction. RESULTS During the study period, 1191 ptosis surgery were performed, with 899 (75%) cases being involutional/aponeurosis-disinsertion ptosis. The mean redo surgery rate within one year from the primary surgery was 10.5% and the mean complication rate was 1.0%, with 78.95% of patients reported being satisfied with the results of the surgery, having no difference between surgeon's grades. The redo surgery rate was higher for cases performed by a junior surgeon (fellow/registrar) (64.26%) than by a consultant (38.94%). CONCLUSIONS We report the success rate of a large cohort of primary involutional ptosis surgery performed at the ophthalmic-specialist tertiary center. The success and complication rates are comparable to the literature at 90% and 1%, respectively. Redo surgeries were more frequently required when performed by junior surgeons compared to the consultants, whereas the patient satisfaction level did not differ between different grades of surgeons.
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Affiliation(s)
- Ofira Zloto
- Adnexal Service, Moorfields Eye Hospital, London, UK
| | - Prachi Shah
- Adnexal Service, Moorfields Eye Hospital, London, UK
| | | | | | - Swan Kang
- Adnexal Service, Moorfields Eye Hospital, London, UK
| | - David Verity
- Adnexal Service, Moorfields Eye Hospital, London, UK
| | - Murta Fabiola
- Adnexal Service, Moorfields Eye Hospital, London, UK
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Marsden MER, Kellett S, Bagga R, Wohlgemut JM, Lyon RL, Perkins ZB, Gillies K, Tai NR. Understanding pre-hospital blood transfusion decision-making for injured patients: an interview study. Emerg Med J 2023; 40:777-784. [PMID: 37704359 PMCID: PMC10646861 DOI: 10.1136/emermed-2023-213086] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 08/01/2023] [Indexed: 09/15/2023]
Abstract
BACKGROUND Blood transfusion for bleeding trauma patients is a promising pre-hospital intervention with potential to improve outcomes. However, it is not yet clear which patients may benefit from pre-hospital transfusions. The aim of this study was to enhance our understanding of how experienced pre-hospital clinicians make decisions regarding patient blood loss and the need for transfusion, and explore the factors that influence clinical decision-making. METHODS Pre-hospital physicians, from two air ambulance sites in the south of England, were interviewed between December 2018 and January 2019. Participants were involved in teaching or publishing on the management of bleeding trauma patients and had at least 5 years of continuous and contemporary practice at consultant level. Interviews were semi-structured and explored how decisions were made and what made decisions difficult. A qualitative description approach was used with inductive thematic analysis to identify themes and subthemes related to blood transfusion decision-making in trauma. RESULTS Ten pre-hospital physicians were interviewed and three themes were identified: recognition-primed analysis, uncertainty and imperfect decision analysis. The first theme describes how participants make decisions using selected cues, incorporating their experience and are influenced by external rules and group expectations. What made decisions difficult for the participants was encapsulated in the uncertainty theme. Uncertainty emerged regarding the patient's true underlying physiological state and the treatment effect of blood transfusion. The last theme focuses on the issues with decision-making itself. Participants demonstrated lapses in decision awareness, often incomplete decision evaluation and described challenges to effective learning due to incomplete patient outcome information. CONCLUSION Pre-hospital clinicians make decisions about bleeding and transfusion which are recognition-primed and incorporate significant uncertainty. Decisions are influenced by experience and are subject to bias. Improved understanding of the decision-making processes provides a theoretical perspective of how decisions might be supported in the future.
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Affiliation(s)
- Max E R Marsden
- Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London, London, UK
- Academic Department of Military Surgery and Trauma, RCI, Defence Medical Services, Birmingham, UK
| | - Suzie Kellett
- Department of Anaesthesia, Univeristy Hospital Southampton, Southampton, UK
| | - Rahul Bagga
- Department of Orthopaedics, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Jared M Wohlgemut
- Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London, London, UK
| | - Richard L Lyon
- Air Ambulance Kent, Surrey and Sussex, Redhill, Surrey, UK
- School of Health Sciences, University of Surrey, Guildford, UK
| | - Zane B Perkins
- Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London, London, UK
- London's Air Ambulance, Barts Health NHS Trust, London, UK
| | - Katie Gillies
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Nigel Rm Tai
- Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London, London, UK
- Academic Department of Military Surgery and Trauma, RCI, Defence Medical Services, Birmingham, UK
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Menshawey R, Menshawey E. Brave Clarice-healthcare serial killers, patterns, motives, and solutions. Forensic Sci Med Pathol 2023; 19:452-463. [PMID: 36454379 PMCID: PMC10518281 DOI: 10.1007/s12024-022-00556-4] [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] [Accepted: 10/31/2022] [Indexed: 12/02/2022]
Abstract
Healthcare serial killing involves the intentional killing of multiple patients by a healthcare professional. It is a formidable challenge to identify in the medical context, and a daunting legal task to prove beyond reasonable doubt. What can be done or remains to be done to intercept these serial killing events and help serve justice, while at the same time not risk dismantling public trust in the healthcare system? In light of several recent modern charges of murder against healthcare practitioners across the world, this review aims to report the themes, patterns, and motives of medical serial killers as well as highlight areas of work on both medical and legal fronts to help identify these events, and to most importantly protect the vulnerable patient community.
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Affiliation(s)
- Rahma Menshawey
- Kasr al Ainy Faculty of Medicine, Cairo University, Geziret Elroda, 11562, Manial, Cairo, Egypt.
| | - Esraa Menshawey
- Kasr al Ainy Faculty of Medicine, Cairo University, Geziret Elroda, 11562, Manial, Cairo, Egypt
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Øyri SF, Søreide K, Søreide E, Tjomsland O. Learning from experience: a qualitative study of surgeons' perspectives on reporting and dealing with serious adverse events. BMJ Open Qual 2023; 12:bmjoq-2023-002368. [PMID: 37286299 DOI: 10.1136/bmjoq-2023-002368] [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: 04/04/2023] [Accepted: 05/27/2023] [Indexed: 06/09/2023] Open
Abstract
INTRODUCTION In surgery, serious adverse events have effects on the patient journey, the patient outcome and may constitute a burden to the surgeon involved. This study aims to investigate facilitators and barriers to transparency around, reporting of and learning from serious adverse events among surgeons. METHODS Based on a qualitative study design, we recruited 15 surgeons (4 females and 11 males) with 4 different surgical subspecialties from four Norwegian university hospitals. The participants underwent individual semistructured interviews and data were analysed according to principles of inductive qualitative content analysis. RESULTS AND DISCUSSION We identified four overarching themes. All surgeons reported having experienced serious adverse events, describing these as part of 'the nature of surgery'. Most surgeons reported that established strategies failed to combine facilitation of learning with taking care of the involved surgeons. Transparency about serious adverse events was by some felt as an extra burden, fearing that openness on technical-related errors could affect their future career negatively. Positive implications of transparency were linked with factors such as minimising the surgeon's feeling of personal burden with positive impact on individual and collective learning. A lack of facilitation of individual and structural transparency factors could entail 'collateral damage'. Our participants suggested that both the younger generation of surgeons in general, and the increasing number of women in surgical professions, might contribute to 'maturing' the culture of transparency. CONCLUSION AND IMPLICATIONS This study suggests that transparency associated with serious adverse events is hampered by concerns at both personal and professional levels among surgeons. These results emphasise the importance of improved systemic learning and the need for structural changes; it is crucial to increase the focus on education and training curriculums and offer advice on coping strategies and establish arenas for safe discussions after serious adverse events.
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Affiliation(s)
- Sina Furnes Øyri
- Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
- Stavanger University Hospital, Stavanger, Norway
- SHARE Centre for Resilience in Healthcare, University of Stavanger, Stavanger, Norway
| | - Kjetil Søreide
- Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- SAFER Surgery, Surgical Research Group, Stavanger University Hospital, Stavanger, Norway
| | - Eldar Søreide
- Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
- Stavanger University Hospital, Stavanger, Norway
| | - Ole Tjomsland
- South-Eastern Norway Regional Health Authority, Oslo, Norway
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Myren BJ, de Hullu JA, Koksma JJ, Gelderblom ME, Hermens RPMG, Zusterzeel PLM. Cyclic workflow to improve implementation of learning points from morbidity and mortality meetings. BMC Health Serv Res 2022; 22:1282. [PMID: 36284295 DOI: 10.1186/s12913-022-08639-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 09/21/2022] [Accepted: 09/28/2022] [Indexed: 08/30/2023] Open
Abstract
BACKGROUND Morbidity and mortality meetings (M&MMs) are organized in most hospital departments with an educational purpose to learn from adverse events (AEs) to improve patient care. M&MMs often lack effectiveness due to unsuccessful systematic follow-up of areas of improvement. This can have an effect on improving patient safety and care. Therefore, a new strategy that focuses on implementing areas of improvement into daily practice is necessary. The study aim is to see if we could improve the implementation of meeting outcomes from the M&MM by using a cyclic workflow, and which factors are important to achieve its implementation. METHODS This prospective study took place at the department of gynecologic oncology of a university hospital. Research was conducted with a participatory action research (PAR) approach using 10 consecutive M&MMs in 2019 and 2020. The cyclical workflow consisted of an action list based on the PDCA-cycle, a check of the implementation of areas for improvement at the next M&MM and regular monitoring of tasks. Each M&MM was observed and each professional with an assigned task was interviewed and gave their informed consent. Thematic content analysis was performed with the program Atlas.ti 8.4.20. RESULTS Out of the 39 tasks that resulted from 10 M&MMs, 37 (94.8%) followed all the steps in the PDCA-cycle and were implemented. In total, 16 interviews were conducted with consultants, nurses, registrars and residents. Five main factors were important to achieve follow-up of areas for improvement: organizational culture, motivation, commitment, communication to mobilize employees and skills. Repetition of the cyclic workflow at the M&MM and an external person who reminded professionals of their assigned task(s) was important to change habits and motivate professionals. CONCLUSION Cyclical tools can support the implementation of areas for improvement to optimize the M&MM. A M&MM with an organizational culture where attendees can discuss openly and freely may motivate attendees to take on tasks successfully. A positive stimulant to reach commitment of professionals is team participation. Integrating new habits of reflection may lead to a deeper level of learning from the PDCA-cycle and of the M&MM. Creating a learning environment outside of the M&MM may support professionals to take on actions and engage in improvement practices. Future research may focus on including a comparative analysis to show a success rate of the implementation of learning points from the M&MM more clearly.
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Affiliation(s)
- B J Myren
- Department of Obstetrics and Gynaecology, Radboudumc, Nijmegen, The Netherlands.
| | - J A de Hullu
- Department of Obstetrics and Gynaecology, Radboudumc, Nijmegen, The Netherlands
| | - J J Koksma
- Health Academy, Radboudumc, Nijmegen, The Netherlands
| | - M E Gelderblom
- Department of Obstetrics and Gynaecology, Radboudumc, Nijmegen, The Netherlands
| | | | - P L M Zusterzeel
- Department of Obstetrics and Gynaecology, Radboudumc, Nijmegen, The Netherlands
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Gohal G. Models of teaching medical errors. Pak J Med Sci 2021; 37:2020-2025. [PMID: 34912437 PMCID: PMC8613064 DOI: 10.12669/pjms.37.7.4506] [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: 04/01/2021] [Revised: 04/20/2021] [Accepted: 07/18/2021] [Indexed: 11/15/2022] Open
Abstract
Medical errors are relatively common causes of preventable iatrogenic adverse events. We have focused on teaching models in certain courses of study that have been reported to have significant positive impacts on the outcomes of teaching about medical errors. All healthcare organizations must establish suitable models of teaching about patient safety and medical errors as a preventive measure and as an early intervention strategy. Teaching undergraduate medical students and physicians in training how to manage and disclose medical errors helps them develop lifelong skills that can effectively reduce such errors. The literature search was conducted in international databases such as PubMed/MEDLINE and Google Scholar search engine using English equivalent keywords, from 1998 up to April, 2020. The search strategy used the following subject headings terms: “Medical error(s)” AND “Teaching”. Out of 40 Studies included, 6 studies were selected to have evaluated models of health care training and simulation based teaching of medical errors and patient safety in undergraduate and postgraduate medical education.
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Affiliation(s)
- Gassem Gohal
- Dr. Gassem Gohal, MD, FRCPC, ABP. Department of Pediatrics, Jazan University, Faculty of Medicine, Jazan, Saudi Arabia
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Rooke F, Burford J, Doorly A, Gush C, Brennan ML. Developing consensus for definitions of key veterinary-specific quality improvement (QI) terms using an eDelphi-study method. Vet Rec 2021; 191:e1174. [PMID: 34888878 DOI: 10.1002/vetr.1174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 10/18/2021] [Accepted: 10/28/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Quality improvement (QI) methods are a continuous process of iterative tests to improve the quality of a service or product. Using common language has been linked to the successful implementation of QI in human healthcare. This study aimed to assimilate and achieve consensus on veterinary-specific definitions for terms associated with quality care and QI methods in UK veterinary practice. METHODS A four-round modified eDelphi process with a panel of 50 UK veterinary practice stakeholders was used to generate consensus. The panel selected or suggested the definition they best felt 'fitted' each term. Consensus was reached if there was >70% agreement, and terms were eliminated if there was <15% selection. RESULTS Thirty-one panellists completed all three rounds of eDelphi; eight participants completed an optional feedback round. From 14 terms, 10 reached consensus, leaving four unresolved definitions. CONCLUSIONS A majority of terms reached consensus; 90% were new or amended definitions proposed by panel members. Utilising plain English refined by stakeholders will allow successful implementation of QI in veterinary healthcare. Not all terms achieved consensus, highlighting a need for further research to enable successful integration of QI principles as seen in human healthcare.
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Affiliation(s)
- Freya Rooke
- School of Veterinary Medicine and Science, University of Nottingham, Loughborough, UK.,Centre for Evidence-Based Veterinary Medicine, School of Veterinary Medicine and Science, University of Nottingham, Loughborough, UK
| | - John Burford
- School of Veterinary Medicine and Science, University of Nottingham, Loughborough, UK
| | | | | | - Marnie L Brennan
- School of Veterinary Medicine and Science, University of Nottingham, Loughborough, UK.,Centre for Evidence-Based Veterinary Medicine, School of Veterinary Medicine and Science, University of Nottingham, Loughborough, UK
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Alshyyab MA, FitzGerald G, Albsoul RA, Ting J, Kinnear FB, Borkoles E. Strategies and interventions for improving safety culture in Australian Emergency Departments: A modified Delphi study. Int J Health Plann Manage 2021; 36:2392-2410. [PMID: 34476834 DOI: 10.1002/hpm.3314] [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: 08/28/2020] [Revised: 06/15/2021] [Accepted: 08/16/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patient safety and safety culture are critical for quality healthcare delivery in general and in Emergency Departments (EDs) in particular. The aim of this study is to identify strategies that may contribute to the improvement and maintenance of patient safety culture and which are considered most feasible in the ED environment. METHODS A two-step modified Delphi method with 11 experts' panel was performed to establish consensus. A list of potential expert participants with a background in patient safety culture in EDs was compiled through the professional networks of the supervisory team. Snowball sampling was used to identify additional possible participants. The expert panel included key leaders in the emergency medicine community in Queensland, Australia: patient safety experts and researchers, patient safety directors, and healthcare providers in an Australian ED The study ran from September 2018 to December 2018. The tool used in Round 1 in this study was developed through triangulating the outcomes of a review of literature, results from a survey of ED staff and findings from semi-structured interviews with key stakeholders in ED. The results from Round 1 informed the development of the Round 2 tool. The responses from the Delphi Round 1 tool were analysed as both qualitative data and quantitative data. The responses from the Delphi Round 2 tool were treated as quantitative data and analysed with the SPSS software. Consensus was calculated based on more than 80% agreement in collapsed categories 1 and 2 (or 4 and 5) of the five-point Likert scale. RESULTS Only six strategies out of 17 (35%) achieved consensus for both importance and feasibility. These strategies may therefore be considered the most important and feasible key strategies for improving safety culture in EDs. Seven strategies (41.1%) achieved consensus for importance, but not for feasibility and four strategies (23.55%) did not achieve consensus for either importance or feasibility. CONCLUSIONS This study offers practical solutions for safety culture improvement in the ED context. Six key strategies were seen as both important and feasible and these grouped into three main themes; leadership through agenda setting, operational management approaches to reinforce the agenda and commitment, and systems and structures to reinforce the agenda and monitor progress.
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Affiliation(s)
- Muhammad Ahmed Alshyyab
- Department of Public Health, School of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Gerard FitzGerald
- Department of Public Health and Social Work, School of Health, Brisbane, Queensland, Australia
| | - Rania Ali Albsoul
- Department of Family and Community Medicine, School of Medicine, The University of Jordan, Amman, Jordan
| | - Joseph Ting
- Department of Public Health and Social Work, School of Health, Brisbane, Queensland, Australia.,Department of Emergency Medicine, Mater Health Services, Brisbane, Queensland, Australia
| | - Frances B Kinnear
- Emergency Department, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Erika Borkoles
- Department of Public Health, School of Medicine, Public Health, Griffith University, Gold Coast Campus, Southport, Queensland, Australia
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Chun JY, Bharadwaz A, Kyaw Tun J, Bilhim T, Gonzalez-Junyent C, Kawa B. CIRSE Standards of Practice on Conducting Meetings on Morbidity and Mortality. Cardiovasc Intervent Radiol 2021; 44:1157-1164. [PMID: 34018022 DOI: 10.1007/s00270-021-02860-y] [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: 11/17/2020] [Accepted: 04/26/2021] [Indexed: 11/27/2022]
Abstract
This CIRSE Standards of Practice document is developed by an expert writing group under the guidance of the CIRSE Standards of Practice Committee. It aims to assist Interventional Radiologists in their daily practice by providing best practices for conducting meetings on morbidity and mortality.
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Affiliation(s)
- Joo-Young Chun
- Department of Radiology, St George's Hospital, London, UK.
| | - Arindam Bharadwaz
- Department of Radiology, Aarhus University Hospital, Aarhus, Denmark
| | - Jimmy Kyaw Tun
- Department of Interventional Radiology, Barts Health NHS Trust, London, UK
| | - Tiago Bilhim
- Interventional Radiology Unit, Centro Hospitalar Universitário de Lisboa Central, Saint Louis and CUF Hospital, Lisbon, Portugal
- Nova Medical School, Lisbon, Portugal
| | | | - Bhavin Kawa
- Department of Radiology, St George's Hospital, London, UK
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13
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The value of Morbidity & Mortality (M&M) conferences in residency training: a proposed model from an academic medical center in Iran. Patient Saf Surg 2020; 14:5. [PMID: 32002024 PMCID: PMC6986155 DOI: 10.1186/s13037-020-0231-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 01/21/2020] [Indexed: 11/12/2022] Open
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