1
|
Reyes Ramos MJ, Costa Abós S. Patient Safety Culture: Nurses' Perspective in the Hospital Setting. Healthcare (Basel) 2024; 12:1010. [PMID: 38786420 PMCID: PMC11121312 DOI: 10.3390/healthcare12101010] [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: 03/26/2024] [Revised: 05/07/2024] [Accepted: 05/11/2024] [Indexed: 05/25/2024] Open
Abstract
(1) Background: Patient safety culture (PSC) encompasses the values, attitudes, norms, beliefs, practices, perceptions, competencies, policies, and behaviours of professionals that determine organisational commitment to quality and patient safety. Few studies use mixed methods to analyse patient safety culture, and none offer the richness of using a mixed methodology to develop their theoretical model. This study aims to identify the factors nurses believe contextualise and influence PSC in relation to existing theoretical frameworks. (2) Methods: This study employed a sequential explanatory mixed-methods design combined with the Pillar Integration Process for data integration. (3) Results: In the final data integration process, 26 factors affecting nurses' PSC were identified. Factors nurses related to PSC not being assessed with the tool used in phase 1 were notification system, flow of patients, patient involvement, resources and infrastructure, and service characteristics. (4) Conclusions: This mixed-methods study provides an opportunity to identify the weaknesses and strengths of currently developed theoretical frameworks related to PSC and offers content for its improvement. Even though multiple studies aim to assess PSC using existing quantitative method tools, the development of this study offers a glimpse of some aspects relevant to nurses' PSC not included in the theoretical framework of the said tools, such as patient involvement, the flow of patients, and service infrastructure.
Collapse
Affiliation(s)
- Maria José Reyes Ramos
- Facultat d’Infermeria, Universitat de Barcelona, 08907 Barcelona, Spain
- Fundació Sanitària Mollet, 08100 Mollet del Vallès, Spain
| | - Silvia Costa Abós
- Facultat d’Infermeria, Universitat de Barcelona, 08907 Barcelona, Spain
| |
Collapse
|
2
|
Jiménez-Martínez E, Adamuz J, González-Samartino M, Muñoz-Carmona MA, Hornero A, Martos-Martínez MP, Membrive-Martínez R, Juvé-Udina ME. Peripheral intravenous catheter failure, nurse staffing levels and care complexity individual factors: A retrospective multicentre cohort study. PLoS One 2024; 19:e0303152. [PMID: 38722995 PMCID: PMC11081384 DOI: 10.1371/journal.pone.0303152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 04/20/2024] [Indexed: 05/13/2024] Open
Abstract
INTRODUCTION Short peripheral intravenous catheter (PIVC) failure is a common complication that is generally underdiagnosed. Some studies have evaluated the factors associated with these complications, but the impact of care complexity individual factors and nurse staffing levels on PIVC failure is still to be assessed. The aim of this study was to determine the incidence and risk factors of PIVC failure in the public hospital system of the Southern Barcelona Metropolitan Area. METHODS A retrospective multicentre observational cohort study of hospitalised adult patients was conducted in two public hospitals in Barcelona from 1st January 2016 to 31st December 2017. All adult patients admitted to the hospitalisation ward were included until the day of discharge. Patients were classified according to presence or absence of PIVC failure. The main outcomes were nurse staffing coverage (ATIC patient classification system) and 27-care complexity individual factors. Data were obtained from electronic health records in 2022. RESULTS Of the 44,661 patients with a PIVC, catheter failure was recorded in 2,624 (5.9%) patients (2,577 [5.8%] phlebitis and 55 [0.1%] extravasation). PIVC failure was more frequent in female patients (42%), admitted to medical wards, unscheduled admissions, longer catheter dwell time (median 7.3 vs 2.2 days) and those with lower levels of nurse staffing coverage (mean 60.2 vs 71.5). Multivariate logistic regression analysis revealed that the female gender, medical ward admission, catheter dwell time, haemodynamic instability, uncontrolled pain, communication disorders, a high risk of haemorrhage, mental impairments, and a lack of caregiver support were independent factors associated with PIVC failure. Moreover, higher nurse staffing were a protective factor against PIVC failure (AUC, 0.73; 95% confidence interval [CI]: 0.72-0.74). CONCLUSION About 6% of patients presented PIVC failure during hospitalisation. Several complexity factors were associated with PIVC failure and lower nurse staffing levels were identified in patients with PIVC failure. Institutions should consider that prior identification of care complexity individual factors and nurse staffing coverage could be associated with a reduced risk of PIVC failure.
Collapse
Affiliation(s)
- Emilio Jiménez-Martínez
- Infectious Disease Department, Bellvitge University Hospital, L’Hospitalet de Llobregat (Barcelona), Barcelona, Spain
- Medicine and Health Science Faculty, School of Nursing, University of Barcelona, L’Hospitalet de Llobregat (Barcelona), Barcelona, Spain
- Bellvitge Institute of Biomedical Research, IDIBELL, Nursing Research Group, Barcelona, Spain
| | - Jordi Adamuz
- Medicine and Health Science Faculty, School of Nursing, University of Barcelona, L’Hospitalet de Llobregat (Barcelona), Barcelona, Spain
- Bellvitge Institute of Biomedical Research, IDIBELL, Nursing Research Group, Barcelona, Spain
- Nursing Knowledge Management and Information Systems Department, Bellvitge University Hospital, L’Hospitalet de Llobregat (Barcelona), Barcelona, Spain
| | - Maribel González-Samartino
- Medicine and Health Science Faculty, School of Nursing, University of Barcelona, L’Hospitalet de Llobregat (Barcelona), Barcelona, Spain
- Bellvitge Institute of Biomedical Research, IDIBELL, Nursing Research Group, Barcelona, Spain
- Nursing Knowledge Management and Information Systems Department, Bellvitge University Hospital, L’Hospitalet de Llobregat (Barcelona), Barcelona, Spain
| | - Maria Antonia Muñoz-Carmona
- Nursing Knowledge Management and Information Systems Department, Viladecans Hospital, Viladecans (Barcelona), Barcelona, Spain
| | - Ana Hornero
- Infectious Disease Department, Bellvitge University Hospital, L’Hospitalet de Llobregat (Barcelona), Barcelona, Spain
- Bellvitge Institute of Biomedical Research, IDIBELL, Nursing Research Group, Barcelona, Spain
| | | | - Remedios Membrive-Martínez
- Infectious Disease Department, Bellvitge University Hospital, L’Hospitalet de Llobregat (Barcelona), Barcelona, Spain
| | - Maria-Eulàlia Juvé-Udina
- Bellvitge Institute of Biomedical Research, IDIBELL, Nursing Research Group, Barcelona, Spain
- Catalan Institute of Health, Barcelona, Spain
| |
Collapse
|
3
|
de Moura Pedro RA, Besen BAMP, Mendes PV, Gomes ACM, de Carvalho MT, Malbouisson LMS, Park M, Taniguchi LU. Adverse events leading to intensive care unit admission in a low-and-middle-income-country: A prospective cohort study and a systematic review. J Crit Care 2024; 80:154510. [PMID: 38150833 DOI: 10.1016/j.jcrc.2023.154510] [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: 10/03/2023] [Revised: 12/12/2023] [Accepted: 12/13/2023] [Indexed: 12/29/2023]
Abstract
INTRODUCTION Adverse events (AE) are frequent in critical care and could be even more prevalent in LMIC due to a shortage of ICU beds and Human resources. There is limited data on how relevant AE are among the reasons for ICU admission, being all of which published by High-Income-Countries services. Our main goal is to describe the rate of adverse events-related ICU admissions and their preventability in a LMIC scenario, comparing our results with previous data. METHODS This was a prospective cohort study, during a one-year period, in two general ICUs from a tertiary public academic hospital. Our exposure of interest was ICU admission related to an AE in adult patients, we further characterized their preventability and clinical outcomes. We also performed a systematic review to identify and compare previous published data on ICU admissions due to AE. RESULTS Among all ICU admissions, 12.1% were related to an AE (9.8% caused by an AE, 2.3% related but not directly caused by an AE). These ICU admissions were not associated with a higher risk of death, but most of them were potentially preventable (70.9% of preventability rate, representing 8.6% of all ICU admissions). The meta-analysis resulted in a proportion of ICU admissions due to AE of 11% (95% CI 6%-16%), with a preventability rate of 54% (95% CI 42%-66%). CONCLUSIONS In this prospective cohort, adverse events were a relevant reason for ICU admission. This result is consistent with data retrieved from non-LMIC as shown in our meta-analysis. The high preventability rate described reinforces that quality and safety programs could work as a tool to optimize scarce resources.
Collapse
Affiliation(s)
| | | | - Pedro Vitale Mendes
- Intensive Care Unit, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil
| | | | | | | | - Marcelo Park
- Intensive Care Unit, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil
| | - Leandro Utino Taniguchi
- Intensive Care Unit, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil; Hospital Sírio-Libanês, São Paulo, SP, Brazil
| |
Collapse
|
4
|
Rezaie F, Mohammadi-Shahboulaghi F, Fadayevatan R, Shati M, Ghaedamini-Harouni G. Working Condition and Job Satisfaction of Nurses as Predicting Factors of the Prevalence of Health care-associated Infections among Elderly Inpatients. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2023; 28:684-689. [PMID: 38205405 PMCID: PMC10775862 DOI: 10.4103/ijnmr.ijnmr_87_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 07/30/2023] [Accepted: 07/31/2023] [Indexed: 01/12/2024]
Abstract
Background Health care-Associated Infections (HCAIs) are among the most common adverse events (AEs) that can negatively affect both patients and health systems. The elderly is among patients at high risk for infections. Some controllable risk factors have received less attention in research. Therefore, this study aims to investigate the relationship between prevalence of HCAIs among elderly inpatients, job satisfaction of nurses, and working condition. Materials and Methods This cross-sectional study was conducted on 211 nurses working in hospitals affiliated with Iran University of Medical Sciences, Tehran, in 2021. The data were collected from HCAIs reports by the Nosocomial Infection Control Committee, a demographic questionnaire, the Practice Environment Scale of the Nursing Work Index (PES-NWI), and the Minnesota Satisfaction Questionnaire (MSQ). The data were statistically analyzed using Pearson correlation coefficient, ANOVA, t-test, and multiple linear regression (MLR) in SPSS 26. Results The results showed that there was a significant relationship between the PES-NWI and MSQ (r = 0.68, p < 0.00). The MLR results indicated that staffing and resource adequacy, nurse participation in hospital affairs, job satisfaction, nursing manager's leadership, and nursing foundations for quality of care are predictive factors that these could explain 78% of the changes in the prevalence of HCAIs and the goodness of fit of the regression model was acceptable [F6.210 = 129.47, p < 0.001]. Conclusions Since job satisfaction and the work condition could predict HCAIs among the elderly patients, healthcare administers are recommended to consider these two variables in the development of HCAIs prevention and control programs.
Collapse
Affiliation(s)
- Fereshteh Rezaie
- Gerontology Department, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Farahnaz Mohammadi-Shahboulaghi
- Iranian Research Center on Aging, Nursing Department, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Reza Fadayevatan
- Iranian Research Center on Aging, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Mohsen Shati
- Mental Health Research Center, Psychosocial Health Research Institute, Tehran, Iran
- Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Gholamreza Ghaedamini-Harouni
- Social Welfare Management Research Center, Social Health Research Institute, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| |
Collapse
|
5
|
Yan L, Liu L, Wang F, Hu X. Construction and validation of safe care theory for older inpatients from the perspective of socio-ecological model: a study protocol. BMJ Open 2023; 13:e072770. [PMID: 37852758 PMCID: PMC10603482 DOI: 10.1136/bmjopen-2023-072770] [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: 02/15/2023] [Accepted: 09/07/2023] [Indexed: 10/20/2023] Open
Abstract
INTRODUCTION In an ageing society, older adults are the main users of healthcare services, and Chinese healthcare systems have been struggling to meet the care demand of older adults. Due to the illness, many older inpatients cannot finish daily activities independently and require healthcare from caregivers. Evaluating the care needs of older adults and exploring the factors affecting safe care at multiple levels are conducive to providing systematic care services for older inpatients. This study aims to examine which and how factors impact safe care for older inpatients and propose a safe care theory to provide directions on improving the safe care system in the hospital. METHODS AND ANALYSIS A mixed-methods study with three interrelated research streams will be designed. (1) A safe care concept model: we will conduct a scoping review to extract the facilitators and barriers influencing the safe care of older inpatients and construct a concept model based on the socio-ecological model and the Yorkshire Contributory Factors Framework. (2) A safe care theory model: we will conduct a qualitative study with thematic analysis (aimed at older inpatients, caregivers and nurses) to define the concept connotations and propose a theory model. (3) A safe care theory: we will use the scales related to the theory model to test the concepts and statements. We will revise the theory model and derive a safe care theory based on the mixed-methods study results. This study will start in October 2023 and end in October 2025. ETHICS AND DISSEMINATION This study was approved by the ethics committee (No. 20221598). All participants will be provided with consent forms prior to data collection. The study will be disseminated via peer-reviewed manuscripts and conferences. TRIAL REGISTRATION NUMBER ChiCTR2300067421.
Collapse
Affiliation(s)
- Lupei Yan
- Innovation Center of Nursing Research and Nursing Key Laboratory of Sichuan Province, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | - Li Liu
- Innovation Center of Nursing Research and Nursing Key Laboratory of Sichuan Province, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | - Fang Wang
- Innovation Center of Nursing Research and Nursing Key Laboratory of Sichuan Province, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | - Xiuying Hu
- Innovation Center of Nursing Research and Nursing Key Laboratory of Sichuan Province, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| |
Collapse
|
6
|
Papier I, Sagi-Dain L, Chermesh I, Mashiach T, Banasiewicz T. Absence of oral nutritional support in low food intake inpatients is associated with an increased risk of hospital-acquired pressure injury. Clin Nutr ESPEN 2022; 51:190-198. [PMID: 36184204 DOI: 10.1016/j.clnesp.2022.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 09/03/2022] [Accepted: 09/04/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND & AIMS Hospital-acquired pressure injury (HAPI) incidence is a common burden in hospitals. Decreased food intake leading to malnutrition compromises body tissues involved in pressure injury occurrence. However, most tools for predicting pressure injuries do not include daily food intake monitoring nor consider further nutritional interventions. This study aimed to investigate clinical practices for food intake monitoring and its association with predicting HAPI risk, together with Norton Scale use, and whether the initiation or absence of oral nutritional supplements (ONS), separately from other nutritional interventions, was associated with HAPI incidence in low food intake inpatients, who consumed less than 50% of requirements. METHODS This observational cohort study covered a one-year period (08/2018-07/2019). Demographic and clinical data were extracted from computerized files of patients hospitalized ≥7 days, aged ≥60 years, and who ate orally. Patients receiving enteral or parenteral nutrition were excluded. Differences were studied between groups without and with HAPI grade ≥2. Subgroups divided by Norton Scale and intake, Norton Scale and albumin levels, food intake and initiation (or not) of any nutritional intervention versus ONS only, were examined for the consistency of association with HAPI. RESULTS Of the 5155 admissions during the study period, 895 patients fulfilled the inclusion criteria: 48% female, mean age 77.6 ± 9.1 years, 11% with MUST score ≥2. Nutritional intake was reported in 76% of patients, of them 22% had low food intake, and 9% of the study group developed HAPI grade ≥2. Regarding HAPI incidence, no differences were found between groups divided by MUST scores. Independent risk factors significantly associated with HAPI were Norton <14, albumin levels <3 g/dl, and low food intake. Not providing ONS in low food intake patients had an adjusted 3.49-fold (95%CI 1.57-7.75) increase in HAPI risk (6-fold for non-adjusted relative risk). CONCLUSION Failure to initiate ONS as part of nutritional support in low food intake patients is associated with high HAPI risk in these patients. Consequently, monitoring of daily food intake for identifying low intake patients should be integrated into routinely used tools such as the Norton Scale, and adherence to nutritional protocols should be addressed.
Collapse
Affiliation(s)
- Irena Papier
- Nursing Department, Rambam Health Care Campus, Haifa, Israel.
| | - Lena Sagi-Dain
- Genetics Institute, Carmel Medical Center, Affiliated to the Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
| | - Irit Chermesh
- Institute of Gastroenterology, Rambam Health Care Campus, Haifa, Israel.
| | - Tanya Mashiach
- Department of Epidemiology, Rambam Health Care Campus, Haifa, Israel.
| | - Tomasz Banasiewicz
- Department of General, Endocrinological Surgery and Gastroenterological Oncology, Poznan University of Medical Sciences, Poland.
| |
Collapse
|
7
|
Health Outcomes of Elder Orphans: an Umbrella and Scoping Review of the Literature. JOURNAL OF POPULATION AGEING 2022. [DOI: 10.1007/s12062-022-09387-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
8
|
Jarošová D, Zeleníková R, Plevová I, Mynaříková E, Kachlová M. Differences in the Incidence of Adverse Events in Acute Care Hospitals: Results of a Multicentre Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095238. [PMID: 35564632 PMCID: PMC9105439 DOI: 10.3390/ijerph19095238] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 04/21/2022] [Accepted: 04/24/2022] [Indexed: 11/28/2022]
Abstract
Background: Adverse events are indicators of patient safety and quality of care. Adverse events clearly have negative impacts on healthcare system costs. Organizational and unit characteristics are not very often studied in relation to adverse events. The aim of the study was to find the differences in the incidence of adverse events and healthcare-associated infections in hospitalized patients in Czech acute care hospitals according to type of hospital and type of unit. Methods: This cross-sectional multicentre study was conducted in 105 acute care medical and surgical units located in 14 acute care hospitals throughout the Czech Republic. The data on adverse events and healthcare-associated infections were reported monthly by nurse researchers. The data were collected from June 2020 to October 2020. Results: The incidence of healthcare-associated infections, pressure ulcers, and medication errors was significantly lower in large hospitals. Statistically significant differences have been further found between the incidence of pressure ulcers (<0.001), falls without injury (<0.001), and falls with injury (<0.001) in surgical and medical units. More pressure ulcers, falls without injury, and falls with injury have been reported in surgical units. Conclusion: The type of hospital and type of unit affected the incidence of adverse events at acute care hospitals. To reduce adverse events, a systematic adverse event measurement and reporting system should be promoted.
Collapse
Affiliation(s)
- Darja Jarošová
- Department of Nursing and Midwifery, Faculty of Medicine, University of Ostrava, 701 03 Ostrava, Czech Republic; (D.J.); (I.P.); (M.K.)
| | - Renáta Zeleníková
- Department of Nursing and Midwifery, Faculty of Medicine, University of Ostrava, 701 03 Ostrava, Czech Republic; (D.J.); (I.P.); (M.K.)
- Correspondence:
| | - Ilona Plevová
- Department of Nursing and Midwifery, Faculty of Medicine, University of Ostrava, 701 03 Ostrava, Czech Republic; (D.J.); (I.P.); (M.K.)
| | - Eva Mynaříková
- Department of Nursing Care, University Hospital Ostrava, 708 00 Ostrava, Czech Republic;
| | - Miroslava Kachlová
- Department of Nursing and Midwifery, Faculty of Medicine, University of Ostrava, 701 03 Ostrava, Czech Republic; (D.J.); (I.P.); (M.K.)
- Department of Nursing Care, University Hospital Ostrava, 708 00 Ostrava, Czech Republic;
| |
Collapse
|
9
|
Friebel R, Henschke C, Maynou L. Comparing the dangers of a stay in English and German hospitals for high-need patients. Health Serv Res 2021; 56 Suppl 3:1405-1417. [PMID: 34486105 PMCID: PMC8579208 DOI: 10.1111/1475-6773.13712] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 06/28/2021] [Accepted: 07/03/2021] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To estimate the risk of an avoidable adverse event for high-need patients in England and Germany and the causal impact that has on outcomes. DATA SOURCES We use administrative, secondary data for all hospital inpatients in 2018. Patient records for the English National Health Service are provided by the Hospital Episode Statistics database and for the German health care system accessed through the Research Data Center of the Federal Statistical Office. STUDY DESIGN We calculated rates of three hospital-acquired adverse events and their causal impact on mortality and length of stay through propensity score matching and estimation of average treatment effects. DATA COLLECTION/EXTRACTION METHODS Patients were identified based on diagnoses codes and translated Patient Safety Indicators developed by the Agency for Healthcare Research and Quality. PRINCIPAL FINDINGS For the average hospital stay, the risk of an adverse event was 5.37% in the English National Health Service and 3.26% in the German health care system. High-need patients are more likely to experience an adverse event, driven by hospital-acquired infections (2.06%-4.45%), adverse drug reactions (2.37%-2.49%), and pressure ulcers (2.25%-0.45%). Adverse event risk is particularly high for patients with advancing illnesses (10.50%-27.11%) and the frail elderly (17.75%-28.19%). Compared to the counterfactual, high-need patients with an adverse event are more likely to die during their hospital stay and experience a longer length of stay. CONCLUSIONS High-need patients are particularly vulnerable with an adverse event risking further deterioration of health status and adding resource use. Our results indicate the need to assess the costs and benefits of a hospital stay, particularly when care could be provided in settings considered less hazardous.
Collapse
Affiliation(s)
- Rocco Friebel
- Department of Health PolicyThe London School of Economics and Political ScienceLondonUK
- Center for Global Development EuropeLondonUK
| | - Cornelia Henschke
- Department of Health Care ManagementBerlin University of TechnologyBerlinGermany
- Berlin Centre of Health Economics ResearchBerlin University of TechnologyBerlinGermany
| | - Laia Maynou
- Department of Health PolicyThe London School of Economics and Political ScienceLondonUK
- Department of Econometrics, Statistics and Applied EconomicsUniversitat de BarcelonaBarcelonaSpain
- Center for Research in Health and EconomicsUniversity of Pompeu FabraBarcelonaSpain
| |
Collapse
|
10
|
Mgobozi P, Mahomed OH. Epidemiology of patient safety incidents in a long-term rehabilitative hospital in KwaZulu-Natal, South Africa (April 2011 to March 2016). Curationis 2021; 44:e1-e6. [PMID: 34082537 PMCID: PMC8182556 DOI: 10.4102/curationis.v44i1.2151] [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: 02/02/2020] [Revised: 02/22/2021] [Accepted: 04/04/2021] [Indexed: 11/23/2022] Open
Abstract
Background Patient safety is a key priority of the National Department of Health. Despite the publication of legislation and other measures to address patient safety incidents (PSIs) there are a paucity of studies relating to patient safety at the different levels of hospitals. Objectives To determine the epidemiology (incidence, nature and root causes) of PSIs at a long-term rehabilitative hospital between April 2011 and March 2016. Method Data were collected through a review and analysis of routinely collected hospital information on patient records and from the PSI register, as well as minutes of adverse health events meetings, quality assurance reports and patient complaints register. Results A total or 4.12 PSIs per 10 000 inpatient days were reported. Approximately 52% of the adverse health events occurred in females with most of the adverse health events occurring in the 50–59 years category: 96% being reported during the day and 33% within the shift change. Pressure ulcers, falls, injury, hospital acquired infections and medication error were the most commonly reported PSIs. Patient factors were listed as the most common root cause for the PSIs. Conclusion The study shows a low reporting rate of PSIs whilst showing a diverse pattern of PSIs over a period of 5 years. There is a need for active change management in order to establish a blame-free culture and learning environment to improve reporting of PSI. A comprehensive quality improvement intervention addressing patients, their families and staff is essential to minimise PSI and its consequences.
Collapse
Affiliation(s)
- Phe Mgobozi
- Department of Public Health Medicine, University of KwaZulu-Natal, Durban.
| | | |
Collapse
|
11
|
Kang Y, Fang XY, Wang D, Wang XJ. Activity of daily living upon admission is an independent predictor of in-hospital mortality in older patients with community-acquired pneumonia. BMC Infect Dis 2021; 21:314. [PMID: 33794779 PMCID: PMC8017749 DOI: 10.1186/s12879-021-06006-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 03/22/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Older patients hospitalized with community-acquired pneumonia (CAP) are at high risk for short-term mortality. Activity of daily living (ADL) is associated with clinical outcomes in older patients. We aimed to investigate the prognostic value of ADL upon admission on the in-hospital mortality in older patients with CAP. METHODS We conducted a retrospective cohort study involving patients aged ≥65 years admitted to Beijing Chao-Yang hospital due to CAP between June 2012 and June 2020. ADL evaluation upon admission was performed by Barthel Index (BI). Data from all patients were extracted from the electronic medical records. RESULTS Four thousand eight hundred eighty patients were included, 131 patients (2.7%) died during their hospitalization. Median BI in the Deceased group was 45 (20-65), Deceased group had lower BI scores than Survivors group (p < 0.001). Low BI (< 60) was more frequent in patients who died in the hospital than in patients discharged alive (69.5% vs. 13%, p < 0.001). In-hospital mortality was higher among patients with worse ADL upon admission (BI< 60) compared to those BI≥60 (12.6% vs. 0.9%). The worse ADL upon admission (BI< 60) was associated with an increase in the risk of death during CAP hospitalization, worse ADL upon admission (BI< 60) showed an odds ratio (OR) for in-hospital mortality of 7.53 (95%CI: 2.77-20.48; P < 0.01). This association remained significant after adjustment for age, comorbid conditions, respiratory failure, pathogens and laboratory findings (OR, 3.74; 95%CI, 2.37-5.91; P < 0.01). Receiver operating characteristic (ROC) curve revealed that BI upon admission is a predictor related to in-hospital mortality in elderly patients, the area under the ROC curve of BI in predicting in-hospital mortality was 0.81 (with 95% confidence interval: 0.78-0.85). The predictive value of ADL upon admission was better than age in our study population. CONCLUSION Activity of daily living upon admission is an independent predictor of in-hospital mortality in older patients with community-acquired pneumonia.
Collapse
Affiliation(s)
- Yu Kang
- Department of Internal Medicine, Beijing Chao-Yang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, China
| | - Xiang-Yang Fang
- Department of Internal Medicine, Beijing Chao-Yang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, China
| | - Dong Wang
- Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Xiao-Juan Wang
- Department of Internal Medicine, Beijing Chao-Yang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, China.
| |
Collapse
|
12
|
Hongo T, Naito H, Fujiwara T, Naito T, Homma Y, Fujimoto Y, Takaya M, Yamamori Y, Nakada T, Nojima T, Nakao A, Fujitani S. Prevalence and predictors of direct discharge home following hospitalization of patients with serious adverse events managed by the rapid response system in Japan: a multicenter, retrospective, observational study. Acute Med Surg 2021; 8:e690. [PMID: 34430036 PMCID: PMC8366722 DOI: 10.1002/ams2.690] [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: 04/02/2021] [Revised: 06/18/2021] [Accepted: 07/26/2021] [Indexed: 11/11/2022] Open
Abstract
AIM The rapid response system (RRS) is an in-hospital medical safety system. To date, not much is known about patient disposition after RRS activation, especially discharge home. This study aimed to investigate the prevalence, characteristics, and outcomes of patients with adverse events who required RRS activation. METHODS Retrospective data from the In-Hospital Emergency Registry in Japan collected from April 2016 to November 2020 were eligible for our analysis. We divided patients into Home Discharge, Transfer, and Death groups. The primary outcome was the prevalence of direct discharge home, and independently associated factors were determined using multivariable logistic regression. RESULTS We enrolled 2,043 patients who met the inclusion criteria. The prevalence of discharge home was 45.7%; 934 patients were included in the Home Discharge group. Age (adjusted odds ratio [AOR] 0.96; 95% confidence interval [CI], 0.95-0.97), malignancy (AOR 0.69; 95% CI, 0.48-0.99), oxygen administration before RRS (AOR 0.49; 95% CI, 0.36-0.66), cerebral performance category score on admission (AOR 0.38; 95% CI, 0.26-0.56), do not attempt resuscitation order before RRS (AOR 0.17; 95% CI, 0.10-0.29), RRS call for respiratory failure (AOR 0.50; 95% CI, 0.34-0.72), RRS call for stroke (AOR 0.12; 95% CI, 0.03-0.37), and intubation (AOR 0.20; 95% CI, 0.12-0.34) were independently negative, and RRS call for anaphylaxis (AOR 15.3; 95% CI, 2.72-86.3) was positively associated with discharge home. CONCLUSION Less than half of the in-hospital patients under RRS activation could discharge home. Patients' conditions before RRS activation, disorders requiring RRS activation, and intubation were factors that affected direct discharge home.
Collapse
Affiliation(s)
- Takashi Hongo
- Emergency DepartmentOkayama Saiseikai General HospitalOkayamaJapan
- Department of Emergency, Critical Care, and Disaster MedicineOkayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesOkayamaJapan
| | - Hiromichi Naito
- Department of Emergency, Critical Care, and Disaster MedicineOkayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesOkayamaJapan
| | | | - Takaki Naito
- Department of Emergency and Critical Care MedicineSt. Marianna University School of MedicineKanagawaJapan
| | - Yosuke Homma
- Department of Emergency and Critical Care MedicineTokyo Bay Urayasu Ichikawa Medical CenterChibaJapan
| | - Yoshihisa Fujimoto
- Department of Emergency and Critical Care MedicineTokyo Bay Urayasu Ichikawa Medical CenterChibaJapan
| | - Morooka Takaya
- Emergency and Critical Care Medical CenterOsaka City General HospitalOsakaJapan
| | - Yuji Yamamori
- Department of Emergency and Critical Care MedicineShimane Prefectural Central HospitalShimaneJapan
| | - Taka‐aki Nakada
- Department of Emergency and Critical Care MedicineChiba University Graduate School of MedicineChibaJapan
| | - Tsuyoshi Nojima
- Department of Emergency, Critical Care, and Disaster MedicineOkayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesOkayamaJapan
| | - Atsunori Nakao
- Department of Emergency, Critical Care, and Disaster MedicineOkayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesOkayamaJapan
| | - Shigeki Fujitani
- Department of Emergency and Critical Care MedicineSt. Marianna University School of MedicineKanagawaJapan
| |
Collapse
|