Assessing the Health-Care Risk: The Clinical-VaR, a Key Indicator for Sound Management

The Selection of Main Surgical Work Factors in Operating Rooms

The main component of error minimization in operating rooms (ORs) is to maintain high reliability of surgical teams. The analysis of adverse events in the OR reveals deficiencies in cognitive and interpersonal skills as the main factors influencing surgeons’ errors. Therefore, research of these additional factors is necessary, besides factors related to surgeons’ clinical knowledge and technical skills. In this paper, the key factors for evaluating activities in surgical operating rooms are identified. Fuzzy analytic hierarchy process is used for identification of key factors. Fifteen key factors are identified for evaluating activities in surgical operating rooms to improve the efficiency of surgical operations. For each group of activities (surgical “capabilities,” operating room characteristics, and non-technical skills), five factors are identified. As the most important, the following factors are obtained: communication, indoor environment standardization, and tool handle design. The aim of the analysis of these key factors is surgeons’ work capability enhancement, rational design of operating rooms, and advancement of operators’ cognitive and interpersonal skills.

Exploring patient safety culture in emergency departments: A Tunisian perspective

BACKGROUND

Emergency departments (EDs) are considered a high-risk environment because of the high frequency of adverse events that occur within. Measuring patient safety culture is an important step that assists healthcare facilities in planning actions to improve the quality of care provided to patients. This study aims to assess patient safety culture within EDs and to determine its associated factors.

METHODS

A cross-sectional study conducted among professionals from all the EDs of public and private healthcare institutions in Tunisia. It spread from June to September 2017. We used the validated French version of the Hospital Survey on Patient Safety Culture questionnaire.

RESULTS

In total, 11 EDs were included in the study, with 442 participants and a participation rate of 80.35%. All the ten dimensions of patient safety culture were in need of improvement. 'Teamwork within units' scored the highest with 46%, however, the lowest score was attributed to 'the frequency of adverse events reporting' (19.6%). Several factors have been found significantly related to safety culture. Private EDs have shown significantly higher scores regarding nine patient safety culture dimensions.

CONCLUSION

This study showed a concerning perception held by participants about the lack of a patient safety culture in their EDs. Also, it provided baseline results giving a clearer vision of the aspects of safety that need improvement.

Application of Geostatistical Analysis and Random Forest for Source Analysis and Human Health Risk Assessment of Potentially Toxic Elements (PTEs) in Arable Land Soil

Arable land soil is one of the most precious natural resources of Earth, it provides the fundamental material and numerous resources essential for the development of human society. To determine the pollution of potential toxic factors in the surface soil of cultivated land and its risks to human health, concentrations of five different potentially toxic elements (PTEs) were detected in 1109 soil samples collected in Xiangzhou, China, in 2019. In this study, health risk assessment was used to judge the degree of pollution in the study area, the result of Geographic Information System (GIS) was as used to research the spatial distribution characteristics of PTEs, and random forest (RF) was used to assess the natural and man-made influencing factors. We investigated the sources of PTEs through quantifying the indicators, which gave further insights. The main results are: (1) In arable land soil, the average content of PTEs is 0.14 mg/kg cadmium (Cd), 0.05 mg/kg mercury (Hg), 12.89 mg/kg arsenic (As), 29.23 mg/kg lead (Pb), and 78.58 mg/kg chromium (Cr), respectively. The content of As and Pb outpaced the background value of Hubei soil. (2) The human health risk assessment in Xiangzhou indicates that the most important exposure pathway is soil ingestion, occupied about 99% to health risks of PTEs; non-carcinogenic risk from exposure to As, Pb and Cr in soil was higher than the limit (overall potential risk index, HI > 1) for both children and adults. Moreover, carcinogenic risk postured by Cd, Cr, and As was higher than the limit (10^-4) through soil exposure for both children and adults, indicating that Cd, As, Pb and Cr in soil have significant effect on people's health through exposure. (3) We found that the increased PTEs in the arable land soil mainly originated from potential water sources, air and soil pollution sources, breeding farms, and mining areas.

Application of the Structure Function in the Evaluation of the Human Factor in Healthcare

A structure function is one of the possible mathematical models of systems in reliability engineering. A structure function maps sets of component states into system performance levels. Methods of system reliability evaluation based on structure function representation are well established. A structure function can be formed based on completely specified data about system behavior. Such data for most real-world systems are incomplete and uncertain. The typical example is analysis and evaluation of the human factor. Therefore, the structure function is not used in human reliability analysis (HRA) typically. In this paper, a method for structure function construction is proposed based on incomplete and uncertain data in HRA. The proposed method application is considered for healthcare to evaluate medical error. This method is developed using a fuzzy decision tree (FDT), which allows all possible component states to be classified into classes of system performance levels. The structure function is constructed based on the decision table, which is formed according to the FDT. A case study for this method is considered by evaluating the human factor in healthcare: complications in the familiarization and exploitation of a new device in a hospital department are analyzed and evaluated. This evaluation shows the decreasing of medical errors in diagnosis after one year of device exploitation and a slight decrease in quality of diagnosis after two months of device exploitation. Numerical values of probabilities of medical error are calculated based on the proposed approach.