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Carbonara N, Pellegrino R, De Luca C. Resilience of hospitals in an age of disruptions: a systematic literature review on resources and capabilities. Health Syst (Basingstoke) 2024; 13:192-228. [PMID: 39175496 PMCID: PMC11338213 DOI: 10.1080/20476965.2024.2365144] [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: 05/18/2023] [Accepted: 06/02/2024] [Indexed: 08/24/2024] Open
Abstract
Hospitals play a critical role in ensuring continuous and effective healthcare delivery, especially during crises. However, the COVID-19 pandemic exposed vulnerabilities in hospital systems, prompting a need to enhance resilience-the ability to withstand, absorb, respond to, recover from, and learn from disasters. A systematic literature review, grounded in the resource-based view, identified organizational characteristics, in terms of resources and capabilities, and their synergistic effects that bolster hospital resilience. The results demonstrate that digital technologies impact on anticipation and adaptation abilities, organizational capabilities to reorganize roles, tasks, and spaces enhance adaptability, and Inter-organizational collaborations increase the responsiveness of the hospitals. The study provides substantial theoretical and practical contributions. It expands knowledge of hospital resilience in light of recent disruptive events and promotes integration capabilities as determinants for the majority of resilience dimensions. All organisational and inter-organisational collaboration, cooperation, and coordination are deemed crucial for hospital resilience.
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Affiliation(s)
- Nunzia Carbonara
- Department of Mechanics Mathematics and Management, Polytechnic University of Bari, Bari, Italy
| | - Roberta Pellegrino
- Department of Mechanics Mathematics and Management, Polytechnic University of Bari, Bari, Italy
| | - Cristina De Luca
- Department of Mechanics Mathematics and Management, Polytechnic University of Bari, Bari, Italy
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Ferrara M, Bertozzi G, Di Fazio N, Aquila I, Di Fazio A, Maiese A, Volonnino G, Frati P, La Russa R. Risk Management and Patient Safety in the Artificial Intelligence Era: A Systematic Review. Healthcare (Basel) 2024; 12:549. [PMID: 38470660 PMCID: PMC10931321 DOI: 10.3390/healthcare12050549] [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: 01/29/2024] [Revised: 02/19/2024] [Accepted: 02/23/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND Healthcare systems represent complex organizations within which multiple factors (physical environment, human factor, technological devices, quality of care) interconnect to form a dense network whose imbalance is potentially able to compromise patient safety. In this scenario, the need for hospitals to expand reactive and proactive clinical risk management programs is easily understood, and artificial intelligence fits well in this context. This systematic review aims to investigate the state of the art regarding the impact of AI on clinical risk management processes. To simplify the analysis of the review outcomes and to motivate future standardized comparisons with any subsequent studies, the findings of the present review will be grouped according to the possibility of applying AI in the prevention of the different incident type groups as defined by the ICPS. MATERIALS AND METHODS On 3 November 2023, a systematic review of the literature according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was carried out using the SCOPUS and Medline (via PubMed) databases. A total of 297 articles were identified. After the selection process, 36 articles were included in the present systematic review. RESULTS AND DISCUSSION The studies included in this review allowed for the identification of three main "incident type" domains: clinical process, healthcare-associated infection, and medication. Another relevant application of AI in clinical risk management concerns the topic of incident reporting. CONCLUSIONS This review highlighted that AI can be applied transversely in various clinical contexts to enhance patient safety and facilitate the identification of errors. It appears to be a promising tool to improve clinical risk management, although its use requires human supervision and cannot completely replace human skills. To facilitate the analysis of the present review outcome and to enable comparison with future systematic reviews, it was deemed useful to refer to a pre-existing taxonomy for the identification of adverse events. However, the results of the present study highlighted the usefulness of AI not only for risk prevention in clinical practice, but also in improving the use of an essential risk identification tool, which is incident reporting. For this reason, the taxonomy of the areas of application of AI to clinical risk processes should include an additional class relating to risk identification and analysis tools. For this purpose, it was considered convenient to use ICPS classification.
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Affiliation(s)
- Michela Ferrara
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, 00161 Rome, Italy; (M.F.); (N.D.F.); (P.F.)
| | - Giuseppe Bertozzi
- Complex Intercompany Structure of Forensic Medicine, 85100 Potenza, Italy;
| | - Nicola Di Fazio
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, 00161 Rome, Italy; (M.F.); (N.D.F.); (P.F.)
| | - Isabella Aquila
- Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, 88100 Catanzaro, Italy;
| | - Aldo Di Fazio
- Regional Hospital “San Carlo”, 85100 Potenza, Italy;
| | - Aniello Maiese
- Department of Surgical Pathology, Medical, Molecular and Critical Area, Institute of Legal Medicine, University of Pisa, 56126 Pisa, Italy;
| | - Gianpietro Volonnino
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, 00161 Rome, Italy; (M.F.); (N.D.F.); (P.F.)
| | - Paola Frati
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, 00161 Rome, Italy; (M.F.); (N.D.F.); (P.F.)
| | - Raffaele La Russa
- Department of Clinical Medicine, Public Health, Life and Environment Science, University of L’Aquila, 67100 L’Aquila, Italy;
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Allen JA, Reiter-Palmon R, Jones KJ, Sabalka L, Ciagala K, Meens A. Nurses' Experience Implementing an Automated Video Monitoring System to Decrease the Risk of Patient Falls during a Global Pandemic. Healthcare (Basel) 2023; 11:2556. [PMID: 37761753 PMCID: PMC10530789 DOI: 10.3390/healthcare11182556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 08/24/2023] [Accepted: 09/01/2023] [Indexed: 09/29/2023] Open
Abstract
Healthcare is a complex sociotechnical system where information systems (IS) and information technology (IT) intersect to solve problems experienced by patients and providers alike. One example of IS/IT in hospitals is the Ocuvera automated video monitoring system (AVMS), which has been implemented in more than 30 hospitals. The purpose of this study was to evaluate nurses' attitudes toward AVMS implementation over time as they received the training program developed for this intervention. Consistent with the job demands-resources (JDR) model, we found that perceptions of AVMS usefulness increased over time and were positively associated with perceptions of social influence and behavioral control. These results were consistent with our finding that there was a significant decrease in the risk of unassisted falls from the bed from baseline to intervention. Leaders in hospital systems and healthcare organizations may want to consider implementing an AVMS as researchers continue to test, verify, and demonstrate the effectiveness of these interventions for improving patient well-being.
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Affiliation(s)
- Joseph A. Allen
- Department of Family and Preventive Medicine, School of Medicine, University of Utah, Salt Lake City, UT 84111, USA
| | - Roni Reiter-Palmon
- Department of Psychology, College of Arts and Sciences, University of Nebraska at Omaha, Omaha, NE 68182, USA; (R.R.-P.); (K.C.)
| | | | | | - Kelsey Ciagala
- Department of Psychology, College of Arts and Sciences, University of Nebraska at Omaha, Omaha, NE 68182, USA; (R.R.-P.); (K.C.)
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Pavithra A, Mannion R, Li L, Westbrook J. The impact of vulnerability and exposure to pervasive interprofessional incivility among medical staff on wellbeing. Front Public Health 2023; 11:1168978. [PMID: 37521972 PMCID: PMC10375044 DOI: 10.3389/fpubh.2023.1168978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 06/28/2023] [Indexed: 08/01/2023] Open
Abstract
Introduction Traditional methods for modelling human interactions within organisational contexts are often hindered by the complexity inherent within these systems. Building on new approaches to information modelling in the social sciences and drawing on the work of scholars in transdisciplinary fields, we proposed that a reliable model of human interaction as well as its emergent properties can be demonstrated using theories related to emergent information. Methods We demonstrated these dynamics through a test case related to data from a prevalence survey of incivility among medical staff. For each survey respondent we defined their vulnerability profile based upon a combination of their biographical characteristics, such as age, gender, and length of employment within a hospital and the hospital type (private or public). We modelled the interactions between the composite vulnerability profile of staff against their reports of their exposure to incivility and the consequent negative impact on their wellbeing. Results We found that vulnerability profile appeared to be proportionally related to the extent to which they were exposed to rudeness in the workplace and to a negative impact on subjective wellbeing. Discussion This model can potentially be used to tailor resources to improve the wellbeing of hospital medical staff at increased risk of facing incivility, bullying and harassment at their workplaces.
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Affiliation(s)
- Antoinette Pavithra
- Faculty of Medicine, Health and Human Sciences, Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
| | - Russell Mannion
- Faculty of Medicine, Health and Human Sciences, Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
- Health Services Management Centre, School of Social Policy, College of Social Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Ling Li
- Faculty of Medicine, Health and Human Sciences, Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
| | - Johanna Westbrook
- Faculty of Medicine, Health and Human Sciences, Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
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Shen Y, Lei S, Wang Q, Wang H, Hao X, Cai H. Analysis of the characteristics and risk factors affecting the judgment results of medical damage liability disputes in 3172 second-instance and retrial cases in China. HUMAN RESOURCES FOR HEALTH 2023; 21:53. [PMID: 37386560 DOI: 10.1186/s12960-023-00832-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 06/07/2023] [Indexed: 07/01/2023]
Abstract
BACKGROUND Medical disputes remain a global public health problem. However, an analysis of the characteristics and risk factors affecting the judgment results of medical damage liability disputes in second-instance and retrial cases in China has yet to be conducted. METHODS We conducted a systematic search and evaluation of second-instance and retrial cases among all medical damage liability disputes in China Judgments Online; SPSS 22.0 was used for the statistical analysis. A χ2 test or likelihood ratio Chi-square test was used to compare differences between groups, and multivariate logistic regression analysis was performed to determine independent risk factors that could affect the judgment results of medical disputes. RESULTS We included 3172 second-instance and retrial cases among all medical damage liability disputes in the analysis. The results showed that 48.04% of cases were unilateral appeals by the patient, and medical institutions were responsible for providing compensation in 80.64% of these cases. Cases involving compensation ranged from Chinese Yuan (CNY) 100 000 to 500 000 ranked first (40.95%); 21.66% were non-compensation cases. Cases involving mental damage compensation of less than CNY 20 000 accounted for 39.03%. Violations of medical treatment and nursing routines accounted for 64.25% of all cases. In addition, re-identification in 54.59% of cases changed the initial appraisal opinion. Independent risk factors for medical personnel to lose a lawsuit in a multivariate logistic regression model included appeal originator [patient side: OR = 18.809 (95% CI 11.854-29.845); both sides: OR = 22.168 (95% CI 12.249-40.117)], change of the original verdict (OR = 5.936, 95% CI 3.875-9.095), judicial identification (OR = 6.395, 95% CI 4.818-8.487), violations of medical treatment and nursing routines (OR = 8.783, 95% CI 6.658-11.588), and non-standard medical document writing (OR = 8.500, 95% CI 4.805-15.037). CONCLUSION Our study clarifies the characteristics of second-instance and retrial cases among all medical damage liability disputes in China from multiple perspectives and identifies the independent risk factors for medical personnel losing a lawsuit. This study could help medical institutions prevent and reduce medical disputes, at the same time, it could be helpful for medical institutions to provide better medical treatment and nursing services for patients.
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Affiliation(s)
- Yanfei Shen
- School of Marxism, Lanzhou University, Lanzhou, China
- Department of Medical Management, Gansu Provincial Hospital, Lanzhou, China
| | - Sheng Lei
- Ray Vow of Gansu Law Firm, Lanzhou, China
| | - Qi Wang
- Department of Medical Management, Gansu Provincial Hospital, Lanzhou, China
| | - Hongjing Wang
- Department of Medical Management, Gansu Provincial Hospital, Lanzhou, China
| | - Xiangyong Hao
- Department of General Surgery, Gansu Provincial Hospital, Lanzhou, China.
| | - Hui Cai
- Department of General Surgery, Gansu Provincial Hospital, Lanzhou, China.
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Tsai SF, Wu CL, Ho YY, Lin PY, Yao AC, Yah YH, Hsiao CM, You YH, Yeh TF, Chen CH. Medical malpractice in hospitals-how healthcare staff feel. Front Public Health 2023; 11:1080525. [PMID: 37333540 PMCID: PMC10270288 DOI: 10.3389/fpubh.2023.1080525] [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: 01/13/2023] [Accepted: 05/12/2023] [Indexed: 06/20/2023] Open
Abstract
Introduction Literature is limited on quantified acute stress reaction, the impact of event scale on medical staff when facing medical malpractice (MMP), and how to individually care for staff. Methods We analyzed data in the Taichung Veterans General Hospital from October 2015 to December 2017, using the Stanford Acute Stress Reaction Questionnaire (SASRQ), the Impact of Event Scale-Revised (IES-R), and the medical malpractice stress syndrome (MMSS). Results and Discussion Of all 98 participants, most (78.8%) were women. Most MMPs (74.5%) did not involve injury to patients, and most staff (85.7%) indicated receiving help from the hospital. The internal-consistency evaluations of the three questionnaires showed good validity and reliability. The highest score of IES-R was the construct of intrusion (30.1); the most severe construct of SASRQ was "Marked symptoms of anxiety or increased arousal," and the most were having mental and mild physical symptoms for MMES. A higher total IES-R was associated with younger age (<40 y/o), and more severe injury on patients (mortality). Those who indicated receiving very much help from the hospital were those having significantly lower SASRQ sores. Our study highlighted that hospital authorities should regularly follow up on staff's response to MMP. With timely interventions, vicious cycles of bad feelings can be avoided, especially in young, non-doctor, and non-administrative staff.
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Affiliation(s)
- Shang-Feng Tsai
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Life Science, Tunghai University, Taichung, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
| | - Chieh-Liang Wu
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
- Department of Critical Care Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Yu-Ying Ho
- Department of Nursing, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Pei-Yi Lin
- Department of Nursing, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Ai-Chu Yao
- Department of Nursing, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Ya-Hui Yah
- Department of Nursing, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Chia-Min Hsiao
- Office of Social Work, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Yu Huei You
- Office of Social Work, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Te-Feng Yeh
- Department of Healthcare Administration, Central Taiwan University of Science and Technology, Taichung, Taiwan
| | - Cheng-Hsu Chen
- Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Life Science, Tunghai University, Taichung, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
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Strengths and weaknesses of the incident reporting system: An Italian experience. JOURNAL OF PATIENT SAFETY AND RISK MANAGEMENT 2023. [DOI: 10.1177/25160435221150568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
One of the cornerstones for enhancing the patient safety culture is the incident reporting system (IRS). It is a process for detecting, reporting, collecting, and summarizing adverse events (AEs) and near-misses in healthcare, and so it represents a vital tool for clinical risk management. We analyzed the 5-year experience of a third-level hospital's IRSs, showing its trends and highlighting its main strengths and weaknesses. Patients’ falls and physical or verbal aggression toward the providers or between patients are the most reported events. Underreporting is the main limitation of the system, especially among nurses. Visible actions, forceful analysis of the reports, operators’ education, no-blame culture promotion, and organizational adjustments may improve operators’ adherence to IRS. Providers do not willingly inform patients’ relatives about fatal incidents. Despite that, the IRS is far from its potential, and the number of data collected has increased.
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Ferorelli D, Moretti L, Benevento M, Mastrapasqua M, Telegrafo M, Solarino B, Dell’Erba A, Bizzoca D, Moretti B. Digital Health Care, Telemedicine, and Medicolegal Issues in Orthopedics: A Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15653. [PMID: 36497728 PMCID: PMC9735483 DOI: 10.3390/ijerph192315653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 11/17/2022] [Accepted: 11/22/2022] [Indexed: 06/17/2023]
Abstract
The use of technologies in medicine has great potential to reduce the costs of health care services by making appropriate decisions that provide timely patient care. The evolution of telemedicine poses a series of clinical and medicolegal considerations. However, only a few articles have dealt with telemedicine and orthopedics. This review assesses the ethical and medicolegal issues related to tele-orthopedics. A systematic review was performed including papers published between 2017 and 2021 focusing on the main medicolegal and clinical-governance aspects of tele-orthopedics. Most of the articles were published during the COVID-19 pandemic, confirming the impetus that the pandemic has also given to the spread of telemedicine in the orthopedic field. The areas of interest dealt with in the scientific evidence, almost exclusively produced in the USA, Europe, the UK, and Canada, are quality, patient satisfaction, and safety. The impact of telemedicine in orthopedics has not yet been fully evaluated and studied in terms of the potential medicolegal concerns. Most of the authors performed qualitative studies with poor consistency. Authorizations and accreditations, protection of patient confidentiality, and professional responsibility are issues that will certainly soon emerge.
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Affiliation(s)
- Davide Ferorelli
- Section of Legal Medicine, Department of Interdisciplinary Medicine, University of Bari, 70121 Bari, Italy
| | - Lorenzo Moretti
- Orthopedics and Trauma Unit, AOUC Policlinico di Bari, Department DiBraiN, University of Bari “Aldo Moro”, 70121 Bari, Italy
| | - Marcello Benevento
- Section of Legal Medicine, Department of Interdisciplinary Medicine, University of Bari, 70121 Bari, Italy
| | - Maurizio Mastrapasqua
- Section of Legal Medicine, Department of Interdisciplinary Medicine, University of Bari, 70121 Bari, Italy
| | - Michele Telegrafo
- Section of Legal Medicine, Department of Interdisciplinary Medicine, University of Bari, 70121 Bari, Italy
| | - Biagio Solarino
- Section of Legal Medicine, Department of Interdisciplinary Medicine, University of Bari, 70121 Bari, Italy
| | - Alessandro Dell’Erba
- Section of Legal Medicine, Department of Interdisciplinary Medicine, University of Bari, 70121 Bari, Italy
| | - Davide Bizzoca
- Orthopedics and Trauma Unit, AOUC Policlinico di Bari, Department DiBraiN, University of Bari “Aldo Moro”, 70121 Bari, Italy
| | - Biagio Moretti
- Orthopedics and Trauma Unit, AOUC Policlinico di Bari, Department DiBraiN, University of Bari “Aldo Moro”, 70121 Bari, Italy
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Mele F, Buongiorno L, Montalbò D, Ferorelli D, Solarino B, Zotti F, Carabellese FF, Catanesi R, Bertolino A, Dell'Erba A, Mandarelli G. Reporting Incidents in the Psychiatric Intensive Care Unit: A Retrospective Study in an Italian University Hospital. J Nerv Ment Dis 2022; 210:622-628. [PMID: 35394976 PMCID: PMC10860884 DOI: 10.1097/nmd.0000000000001504] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT To evaluate the characteristics of the reported workplace violence in a psychiatric intensive care unit (PICU) by analyzing an electronic hospital incident reporting system (IRS). One hundred thirty reports were retrieved from January 2017 to June 2020, referring to assaults committed by patients (71% males) with an average age of 29.8 years (SD, 14.9). The most frequent psychiatric diagnosis was a neurodevelopmental disorder (33%). Physical aggression (84%) was more frequent than the other types of aggression. Nurses and unlicensed assistive personnel were the most frequent victims (65%). Aggressions were more frequent on Friday (18%) and between 4 p.m. and 8 p.m. (35%). A total of 64.9% of the incidents happened in the first 5 days of hospitalization. A significant association between physical aggression and diagnosis of neurodevelopmental disorder emerged. IRS could be helpful to identify high-risk patient groups and develop clinical strategies to reduce adverse events in clinical practice.
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Affiliation(s)
- Federica Mele
- Section of Legal Medicine, Interdisciplinary Department of Medicine
| | - Luigi Buongiorno
- Section of Legal Medicine, Interdisciplinary Department of Medicine
| | | | - Davide Ferorelli
- Section of Legal Medicine, Interdisciplinary Department of Medicine
| | - Biagio Solarino
- Section of Legal Medicine, Interdisciplinary Department of Medicine
| | - Fiorenza Zotti
- Section of Legal Medicine, Interdisciplinary Department of Medicine
| | - Felice Francesco Carabellese
- Section of Criminology and Forensic Psychiatry, Interdisciplinary Department of Medicine, University of Bari Aldo Moro, Policlinico di Bari Hospital, Bari, Italy
| | - Roberto Catanesi
- Section of Criminology and Forensic Psychiatry, Interdisciplinary Department of Medicine, University of Bari Aldo Moro, Policlinico di Bari Hospital, Bari, Italy
| | | | | | - Gabriele Mandarelli
- Section of Criminology and Forensic Psychiatry, Interdisciplinary Department of Medicine, University of Bari Aldo Moro, Policlinico di Bari Hospital, Bari, Italy
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Guo YQ, Huang J, Xu NN, Ma XJ. Worker Characteristics and Measures Associated With Patient and Visitor Violence in the COVID-19 Pandemic: A Multilevel Regression Analysis From China. Front Public Health 2022; 10:877843. [PMID: 35719686 PMCID: PMC9201521 DOI: 10.3389/fpubh.2022.877843] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 05/12/2022] [Indexed: 11/25/2022] Open
Abstract
Objective To analyze the patient and visitor workplace violence (PVV) toward health workers (HWs) and identify correlations between worker characteristics, measures against violence and exposure to PVV in COVID-19 pandemic. Methods A cross-sectional survey utilizing the international questionnaires in six public tertiary hospitals from Beijing in 2020 was conducted, and valid data from 754 respondents were collected. Multilevel logistic regression models were used to determine the association between independents and exposure to PVV. Results During COVID-19 pandemic and regular epidemic prevention and control, doctors were 5.3 times (95% CI = 1.59~17.90) more likely to suffer from physical PVV than nurses. HWs most frequently work with infants were 7.2 times (95% CI = 2.24~23.19) more likely to suffer from psychological PVV. More than four-fifth of HWs reported that their workplace had implemented security measures in 2020, and the cross-level interactions between the security measures and profession variable indicates that doctors in the workplace without security measures were 11.3 times (95% CI = 1.09~116.39) more likely to suffer from physical PVV compared to nurses in the workplace with security measures. Conclusion Doctors have higher risk of physical PVV in COVID-19 containment, and the security measures are very important and effective to fight against the physical PVV. Comprehensive measures should be implemented to mitigate hazards and protect the health, safety, and well-being of health workers.
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Affiliation(s)
- Ya-Qian Guo
- Institute of Medical Information, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ju Huang
- Institute of Medical Information, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Na-Na Xu
- The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Xiao-Jing Ma
- Institute of Medical Information, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Ma Y, Wang L, Wang Y, Li Z, Zhang Y, Fan L, Ni X. Causes of Hospital Violence, Characteristics of Perpetrators, and Prevention and Control Measures: A Case Analysis of 341 Serious Hospital Violence Incidents in China. Front Public Health 2022; 9:783137. [PMID: 35071165 PMCID: PMC8777225 DOI: 10.3389/fpubh.2021.783137] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Accepted: 12/08/2021] [Indexed: 11/18/2022] Open
Abstract
Objective: Hospital violence remains a global public health problem. This study aims to analyze serious hospital violence causes in China and the characteristics of perpetrators. It likewise seeks to understand frontline personnel's needs and put forward targeted suggestions. Methods: Serious hospital violence cases from 2011 to 2020 in the China Judgment Online System (CJOS) were selected for descriptive statistical analysis. A total of 72 doctors, nurses, hospital managers, and security personnel from 20 secondary and tertiary hospitals in China were selected for semi-structured interviews. Results: Of the incidents, 62.17% were caused by patients' deaths and dissatisfaction with their treatment results. Moreover, it was found that out-of-hospital disputes (11.14%) were also one of the main reasons for serious hospital violence. The perpetrators were mainly males (80.3%), and had attained junior high school education or lower (86.5%). Furthermore, most of them were family members of the patients (76.1%). Healthcare workers urgently hope that relevant parties will take new measures in terms of legislation, security, and dispute handling capacity. Conclusion: In the past 10 years, serious hospital violence's frequency in China has remained high. Furthermore, their harmful consequences are more serious. The causes of hospital violence are diverse, and the characteristics of perpetrators are obvious. Frontline healthcare workers urgently need relevant parties to take effective measures in terms of legislation, security, and dispute handling capacity, to prevent the occurrence of violence and protect medical personnel's safety.
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Affiliation(s)
- Yuanshuo Ma
- Department of Health Management, School of Health Management, Harbin Medical University, Harbin, China
| | - Licheng Wang
- Department of Health Management, School of Health Management, Harbin Medical University, Harbin, China
| | - Yongchen Wang
- Department of General Practice, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Zhe Li
- Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Yafeng Zhang
- Department of Health Management, School of Health Management, Harbin Medical University, Harbin, China
| | - Lihua Fan
- Department of Health Management, School of Health Management, Harbin Medical University, Harbin, China
| | - Xin Ni
- Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
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From Syndemic Lesson after COVID-19 Pandemic to a "Systemic Clinical Risk Management" Proposal in the Perspective of the Ethics of Job Well Done. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 19:ijerph19010015. [PMID: 35010289 PMCID: PMC8750949 DOI: 10.3390/ijerph19010015] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 12/18/2021] [Accepted: 12/19/2021] [Indexed: 12/19/2022]
Abstract
The syndemic framework proposed by the 2021-2030 World Health Organization (WHO) action plan for patient safety and the introduction of enabling technologies in health services involve a more effective interpretation of the data to understand causation. Based on the Systemic Theory, this communication proposes the "Systemic Clinical Risk Management" (SCRM) to improve the Quality of Care and Patient Safety. This is a new Clinical Risk Management model capable of developing the ability to observe and synthesize different elements in ways that lead to in-depth interventions to achieve solutions aligned with the sustainable development of health services. In order to avoid uncontrolled decision-making related to the use of enabling technologies, we devised an internal Learning Algorithm Risk Management (LARM) level based on a Bayesian approach. Moreover, according to the ethics of Job Well Done, the SCRM, instead of giving an opinion on events that have already occurred, proposes a bioethical co-working because it suggests the best way to act from a scientific point of view.
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Heier L, Riouchi D, Hammerschmidt J, Gambashidze N, Kocks A, Ernstmann N. Safety Performance in Acute Medical Care: A Qualitative, Explorative Study on the Perspectives of Healthcare Professionals. Healthcare (Basel) 2021; 9:healthcare9111543. [PMID: 34828589 PMCID: PMC8621721 DOI: 10.3390/healthcare9111543] [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: 10/19/2021] [Revised: 11/03/2021] [Accepted: 11/11/2021] [Indexed: 11/17/2022] Open
Abstract
Healthcare professionals need specific safety performance skills in order to maintain and improve patient safety. The purpose of this study is to get a deeper understanding of healthcare professionals’ perspective in acute care on the topic of safety performance. This study was conducted using a qualitative approach. Healthcare professionals working in nursing were interviewed using semi-structured interviews. Using content analyzing, categories were identified which present aspects of safety performance; subcategories were developed deductively. A total of 23 healthcare professionals were interviewed, of which 15 were registered nurses, five were nursing students and three were pedagogical personnel. Nine (39.1%) were <30 years old, 17 (73.9%) were female, and 9 (39.1%) had a leadership function. Results highlight the importance of safety performance as a construct of occupational health rather than of patient safety, and the role of the organization, as well as the self-responsibility of healthcare professionals. Healthcare professionals should be more conscious of their role, have a deeper understanding of the interaction of individual, team, patient, organization and work environment factors.
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Affiliation(s)
- Lina Heier
- Institute for Patient Safety (IfPS), University Hospital Bonn, 53127 Bonn, Germany; (D.R.); (J.H.); (N.G.); (N.E.)
- Center for Health Communication and Health Services Research (CHSR), Department for Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, 53127 Bonn, Germany
- Correspondence:
| | - Donia Riouchi
- Institute for Patient Safety (IfPS), University Hospital Bonn, 53127 Bonn, Germany; (D.R.); (J.H.); (N.G.); (N.E.)
| | - Judith Hammerschmidt
- Institute for Patient Safety (IfPS), University Hospital Bonn, 53127 Bonn, Germany; (D.R.); (J.H.); (N.G.); (N.E.)
| | - Nikoloz Gambashidze
- Institute for Patient Safety (IfPS), University Hospital Bonn, 53127 Bonn, Germany; (D.R.); (J.H.); (N.G.); (N.E.)
| | - Andreas Kocks
- Directorate of Nursing, University Hospital Bonn, 53127 Bonn, Germany;
| | - Nicole Ernstmann
- Institute for Patient Safety (IfPS), University Hospital Bonn, 53127 Bonn, Germany; (D.R.); (J.H.); (N.G.); (N.E.)
- Center for Health Communication and Health Services Research (CHSR), Department for Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, 53127 Bonn, Germany
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Gens-Barberà M, Hernández-Vidal N, Vidal-Esteve E, Mengíbar-García Y, Hospital-Guardiola I, Oya-Girona EM, Bejarano-Romero F, Castro-Muniain C, Satué-Gracia EM, Rey-Reñones C, Martín-Luján FM. Analysis of Patient Safety Incidents in Primary Care Reported in an Electronic Registry Application. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:8941. [PMID: 34501530 PMCID: PMC8430626 DOI: 10.3390/ijerph18178941] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 08/13/2021] [Accepted: 08/17/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVES (1) To describe the epidemiology of patient safety (PS) incidents registered in an electronic notification system in primary care (PC) health centres; (2) to define a risk map; and (3) to identify the critical areas where intervention is needed. DESIGN Descriptive analytical study of incidents reported from 1 January to 31 December 2018, on the TPSC Cloud™ platform (The Patient Safety Company) accessible from the corporate website (Intranet) of the regional public health service. SETTING 24 Catalan Institute of Health PC health centres of the Tarragona region (Spain). PARTICIPANTS Professionals from the PC health centres and a Patient Safety Functional Unit. MEASUREMENTS Data obtained from records voluntarily submitted to an electronic, standardised and anonymised form. Data recorded: healthcare unit, notifier, type of incident, risk matrix, causal and contributing factors, preventability, level of resolution and improvement actions. RESULTS A total of 1544 reports were reviewed and 1129 PS incidents were analysed: 25.0% of incidents did not reach the patient; 66.5% reached the patient without causing harm, and 8.5% caused adverse events. Nurses provided half of the reports (48.5%), while doctors reported more adverse events (70.8%; p < 0.01). Of the 96 adverse events, 46.9% only required observation, 34.4% caused temporary damage that required treatment, 13.5% required (or prolonged) hospitalization, and 5.2% caused severe permanent damage and/or a situation close to death. Notably, 99.2% were considered preventable. The main critical areas were: communication (27.8%), clinical-administrative management (25.1%), care delivery (23.5%) and medicines (18.4%); few incidents were related to diagnosis (3.6%). CONCLUSIONS PS incident notification applications are adequate for reporting incidents and adverse events associated with healthcare. Approximately 75% and 10% of incidents reach the patient and cause some damage, respectively, and most cases are considered preventable. Adequate and strengthened risk management of critical areas is required to improve PS.
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Affiliation(s)
- Montserrat Gens-Barberà
- Quality and Patient Safety Central Functional Unit, Gerència d’Atenció Primària Camp de Tarragona, Institut Català de la Salut, 43005 Tarragona, Spain; (N.H.-V.); (E.V.-E.); (Y.M.-G.); (I.H.-G.); (E.M.O.-G.); (F.B.-R.); (C.C.-M.)
| | - Núria Hernández-Vidal
- Quality and Patient Safety Central Functional Unit, Gerència d’Atenció Primària Camp de Tarragona, Institut Català de la Salut, 43005 Tarragona, Spain; (N.H.-V.); (E.V.-E.); (Y.M.-G.); (I.H.-G.); (E.M.O.-G.); (F.B.-R.); (C.C.-M.)
| | - Elisa Vidal-Esteve
- Quality and Patient Safety Central Functional Unit, Gerència d’Atenció Primària Camp de Tarragona, Institut Català de la Salut, 43005 Tarragona, Spain; (N.H.-V.); (E.V.-E.); (Y.M.-G.); (I.H.-G.); (E.M.O.-G.); (F.B.-R.); (C.C.-M.)
| | - Yolanda Mengíbar-García
- Quality and Patient Safety Central Functional Unit, Gerència d’Atenció Primària Camp de Tarragona, Institut Català de la Salut, 43005 Tarragona, Spain; (N.H.-V.); (E.V.-E.); (Y.M.-G.); (I.H.-G.); (E.M.O.-G.); (F.B.-R.); (C.C.-M.)
| | - Immaculada Hospital-Guardiola
- Quality and Patient Safety Central Functional Unit, Gerència d’Atenció Primària Camp de Tarragona, Institut Català de la Salut, 43005 Tarragona, Spain; (N.H.-V.); (E.V.-E.); (Y.M.-G.); (I.H.-G.); (E.M.O.-G.); (F.B.-R.); (C.C.-M.)
- Primary Health-Care Centre, Institut Català de la Salut, 43005 Tarragona, Spain
| | - Eva M. Oya-Girona
- Quality and Patient Safety Central Functional Unit, Gerència d’Atenció Primària Camp de Tarragona, Institut Català de la Salut, 43005 Tarragona, Spain; (N.H.-V.); (E.V.-E.); (Y.M.-G.); (I.H.-G.); (E.M.O.-G.); (F.B.-R.); (C.C.-M.)
- Primary Health-Care Centre, Institut Català de la Salut, 43005 Tarragona, Spain
| | - Ferran Bejarano-Romero
- Quality and Patient Safety Central Functional Unit, Gerència d’Atenció Primària Camp de Tarragona, Institut Català de la Salut, 43005 Tarragona, Spain; (N.H.-V.); (E.V.-E.); (Y.M.-G.); (I.H.-G.); (E.M.O.-G.); (F.B.-R.); (C.C.-M.)
- Pharmacy Unit, Gerència d’Atenció Primària Camp de Tarragona, Institut Català de la Salut, 43005 Tarragona, Spain
| | - Carles Castro-Muniain
- Quality and Patient Safety Central Functional Unit, Gerència d’Atenció Primària Camp de Tarragona, Institut Català de la Salut, 43005 Tarragona, Spain; (N.H.-V.); (E.V.-E.); (Y.M.-G.); (I.H.-G.); (E.M.O.-G.); (F.B.-R.); (C.C.-M.)
| | - Eva M. Satué-Gracia
- Research Support Unit Tarragona-Reus, Institut Universitari D’investigació en L’atenció Primària Jordi Gol, (IDIAP Jordi Gol), Institut Català de la Salut, 43202 Reus, Spain; (E.M.S.-G.); (C.R.-R.); (F.M.M.-L.)
| | - Cristina Rey-Reñones
- Research Support Unit Tarragona-Reus, Institut Universitari D’investigació en L’atenció Primària Jordi Gol, (IDIAP Jordi Gol), Institut Català de la Salut, 43202 Reus, Spain; (E.M.S.-G.); (C.R.-R.); (F.M.M.-L.)
- Faculty of Medicine and Health Sciences, Universitat Rovira i Virgili, 43201 Reus, Spain
| | - Francisco M. Martín-Luján
- Research Support Unit Tarragona-Reus, Institut Universitari D’investigació en L’atenció Primària Jordi Gol, (IDIAP Jordi Gol), Institut Català de la Salut, 43202 Reus, Spain; (E.M.S.-G.); (C.R.-R.); (F.M.M.-L.)
- Faculty of Medicine and Health Sciences, Universitat Rovira i Virgili, 43201 Reus, Spain
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