1
|
Diwekar U, Amekudzi-Kennedy A, Bakshi B, Baumgartner R, Boumans R, Burger P, Cabezas H, Egler M, Farley J, Fath B, Gleason T, Huang Y, Karunanithi A, Khanna V, Mangan A, Mayer AL, Mukherjee R, Mullally G, Rico-Ramirez V, Shonnard D, Svanström M, Theis T. A perspective on the role of uncertainty in sustainability science and engineering. Resour Conserv Recycl 2021; 164:105140. [PMID: 32921915 PMCID: PMC7480224 DOI: 10.1016/j.resconrec.2020.105140] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 08/25/2020] [Accepted: 08/26/2020] [Indexed: 06/11/2023]
Abstract
The Trans-Atlantic Research and Development Interchange on Sustainability Workshop (TARDIS) is a meeting on scientific topics related to sustainability. The 2019 workshop theme was "On the Role of Uncertainty in Managing the Earth for Global Sustainability." This paper presents the perspectives on this topic derived from talks and discussions at the 2019 TARDIS workshop. There are four kinds of uncertainties encountered in sustainability ranging from clear enough futures to true surprises. The current state-of-the-art in assessing and mitigating these uncertainties is discussed.
Collapse
Affiliation(s)
- U Diwekar
- Vishwamitra Research Institute, Crystal Lake, IL 60012, United States
| | | | - B Bakshi
- The Ohio State University, Columbus, OH 43210, United States
| | - R Baumgartner
- University of Graz, Merangasse 18/I, 8010, Graz, Austria
| | - R Boumans
- AFORDable Futures LLC, Charlotte, VT, United States
| | - P Burger
- University of Basel, Basel, Switzerland
| | - H Cabezas
- University of Miskolc, Miskolc, Hungary
| | - M Egler
- University of Vermont, Burlington, VT, United States
| | - J Farley
- University of Vermont, Burlington, VT, United States
| | - B Fath
- Towson University, Towson, MD, United States
- Advanced Systems Analysis Program, International Institute for Applied Systems Analysis, Laxenburg, Austria
| | - T Gleason
- USA Environmental Protection Agency, Narragansett, Rhode Island 02882, United States
| | - Y Huang
- Wayne State University, Detroit, Michigan 48202, United States
| | - A Karunanithi
- University of Colorado Denver, Denver, CO, 80217, United States
| | - V Khanna
- University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - A Mangan
- United States Business Council for Sustainable Development, Austin, Texas, United States
| | - A L Mayer
- Michigan Technological University, Houghton, MI, United States
| | - R Mukherjee
- Vishwamitra Research Institute, Crystal Lake, IL 60012, United States
- The University of Texas Permian Basin, Odessa, TX, 79762, United States
| | | | - V Rico-Ramirez
- Instituto Tecnologico de Celaya, Celaya, Guanajuato 38010, Mexico
| | - D Shonnard
- Michigan Technological University, Houghton, MI, United States
| | - M Svanström
- Chalmers University of Technology, Gothenburg, Sweden
| | - T Theis
- The University of Illinois at Chicago, Chicago, IL, 60612, United States
| |
Collapse
|
2
|
Khan A, Coffey M, Litterer KP, Baird JD, Furtak SL, Garcia BM, Ashland MA, Calaman S, Kuzma NC, O'Toole JK, Patel A, Rosenbluth G, Destino LA, Everhart JL, Good BP, Hepps JH, Dalal AK, Lipsitz SR, Yoon CS, Zigmont KR, Srivastava R, Starmer AJ, Sectish TC, Spector ND, West DC, Landrigan CP, Allair BK, Alminde C, Alvarado-Little W, Atsatt M, Aylor ME, Bale JF, Balmer D, Barton KT, Beck C, Bismilla Z, Blankenburg RL, Chandler D, Choudhary A, Christensen E, Coghlan-McDonald S, Cole FS, Corless E, Cray S, Da Silva R, Dahale D, Dreyer B, Growdon AS, Gubler L, Guiot A, Harris R, Haskell H, Kocolas I, Kruvand E, Lane MM, Langrish K, Ledford CJW, Lewis K, Lopreiato JO, Maloney CG, Mangan A, Markle P, Mendoza F, Micalizzi DA, Mittal V, Obermeyer M, O'Donnell KA, Ottolini M, Patel SJ, Pickler R, Rogers JE, Sanders LM, Sauder K, Shah SS, Sharma M, Simpkin A, Subramony A, Thompson ED, Trueman L, Trujillo T, Turmelle MP, Warnick C, Welch C, White AJ, Wien MF, Winn AS, Wintch S, Wolf M, Yin HS, Yu CE. Families as Partners in Hospital Error and Adverse Event Surveillance. JAMA Pediatr 2017; 171:372-381. [PMID: 28241211 PMCID: PMC5526631 DOI: 10.1001/jamapediatrics.2016.4812] [Citation(s) in RCA: 87] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Importance Medical errors and adverse events (AEs) are common among hospitalized children. While clinician reports are the foundation of operational hospital safety surveillance and a key component of multifaceted research surveillance, patient and family reports are not routinely gathered. We hypothesized that a novel family-reporting mechanism would improve incident detection. Objective To compare error and AE rates (1) gathered systematically with vs without family reporting, (2) reported by families vs clinicians, and (3) reported by families vs hospital incident reports. Design, Setting, and Participants We conducted a prospective cohort study including the parents/caregivers of 989 hospitalized patients 17 years and younger (total 3902 patient-days) and their clinicians from December 2014 to July 2015 in 4 US pediatric centers. Clinician abstractors identified potential errors and AEs by reviewing medical records, hospital incident reports, and clinician reports as well as weekly and discharge Family Safety Interviews (FSIs). Two physicians reviewed and independently categorized all incidents, rating severity and preventability (agreement, 68%-90%; κ, 0.50-0.68). Discordant categorizations were reconciled. Rates were generated using Poisson regression estimated via generalized estimating equations to account for repeated measures on the same patient. Main Outcomes and Measures Error and AE rates. Results Overall, 746 parents/caregivers consented for the study. Of these, 717 completed FSIs. Their median (interquartile range) age was 32.5 (26-40) years; 380 (53.0%) were nonwhite, 566 (78.9%) were female, 603 (84.1%) were English speaking, and 380 (53.0%) had attended college. Of 717 parents/caregivers completing FSIs, 185 (25.8%) reported a total of 255 incidents, which were classified as 132 safety concerns (51.8%), 102 nonsafety-related quality concerns (40.0%), and 21 other concerns (8.2%). These included 22 preventable AEs (8.6%), 17 nonharmful medical errors (6.7%), and 11 nonpreventable AEs (4.3%) on the study unit. In total, 179 errors and 113 AEs were identified from all sources. Family reports included 8 otherwise unidentified AEs, including 7 preventable AEs. Error rates with family reporting (45.9 per 1000 patient-days) were 1.2-fold (95% CI, 1.1-1.2) higher than rates without family reporting (39.7 per 1000 patient-days). Adverse event rates with family reporting (28.7 per 1000 patient-days) were 1.1-fold (95% CI, 1.0-1.2; P = .006) higher than rates without (26.1 per 1000 patient-days). Families and clinicians reported similar rates of errors (10.0 vs 12.8 per 1000 patient-days; relative rate, 0.8; 95% CI, .5-1.2) and AEs (8.5 vs 6.2 per 1000 patient-days; relative rate, 1.4; 95% CI, 0.8-2.2). Family-reported error rates were 5.0-fold (95% CI, 1.9-13.0) higher and AE rates 2.9-fold (95% CI, 1.2-6.7) higher than hospital incident report rates. Conclusions and Relevance Families provide unique information about hospital safety and should be included in hospital safety surveillance in order to facilitate better design and assessment of interventions to improve safety.
Collapse
Affiliation(s)
- Alisa Khan
- Division of General Pediatrics, Department of Medicine, Boston Children's Hospital, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Maitreya Coffey
- Centre for Quality Improvement and Patient Safety, Department of Paediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | | | - Jennifer D Baird
- Department of Nursing, Cardiovascular, and Critical Care Services, Boston Children's Hospital, Boston, Massachusetts
| | - Stephannie L Furtak
- Division of General Pediatrics, Department of Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Briana M Garcia
- Division of General Pediatrics, Department of Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Michele A Ashland
- Family-Centered Care, Lucile Packard Children's Hospital, Palo Alto, California
| | - Sharon Calaman
- Section of Critical Care, Department of Pediatrics, St Christopher's Hospital for Children, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Nicholas C Kuzma
- Section of Hospital Medicine, Department of Pediatrics, St Christopher's Hospital for Children, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Jennifer K O'Toole
- Department of Pediatrics, Cincinnati Children's Hospital, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Aarti Patel
- Department of Pediatrics, Cincinnati Children's Hospital, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Glenn Rosenbluth
- Department of Pediatrics, Benioff Children's Hospital, University of California-San Francisco School of Medicine, San Francisco
| | - Lauren A Destino
- Division of Pediatric Hospital Medicine, Lucile Packard Children's Hospital, Stanford University School of Medicine, Palo Alto, California
| | - Jennifer L Everhart
- Division of Pediatric Hospital Medicine, Lucile Packard Children's Hospital, Stanford University School of Medicine, Palo Alto, California
| | - Brian P Good
- Department of Pediatrics, Primary Children's Hospital, University of Utah School of Medicine, Salt Lake City
| | - Jennifer H Hepps
- Department of Pediatrics, Walter Reed National Military Medical Center, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Anuj K Dalal
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
- The Center for Patient Safety Research and Practice, Division of General Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Stuart R Lipsitz
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
- The Center for Patient Safety Research and Practice, Division of General Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Catherine S Yoon
- The Center for Patient Safety Research and Practice, Division of General Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Katherine R Zigmont
- The Center for Patient Safety Research and Practice, Division of General Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Rajendu Srivastava
- Department of Pediatrics, Primary Children's Hospital, University of Utah School of Medicine, Salt Lake City
- Institute for Healthcare Delivery Research, Intermountain Healthcare, Salt Lake City, Utah
| | - Amy J Starmer
- Division of General Pediatrics, Department of Medicine, Boston Children's Hospital, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Theodore C Sectish
- Division of General Pediatrics, Department of Medicine, Boston Children's Hospital, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Nancy D Spector
- Section of General Pediatrics, Department of Pediatrics, St Christopher's Hospital for Children, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Daniel C West
- Department of Pediatrics, Benioff Children's Hospital, University of California-San Francisco School of Medicine, San Francisco
| | - Christopher P Landrigan
- Division of General Pediatrics, Department of Medicine, Boston Children's Hospital, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
- Division of Sleep Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | | | - Claire Alminde
- St Christopher's Hospital for Children, Philadelphia, Pennsylvania
| | | | - Marisa Atsatt
- Lucile Packard Children's Hospital, Stanford, California
| | - Megan E Aylor
- Doernbecher Children's Hospital, Oregon Health and Science University, Portland
| | - James F Bale
- Primary Children's Hospital, Intermountain Healthcare, University of Utah School of Medicine, Salt Lake City
| | - Dorene Balmer
- Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Kevin T Barton
- St Louis Children's Hospital, Washington University School of Medicine, St Louis, Missouri
| | - Carolyn Beck
- Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Zia Bismilla
- Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | | | - Debra Chandler
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | | | | | | | - F Sessions Cole
- St Louis Children's Hospital, Washington University School of Medicine, St Louis, Missouri
| | | | - Sharon Cray
- St Christopher's Hospital for Children, Philadelphia, Pennsylvania
| | - Roxi Da Silva
- Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Devesh Dahale
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Benard Dreyer
- New York University Langone Medical Center, New York University School of Medicine, New York
| | - Amanda S Growdon
- Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - LeAnn Gubler
- Primary Children's Hospital, Salt Lake City, Utah
| | - Amy Guiot
- Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Roben Harris
- St Louis Children's Hospital, St Louis, Missouri
| | - Helen Haskell
- Mothers Against Medical Error, Columbia, South Carolina
| | - Irene Kocolas
- Primary Children's Hospital, Intermountain Healthcare, University of Utah School of Medicine, Salt Lake City
| | | | | | - Kathleen Langrish
- Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Christy J W Ledford
- Walter Reed National Military Medical Center, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Kheyandra Lewis
- St Christopher's Hospital for Children, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Joseph O Lopreiato
- Walter Reed National Military Medical Center, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Christopher G Maloney
- Primary Children's Hospital, Intermountain Healthcare, University of Utah School of Medicine, Salt Lake City
| | - Amanda Mangan
- Benioff Children's Hospital, San Francisco, California
| | - Peggy Markle
- Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Fernando Mendoza
- Lucile Packard Children's Hospital, Stanford University, Stanford, California
| | | | - Vineeta Mittal
- Children's Medical Center Dallas, University of Texas Southwestern Medical Center, Dallas
| | - Maria Obermeyer
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | | | - Mary Ottolini
- Children's National Health System, George Washington University School of Medicine, Washington, DC
| | - Shilpa J Patel
- Kapi'olani Medical Center for Women and Children, University of Hawai'i John A. Burns School of Medicine, Honolulu
| | | | | | - Lee M Sanders
- Lucile Packard Children's Hospital, Stanford University, Stanford, California
| | | | - Samir S Shah
- Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | | | | | - Anupama Subramony
- Cohen Children's Medical Center, Hofstra Northwell School of Medicine, East Garden City, New York
| | - E Douglas Thompson
- St Christopher's Hospital for Children, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Laura Trueman
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | | | - Michael P Turmelle
- St Louis Children's Hospital, Washington University School of Medicine, St Louis, Missouri
| | | | | | - Andrew J White
- St Louis Children's Hospital, Washington University School of Medicine, St Louis, Missouri
| | | | - Ariel S Winn
- Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - Michael Wolf
- Northwestern University Feinberg School of Medicine, Evanston, Illinois
| | - H Shonna Yin
- New York University Langone Medical Center, New York University School of Medicine, New York
| | - Clifton E Yu
- Walter Reed National Military Medical Center, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| |
Collapse
|