1
|
Soenens G, Gorden L, Doyen B, Wheatcroft M, de Mestral C, Palter V, Van Herzeele I. Development and Testing of Step, Error, and Event Frameworks to Evaluate Technical Performance in Peripheral Endovascular Interventions. Eur J Vasc Endovasc Surg 2024:S1078-5884(24)00252-1. [PMID: 38492630 DOI: 10.1016/j.ejvs.2024.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 12/22/2023] [Accepted: 03/11/2024] [Indexed: 03/18/2024]
Abstract
OBJECTIVE Tools for endovascular performance assessment are necessary in competency based education. This study aimed to develop and test a detailed analysis tool to assess steps, errors, and events in peripheral endovascular interventions (PVI). METHODS A modified Delphi consensus was used to identify steps, errors, and events in iliac-femoral-popliteal endovascular interventions. International experts in vascular surgery, interventional radiology, cardiology, and angiology were identified, based on their scientific track record. In an initial open ended survey round, experts volunteered a comprehensive list of steps, errors, and events. The items were then rated on a 5-point Likert scale until consensus was reached with a pre-defined threshold (Cronbach's alpha > 0.7) and > 70% expert agreement. An experienced endovascular surgeon applied the finalised frameworks on ten previously videorecorded elective PVI cases. RESULTS The expert consensus panel was formed by 28 of 98 invited proceduralists, consisting of three angiologists, seven interventional radiologists, five cardiologists, and 13 vascular surgeons, with 29% from North America and 71% from Europe. The Delphi process was completed after three rounds (Cronbach's alpha; αsteps = 0.79; αerrors = 0.90; αevents = 0.90), with 15, 26, and 18 items included in the final step (73 - 100% agreement), error (73 - 100% agreement), and event (73 - 100% agreement) frameworks, respectively. The median rating time per case was 4.3 hours (IQR 3.2, 5 hours). A median of 55 steps (IQR 40, 67), 27 errors (IQR 21, 49), and two events (IQR 1, 6) were identified per case. CONCLUSION An evaluation tool for the procedural steps, errors, and events in iliac-femoral-popliteal endovascular procedures was developed through a modified Delphi consensus and applied to recorded intra-operative data to identify hazardous steps, common errors, and events. Procedural mastery may be promoted by using the frameworks to provide endovascular proceduralists with detailed technical performance feedback.
Collapse
Affiliation(s)
- Gilles Soenens
- Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium
| | - Lauren Gorden
- Division of Vascular Surgery, University of Toronto, Canada; International Centre for Surgical Safety, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Canada; Biomedical Engineering (BME), University of Toronto, Canada
| | - Bart Doyen
- Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium
| | - Mark Wheatcroft
- Division of Vascular Surgery, University of Toronto, Canada; Department of Surgery, St. Michael's Hospital, Toronto, Canada
| | - Charles de Mestral
- Division of Vascular Surgery, University of Toronto, Canada; Department of Surgery, St. Michael's Hospital, Toronto, Canada
| | - Vanessa Palter
- International Centre for Surgical Safety, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Canada
| | - Isabelle Van Herzeele
- Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium.
| |
Collapse
|
2
|
Vikan M, Deilkås EC, Valeberg BT, Bjørnnes AK, Husby VS, Haugen AS, Danielsen SO. The anatomy of safe surgical teams: an interview-based qualitative study among members of surgical teams at tertiary referral hospitals in Norway. Patient Saf Surg 2024; 18:7. [PMID: 38374077 PMCID: PMC10877820 DOI: 10.1186/s13037-024-00389-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 01/26/2024] [Indexed: 02/21/2024] Open
Abstract
BACKGROUND In spite of the global implementation of surgical safety checklists to improve patient safety, patients undergoing surgical procedures remain vulnerable to a high risk of potentially preventable complications and adverse outcomes. The present study was designed to explore the surgical teams' perceptions of patient safety culture, capture their perceptions of the risk for adverse events, and identify themes of interest for quality improvement within the surgical department. METHODS This qualitative study had an explorative design with an abductive approach. Individual semi-structured in-depth interviews were conducted between 10/01/23 and 11/05/23. The participants were members of surgical teams (n = 17), general and orthopedic surgeons (n = 5), anesthesiologists (n = 4), nurse anesthetists (n = 4) and operating room nurses (n = 4). Middle managers recruited purposively from general and orthopedic surgical teams in two tertiary hospitals in Norway, aiming for a maximum variation due to gender, age, and years within the specialty. The data material was analyzed following Braun and Clarke's method for reflexive thematic analysis to generate patterns of meaning and develop themes and subthemes. RESULTS The analysis process resulted in three themes describing the participants' perceptions of patient safety culture in the surgical context: (1) individual accountability as a safety net, (2) psychological safety as a catalyst for well-being and safe performance in the operating room, and (3) the importance of proactive structures and participation in organizational learning. CONCLUSIONS This study provided an empirical insight into the culture of patient safety in the surgical context. The study highlighted the importance of supporting the individuals' competence, building psychological safety in the surgical team, and creating structures and culture promoting a learning organization. Quality improvement projects, including interventions based on these results, may increase patient safety culture and reduce the frequency of adverse events in the surgical context.
Collapse
Affiliation(s)
- Magnhild Vikan
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, St. Olavs Plass, P.O. Box 4, Oslo, 0130, Norway.
| | - Ellen Ct Deilkås
- Department of Health Services Research, Akershus University Hospital, Lørenskog, Norway
| | - Berit T Valeberg
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, St. Olavs Plass, P.O. Box 4, Oslo, 0130, Norway
| | - Ann K Bjørnnes
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, St. Olavs Plass, P.O. Box 4, Oslo, 0130, Norway
| | - Vigdis S Husby
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, St. Olavs Plass, P.O. Box 4, Oslo, 0130, Norway
- Department of Orthopedic Surgery, Trondheim University Hospital, Trondheim, Norway
- Department of Health Sciences Aalesund, Faculty of Medicine and Health Science, Norwegian University of Science and Technology, Aalesund, Norway
| | - Arvid S Haugen
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, St. Olavs Plass, P.O. Box 4, Oslo, 0130, Norway
- Department of Anesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway
| | - Stein O Danielsen
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, St. Olavs Plass, P.O. Box 4, Oslo, 0130, Norway
| |
Collapse
|
3
|
Okonta PI, Umeora OUJ. Ethical challenges in obstetric emergencies in low- and middle-income countries. Best Pract Res Clin Obstet Gynaecol 2024; 92:102451. [PMID: 38134717 DOI: 10.1016/j.bpobgyn.2023.102451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 12/01/2023] [Accepted: 12/01/2023] [Indexed: 12/24/2023]
Abstract
Obstetric emergencies are challenging, requiring implementation of a rapid sequence of interventions in a very short time to optimize clinical outcome. Managing obstetric emergencies could evoke ethical dilemmas for the obstetrician because of limited time to adequately educate the patient about her condition; impaired consciousness of the patient to give consent; nonexistent prior patient -doctor relationship and the need to consider both the patient and the fetus. In Low- and middle-income countries (LMICs), poor access to appropriate emergency care, structural and financial barriers and a largely uneducated and a deeply cultural population contribute to the ethical challenges. In this article we review key ethical issues in obstetric emergencies in LMICs such as informed consent, refusal of life saving treatment, confidentiality, disclosure of patient medical information and discharge against medical advice. The duties and responsibilities of the state to disadvantaged pregnant women and the ethical imperative of the obstetrician to provide care under these circumstances are discussed.
Collapse
Affiliation(s)
- Patrick Ifeanyi Okonta
- Department of Obstetrics and Gynaecology, Faculty of Clinical Sciences, College of Health Sciences, Delta State University, Abraka, Delta State, Nigeria.
| | - Odidika Ugochukwu Joannes Umeora
- Department of Obstetrics and Gynaecology, Faculty of Clinical Medicine, College of Medical Sciences, Alex Ekwueme Federal University, Ndufu-Alike, Ebonyi State, Nigeria.
| |
Collapse
|
4
|
Kong X, Tao X, Li L, Zhao X, Ren J, Yang S, Chen X, Xiang H, Wu G, Li Y, Dong D. Global trends and partial forecast of adverse effects of medical treatment from 1990 to 2019: an epidemiological analysis based on the global burden of disease study 2019. BMC Public Health 2024; 24:295. [PMID: 38273270 PMCID: PMC10809510 DOI: 10.1186/s12889-023-17560-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 12/21/2023] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND The possibility of adverse effects of medical treatment (AEMT) is increasing worldwide, but little is known about AEMT in China. This study analyzed the health burden of AEMT in China in recent years through the Global Burden of Disease Study (GBD) 2019 and compared it with the worldwide average level and those in different sociodemographic index (SDI) regions. METHODS We calculated the age-standardized rate (ASR) of deaths, disability-adjusted life years (DALYs), years of life lost (YLLs), years lived with disability (YLDs), incidence and prevalence attributed to AEMT in China, worldwide and countries with different sociodemographic indices during 1990-2019 using the latest data and methods from the GBD 2019. RESULTS From 1990 to 2019, the global age-standardized death rate (ASDR), DALYs, and YLLs for AEMT showed a significant downward trend and were negatively associated with the SDI. By 2040, the ASDR is expected to reach approximately 1.58 (95% UI: 1.33-1.80). From 1990 to 2019, there was no significant change in the global incidence of AEMT. The occurrence of AEMT was related to sex, and the incidence of AEMT was greater among females. In addition, the incidence of AEMT-related injuries and burdens, such as ASR of DALYs, ASR of YLLs and ASR of YLDs, was greater among women than among men. Very old and very young people were more likely to be exposed to AEMT. CONCLUSIONS From 1990 to 2019, progress was made worldwide in reducing the harm caused by AEMT. However, the incidence and prevalence of AEMT did not change significantly overall during this period. Therefore, the health sector should pay more attention to AEMT and take effective measures to reduce AEMT.
Collapse
Affiliation(s)
- Xin Kong
- Department of Pharmacy, First Affiliated Hospital of Dalian Medical University, Dalian, 116011, China
- School of pharmacy, Dalian Medical University, Dalian, 116044, China
| | - Xufeng Tao
- Department of Pharmacy, First Affiliated Hospital of Dalian Medical University, Dalian, 116011, China
| | - Lu Li
- Department of Pharmacy, First Affiliated Hospital of Dalian Medical University, Dalian, 116011, China
| | - Xinya Zhao
- Department of Pharmacy, First Affiliated Hospital of Dalian Medical University, Dalian, 116011, China
- School of pharmacy, Dalian Medical University, Dalian, 116044, China
| | - Jiaqi Ren
- Department of Pharmacy, First Affiliated Hospital of Dalian Medical University, Dalian, 116011, China
- School of pharmacy, Dalian Medical University, Dalian, 116044, China
| | - Shilei Yang
- Department of Pharmacy, First Affiliated Hospital of Dalian Medical University, Dalian, 116011, China
| | - Xuyang Chen
- Department of Pharmacy, First Affiliated Hospital of Dalian Medical University, Dalian, 116011, China
| | - Hong Xiang
- Laboratory of Integrative Medicine, First Affiliated Hospital of Dalian Medical University, Dalian, 116011, China
| | - Guoyu Wu
- Department of Pharmacy, First Affiliated Hospital of Dalian Medical University, Dalian, 116011, China.
| | - Yunming Li
- Department of Pharmacy, First Affiliated Hospital of Dalian Medical University, Dalian, 116011, China.
| | - Deshi Dong
- Department of Pharmacy, First Affiliated Hospital of Dalian Medical University, Dalian, 116011, China.
| |
Collapse
|
5
|
Heydarikhayat N, Ghanbarzehi N, Sabagh K. Strategies to prevent medical errors by nursing interns: a qualitative content analysis. BMC Nurs 2024; 23:48. [PMID: 38233901 PMCID: PMC10792785 DOI: 10.1186/s12912-024-01726-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 01/09/2024] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND Nursing interns often face the serious challenges and stress of clinical training. Identifying effective strategies in reducing medical errors can improve student performance and decrease patient risk and injury from errors. The purpose of this study was to identify strategies to prevent medical errors by nursing interns in Medical Universities in Sistan and Baluchistan, Southeast of Iran. METHODS This is a qualitative study using a content analysis approach. Purposive sampling was used. The study was conducted in 3 medical universities. Ten nursing interns participated in this study. Open-ended, semi-structured, and face-to-face, interviews were used to explore the experience of nursing interns about strategies to prevent medical errors during their internship. RESULTS Findings include 20 subcategories, 6 categories and one theme. The main theme is "strategies to prevent medical errors during internship". Six categories included "strategies to prevent medical errors during internship". These included "Professional acceptance and support", "Revision of the implementation of the educational curriculum", "Retraining courses for challenging skills", "Creating learning opportunities" "Professionalization", and "Facilities and requirements". CONCLUSIONS Preventing medical errors requires different strategies before and during nursing internship. Error prevention strategies include retraining and preparatory courses for challenging areas, evaluation of students' performance, and accepting students as members of the health care team, respecting and supporting them and protecting their rights. Learning from medical errors, analysis and reflection on errors should be part of the curriculum during the internship.
Collapse
Affiliation(s)
- Nastaran Heydarikhayat
- Nursing Department, School of Medicine, Iranshahr University of Medical Sciences, Iranshahr, Iran
| | - Nezar Ghanbarzehi
- Nursing Department, School of Medicine, Iranshahr University of Medical Sciences, Iranshahr, Iran
| | - Kimiya Sabagh
- Department of Pediatric Nursing, School of Nursing and Midwifery, Zahedan University of Medical Sciences, Zahedan, Iran.
| |
Collapse
|
6
|
Plasencia-Martínez JM, Sánchez-Canales M, Otón-González E, Casado-Alarcón NI, Molina-Lozano B, Cotillo-Ramos E, Ortiz-Mayoral H, García-Santos JM. Inappropriate requests for cranial CT scans in emergency departments increase overuse and reduce test performance. Emerg Radiol 2023; 30:733-741. [PMID: 37973624 DOI: 10.1007/s10140-023-02185-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 11/01/2023] [Indexed: 11/19/2023]
Abstract
PURPOSE The number of non-traumatic urgent cranial computed tomography (NT-UCCT) is exponentially increasing but limited research has been conducted on the quality of clinical justification. Accordingly, we aimed (1) to assess how clinical information in the electronic NT-UCCT request agreed with that provided in the patient's emergency department discharge summary and (2) to analyze the potential effect of those discrepancies on the NT-UCCT overload. MATERIAL AND METHODS Patients undergoing NT-UCCT in 2017-2021 were randomly selected for this retrospective research-board-approved study. Signs and symptoms (S/S) in electronic request and emergency department discharge summary, acute and relevant computed tomography (CT) findings (acute ischemia or hemorrhage, masses, brain edema, or previously undetected hydrocephalus), and final diagnosis at emergency department discharge summary were collected. Concordance between digital request and emergency department discharge summary and their association with both acute and relevant CT findings and final diagnosis were analyzed. RESULTS We recruited 156 patients: 80 men; mean age, 55. Acute, relevant CT findings were detected in 28 cases (17.9%). The final diagnosis was neurological disease, non-neurological disease, and no definitive diagnosis in 46 (29.5%), 58 (37.2%), and 51 (32.7%) cases, respectively. Full agreement between the electronic request and emergency department discharge summary occurred in only 36 patients (23.1%). Motor deficit was the most frequent false positive electronic request S/S (18; 11.54%), having low positive predictive value (30.30%; 95%CI 15.59-48.71%) and worst association with acute relevant CT findings than when true positive (OR 2.54; 95%CI 0.04-6.21 vs. OR 6.26, 95%CI 2.21-17.78). Nausea/vomiting was the third most common false negative electronic request S/S (13; 10.26%) and reduced the likelihood of acute and relevant CT findings (OR 0.126; 95%CI 0.016-0.971; p = 0.020). False S/S in electronic request predominated in non-neurological diseases (50-60.2% vs. 33-39.8%; p = 0.068). CONCLUSION Discrepancies between electronic request and emergency department discharge summary were observed in >75% of patients, leading to unnecessary NT-UCCT tests.
Collapse
Affiliation(s)
- Juana María Plasencia-Martínez
- Department of Radiology, Hospital General Universitario Morales Meseguer, Avenida Marqués de los Vélez, s/n, 30008, Murcia, Spain.
| | - Marta Sánchez-Canales
- Department of Radiology, Hospital General Universitario Morales Meseguer, Avenida Marqués de los Vélez, s/n, 30008, Murcia, Spain
| | - Elena Otón-González
- Department of Radiology, Hospital General Universitario Morales Meseguer, Avenida Marqués de los Vélez, s/n, 30008, Murcia, Spain
| | - Nuria Isabel Casado-Alarcón
- Department of Radiology, Hospital General Universitario Morales Meseguer, Avenida Marqués de los Vélez, s/n, 30008, Murcia, Spain
| | | | - Estefanía Cotillo-Ramos
- Department of Radiology, Hospital General Universitario Morales Meseguer, Avenida Marqués de los Vélez, s/n, 30008, Murcia, Spain
| | - Herminia Ortiz-Mayoral
- Department of Radiology, Hospital General Universitario Morales Meseguer, Avenida Marqués de los Vélez, s/n, 30008, Murcia, Spain
| | - José María García-Santos
- Department of Radiology, Hospital General Universitario Morales Meseguer, Avenida Marqués de los Vélez, s/n, 30008, Murcia, Spain
| |
Collapse
|
7
|
Taheri Moghadam S, Sheikhtaheri A, Hooman N. Patient safety classifications, taxonomies and ontologies, part 2: A systematic review on content coverage. J Biomed Inform 2023; 148:104549. [PMID: 37984548 DOI: 10.1016/j.jbi.2023.104549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 10/11/2023] [Accepted: 11/16/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND Content coverage of patient safety ontology and classification systems should be evaluated to provide a guide for users to select appropriate ones for specific applications. In this review, we identified and compare content coverage of patient safety classifications and ontologies. METHODS We searched different databases and ontology/classification repositories to identify these classifications and ontologies. We included patient safety-related taxonomies, ontologies, classifications, and terminologies. We identified and extracted different concepts covered by these systems and mapped these concepts to international classification for patient safety (ICPS) and finally compared the content of these systems. RESULTS Finally, 89 papers (77 classifications or ontologies) were analyzed. Thirteen classifications have been developed to cover all medical domains. Among specific domain systems, most systems cover medication (16), surgery (8), medical devices (3), general practice (3), and primary care (3). The most common patient safety-related concepts covered in these systems include incident types (41), contributing factors/hazards (31), patient outcomes (29), degree of harm (25), and action (18). However, stage/phase (6), incident characteristics (5), detection (5), people involved (5), organizational outcomes (4), error type (4), and care setting (3) are some of the less covered concepts in these classifications/ontologies. CONCLUSION Among general systems, ICPS, World Health Organization's Adverse Reaction Terminology (WHO-ART), and Ontology of Adverse Events (OAE) cover most patient safety concepts and can be used as a gold standard for all medical domains. As a result, reporting systems could make use of these broad classifications, but the majority of their covered concepts are related to patient outcomes, with the exception of ICPS, which covers other patient safety concepts. However, the ICPS does not cover specialized domain concepts. For specific medical domains, MedDRA, NCC MERP, OPAE, ADRO, PPST, OCCME, TRTE, TSAHI, and PSIC-PC provide the broadest coverage of concepts. Many of the patient safety classifications and ontologies are not formally registered or available as formal classification/ontology in ontology repositories such as BioPortal. This study may be used as a guide for choosing appropriate classifications for various applications or expanding less developed patient safety classifications/ontologies. Furthermore, the same concepts are not represented by the same terms; therefore, the current study could be used to guide a harmonization process for existing or future patient safety classifications/ontologies.
Collapse
Affiliation(s)
- Sharare Taheri Moghadam
- Department of Health Information Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Abbas Sheikhtaheri
- Department of Health Information Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran.
| | - Nakysa Hooman
- Aliasghar Clinical Research Development Center (AACRDC), Aliasghar Children Hospital, Department of Pediatrics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
8
|
Phillips AJK, St Hilaire MA, Barger LK, O'Brien CS, Rahman SA, Landrigan CP, Lockley SW, Czeisler CA, Klerman EB. Predicting neurobehavioral performance of resident physicians in a Randomized Order Safety Trial Evaluating Resident-Physician Schedules (ROSTERS). Sleep Health 2023:S2352-7218(23)00255-3. [PMID: 38007304 DOI: 10.1016/j.sleh.2023.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 10/20/2023] [Accepted: 10/27/2023] [Indexed: 11/27/2023]
Abstract
OBJECTIVES Mathematical models of human neurobehavioral performance that include the effects of acute and chronic sleep restriction can be key tools in assessment and comparison of work schedules, allowing quantitative predictions of performance when empirical assessment is impractical. METHODS Using such a model, we tested the hypothesis that resident physicians working an extended duration work roster, including 24-28 hours of continuous duty and up to 88 hours per week averaged over 4weeks, would have worse predicted performance than resident physicians working a rapidly cycling work roster intervention designed to reduce the duration of extended shifts. The performance metric used was attentional failures (ie, Psychomotor Vigilance Task lapses). Model input was 169 actual work and sleep schedules. Outcomes were predicted hours per week during work hours spent at moderate (equivalent to 16-20 hours of continuous wakefulness) or high (equivalent to ≥20 hours of continuous wakefulness) performance impairment. RESULTS The model predicted that resident physicians working an extended duration work roster would spend significantly more time at moderate impairment (p = .02, effect size=0.2) than those working a rapidly cycling work roster; this difference was most pronounced during the circadian night (p < .001). On both schedules, performance was predicted to decline from weeks 1 + 2 to weeks 3 + 4 (p < .001), but the rate of decline was significantly greater on extended duration work roster (p < .01). Predicted performance impairment was inversely related to prior sleep duration (p < .001). CONCLUSIONS These findings demonstrate the utility of a mathematical model to evaluate the predicted performance profile of schedules for resident physicians and others who experience chronic sleep restriction and circadian misalignment.
Collapse
Affiliation(s)
- Andrew J K Phillips
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA; Division of Sleep Medicine, Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Melissa A St Hilaire
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA; Division of Sleep Medicine, Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA.
| | - Laura K Barger
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA; Division of Sleep Medicine, Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Conor S O'Brien
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA; Division of Sleep Medicine, Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Shadab A Rahman
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA; Division of Sleep Medicine, Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Christopher P Landrigan
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA; Division of Sleep Medicine, Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA; Division of General Pediatrics, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Steven W Lockley
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA; Division of Sleep Medicine, Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Charles A Czeisler
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA; Division of Sleep Medicine, Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Elizabeth B Klerman
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA; Division of Sleep Medicine, Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
9
|
Mul Fedele ML, López Gabeiras MDP, Simonelli G, Diez JJ, Bellone GJ, Cagliani J, Larrateguy L, Eiguchi K, Golombek DA, Cardinali DP, Pérez-Chada D, Vigo DE. "Multivariate analysis of the impact of sleep and working hours on medical errors: a MICE approach". BMC Public Health 2023; 23:2317. [PMID: 37996804 PMCID: PMC10666331 DOI: 10.1186/s12889-023-17130-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 11/01/2023] [Indexed: 11/25/2023] Open
Abstract
BACKGROUND The main objective of this study was to describe the relationship between working conditions, sleep and psycho-affective variables and medical errors. METHODS This was an observational, analytical and cross-sectional study in which 661 medical residents answered questionnaires about working conditions, sleep and psycho-affective variables. Actigraphic sleep parameters and peripheral temperature circadian rhythm were measured in a subgroup of 38 subjects. Bivariate and multivariate predictors of medical errors were assessed. RESULTS Medical residents reported working 66.2 ± 21.9 weekly hours. The longest continuous shift was of 28.4 ± 10.9 h. They reported sleeping 6.1 ± 1.6 h per day, with a sleep debt of 94 ± 129 min in workdays. A high percentage of them reported symptoms related to psycho-affective disorders. The longest continuous shift duration (OR = 1.03 [95% CI, 1.00-1.05], p = 0.01), working more than six monthly on-call shifts (OR = 1.87 [95% CI, 1.16-3.02], p = 0.01) and sleeping less than six hours per working day (OR = 1.66 [95% CI, 1.10-2.51], p = 0.02) were independently associated with self-reported medical errors. The report of medical errors was associated with an increase in the percentage of diurnal sleep (2.2% [95% CI, 0.1-4.3] vs 14.5% [95% CI, 5.9-23.0]; p = 0.01) in the actigraphic recording. CONCLUSIONS Medical residents have a high working hour load that affect their sleep opportunities, circadian rhythms and psycho-affective health, which are also related to the report of medical errors. These results highlight the importance of implementing multidimensional strategies to improve medical trainees' sleep and wellbeing, increasing in turn their own and patients' safety.
Collapse
Affiliation(s)
- Malena Lis Mul Fedele
- Chronophysiology Lab, Institute for Biomedical Research (UCA-CONICET), Buenos Aires, Argentina
| | | | - Guido Simonelli
- Centre d'études Avancées en Médecine du Sommeil, Hôpital du Sacré-Coeur de Montréal, CIUSSS du Nord de L'Île-de-Montréal, Montreal, Canada
- Department of Medicine, Faculty of Medicine, University of Montreal, Montreal, Canada
- Department of Neuroscience, Faculty of Medicine, University of Montreal, Montreal, Canada
| | - Joaquín José Diez
- Pan-American Institute of Sleep Medicine and Chronobiology, Buenos Aires, Argentina
| | - Giannina Julieta Bellone
- Pontifical Catholic University of Argentina, Buenos Aires, Argentina
- Chronobiology Lab, Department of Science and Technology, National University of Quilmes, Bernal, Argentina
| | - Joaquín Cagliani
- Anesthesiology Department, North Shore University Hospital, Manhasset, NY, USA
| | - Luis Larrateguy
- Private Center of Respiratory Medicine of Paraná, Entre Ríos, Argentina
| | | | - Diego Andrés Golombek
- Chronobiology Lab, Department of Science and Technology, National University of Quilmes, Bernal, Argentina
- Interdisciplinary Time Lab, San Andrés University, Buenos Aires, Argentina
| | | | | | - Daniel Eduardo Vigo
- Chronophysiology Lab, Institute for Biomedical Research (UCA-CONICET), Buenos Aires, Argentina.
- Katholieke Universiteit Leuven, Leuven, Belgium.
| |
Collapse
|
10
|
Ascenção R, Nogueira P, Sampaio F, Henriques A, Costa A. Adverse drug reactions in hospitals: population estimates for Portugal and the ICD-9-CM to ICD-10-CM crosswalk. BMC Health Serv Res 2023; 23:1222. [PMID: 37940971 PMCID: PMC10634004 DOI: 10.1186/s12913-023-10225-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 10/27/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND Adverse drug reactions (ADR), both preventable and non-preventable, are frequent and pose a significant burden. This study aimed to produce up-to-date estimates for ADR rates in hospitals, in Portugal, from 2010 to 2018. In addition, it explores possible pitfalls when crosswalking between ICD-9-CM and ICD-10-CM code sets for ADR identification. METHODS The Portuguese Hospital Morbidity Database was used to identify hospital episodes (outpatient or inpatient) with at least one ICD code of ADR. Since the study period spanned from 2010 to 2018, both ICD-9-CM and ICD-10-CM codes based on previously published studies were used to define episodes. This was an exploratory study, and descriptive statistics were used to provide ADR rates and summarise episode features for the full period (2010-2018) as well as for the ICD-9-CM (2010-2016) and ICD -10-CM (2017-2018) eras. RESULTS Between 2010 and 2018, ADR occurred in 162,985 hospital episodes, corresponding to 1.00% of the total number of episodes during the same period. Higher rates were seen in the oldest age groups. In the same period, the mean annual rate of episodes related to ADR was 174.2/100,000 population. The episode rate (per 100,000 population) was generally higher in males, except in young adults (aged '15-20', '25-30' and '30-35' years), although the overall frequency of ADR in hospital episodes was higher in females. CONCLUSIONS Despite the ICD-10-CM transition, administrative health data in Portugal remain a feasible source for producing up-to-date estimates on ADR in hospitals. There is a need for future research to identify target recipients for preventive interventions and improve medication safety practices in Portugal.
Collapse
Affiliation(s)
- Raquel Ascenção
- Laboratório de Farmacologia Clínica e Terapêutica, Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-028, Lisboa, Portugal.
| | - Paulo Nogueira
- Escola Nacional de Saúde Pública - Universidade Nova de Lisboa, Lisboa, Portugal
| | - Filipa Sampaio
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Adriana Henriques
- Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), Nursing School of Lisbon, Lisboa, Portugal
| | - Andreia Costa
- Instituto de Saúde Ambiental (ISAMB), Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| |
Collapse
|
11
|
Sorrentino TA, Sutaria S, Butler P, Burnett D, Bennett-Guerrero E. Evaluation of a novel platform for placement confirmation of enteral feeding tubes in adults. Nutrition 2023; 115:112144. [PMID: 37506554 DOI: 10.1016/j.nut.2023.112144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 06/13/2023] [Accepted: 06/27/2023] [Indexed: 07/30/2023]
Abstract
OBJECTIVE The aim of this study was to validate the ability of a novel, impedance-based platform for nasogastric feeding tube (FT) insertion to correctly predict intragastric FT placement in healthy individuals with and without acid suppression medication. METHODS Ten patients underwent successive placement of 8, 10, and 12 French FTs with the final intragastric position predicted using an impedance-based algorithm and verified with an abdominal x-ray. Study procedures were repeated after patients received a proton pump inhibitor (PPI) for 3 d. RESULTS Nasogastric FTs with embedded electrodes spaced along the distal 31 cm of the tubes were placed with the final insertion depth determined by an algorithm integrating impedance and other physiologic parameters. Sixty FT (30 pre-PPI and 30 post-PPI) insertions were performed. The algorithm-predicted location was confirmed as intragastric in all insertions by post-placement abdominal x-ray. For all tube sizes and those with and without PPIs, the impedance at electrodes within the esophagus was significantly higher than at electrodes in the stomach (P < 0.01). As a secondary objective to assess the use of gastric aspirate pH to determine location, gastric aspirate could only be obtained in 30% of insertions. The mean gastric pH was 6.9 (SD 0.6) in patients taking PPIs. CONCLUSIONS A novel platform for real-time assistance with nasogastric FT placement confirmation correctly determined intragastric FT location as confirmed by abdominal x-ray (standard of care) in all 60 insertions. Gastric pH measurements were difficult to obtain and unreliable for intragastric FT placement confirmation in patients taking acid suppression medication.
Collapse
Affiliation(s)
- Thomas A Sorrentino
- Department of Surgery, University of California, San Francisco, San Francisco, California, United States.
| | - Saheel Sutaria
- Gravitas Medical, San Francisco, California, United States
| | - Patrick Butler
- Department of Computer Science, Virginia Tech, Blacksburg, Virgina, United States
| | - Daniel Burnett
- Gravitas Medical, San Francisco, California, United States
| | | |
Collapse
|
12
|
Berdahl CT, Henreid AJ, Cohen TN, Coleman BL, Seferian EG, Leang D, Kim S, Diniz MA, Grissinger M, Kaiser K, McCleskey S, Zhu X, Nuckols TK. Comparing the Safety Action Feedback and Engagement (SAFE) Loop with an established incident reporting system: Study protocol for a pragmatic cluster randomized controlled trial. Contemp Clin Trials Commun 2023; 35:101192. [PMID: 37538195 PMCID: PMC10393596 DOI: 10.1016/j.conctc.2023.101192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 06/30/2023] [Accepted: 07/15/2023] [Indexed: 08/05/2023] Open
Abstract
Background Incident reporting is widely used in hospitals to improve patient safety, but current reporting systems do not function optimally. The utility of incident reports is limited because hospital staff may not know what to report, may fear retaliation, and may doubt whether administrators will review reports and respond effectively. Methods This is a clustered randomized controlled trial of the Safety Action Feedback and Engagement (SAFE) Loop, an intervention designed to transform hospital incident reporting systems into effective tools for improving patient safety. The SAFE Loop has six key attributes: obtaining nurses' input about which safety problems to prioritize on their unit; focusing on learning about selected high-priority events; training nurses to write more informative event reports; prompting nurses to report high-priority events; integrating information about events from multiple sources; and providing feedback to nurses on findings and mitigation plans. The study will focus on medication errors and randomize 20 nursing units at a large academic/community hospital in Los Angeles. Outcomes include: (1) incident reporting practices (rates of high-priority reports, contributing factors described in reports), (2) nurses' attitudes toward incident reporting, and (3) rates of high-priority events. Quantitative analyses will compare changes in outcomes pre- and post-implementation between the intervention and control nursing units, and qualitative analyses will explore nurses' experiences with implementation. Conclusion If effective, SAFE Loop will have several benefits: increasing nurses' engagement with reporting, producing more informative reports, enabling safety leaders to understand problems, designing system-based solutions more effectively, and lowering rates of high-priority patient safety events.
Collapse
Affiliation(s)
- Carl T. Berdahl
- Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Los Angeles, CA, 90048, USA
| | - Andrew J. Henreid
- Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Los Angeles, CA, 90048, USA
- University of Connecticut Department of Psychological Sciences, Bousfield Psychology Building, 406 Babbidge Road, Unit 1020, Storrs, CT, 06269-1020, USA
| | - Tara N. Cohen
- Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Los Angeles, CA, 90048, USA
| | - Bernice L. Coleman
- Nursing Research, Brawerman Nursing Institute, Cedars-Sinai Medical Center, 6500 Wilshire Boulevard, Los Angeles, CA, 90048, USA
| | - Edward G. Seferian
- Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Los Angeles, CA, 90048, USA
| | - Donna Leang
- Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Los Angeles, CA, 90048, USA
| | - Sungjin Kim
- Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Los Angeles, CA, 90048, USA
| | - Marcio A. Diniz
- Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Los Angeles, CA, 90048, USA
| | - Matthew Grissinger
- Institute for Safe Medication Practices, 5200 Butler Pike, Plymouth Meeting, PA, 19462, USA
| | - Karen Kaiser
- Feinberg School of Medicine, Northwestern University, 625 N Michigan Ave, Chicago, IL, 60611, USA
| | - Sara McCleskey
- RAND Corporation, 1776 Main St, Santa Monica, CA, 90401, USA
| | - Xi Zhu
- Fielding School of Public Health, UCLA, 650 Charles E. Young Dr. South, Los Angeles, CA, 90095, USA
| | - Teryl K. Nuckols
- Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Los Angeles, CA, 90048, USA
| |
Collapse
|
13
|
Dato Md Yusof YJ, Ng QX, Teoh SE, Loh CYL, Xin X, Thumboo J. Validation and use of the Second Victim Experience and Support Tool questionnaire: a scoping review. Public Health 2023; 223:183-192. [PMID: 37672831 DOI: 10.1016/j.puhe.2023.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 06/23/2023] [Accepted: 08/01/2023] [Indexed: 09/08/2023]
Abstract
OBJECTIVES Patient safety incidents can impact not only patients and families but also healthcare providers, who may experience negative emotions and symptoms, such as anxiety, guilt, stress, and loss of confidence. To identify and support these "second victims," a screening tool called the Second Victim Experience and Support Tool (SVEST) has been developed. This scoping review aims to map our current knowledge of the SVEST in terms of its scope of use, validation and limitations. STUDY DESIGN Scoping review. METHODS In accordance with the framework outlined by Arksey and O'Malley and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews, we conducted a literature search in MEDLINE, CINAHL, Cochrane Library, SCOPUS, Embase and PsycINFO databases from database inception up till 1 March 2023. RESULTS A total of 31 studies were reviewed. The SVEST has been cross-culturally adapted from English into other languages. The SVEST has been successfully used in different contexts and with various healthcare professionals, including doctors, nurses, allied health professionals, midwives and pharmacists. The tool has been used to assess the impact of second victim experiences and the effectiveness of support interventions in addressing the phenomenon. Validity assessment of translated versions of SVEST in the reviewed studies revealed good content validity in most cases, although some studies did not report clear values for scale-level Content Validity Index. On the whole, SVEST is generally a reliable and valid tool, although further refinements and modifications may improve its validity and reliability. CONCLUSIONS The review highlights the significance of SVEST as a crucial resource for healthcare providers and organisations that prioritise well-being and safety in health care. It also underscores the importance of recognising the needs of second victims and offering them appropriate interventions to manage the aftermath of adverse events.
Collapse
Affiliation(s)
- Y J Dato Md Yusof
- Health Services Research Unit, Singapore General Hospital, Singapore
| | - Q X Ng
- Health Services Research Unit, Singapore General Hospital, Singapore.
| | - S E Teoh
- NUS Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - C Y L Loh
- NUS Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - X Xin
- Health Services Research Unit, Singapore General Hospital, Singapore
| | - J Thumboo
- Health Services Research Unit, Singapore General Hospital, Singapore; SingHealth Duke-NUS Medicine Academic Clinical Programme, Duke-NUS Medical School, Singapore
| |
Collapse
|
14
|
Al-Sawalha I, Jaloudi N, Zaben S, Hamamreh R, Awamleh H, Al-Abbadi S, Abuzaid L, Abu-Ekteish F. Attitudes of undergraduate medical students toward patients' safety in Jordan: a multi-center cross-sectional study. BMC Med Educ 2023; 23:695. [PMID: 37740186 PMCID: PMC10517504 DOI: 10.1186/s12909-023-04672-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 09/12/2023] [Indexed: 09/24/2023]
Abstract
BACKGROUND Patient safety practices are crucial in healthcare as they aim to reduce harm, medical errors, and ensure favorable outcomes for patients. Therefore, this study aims to examine the attitudes towards patient safety among undergraduate medical students in Jordanian medical schools. METHODS A descriptive cross-sectional study was conducted among undergraduate medical students. Participants completed the Attitudes to Patient Safety Questionnaire- III (APSQ-III), which examines students' attitudes in 26 items distributed in nine domains. Results are represented as mean ± standard deviation for all participants and subgroups. RESULTS Our study included 1226 medical students. They reported positive attitudes toward patient safety with a mean score of 4.9 (SD ± 0.65). Participants scored the highest score in "Working hours as error cause" followed by "Team functioning". Gender, academic-year, and first-generation student status had a significant association with certain patient safety domains. Females scored significantly higher than males in four domains, while males scored higher in one domain. First-generation medical students had a significantly lower score for "Professional incompetence as error cause". Interestingly, pre-clinical students recorded more positive attitudes in "Patient safety training received" and "Disclosure responsibility" domains. CONCLUSION Undergraduate medical students in Jordan demonstrated positive attitudes towards patient safety concepts. Our study provides baseline data to improve current educational programs and enhance the patient safety culture among medical students. Additional studies are needed to delve into actual attitudes toward patient safety and to assess how educational programs contribute to the cultivation of this culture.
Collapse
Affiliation(s)
- Ibrahim Al-Sawalha
- Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan.
| | - Nebras Jaloudi
- Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Shaima' Zaben
- Faculty of Medicine, University of Jordan, Amman, Jordan
| | - Rawan Hamamreh
- Faculty of Medicine, The Hashemite University, Zarqa, Jordan
| | - Hala Awamleh
- Faculty of Medicine, Al-Balqa' Applied University, As-Salt, Jordan
| | | | - Leen Abuzaid
- Faculty of Medicine, Yarmouk University, Irbid, Jordan
| | - Faisal Abu-Ekteish
- Department of Pediatrics and Neonatology, Jordan University of Science and Technology, Irbid, Jordan
| |
Collapse
|
15
|
Balogun JA, Adekanmbi AA, Balogun FM. Surgical residents as "second victims" following exposure to medical errors in a tertiary health training facility in Nigeria: a phenomenology study. Patient Saf Surg 2023; 17:18. [PMID: 37464356 DOI: 10.1186/s13037-023-00370-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 07/10/2023] [Indexed: 07/20/2023] Open
Abstract
INTRODUCTION The "second victim" phenomenon refers to the distress and other negative consequences that physicians experience when they commit medical error. There has been increasing awareness about this phenomenon and efforts are being made to address it. However, there is dearth of information about it in developing countries. This study explored the experiences of surgical resident doctors of the University College Hospital in Ibadan, Nigeria about the "second victim" phenomenon and the support they had following medical errors. METHODS This is a phenomenology study in which qualitative data were obtained from interviews with 31 resident doctors across 10 surgical units/departments. Interviews were transcribed verbatim, and data were coded inductively. Data were analyzed using content analysis method. Themes and subthemes were generated using axial coding. The themes were then integrated using selective coding. RESULTS There were 31 participants and 10(32.3%) were females. All had witnessed other physicians encountering medical errors while 28(90.3%) had been directly involved in medical errors. Most of the errors were at the inter-operative stage. Prolonged work hours with inadequate sleep were identified as major causes of most medical errors. The feelings following medical errors were all negative and was described as 'stressful'. Most of the residents got support from their colleagues, mostly contemporaries following medical errors, and many viewed medical errors as a learning point to improve their practice. However, there was a general belief that the systemic support following medical errors was inadequate. CONCLUSION The "second victim" phenomenon was common among the study group with consequent negative effects. Normalizing discussions about medical errors, reduction of work hours and meticulous intraoperative guidance may reduce medical errors and its consequences on the surgical residents. Steps should be taken within the system to address this issue effectively.
Collapse
Affiliation(s)
- James Ayokunle Balogun
- Division of Neurosurgery, Department of Surgery, College of Medicine, University of Ibadan, No. 1, Queen Elizabeth road, University College Hospital Campus, Ibadan, 200001, Nigeria.
| | | | | |
Collapse
|
16
|
Chen HW, Wu JC, Kang YN, Chiu YJ, Hu SH. Assertive communication training for nurses to speak up in cases of medical errors: A systematic review and meta-analysis. Nurse Educ Today 2023; 126:105831. [PMID: 37121073 DOI: 10.1016/j.nedt.2023.105831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 04/02/2023] [Accepted: 04/18/2023] [Indexed: 05/25/2023]
Abstract
BACKGROUND Several authors have previously assessed the effects of assertive communication training for nurses to speak up in cases of medical errors. Inconsistent results regarding the nurses' attitudes, behaviors, and confidence levels were noticed. OBJECTIVE To identify the effectiveness of assertive communication training on nurses' behaviors, attitudes, and confidence levels for speaking up in cases of medical errors and to identify vital components for success. DESIGN Systematic review and meta-analysis. DATA SOURCES PubMed, ERIC, Embase, Scopus, and CINAHL were searched up for studies published from the inception of the database to December 16, 2022. METHODS Two researchers independently performed a primary screening of titles and abstracts for relevant studies, followed by a review of full texts if the references met inclusion criteria and quality assessment. Data were retrieved for nurses and nursing students who received medical error-related assertive communication training for speaking up, and learning outcomes for attitudes, behaviors, and confidence levels were reported based on pooled data. Pooled estimates were calculated using a random-effects model. RESULTS A total of eleven studies with 1299 participants were included in systematic review, and among them nine studies with 804 participants were analyzed in meta-analysis. From the pooled results, the intervention group, which received assertive communication training, exhibited substantially improved speaking-up behaviors compared with the control group (SMD = 0.58; 95 % CI, 0.14-1.03). Considerable differences were noted in the nurses' times of speaking up in cases of medical errors between pretest (38 %; 95 % CI, 0.14-0.68) and posttest (78 %; 95 %CI, 0.70-0.85) based on the pooled data. The nurses' attitudes and confidence levels for speaking up varied markedly between pretest and posttest. CONCLUSION Structured assertive communication training may improve nurses' speaking-up behaviors in cases of medical errors. To conduct effective assertive communication training, nursing educators should incorporate multiple teaching approaches into structured training and ensure an adequate training duration.
Collapse
Affiliation(s)
- Hui-Wen Chen
- Doctoral Program, Department of Nursing, College of Nursing, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Jen-Chieh Wu
- Department of Emergency, Taipei Medical University Hospital, Department of Medical Education and Humanities, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan, ROC
| | - Yi-No Kang
- Department of Emergency, Taipei Medical University Hospital, Department of Education and Humanities in Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan, ROC; Institute of Health Policy & Management, College of Public Health, National Taiwan University, Taipei, Taiwan, ROC
| | - Yu-Jui Chiu
- Department of Emergency Medicine, Taipei Medical University Hospital, Taipei, Taiwan, ROC
| | - Sophia H Hu
- Department of Nursing, College of Nursing, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC.
| |
Collapse
|
17
|
Lin YT, Shia BC, Chang CJ, Wu Y, Yang JD, Kang JH. Using Transfer Learning of Convolutional Neural Network on Neck Radiographs to Identify Acute Epiglottitis. J Digit Imaging 2023; 36:893-901. [PMID: 36658377 PMCID: PMC10287858 DOI: 10.1007/s10278-023-00774-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 01/03/2023] [Accepted: 01/04/2023] [Indexed: 01/21/2023] Open
Abstract
Acute epiglottitis (AE) is a life-threatening condition and needs to be recognized timely. Diagnosis of AE with a lateral neck radiograph yields poor reliability and sensitivity. Convolutional neural networks (CNN) are powerful tools to assist the analysis of medical images. This study aimed to develop an artificial intelligence model using CNN-based transfer learning to identify AE in lateral neck radiographs. All cases in this study are from two hospitals, a medical center, and a local teaching hospital in Taiwan. In this retrospective study, we collected 251 lateral neck radiographs of patients with AE and 936 individuals without AE. Neck radiographs obtained from patients without and with AE were used as the input for model transfer learning in a pre-trained CNN including Inception V3, Densenet201, Resnet101, VGG19, and Inception V2 to select the optimal model. We used five-fold cross-validation to estimate the performance of the selected model. The confusion matrix of the final model was analyzed. We found that Inception V3 yielded the best results as the optimal model among all pre-train models. Based on the average value of the fivefold cross-validation, the confusion metrics were obtained: accuracy = 0.92, precision = 0.94, recall = 0.90, and area under the curve (AUC) = 0.96. Using the Inception V3-based model can provide an excellent performance to identify AE based on radiographic images. We suggest using the CNN-based model which can offer a non-invasive, accurate, and fast diagnostic method for AE in the future.
Collapse
Affiliation(s)
- Yang-Tse Lin
- Department of Emergency Medicine, Hsinchu Cathay General Hospital, 30060, Hsinchu City, Taiwan
| | - Ben-Chang Shia
- Graduate Institute of Business Administration, College of Management, Fu Jen Catholic University, No. 510, Zhongzheng Road, Xinzhuang District, New Taipei City, 242062, Taiwan
| | - Chia-Jung Chang
- Division of Pediatric Emergency, Department of Pediatrics, MacKay Children's Hospital and Mackay Memorial Hospital, No. 92, Sec.2, Zhongshan N Road, Taipei City, 10449, Taiwan
| | - Yueh Wu
- Department of Orthopedics, Taipei Municipal Wanfang Hospital, No.111, Sec. 3, Xinglong Rd., Wenshan Dist., Taipei City, 116081, Taiwan
| | - Jheng-Dao Yang
- Department of Physical Medicine and Rehabiliation, Taipei Medical University Hospital, No. 252 WuHsing Street, 110, Taipei City, Taiwan
| | - Jiunn-Horng Kang
- Department of Physical Medicine and Rehabiliation, Taipei Medical University Hospital, No. 252 WuHsing Street, 110, Taipei City, Taiwan.
- Graduate Institute of Nanomedicine and Medical Engineering, College of Biomedical Engineering, Taipei Medical University, No. 250, Wuxing StXinyi Dist., Taipei City, 110301, Taiwan.
- Professional Master Program in Artificial Intelligence in Medicine, College of Medicine, Taipei Medical University, No. 250, Wuxing StXinyi Dist., 110301, Taipei City, Taiwan.
| |
Collapse
|
18
|
Arbaeen A, Wheate NJ, Brown JA, Cairns R. Over-the-counter cough and cold medicines: reported poisonings of children before and after the 2012 and 2020 labelling changes in Australia. Med J Aust 2023; 218:410-411. [PMID: 36810714 PMCID: PMC10953310 DOI: 10.5694/mja2.51865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 02/07/2023] [Accepted: 02/07/2023] [Indexed: 02/24/2023]
Affiliation(s)
| | | | - Jared A Brown
- NSW Poisons Information CentreChildren's Hospital at WestmeadSydneyNSW
| | - Rose Cairns
- The University of SydneySydneyNSW
- NSW Poisons Information CentreChildren's Hospital at WestmeadSydneyNSW
| |
Collapse
|
19
|
Tarhan M, Elibol E. The effect of a brief mindfulness-based stress reduction program on strengthening awareness of medical errors and risks among nursing students. Nurse Educ Pract 2023; 70:103655. [PMID: 37167800 DOI: 10.1016/j.nepr.2023.103655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 04/07/2023] [Accepted: 04/26/2023] [Indexed: 05/13/2023]
Abstract
INFORMATION Healthcare professionals' awareness of medical errors and risks results in effective medical error reporting and patient safety. Mindfulness has positive effects on strengthening attention and awareness. However, little is known about the use of mindfulness in patient safety education among nursing students. This study aimed to examine if a brief mindfulness-based stress reduction program would have a beneficial impact on (a) medical error attitudes, (b) the number of medical errors and risks in a simulation environment, and (c) self-confidence and satisfaction among nursing students. METHODS A quasi-experimental design with a control group was conducted with 78 third-year nursing students at a private, accredited, nursing program in Istanbul, Türkiye. RESULTS There was a statistically significant improvement in the intervention group between the pre-test and post-test for medical error attitudes (p < 0.001), and the number of medical errors and risks in a simulation environment (p < 0.001). There was no statistical difference in the intervention and control groups for self-confidence and satisfaction (p > 0.05). CONCLUSION These results suggest that a brief mindfulness-based stress reduction program positively strengthens nursing students' awareness of medical errors and risks.
Collapse
Affiliation(s)
- Merve Tarhan
- Istanbul Medipol University, Health Sciences Faculty, Nursing Department, The Neighbourhood of Goztepe, Ataturk Road, Number: 40, 34815 Beykoz, İstanbul, Turkey.
| | - Esengül Elibol
- Istanbul Bilgi University, Health Sciences Faculty, Nursing Department, The Neighbourhood of Hacı Ahmet, Pir Hüsamettin Road, Number: 20, 34440 Beyoğlu, İstanbul, Turkey
| |
Collapse
|
20
|
Rogers KJ, Krasowski MD. A dataset examining the impact of direct electronic medical record interfacing on the accuracy of point-of-care urinalysis results. Data Brief 2023; 47:109012. [PMID: 36936643 PMCID: PMC10014286 DOI: 10.1016/j.dib.2023.109012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 02/13/2023] [Accepted: 02/21/2023] [Indexed: 03/05/2023] Open
Abstract
Point-of-care testing is widely used in a variety of clinical settings. While this testing provides immediate and actionable clinical information, it is prone to error in both the interpretation and reporting of results. Point-of-care urinalysis presents unique opportunities for errors, ranging from variation in visual interpretation to input of results. The data included here represent the results from 63,279 urinalyses from 36,780 unique patients performed over a span of three years at an academic medical center and its associated clinics. The data include the patient age/legal sex, methodology (instrument and test strip used), and the available test results (color, clarity, glucose, bilirubin, ketones, specific gravity, blood, pH, protein, urobilinogen, nitrite, and leukocyte esterase). Additionally, we include the method of interface between the testing instrumentation and our electronic medical record (EMR). These fell into one of three broad categories: "Interfaced" (results directly transmitted from the urinalysis instrument to the EMR via specialized data interface), "Manual" (results input by selecting from a drop-down menu in the laboratory information system), and "Enter/Edit" (results typed freely into a text field in the EMR). Analysis of this data was primarily a direct comparison of detectable errors (typos, uninterpretable results, and results outside the reportable range) as a function of the method of entry into the EMR. Secondary analysis comparing the impact of restricting drop-down menu options for urine color and clarity was also performed. These data are of use to others as they are diverse in terms of the test performed and the method of interface. Others may wish to analyze these data when making decisions as to how to perform and report these tests and when estimating risks of error with various methods of data entry.
Collapse
|
21
|
Vikan M, Haugen AS, Bjørnnes AK, Valeberg BT, Deilkås ECT, Danielsen SO. The association between patient safety culture and adverse events - a scoping review. BMC Health Serv Res 2023; 23:300. [PMID: 36991426 DOI: 10.1186/s12913-023-09332-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 03/23/2023] [Indexed: 03/31/2023] Open
Abstract
BACKGROUND Adverse events (AEs) affect 10% of in-hospital patients, causing increased costs, injuries, disability and mortality. Patient safety culture (PSC) is an indicator of quality in healthcare services and is thus perceived as a proxy for the quality of care. Previous studies show variation in the association between PSC scores and AE rates. The main objective of this scoping review is to summarise the evidence on the association between PSC scores and AE rates in healthcare services. In addition, map the characteristics and the applied research methodology in the included studies, and study the strengths and limitations of the evidence. METHODS We applied a scoping review methodology to answer the broad research questions of this study, following the PRISMA-ScR checklist. A systematic search in seven databases was conducted in January 2022. The records were screened independently against eligibility criteria using Rayyan software, and the extracted data were collated in a charting form. Descriptive representations and tables display the systematic mapping of the literature. RESULTS We included 34 out of 1,743 screened articles. The mapping demonstrated a statistical association in 76% of the studies, where increased PSC scores were associated with reduced AE rates. Most of the studies had a multicentre design and were conducted in-hospital in high-income countries. The methodological approaches to measuring the association varied, including missing reports on the tools` validation and participants, different medical specialties, and work unit level of measurements. In addition, the review identified a lack of eligible studies for meta-analysis and synthesis and demonstrated a need for an in-depth understanding of the association, including context complexity. CONCLUSIONS We found that the vast majority of studies report reduced AE rates when PSC scores increase. This review demonstrates a lack of studies from primary care and low- and- middle-income countries. There is a discrepancy in utilised concepts and methodology, hence there is a need for a broader understanding of the concepts and the contextual factors, and more uniform methodology. Longitudinal prospective studies with higher quality can enhance efforts to improve patient safety.
Collapse
Affiliation(s)
- Magnhild Vikan
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway.
| | - Arvid Steinar Haugen
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
- Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway
| | - Ann Kristin Bjørnnes
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Berit Taraldsen Valeberg
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
- University of South-Eastern Norway, Drammen, Norway
| | | | - Stein Ove Danielsen
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| |
Collapse
|
22
|
Swinfen D, Labuschagne M, Joubert G. Disclosing medical errors: how do we prepare our students? BMC Med Educ 2023; 23:191. [PMID: 36978065 PMCID: PMC10054053 DOI: 10.1186/s12909-023-04125-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 02/24/2023] [Indexed: 06/18/2023]
Abstract
PURPOSE Despite patient safety initiatives, medical errors remain common and devastating. Disclosing errors is not only ethical, but also promotes restoration of the doctor-patient relationship. However, studies show active avoidance of error disclosure and the need for explicit training. In the South African setting, sparse information exists in terms of undergraduate medical training in error disclosure. To address this knowledge gap, the training of error disclosure in an undergraduate medical programme was examined, against the background of the available literature. The objective was to formulate a strategy to improve error disclosure teaching and practice, with the goal of improving patient care. METHODS Firstly, the literature was reviewed regarding the training of medical error disclosure. Secondly, the undergraduate medical training in error disclosure was probed, by looking at the pertinent findings from a broader study on undergraduate communication skills training. The design of the study was descriptive and cross-sectional. Anonymous questionnaires were distributed to all fourth- and fifth-year undergraduate medical students. Data were predominantly analysed quantitatively. Open-ended questions were analysed qualitatively using grounded theory coding. RESULTS Out of 132 fifth-year medical students, 106 participated (response rate 80.3%), while 65 out of 120 fourth-year students participated (response rate 54.2%). Of these participants, 48 fourth-year students (73.9%) and 64 fifth-year students (60.4%) reported infrequent teaching in the disclosure of medical errors. Almost half of the fourth-year students (49.2%) considered themselves novices in error disclosure, while 53.3% of fifth-year students rated their ability as average. According to 37/63 (58.7%) fourth-year students and 51/100 (51.0%) fifth-year students, senior doctors seldom or never modelled patient-centred care in the clinical training setting. These results resonated with the findings of other studies that showed lack of patient-centredness, as well as insufficient training in error disclosure, with resultant low confidence in this skill. CONCLUSION The study findings confirmed a dire need for more frequent experiential training in the disclosure of medical errors, in undergraduate medical education. Medical educators should view errors as learning opportunities to improve patient care and model error disclosure in the clinical learning environment.
Collapse
Affiliation(s)
- Dirkie Swinfen
- Clinical Simulation and Skills Unit, Faculty of Health Sciences, University of the Free State, 205 Nelson Mandela Drive, 9300, Bloemfontein, South Africa.
| | - Mathys Labuschagne
- Clinical Simulation and Skills Unit, Faculty of Health Sciences, University of the Free State, 205 Nelson Mandela Drive, 9300, Bloemfontein, South Africa
| | - Gina Joubert
- Department of Biostatistics, School of Biomedical Sciences, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
| |
Collapse
|
23
|
Lee YS, Jang JY, Bae JY, Oh EH, Park Y, Kwon YH, Shin JE, Lee JK, Lee TH, Paik CN. Medical disputes related to advanced endoscopic procedures with endoscopic retrograde cholangiopancreatography or endoscopic ultrasonography for the management of pancreas and biliary tract diseases. Clin Endosc 2023:ce.2022.208. [PMID: 36997186 PMCID: PMC10393579 DOI: 10.5946/ce.2022.208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 09/23/2022] [Indexed: 04/01/2023] Open
Abstract
Background/Aims This study aimed to evaluate the characteristics of endoscopic retrograde cholangiopancreatography (ERCP) or endoscopic ultrasonography (EUS)-related adverse events (AEs) that eventually lead to medical disputes or claims on medical professional liability. Methods Medical disputes for ERCP/EUS-related AEs filed in the Korea Medical Dispute Mediation and Arbitration Agency between April 2012 and August 2020 were evaluated using corresponding medical records. AEs were categorized into three sections: procedure-related, sedation-related, and safety-related AEs. Results Among a total of 34 cases, procedure-related AEs were 26 (76.5%; 12 duodenal perforations, seven post-ERCP pancreatitis, five bleedings, 2 perforations combined with post-ERCP pancreatitis); sedation-related AEs were five (14.7%; 4 cardiac arrests, one desaturation), and safety-related AEs were three (8.8%; 1 follow-up loss for stent removal, one asphyxia, 1 fall). Regarding clinical outcomes, 20 (58.8%) were fatal and eventually succumbed to AEs. For the types of medical institutions, 21 cases (61.8%) occurred at tertiary or academic hospitals, and 13 (38.2%) occurred at community hospitals. Conclusions The ERCP/EUS-related AEs filed in Korea Medical Dispute Mediation and Arbitration Agency showed distinct features: duodenal perforation was the most frequent AE, and clinical outcomes were fatal, resulting in at least more than permanent physical impairment.
Collapse
Affiliation(s)
- Yoon Suk Lee
- Department of Internal Medicine, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Jae-Young Jang
- Department of Internal Medicine, Kyung Hee University Medical Center, Seoul, Korea
| | - Jun Yong Bae
- Department of Internal Medicine, Seoul Medical Center, Seoul, Korea
| | - Eun Hye Oh
- Department of Internal Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea
| | - Yehyun Park
- Department of Internal Medicine, Ewha Womans University Seoul Hospital, Ewha Women's University College of Medicine, Seoul, Korea
| | - Yong Hwan Kwon
- Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea
| | - Jeong Eun Shin
- Department of Internal Medicine, Dankook University Hospital, Dankook University College of Medicine, Cheonan, Korea
| | - Jun Kyu Lee
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang, Korea
| | - Tae Hee Lee
- Institute for Digestive Research and Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Chang Nyol Paik
- Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| |
Collapse
|
24
|
Enzmann T, Pramann O. [Where do dangers lurk in informed consent and documentation and what are common technical mistakes?]. Urologie 2023; 62:241-6. [PMID: 36820844 DOI: 10.1007/s00120-023-02033-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/16/2023] [Indexed: 02/24/2023]
Abstract
In legal expert discussions, the following questions are usually raised: Is the procedure indicated? Have all diagnostic and therapeutic steps been carried out lege artis? Has sufficient informed consent been provided? Is there a diagnostic or treatment error? Did this cause any damage? Is the damage causally related to the error? Consideration of these fundamental questions in daily practice and good communication between patient-physician, physician-patient, and between physicians themselves is good protection in legal disputes.
Collapse
|
25
|
Steffens F, Steffens J, Kranz J, Enzmann T. [Experiences from the commission of experts]. Urologie 2023; 62:256-60. [PMID: 36820845 DOI: 10.1007/s00120-023-02034-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/16/2023] [Indexed: 02/24/2023]
Abstract
The task of the commission of experts on medical errors is to provide a neutral and independent assessment of a treatment for which a physician is responsible and evaluate the liability issue. The objective evaluation is intended to make it easier for the person whose health has been damaged by a treatment error to assert justified claims and for the physician to reject unfounded accusations. The aim is to promote amicable dispute resolution. For the legal classification of the term "complication", a definition is necessary. The physician understands this to mean a deviation from the actual course and consequences of treatment. The lawyer sees a complication as an undesirable consequence of incorrect patients' information or treatment. One-third of all court cases end with a finding of medical malpractice. This rate corresponds to the medical malpractice rate in medical malpractice litigation. If medical malpractice is found, the physician's liability insurance is contacted to settle the claim. If the commission of experts denies medical malpractice, the patient usually refrains from taking legal action.
Collapse
|
26
|
Zeichen J. [Assessments in medical training : What makes assessments interesting?]. Unfallchirurgie (Heidelb) 2023; 126:339-347. [PMID: 36735013 DOI: 10.1007/s00113-023-01288-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/03/2023] [Indexed: 02/04/2023]
Abstract
The assessment represents an elementary medical task. The medical assessment is the basis of a legal decision and is initiated by the client if medical expertise is required to assess a situation. A medical assessment is a scientifically based conclusion made by a physician about a person's state of health or functional limitations or other medical circumstances. The reports must be scientifically sound, medically conclusive, understandable and comprehensible. The ability to do this is acquired as part of medical further training after obtaining a license to practice medicine. With a systematic approach to the preparation of reports, one's own treatment processes can be improved and lessons can be learnt from mistakes. Expert opinions in the context of further training are of enormous importance for further professional life.
Collapse
Affiliation(s)
- J Zeichen
- Klinik für Unfallchirurgie und Orthopädie, Johannes Wesling Klinikum Minden, Hans Nolte Straße 1, 32429, Minden, Deutschland. .,Sektion Begutachtung, Deutsche Gesellschaft für Orthopädie und Unfallchirurgie, Berlin, Deutschland.
| |
Collapse
|
27
|
Al-Otaibi T, Abbas A, Ashry Gheith O, Nair P, Zahab MA, Hammouda MAA, Farid MM, Aljowaie RM, AlKubaisi NA, Mohamed EF, Abassi AM, Eisa YH. Determinants, predictors and negative impacts of burnout among health care workers during COVID-19 pandemic. J King Saud Univ Sci 2023; 35:102441. [PMID: 36405649 PMCID: PMC9650511 DOI: 10.1016/j.jksus.2022.102441] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 09/27/2022] [Revised: 10/24/2022] [Accepted: 11/07/2022] [Indexed: 05/28/2023]
Abstract
The first defense line of the battle, healthcare workers (HCWs), faces a significant challenge in managing the current COVID-19 pandemic. An online electronic survey was sent to HCWs via email and social media networks. Socio-demographic data and work environment-related variables were assessed. Consequences of burnout (BO) were reported, e.g., elicited medical errors. Maslach burnout inventory was used to diagnose BO. Two hundred and eighty-four participants were included with a mean age of 39.83 ± 7.34 years, 70.8% worked in the COVID-19 frontline, 91.9% were followed daily updates about COVID-19, 63.7% were not satisfied with the coordination between triage and isolation, 64.4% got COVID-19 infection, 91.9% had a colleague or family member developed COVID-19 infection, and 21.5% experienced a colleague /a family member died due to COVID-19. Multivariate analysis by linear regression revealed that; working as a frontline HCW (OR 1.28, CI = 0.14-2.55) and sleep deprivation (OR 3.93, CI = 1.88-8.22) were the predictors of burnout.
Collapse
Affiliation(s)
- Torki Al-Otaibi
- The Nephrology Department, Hamed Al-Essa Organ Transplant Center, Ibn Sina Hospital, Sabah Area, Kuwait
| | - Ahmad Abbas
- The Nephrology Department, Hamed Al-Essa Organ Transplant Center, Ibn Sina Hospital, Sabah Area, Kuwait
- Chest Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Osama Ashry Gheith
- The Nephrology Department, Hamed Al-Essa Organ Transplant Center, Ibn Sina Hospital, Sabah Area, Kuwait
- Department of Dialysis and Transplantation, Urology Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Prasad Nair
- The Nephrology Department, Hamed Al-Essa Organ Transplant Center, Ibn Sina Hospital, Sabah Area, Kuwait
| | - Mohamed A Zahab
- The Nephrology Department, Hamed Al-Essa Organ Transplant Center, Ibn Sina Hospital, Sabah Area, Kuwait
| | - Mryhan A A Hammouda
- Lecturer of Industrial Medicine and Occupational Health, Community, Environmental and Occupational Medicine Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Mahmoud M Farid
- Clinical Pathology Specialist, National Blood Transfusion Services, Egypt
- Health Care Management Consultant, Technical Office, MOH, Kuwait
| | - Reem M Aljowaie
- Department of Botany and Microbiology, College of Science, King Saud University, P.O. 2455, Riyadh 11451, Saudi Arabia
| | - Noorah A AlKubaisi
- Department of Botany and Microbiology, College of Science, King Saud University, P.O. 2455, Riyadh 11451, Saudi Arabia
| | | | - Arshad Mehmood Abassi
- Department of Environmental Sciences, COMSATS University Islamabad, Abbottabad Campus, 22060, Pakistan
- University of Gastronomic Sciences, Piazza Vittorio Emanuele II, 9, 12042 Pollenzo, Italy
| | - Yasmine H Eisa
- Community Medicine Department, Public Health and Preventive Medicine, Faculty of Medicine October 6 University, Giza, Egypt
| |
Collapse
|
28
|
Gutiérrez-Cirlos C, Carrillo-Pérez DL, Bermúdez-González JL, Hidrogo-Montemayor I, Carrillo-Esper R, Sánchez-Mendiola M. ChatGPT: opportunities and risks in the fields of medical care, teaching, and research. GAC MED MEX 2023; 159:372-379. [PMID: 38096831 DOI: 10.24875/gmm.m23000811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 07/31/2023] [Indexed: 12/18/2023] Open
Abstract
ChatGPT is a virtual assistant with artificial intelligence (AI) that uses natural language to communicate, i.e., it holds conversations as those that would take place with another human being. It can be applied at all educational levels, including medical education, where it can impact medical training, research, the writing of scientific articles, clinical care, and personalized medicine. It can modify interactions between physicians and patients and thus improve the standards of healthcare quality and safety, for example, by suggesting preventive measures in a patient that sometimes are not considered by the physician for multiple reasons. ChatGPT potential uses in medical education, as a tool to support the writing of scientific articles, as a medical care assistant for patients and doctors for a more personalized medical approach, are some of the applications discussed in this article. Ethical aspects, originality, inappropriate or incorrect content, incorrect citations, cybersecurity, hallucinations, and plagiarism are some examples of situations to be considered when using AI-based tools in medicine.
Collapse
Affiliation(s)
- Carlos Gutiérrez-Cirlos
- Faculty of Medicine, Secretariat of Clinical Teaching, Medical Internship and Social Service, Universidad Nacional Autónoma de México, Mexico City
- Department of Internal Medicine, Medical Directorate, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City
| | - Diego L Carrillo-Pérez
- Department of Internal Medicine, Medical Directorate, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City
- School of Medicine and Health Sciences, Tecnológico de Monterrey, Mexico City
| | - Jorge Luis Bermúdez-González
- Department of Internal Medicine, Medical Directorate, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City
| | | | | | - Melchor Sánchez-Mendiola
- Postgraduate Education Division, Faculty of Medicine, Universidad Nacional Autónoma de México, Mexico City
- Open University Coordination, Educational Innovation and Distance Education, Directorate of Educational Evaluation, Universidad Nacional Autónoma de México, Mexico City. Mexico
| |
Collapse
|
29
|
Lanzagorta-Ortega D, Carrillo-Pérez DL, Carrillo-Esper R. [Artificial intelligence in medicine: present and future]. GAC MED MEX 2022; 158:17-21. [PMID: 36921221 DOI: 10.24875/gmm.m22000688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Artificial intelligence (AI) promises a significant transformation of health care in all medical areas, which could represent "Gutenberg moment" for medicine. The future of medical specialties came largely from human interaction and creativity, forcing physicians to evolve and use AI as a tool in patient care. AI will offer patients safety, autonomy, and access to timely medical care in hard-to-reach areas while reducing administrative burden, screen time, and professional burnout for physicians. AI will also make it possible to reduce the frequency of medical errors and improve diagnostic accuracy through the integration, analysis, and interpretation of information by algorithms and software. The safety of repetitive activities will free up time for health personnel and will enhance the doctor-patient relationship, return to personalized attention and interaction with the patient, through accompaniment, communication, empathy, and trust during illness, activities that will never be replaced by AI. It is still necessary to standardize research in the area, which allows improving the quality of scientific evidence knowing its advantages and risks, accelerating its implementation in current medical practice.
Collapse
Affiliation(s)
| | - Diego L Carrillo-Pérez
- Escuela de Medicina y Ciencias de la Salud, Tecnológico de Monterrey; Dirección de Medicina, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; Ciudad de México, México
| | | |
Collapse
|
30
|
Abry S, Mehrabian F, Omidi S, Karimy M, Kasmaei P, Haryalchi K. Investigation of factors related to the behavior of reporting clinical errors in nurses working in educational and medical centers in Rasht city, Iran. BMC Nurs 2022; 21:348. [PMID: 36482463 PMCID: PMC9733308 DOI: 10.1186/s12912-022-01134-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 11/30/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Report of medical error is one of the effective components in the quality of healthcare services. A significant part of medical errors can be prevented by acting appropriately. The theory of planned behavior offers a framework in which the nurse intention to perform the behavior of error reporting is investigated. This study was conducted to determine the factors related to the behavior of reporting clinical errors in nurses working in educational and medical centers in Rasht based on the theory of planned behavior in 2020. METHODS In this descriptive-analytical study, 326 nurses in all medical centers in Rasht were selected by the multi-stage random sampling method. Data collection tool was a valid and reliable questionnaire based on the theory of planned behavior. Data analysis was conducted using the SPSS software, analysis of variance, correlation, and linear regression. RESULTS 39% of nurses reported that they had reported a medical error, and the average number of error reports per nurse during the last 3 months was 1.42 errors. The predictive power of the theory of behavioral intention was 47%, and predictive constructs were attitude (B = .43), perceived behavioral control (B = .33), and subjective norm (B = .04) using linear regression. The predictive power of the theory for nurses' behavior was 3.1%. None of the demographic variables played a role in predicting the behavior of nurses' reporting clinical error, and no behavioral intention predicted the behavior of nurses' reporting clinical errors. CONCLUSION The theory of planned behavior expresses the factors affecting the behavior intention of nurses' reporting clinical errors satisfactorily. However, it was an inappropriate theory in behavior prediction. It appears that factors, such as fear of consequences of error reporting, social pressures by colleagues and officials, and lack of knowledge and skills required to identify medical errors, are the barriers to conversion of intention to the behavior of reporting clinical errors. It is necessary to provide the ground to increase nurses' report of clinical errors by acting appropriately.
Collapse
Affiliation(s)
- Somayeh Abry
- grid.411874.f0000 0004 0571 1549Department of Health Education and Promotion, School of Health, Guilan University of Medical Sciences, Rasht, Iran
| | - Fardin Mehrabian
- grid.411874.f0000 0004 0571 1549Department of Health Education and Promotion, Research Center of Health and Environment, School of Health, Guilan University of Medical Sciences, Rasht, Iran
| | - Saeed Omidi
- grid.411874.f0000 0004 0571 1549Guilan University of Medical Sciences, Rasht, Iran
| | - Mahmood Karimy
- grid.510755.30000 0004 4907 1344Department of Public Health, Social Determinants of Health Research Center, Saveh University of Medical Sciences, Saveh, Iran
| | - Parisa Kasmaei
- grid.411874.f0000 0004 0571 1549Department of Health Education and Promotion, Research Center of Health and Environment, School of Health, Guilan University of Medical Sciences, Rasht, Iran
| | - Katayoun Haryalchi
- Department of Obstetrics & Gynecology, School of Medicine, Reproductive Health Research CenterAlzahra HospitalGuilan University of Medical Science, Rasht, Iran
| |
Collapse
|
31
|
Gharaibeh ZIY. The Impacts of Applications of Criminal Law on Medical Practice. Med Arch 2022; 76:377-382. [PMID: 36545448 PMCID: PMC9760231 DOI: 10.5455/medarh.2022.76.377-382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 11/01/2022] [Indexed: 11/16/2022] Open
Abstract
Background Human health is the single most asset that any one person can and need to have it as qualitative as.. Despite this, however, there are occasions when things go wrong in practice and the patients wind up getting hurt while they are receiving treatment at the healthcare facility Obtaining and maintaining a good health are the goals of individuals and communities, which require having good medical systems. In rare cases, malpractice of medical systems may occur, a matter that affects patients and health providers. Objective The main objectives of the present study were to review the literature for medical malpractice and how the application of criminal law impacts the medical practice. Methods This is descriptive review based on the related studies published in scientific literature and deposited in on-line indexed databases. Results and Discussion Main findings of the study showed that medical errors are likely to increase overtime. Malpractice is likely to take place as if good intention to do the best. Activation of criminal law against medical malpractice may put stress on medical staff, and may be a triggering factor for improving services submitted to the patients. Conclusion Activation of criminal law against medical errors places stress on medical community from one side, and may be a triggering factor for improving services from another side.
Collapse
|
32
|
Taheri Moghadam S, Hooman N, Sheikhtaheri A. Patient safety classification, taxonomy and ontology systems: A systematic review on development and evaluation methodologies. J Biomed Inform 2022;:104150. [PMID: 35878822 DOI: 10.1016/j.jbi.2022.104150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 06/11/2022] [Accepted: 07/19/2022] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Patient safety classifications/ontologies enable patient safety information systems to receive and analyze patient safety data to improve patient safety. Patient safety classifications/ontologies have been developed and evaluated using a variety of methods. The purpose of this review was to discuss and analyze the methodologies for developing and evaluating patient safety classifications/ontologies. METHODS Studies that developed or evaluated patient safety classifications, terminologies, taxonomies, or ontologies were searched through Google Scholar, Google search engines, National Center for Biomedical Ontology (NCBO) BioPortal, Open Biological and Biomedical Ontology (OBO) Foundry and World Health Organization (WHO) websites and Scopus, Web of Science, PubMed, and Science Direct. We updated our search on 30 February 2021 and included all studies published until the end of 2020. Studies that developed or evaluated classifications only for patient safety and provided information on how they were developed or evaluated were included. Systems with covered patient safety terms (such as ICD-10) but are not specifically developed for patient safety were excluded. The quality and the risk of bias of studies were not assessed because all methodologies and criteria were intended to be covered. In addition, we analyzed the data through descriptive narrative synthesis and compared and classified the development and evaluation methods and evaluation criteria according to available development and evaluation approaches for biomedical ontologies. RESULTS We identified 84 articles that met all of the inclusion criteria, resulting in 70 classifications/ontologies, nine of which were for the general medical domain. The most papers were published in 2010 and 2011, with 8 and 7 papers, respectively. The United States (50) and Australia (23) have the most studies. The most commonly used methods for developing classifications/ontologies included the use of existing systems (for expanding or mapping) (44) and qualitative analysis of event reports (39). The most common evaluation methods were coding or classifying some safety report samples (25), quantitative analysis of incidents based on the developed classification (24), and consensus among physicians (16). The most commonly applied evaluation criteria were reliability (27), content and face validity (9), comprehensiveness (6), usability (5), linguistic clarity (5), and impact (4), respectively. CONCLUSIONS Because of the weaknesses and strengths of the development/evaluation methods, it is advised that more than one method for development or evaluation, as well as evaluation criteria, should be used. To organize the processes of developing classification/ontologies, well-established approaches such as Methontology are recommended. The most prevalent evaluation methods applied in this domain are well fitted to the biomedical ontology evaluation methods, but it is also advised to apply some evaluation approaches such as logic, rules, and Natural language processing (NLP) based in combination with other evaluation approaches. This research can assist domain researchers in developing or evaluating domain ontologies using more complete methodologies. There is also a lack of reporting consistency in the literature and same methods or criteria were reported with different terminologies.
Collapse
|
33
|
Cheng PM. Bigram frequency analysis for detection of radiology report errors. Clin Imaging 2022; 89:84-8. [PMID: 35759885 DOI: 10.1016/j.clinimag.2022.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 06/11/2022] [Accepted: 06/19/2022] [Indexed: 11/22/2022]
Abstract
PURPOSE This pilot study evaluates the utility of analyzing bigram frequencies for detecting radiology report errors. METHODS A corpus of 48,050 CT reports was used to enumerate the frequency of each bigram (FAB), and the expected frequency of each bigram in the corpus based on the constituent unigram frequencies (PAB). A test set consisted of a separate random sample of 200 radiology reports dictated by attendings for CT scans of the abdomen in 2019, as well as a random sample of 200 radiology reports for CT scans of the abdomen dictated in 2019 by 52 different residents or fellows prior to editing by the signing attendings. Bigrams in the test reports that occurred either rarely or not at all in the corpus were flagged for manual review by an abdominal radiologist. FINDINGS Of 682 n-grams flagged in attending reports, 11.6% were true errors, while of 1378 n-grams flagged in trainee reports, 7.9% were true errors. The largest group of flagged n-grams in both test sets involved bigrams that did not appear in the corpus, but whose constituent words did appear in the corpus. Subsets of 50 attending and 50 resident reports were manually reviewed, revealing that the flagging procedure had a sensitivity for errors of 58% (22/38) in the attending reports and 97% (31/32) in the resident reports. CONCLUSION Bigram frequency analysis may be of practical value in reviewing radiology reports for errors. Further methodological refinement to improve the positive predictive value of error detection is required.
Collapse
|
34
|
Romero-Zayas I, Campos Añón F, Santos Virosta M, Cordón Del Pozo J, Santos Montero C, Niñerola Baizán A, Fuster D. Implementation of the failure modes and effects analysis in a Hospital Radiopharmacy Unit. Rev Esp Med Nucl Imagen Mol 2022; 41:300-310. [PMID: 35668016 DOI: 10.1016/j.remnie.2022.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 12/02/2021] [Accepted: 12/11/2021] [Indexed: 11/26/2022]
Abstract
AIM The aim of this study is the implementation in a Hospital Radiopharmacy Unit of a risk analysis methodology in order to proactively identify possible failure modes and prioritize corrective measures. MATERIALS AND METHODS By means of the failure modes and effects analysis (FMEA), the possible failure modes of each of the stages of the processes of prescription, preparation, and administration of radiopharmaceuticals for diagnostic and therapy were identified. From the variables of severity, probability and detectability, the risk was quantified using the Risk Priority Number (RPN) for each failure mode, sub-process, and type of radiopharmaceutical. Improvement measures were established and the reduction in the RPN value was calculated. RESULTS A total of 96 failure modes were identified (58 for diagnostic radiopharmaceuticals and 38 for therapy). Biunivocal identification of the patient with the radiopharmaceutical is the failure mode with the highest RPN (60) and the radiolabeling cell sub-process the one that has the highest risk (RPN 286). As a result of the improvement measures, the overall RPN was reduced by 22% for diagnostic radiopharmaceuticals and 20% for therapy. This reduction would be 46% and 31% respectively if radiopharmacy software and a barcode technology in the administration were implemented. CONCLUSIONS The application of the FMEA methodology as a risk analysis tool allows to identify the critical points of the processes related to radiopharmaceuticals and prioritize measures to reduce the risk.
Collapse
Affiliation(s)
- I Romero-Zayas
- Unidad de Radiofarmacia, Servicio de Medicina Nuclear, Hospital Clínic, Barcelona, Spain.
| | - F Campos Añón
- Unidad de Radiofarmacia, Servicio de Medicina Nuclear, Hospital Clínic, Barcelona, Spain
| | - M Santos Virosta
- Unidad de Radiofarmacia, Servicio de Medicina Nuclear, Hospital Clínic, Barcelona, Spain
| | - J Cordón Del Pozo
- Unidad de Radiofarmacia, Servicio de Medicina Nuclear, Hospital Clínic, Barcelona, Spain
| | - C Santos Montero
- Unidad de Radiofarmacia, Servicio de Medicina Nuclear, Hospital Clínic, Barcelona, Spain
| | - A Niñerola Baizán
- Servicio de Medicina Nuclear, Hospital Clínic, Barcelona, Spain; Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Barcelona, Spain
| | - D Fuster
- Servicio de Medicina Nuclear, Hospital Clínic, Barcelona, Spain
| |
Collapse
|
35
|
Jafari E, Malekpour Afshar R, Aminzade R. Rates and Reasons of Laboratory Sample Rejection due to Pre-analytical Errors in Clinical Settings. Arch Iran Med 2022; 25:166-170. [PMID: 35429958 DOI: 10.34172/aim.2022.28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 06/16/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Laboratory analysis errors in procedure or interpretation may be seen during the process of completing physician test orders. They may also result in rejection of the requests due to some applicability reasons. Hence, this study was carried out to determine the rate and reasons for such rejections in clinical settings. METHODS This cross-sectional comparative study was performed on 104008 laboratory tests in a one-year period in terms of the percentage and type of errors that occurred in Shahid Bahonar Hospital in Kerman, Iran, in 2018. The types of studied errors included hemolysis, sample clotting, insufficient sample size, and mistakes in labels or absence of labels on the sample. RESULTS In this study, 104008 laboratory tests were performed, with 2299 (2.21%) sample rejections, 456 (32.31%) complete blood count (CBC) sample clotting; 417 (29.38 %) hemolysis; and 150 (17.47 %) inadequate sample volume as the majority of errors. There was no statistically significant relationship between pre-analysis errors and clinical aspects (P=0.124). CONCLUSION According to the results, it may be concluded that considering the high prevalence of laboratory errors in comparison with the majority of other studies, continuous training courses and determination of the causes of these errors are crucial to attaining better function and basic knowledge.
Collapse
Affiliation(s)
- Elham Jafari
- Pathology and Stem Cells Research Center, Department of Pathology, Kerman University of Medical Sciences, Kerman, Iran
| | - Reza Malekpour Afshar
- Pathology and Stem Cells Research Center, Department of Pathology, Kerman University of Medical Sciences, Kerman, Iran
| | - Razieh Aminzade
- Pathology and Stem Cells Research Center, Department of Pathology, Kerman University of Medical Sciences, Kerman, Iran
| |
Collapse
|
36
|
Gampetro PJ, Segvich JP, Hughes AM, Kanich C, Schlaeger JM, McFarlin BL. Associations between safety outcomes and communication practices among pediatric nurses in the United States. J Pediatr Nurs 2022; 63:20-27. [PMID: 34942469 DOI: 10.1016/j.pedn.2021.12.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 12/08/2021] [Accepted: 12/09/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE To gain a deeper understanding of RNs communication related to patient safety. RESEARCH AIMS To determine: (1) the associations between the communication of registered nurses (RNs) within their health care teams and the frequency that they reported safety events; (2) the associations between RNs' communication within their health care teams and their perceptions of safety within the hospital unit; and (3) whether RNs' communication had improved from 2016 to 2018. THEORETICAL FRAMEWORK AND METHODS We used the United Kingdom's Safety Culture model as the theoretical framework for this study. Our secondary data analysis from the Agency for Healthcare Research and Quality's Hospital Survey on Patient Safety Culture included 2016 (n = 5298) and 2018 (n = 3476) using multiple regression models to determine associations between responses for Communication Openness and Feedback & Communication About Error, and outcome responses for Frequency of Events Reported and Overall Perceptions of Safety. RESULTS Our findings were: 1). In both 2016 and 2018 datasets, Feedback About Error had a greater impact on Reporting Frequency than Open Communication; 2). Feedback About Error had a greater impact on Safety Perceptions than Open Communication; 3). Open Communication and Feedback About Error and their associations with Reporting Frequency and Safety Perceptions showed little change; and, 4). The proportion of variance was low, indicating factors other than Open Communication and Feedback About Error were involved with Reporting Frequency and Safety Perceptions. CONCLUSION Pediatric RNs' communication, reporting, and perceptions of patient safety have not improved. (245 words).
Collapse
Affiliation(s)
- Pamela J Gampetro
- University of Illinois Chicago, College of Nursing, Department of Human Development Nursing Science, 845 S. Damen Avenue, Chicago, IL 60612, United States.
| | - John P Segvich
- Statistical Consultant, 14524 Kolin Avenue, Midlothian, IL 60445, United States
| | - Ashley M Hughes
- University of Illinois Chicago, College of Applied Health Sciences, Department of Biomedical & Health Information Sciences, Director, Systems-based Approach for Enhancing Teamwork (SAFE-T) lab, 1919 W. Taylor Street, Chicago, IL 60612, United States.
| | - Chris Kanich
- University of Illinois Chicago, College of Engineering, Department of Computer Science, 851 S. Morgan Street, Chicago, IL 60607, United States.
| | - Judith M Schlaeger
- University of Illinois Chicago, College of Nursing, Department of Human Development Nursing Science, 845 S. Damen Avenue, Chicago, IL 60612, United States.
| | - Barbara L McFarlin
- University of Illinois Chicago, College of Nursing, Department of Human Development Nursing Science, 845 S. Damen Avenue, Chicago, IL 60612, United States.
| |
Collapse
|
37
|
Shenoy A, Shenoy GN, Shenoy GG. Patient safety assurance in the age of defensive medicine: a review. Patient Saf Surg 2022; 16:10. [PMID: 35177113 PMCID: PMC8851719 DOI: 10.1186/s13037-022-00319-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 01/17/2022] [Indexed: 11/28/2022] Open
Abstract
The definition of defensive medicine has evolved over time given various permutations and combinations. The underlying meaning, however, has persisted in its relevance towards two classifications, positive and negative defensive medicine. Positive defensive medicine is specific to overutilization, excessive testing, over-diagnosing, and overtreatment. Negative defensive medicine, on the contrary, is specific to avoiding, referring, or transferring high risk patients. Given the above bifurcation, the present research analyzes defensive medicine in the landscape of medical errors. In its specificity to medical errors, we consider the cognitive taxonomies of medical errors contextual to execution and evaluation slips and mistakes. We, thereafter, illustrate how the above taxonomy interclasps with five classifications of medical errors. These classifications are those that involve medical errors of operative, drug-related, diagnostic, procedure-related, and other types. This analytical review illustrates the nodular frameworks of defensive medicine. As furtherance of our analysis, this review deciphers the above nodular interconnectedness to these error taxonomies in a cascading stepwise sequential manner. This paper was designed to elaborate and to stress repeatedly that practicing defensive medicine entails onerous implications to physicians, administrators, the healthcare system, and to patients. Practicing defensive medicine, thereby, is far from adhering to those optimal healthcare practices that support quality of care metrics/milestones, and patient safety measures. As an independent standalone concept, defensive medicine is observed to align with the taxonomies of medical errors based on this paper’s diagrammatic and analytical inference.
Collapse
Affiliation(s)
- Amrita Shenoy
- Assistant Professor of Healthcare Administration, University of Baltimore, College of Public Affairs, School of Health and Human Services, 1420 N. Charles Street, Baltimore, MD, 21201, USA.
| | - Gopinath N Shenoy
- Medical Malpractice Attorney/Senior Medicolegal Consultant, Post-Graduate Examiner of Law (LLM & PhD) at the University of Mumbai, Former Honorary Professor of Obstetrics/Gynecology at K J Somaiya Medical College and Hospital, Former President and Post-Graduate Examiner of Obstetrics/Gynecology at the College of Physicians and Surgeons of Bombay, and Former Member of the Consumer Disputes Redressal Forum, Mumbai Suburban District, State Government of Maharashtra, Mumbai, India
| | - Gayatri G Shenoy
- Former Assistant Professor and Diplomate of the National Board (DNB) Faculty of Anesthesiology, K J Somaiya Medical College and Hospital, Mumbai, Maharashtra, India
| |
Collapse
|
38
|
Abstract
Error in medicine and medical liability has a long history dating back to Antiquity. During the 19th Century, most lawsuits related to errors in treating surgical problems were settled. However, in the first half of the 20th Century, lawsuits claimed that mistakes were related to the doctor's action: the doctor made something wrong (errors of commission). In Brazil, medical error is defined as inappropriate conduct, including negligence and recklessness, that causes harm to the patient. The physician's fear of being suited is the reason for some practice named defensive Medicine (D.M.), defined as ordering unnecessary tests and procedures or avoiding treatments for patients considered at high-risk. Thus, this narrative review aims to analyze and describe the relationship between medical errors, medical negligence, and the practice of D.M. So, the authors propose procedures and attitudes to avoid medical errors and the approach of D.M.: a national focus to create leadership and research tools to enhance the knowledge base about patient safety; a reporting system that would help to identify and learn from errors; the use of a computer-based protocol reminder; some technological devices to help the medical practice (electronic prescribing and information technology systems); creating risk management programs in hospitals. Therefore, the authors conclude that the most critical attitude to avoid medical liability is a good and ethical medical practice with the proper use of technology, based on knowledge of scientific evidence and ethical principles of medicine - for the benefit of patients.
Collapse
Affiliation(s)
- Ivan Dieb Miziara
- Department of Legal Medicine, Ethics and Occupational Health, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil.
| | | |
Collapse
|
39
|
Al-Ghunaim TA, Johnson J, Biyani CS, Alshahrani KM, Dunning A, O'Connor DB. Surgeon burnout, impact on patient safety and professionalism: A systematic review and meta-analysis. Am J Surg 2021; 224:228-238. [PMID: 34974884 DOI: 10.1016/j.amjsurg.2021.12.027] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 11/19/2021] [Accepted: 12/21/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Previous systematic reviews have found high burnout in healthcare professionals is associated with poorer patient care. However, no review or meta-analysis has investigated this association in surgeons specifically. The present study addressed this gap, by examining the association between surgeon burnout and 1) patient safety and 2) surgical professionalism. METHODS A systematic review was performed in accordance with PRISMA guidelines. We included original empirical studies that measured burnout and patient care or professionalism in surgeons. Six databases were searched (PsycINFO, Ovid MEDLINE(R), EMBASE, Cochrane Database, CINAHL, and Web of Science) from inception to February 2021. An adapted version of the Cochrane Risk of Bias tool was used to assess study quality. Meta-analysis and narrative synthesis were utilised to synthesise results. RESULTS Fourteen studies were included in the narrative review (including 27,248 participants) and nine studies were included in the meta-analysis. Burnout was associated with a 2.5-fold increased risk of involvement in medical error (OR = 2.51, 95% Cl [1.68-3.72]). The professionalism outcome variables were too diverse for meta-analysis, however, the narrative synthesis indicated a link between high burnout and a higher risk of loss of temper and malpractice suits and lower empathy. No link was found between burnout and patient satisfaction. CONCLUSION There is a significant association between higher burnout in surgeons and poorer patient safety. The delivery of interventions to reduce surgeon burnout should be prioritised; such interventions should be evaluated for their potential to produce concomitant improvements in patient safety.
Collapse
Affiliation(s)
- Tmam A Al-Ghunaim
- School of Psychology University of Leeds, Leeds, LS2 9JT, United Kingdom.
| | - Judith Johnson
- School of Psychology University of Leeds, Leeds, LS2 9JT, United Kingdom
| | - Chandra Shekhar Biyani
- Department of Urology, St James's University Hospital, Beckett Street, Leeds, West Yorkshire, LS9 7TF, United Kingdom
| | - Khalid M Alshahrani
- School of Psychology University of Leeds, Leeds, LS2 9JT, United Kingdom; Psychology Department King Abdulaziz University, Jeddah, Saudi Arabia
| | - Alice Dunning
- Bradford Teaching Hospitals NHS Foundation Trust, United Kingdom
| | - Daryl B O'Connor
- School of Psychology University of Leeds, Leeds, LS2 9JT, United Kingdom
| |
Collapse
|
40
|
Badr M, Goulard M, Theret B, Roubertie A, Badiou S, Pifre R, Bres V, Cambonie G. Fatal accidental lipid overdose with intravenous composite lipid emulsion in a premature newborn: a case report. BMC Pediatr 2021; 21:584. [PMID: 34930217 PMCID: PMC8686371 DOI: 10.1186/s12887-021-03064-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 12/08/2021] [Indexed: 01/30/2023] Open
Abstract
Background Tenfold or more overdose of a drug or preparation is a dreadful adverse event in neonatology, often due to an error in programming the infusion pump flow rate. Lipid overdose is exceptional in this context and has never been reported during the administration of a composite intravenous lipid emulsion (ILE). Case presentation Twenty-four hours after birth, a 30 weeks’ gestation infant with a birthweight of 930 g inadvertently received 28 ml of a composite ILE over 4 h. The ILE contained 50% medium-chain triglycerides and 50% soybean oil, corresponding to 6 g/kg of lipids (25 mg/kg/min). The patient developed acute respiratory distress with echocardiographic markers of pulmonary hypertension and was treated with inhaled nitric oxide and high-frequency oscillatory ventilation. Serum triglyceride level peaked at 51.4 g/L, 17 h after the lipid overload. Triple-volume exchange transfusion was performed twice, decreasing the triglyceride concentration to < 10 g/L. The infant’s condition remained critical, with persistent bleeding and shock despite supportive treatment and peritoneal dialysis. Death occurred 69 h after the overdose in a context of refractory lactic acidosis. Conclusions Massive ILE overdose is life-threatening in the early neonatal period, particularly in premature and hypotrophic infants. This case highlights the vigilance required when ILEs are administered separately from other parenteral intakes. Exchange transfusion should be considered at the first signs of clinical or biological worsening to avoid progression to multiple organ failure. Supplementary Information The online version contains supplementary material available at 10.1186/s12887-021-03064-6.
Collapse
Affiliation(s)
- Maliha Badr
- Department of Neonatal Medicine and Paediatric Intensive Care, Arnaud de Villeneuve Hospital, Montpellier University Hospital, University of Montpellier, 371 Avenue du Doyen Gaston Giraud, 34295, Montpellier Cedex 5, France
| | - Marion Goulard
- Department of Neonatal Medicine and Paediatric Intensive Care, Arnaud de Villeneuve Hospital, Montpellier University Hospital, University of Montpellier, 371 Avenue du Doyen Gaston Giraud, 34295, Montpellier Cedex 5, France
| | - Bénédicte Theret
- Department of Neonatal Medicine and Paediatric Intensive Care, Arnaud de Villeneuve Hospital, Montpellier University Hospital, University of Montpellier, 371 Avenue du Doyen Gaston Giraud, 34295, Montpellier Cedex 5, France
| | - Agathe Roubertie
- Department of Neuropaediatrics, Gui de Chauliac Hospital, Montpellier University Hospital, University of Montpellier, Montpellier, France
| | - Stéphanie Badiou
- Department of Biochemistry and Hormonology, Lapeyronie Hospital, Montpellier University Hospital, University of Montpellier, Montpellier, France
| | - Roselyne Pifre
- Department of Neonatal Medicine and Paediatric Intensive Care, Arnaud de Villeneuve Hospital, Montpellier University Hospital, University of Montpellier, 371 Avenue du Doyen Gaston Giraud, 34295, Montpellier Cedex 5, France
| | - Virginie Bres
- Department of Medical Pharmacology and Toxicology, Montpellier University Hospital, University of Montpellier, Montpellier, France
| | - Gilles Cambonie
- Department of Neonatal Medicine and Paediatric Intensive Care, Arnaud de Villeneuve Hospital, Montpellier University Hospital, University of Montpellier, 371 Avenue du Doyen Gaston Giraud, 34295, Montpellier Cedex 5, France. .,Pathogenesis and Control of Chronic Infection, INSERM UMR 1058, University of Montpellier, Montpellier, France.
| |
Collapse
|
41
|
Gohal G. Models of teaching medical errors. Pak J Med Sci 2021; 37:2020-2025. [PMID: 34912437 PMCID: PMC8613064 DOI: 10.12669/pjms.37.7.4506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 04/20/2021] [Accepted: 07/18/2021] [Indexed: 11/15/2022] Open
Abstract
Medical errors are relatively common causes of preventable iatrogenic adverse events. We have focused on teaching models in certain courses of study that have been reported to have significant positive impacts on the outcomes of teaching about medical errors. All healthcare organizations must establish suitable models of teaching about patient safety and medical errors as a preventive measure and as an early intervention strategy. Teaching undergraduate medical students and physicians in training how to manage and disclose medical errors helps them develop lifelong skills that can effectively reduce such errors. The literature search was conducted in international databases such as PubMed/MEDLINE and Google Scholar search engine using English equivalent keywords, from 1998 up to April, 2020. The search strategy used the following subject headings terms: “Medical error(s)” AND “Teaching”. Out of 40 Studies included, 6 studies were selected to have evaluated models of health care training and simulation based teaching of medical errors and patient safety in undergraduate and postgraduate medical education.
Collapse
Affiliation(s)
- Gassem Gohal
- Dr. Gassem Gohal, MD, FRCPC, ABP. Department of Pediatrics, Jazan University, Faculty of Medicine, Jazan, Saudi Arabia
| |
Collapse
|
42
|
Brenner MJ, Hickson GB, Rushton CH, Prince MEP, Bradford CR, Boothman RC. Honesty and Transparency, Indispensable to the Clinical Mission-Part II: How Communication and Resolution Programs Promote Patient Safety and Trust. Otolaryngol Clin North Am 2022; 55:63-82. [PMID: 34823721 DOI: 10.1016/j.otc.2021.07.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
When patients are harmed by health care, concerns fan out in all directions. Patients and families confront a sea of uncertainty, contending with injuries that drain them physically, emotionally, and financially. Health care professionals experience a powerful mix of emotions, but are seldom afforded the time to process what happened or the resources to relieve suffering and prevent harm. Honesty, transparency, and empathy are indispensable to a comprehensive approach that prioritizes patient and family-centered response to unintended harm, clinical improvement, and redemptive peer review. Part 2 introduces the second of three pillars for advancing the clinical mission: communication and transparency.
Collapse
|
43
|
Verulava T, Jorbenadze R. Analysis of Critical Incident Reporting System as an indicator of quality healthcare in a cardiology center in Tbilisi, Georgia. J Healthc Qual Res 2021:S2603-6479(21)00100-7. [PMID: 34840073 DOI: 10.1016/j.jhqr.2021.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 10/13/2021] [Accepted: 10/18/2021] [Indexed: 11/22/2022]
Abstract
Critical Incident Reporting System (CIRS) have become most common patient safety tools in healthcare. The purpose of this study was to determine how effectively CIRS is used and how well healthcare professionals recognize it as a risk management tool. A quantitative approach using a cross sectional survey was adopted. The most common critical incidents were due to lack of personal attention and related to individual errors. The most of the critical incidents arise from non-adherence to guidelines and standards. CIRS can be seen as an effective clinical risk management tool that can be used to identify potential sources of critical incidents and help ensure patient safety at a healthcare organization.
Collapse
|
44
|
Faria GN, Zilotti LT, Andrade RJ. The most common inadequacies in red blood cell requests at a reference center in Western Paraná state. Hematol Transfus Cell Ther 2021:S2531-1379(21)01306-7. [PMID: 34896018 DOI: 10.1016/j.htct.2021.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 06/17/2021] [Accepted: 07/13/2021] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION In the current scenario, in which evidence-based medicine is almost obligatory, therapeutic approaches are increasingly being restricted to measures that are proven to bring benefits to the patient. Transfusion therapy follows the same concept. Even though it can be an essential support procedure in some situations, it must be carefully used, exclusively in situations in which the literature assures scientific support for its usage. Transfusion exposes patients to risks and complications, so it is necessary that we, as doctors, continue working to reduce possible mistakes involving the practice of this type of therapy. OBJECTIVE To analyze if the red blood cell requests are properly made, analyzing the indication written on them (by the doctor, comparing them to the references in the actual literature. METHOD In this research, we have analyzed and reviewed the requests for red blood cell concentrates between August and September of 2018 received at the Hematology and Hemotherapy Center studied to find the most common mistakes made by requesters/doctors. RESULTS A total of 397 of the 754 analyzed requests were evaluated as inadequate. Therefore, 1 out of every 2 transfusions performed did not have their requests properly completed in the city of Cascavel, Paraná. CONCLUSIONS The number of inappropriate requests was high during the studied period, especially when compared to studies available in the literature. The number of inadequacies suggests that the blood component requests and the subsequent evaluation by the transfusion agency needs to be better addressed in clinical practice.
Collapse
|
45
|
Abstract
Epidemiologic studies of diagnostic error in the intensive care unit (ICU) consist mostly of descriptive autopsy series. In these studies, rates of diagnostic errors are approximately 5% to 10%. Recently validated methods for retrospectively measuring error have expanded our understanding of the scope of the problem. These alternative measurement strategies have yielded similar estimates for the frequency of diagnostic error in the ICU. Although there is a fair understanding of the frequency of errors, further research is needed to better define the risk factors for diagnostic error in the ICU.
Collapse
Affiliation(s)
- Paul A Bergl
- Department of Critical Care, Gundersen Lutheran Medical Center, 1900 South Avenue, Mail Stop LM3-001, La Crosse, WI 54601, USA; Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
| | - Yan Zhou
- Department of Critical Care Medicine, Geisinger Medical Center, 100 N Academy Avenue, Danville, PA 17822, USA; Geisinger Commonwealth School of Medicine, Scranton, PA, USA
| |
Collapse
|
46
|
Zamudio Burbano MA, González Giraldo D, López Agudelo LD, Casas Arroyave FD. Validation in Spanish of the Ottawa scale for non-technical skills in health personnel in crisis situations. Rev Esp Anestesiol Reanim (Engl Ed) 2021; 68:523-530. [PMID: 34801469 DOI: 10.1016/j.redare.2021.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 02/01/2021] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Non-technical skills are related to morbi-mortality in medicine; it has been proposed that 46% of fatal outcomes are explained to limitations in non-technical skills and only 5% to technical skills deficiencies, however, there is no validated instrument or scale in spanish that allows its evaluation in the management of medical crisis. OBJECTIVE To evaluate the psychometric properties of a Spanish-adapted version of the "Ottawa crisis resource management (CRM) global rating scale (GRS)" in medical staff involved in critical decision-making based in high-fidelity simulation, which could be beneficial to impact patient safety and improve clinical outcomes. METHODS Transversal cultural instrument validation and adaptation study, included 91 participants who simulated a medical crisis between 2018 and 2019, and to whom the Spanish version of the CRM-GRS was applied in order to evaluate its psychometric properties. RESULTS A cultural adaptation with translation into Spanish of the CRM-GRS was made. Subsequently, the scale was applied to 91 participants. An internal consistency (Cronbach's alpha) greater than 0.9 was found in each dimension. The level of inter-rater reliability, evaluated by the interclass coefficient was 0.59 to 0.69, and test-retest reliability with an interclass coefficient greater than 0.7. The validity of the convergent construct was moderate (interclass coefficient between 0.6 and 0.7 for all domains) and the validity of the divergent construct between 0.4 and 0.5 was found adequate. CONCLUSION The translated and adapted Spanish version of the CRM-GRS in crisis had adequate internal consistency, reliability, and construct validity.
Collapse
Affiliation(s)
- M A Zamudio Burbano
- Facultad de Medicina, Universidad de Antioquia; Anestesiología, IPS Universitaria, Medellín, Colombia.
| | - D González Giraldo
- Anestesiología y reanimación, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia
| | - L D López Agudelo
- Anestesiología y reanimación, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia
| | - F D Casas Arroyave
- Facultad de Medicina, Universidad de Antioquia, Anestesiología, Hospital Universitario San Vicente Fundación, Medellín, Colombia
| |
Collapse
|
47
|
Woo MWJ, Avery MJ. Nurses' experiences in voluntary error reporting: An integrative literature review. Int J Nurs Sci 2021; 8:453-469. [PMID: 34631996 PMCID: PMC8488811 DOI: 10.1016/j.ijnss.2021.07.004] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 06/26/2021] [Accepted: 07/28/2021] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE This integrative review aimed to examine and understand nurses' experiences of voluntary error reporting (VER) and elucidate factors underlying their decision to engage in VER. METHOD This is an integrative review based on Whittemore & Knafl five-stage framework. A systematic search guided by the PRISMA 2020 approach was performed on four electronic databases: CINAHL, Medline (PubMed), Scopus, and Embase. Peer-reviewed articles published in the English language from January 2010 to December 2020 were retrieved and screened for relevancy. RESULTS Totally 31 papers were included in this review following the quality appraisal. A constant comparative approach was used to synthesize findings of eligible studies to report nurses' experiences of VER represented by three major themes: nurses' beliefs, behavior, and sentiments towards VER; nurses' perceived enabling factors of VER and nurses' perceived inhibiting factors of VER. Findings of this review revealed that nurses' experiences of VER were less than ideal. Firstly, these negative experiences were accounted for by the interplays of factors that influenced their attitudes, perceptions, emotions, and practices. Additionally, their negative experiences were underpinned by a spectrum of system, administrative and organizational factors that focuses on attributing the error to human failure characterized by an unsupportive, blaming, and punitive approach to error management. CONCLUSION Findings of this review add to the body of knowledge to inform on the areas of focus to guide nursing management perspectives to strengthen institutional efforts to improve nurses' recognition, reception, and contribution towards VER. It is recommended that nursing leaders prioritize and invest in strategies to enhance existing institutional error management approaches to establish a just and open patient safety culture that would promote positivity in nurses' overall experiences towards VER.
Collapse
Affiliation(s)
- Ming Wei Jeffrey Woo
- School of Health & Social Sciences, Nanyang Polytechnic, Singapore
- Department of Health Services Management, School of Medicine, Griffith University, Brisbane, Australia
| | - Mark James Avery
- Department of Health Services Management, School of Medicine, Griffith University, Brisbane, Australia
| |
Collapse
|
48
|
Zamudio Burbano MA, González Giraldo D, López Agudelo LD, Casas Arroyave FD. Validation in spanish of the Ottawa scale for non-techical skills in health personnel in crisis situations. Rev Esp Anestesiol Reanim (Engl Ed) 2021; 68:S0034-9356(21)00106-7. [PMID: 34538662 DOI: 10.1016/j.redar.2021.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 01/26/2021] [Accepted: 02/01/2021] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Non-technical skills are related to morbi-mortality in medicine; it has been proposed that 46% of fatal outcomes are explained to limitations in non-technical skills and only 5% to technical skills deficiencies, however, there is no validated instrument or scale in spanish that allows its evaluation in the management of medical crisis. OBJECTIVE To evaluate the psychometric properties of a Spanish-adapted version of the "Ottawa crisis resource management (CRM) global rating scale (GRS)" in medical staff involved in critical decision-making based in high-fidelity simulation, which could be beneficial to impact patient safety and improve clinical outcomes. METHODS Transversal cultural instrument validation and adaptation study, included 91 participants who simulated a medical crisis between 2018 and 2019, and to whom the Spanish version of the CRM-GRS was applied in order to evaluate its psychometric properties. RESULTS A cultural adaptation with translation into Spanish of the CRM-GRS was made. Subsequently, the scale was applied to 91 participants. An internal consistency (Cronbach's alpha) greater than 0.9 was found in each dimension. The level of inter-rater reliability, evaluated by the interclass coefficient was 0.59 to 0.69, and test-retest reliability with an interclass coefficient greater than 0.7. The validity of the convergent construct was moderate (interclass coefficient between 0.6 and 0.7 for all domains) and the validity of the divergent construct between 0.4 and 0.5 was found adequate. CONCLUSION The translated and adapted Spanish version of the CRM-GRS in crisis had adequate internal consistency, reliability, and construct validity.
Collapse
Affiliation(s)
- M A Zamudio Burbano
- Facultad de Medicina, Universidad de Antioquia; Anestesiología, IPS Universitaria, Medellín, Colombia.
| | - D González Giraldo
- Anestesiología y reanimación, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia
| | - L D López Agudelo
- Anestesiología y reanimación, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia
| | - F D Casas Arroyave
- Facultad de Medicina, Universidad de Antioquia, Anestesiología, Hospital Universitario San Vicente Fundación, Medellín, Colombia
| |
Collapse
|
49
|
Fatima S, Soria S, Esteban-Cruciani N. Medical errors during training: how do residents cope?: a descriptive study. BMC Med Educ 2021; 21:408. [PMID: 34325691 PMCID: PMC8320044 DOI: 10.1186/s12909-021-02850-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 07/15/2021] [Indexed: 05/16/2023]
Abstract
BACKGROUND Physicians' self-perceived medical errors lead to substantial emotional distress, which has been termed the "second victim phenomenon." Medical errors during residency are associated with increased burnout and depression. It is important to know how residents cope with self-perceived medical errors and how they gain personal and emotional support in order to develop effective interventions. OBJECTIVE To assess the impact of self-perceived medical errors on residents' well-being, the range of coping strategies during training, and the extent of personal and institutional support. METHODS An online cross-sectional survey was administered via email in October 2018 to 286 residents across all specialties in a 548-bed single urban academic medical center. The survey covered three domains focusing on residents' most serious self-perceived medical error: (1) emotional response, (2) coping strategies using the BRIEF COPE Inventory, and (3) personal and institutional support. RESULTS 109/286 residents from various specialties responded. Internal Medicine, Pediatrics and Emergency Medicine constituting 80 % of respondents. Self-perceived medical errors during residency were widespread (95 %). One in five medical errors was classified as moderate to severe. Most residents acknowledged a sense of guilt, remorse and/or inadequacy. Use of maladaptive coping strategies was high. Open-ended responses pointed to fear of retaliation, judgement, shame and retribution. Most residents disclosed their error to a senior resident but did not discuss it with the patient's family. Only 32 % of residents participated in a debriefing session. CONCLUSIONS Most residents were directly involved in medical errors, which affected their emotional well-being. The use of maladaptive coping strategies was high. Residents' fear of consequences prevented disclosure and discussion of self-perceived medical errors. This information is relevant to implement targeted interventions.
Collapse
Affiliation(s)
- Saba Fatima
- Division of Hospital Medicine, Department of Pediatrics, University of Kansas School Of Medicine- Wichita, 3243 E Murdock, Suite 402, Wichita, Kansas, 67208, USA.
| | - Stefania Soria
- Department of Pediatric Cardiology, Rush University Medical Center, Chicago, USA
| | - Nora Esteban-Cruciani
- Department of Pediatrics and Adolescent Medicine, Einstein Medical Center, Philadelphia, USA
| |
Collapse
|
50
|
Abstract
BACKGROUND Defensive medicine (DM) practice refers to the ordering or prescription of unnecessary treatments or tests while avoiding risky procedures for critically ill patients with the aim to alleviate the physician's legal responsibility and preserve reputation. Although DM practice is recognized, its dimensions are still uncertain. The subject has been highly investigated in developed countries, but unfortunately, many developing countries are unable to investigate it properly. DM has many serious ramifications, exemplified by the increase in treatment costs for patients and health systems, patients' exposure to risks, and negative effects on the psychological health of both health providers and recipients. Ultimately, the most serious consequence is the ethical consequences. METHODS This work is based on a review of the literature related to DM worldwide and a comparison with the available knowledge found in Jordan. It is qualitative with a descriptive nature, aiming to diagnose the current DM practice in Jordan. RESULTS This is the first published article that discusses DM in Jordan by diagnosing its ethical and economic consequences for the health system as well as for patients. Despite the knowledge of the reasons that support its practice, little is being done to solve this issue. The absence of agreeable medical malpractice law, the dearth of unified medical protocols, the overwhelming pressure imposed by patients on medical staff, and the deteriorating patient-physician relationship are some of the causes of DM practice. Surely, the solution to these issues is to focus on fortifying the ethical and humanitarian aspects on the side of both the physician and the patient to ensure positive collaboration. The ethical aim of the physician to treat the patient faithfully and do what is possible to help combined with the appreciation of the physician's efforts and the choice to not take advantage of the physician through litigation could be the most reasonable solution in the near future. CONCLUSION Jordan is suffering from DM due to the limited financial expenditure on the health sector and the impracticality of medical malpractice law. The authors highlight that the cardinal step in solving this dilemma is restoring the ethical dimension of the patient-physician relationship.
Collapse
Affiliation(s)
- Qosay A. E. Al-Balas
- grid.37553.370000 0001 0097 5797Department of Medicinal Chemistry and Pharmacognosy, Faculty of Pharmacy, Jordan University of Science and Technology, P.O. Box 3030, Irbid, 22110 Jordan
| | - Hassan A. E. Al-Balas
- grid.37553.370000 0001 0097 5797Department of Radiology, Faculty of Medicine, Jordan University of Science and Technology, P.O. Box 3030, Irbid, 22110 Jordan ,grid.39382.330000 0001 2160 926XBaylor College of Medicine, Houston, TX USA
| |
Collapse
|