[Patient education during outpatient procedures]

Patient education is a key obligation for doctors under the treatment contract. The expansion of the AOP catalogue (catalogue of operations that can be performed on an outpatient basis in accordance with Section 115b of the Fifth Book of the German Social Code (SGB V)) from January 2023 opens up new outpatient treatment options that tend to involve higher risks. This risk profile must be taken into account when informing patients.In any case, the timing of the information should be chosen so that the patient can give their consent in a well-considered manner. There is no fixed "blocking period" between information and consent, so the patient can consent immediately. In the case of high-risk procedures, the patient should be informed several days in advance. Criteria for determining the right time are the type and severity of the procedure, urgency and individual circumstances of the patient. The information provided should be complete and comprehensible, including the diagnosis, need for treatment, risks and alternatives. Comprehensive documentation of the information provided goes without saying.Telemedical counselling is possible in suitable cases, but the risk of timely and complete counselling remains with the doctor performing the procedure. In view of outpatient procedures that require follow-up care at home, the safety information should be more comprehensive.The expansion of the AOP catalogue opens up new opportunities for outpatient procedures, but harbours legal risks. Adapted risk and safety information is required, whereby telemedicine can optimise practice organisation.

[Patient education during outpatient procedures]

Patient education is a key obligation for doctors under the treatment contract. The expansion of the AOP catalogue (catalogue of operations that can be performed on an outpatient basis in accordance with Section 115b of the Fifth Book of the German Social Code (SGB V)) from January 2023 opens up new outpatient treatment options that tend to involve higher risks. This risk profile must be taken into account when informing patients.In any case, the timing of the information should be chosen so that the patient can give their consent in a well-considered manner. There is no fixed "blocking period" between information and consent, so the patient can consent immediately. In the case of high-risk procedures, the patient should be informed several days in advance. Criteria for determining the right time are the type and severity of the procedure, urgency and individual circumstances of the patient. The information provided should be complete and comprehensible, including the diagnosis, need for treatment, risks and alternatives. Comprehensive documentation of the information provided goes without saying.Telemedical counselling is possible in suitable cases, but the risk of timely and complete counselling remains with the doctor performing the procedure. In view of outpatient procedures that require follow-up care at home, the safety information should be more comprehensive.The expansion of the AOP catalogue opens up new opportunities for outpatient procedures, but harbours legal risks. Adapted risk and safety information is required, whereby telemedicine can optimise practice organisation.

Massive open online course (MOOC) learning builds capacity and improves competence for patient safety among global learners: A prospective cohort study

BACKGROUND

Education about patient safety has historically been limited in health professionals curricula and largely inaccessible to the general public. We developed a massive open online course (MOOC), The Science of Safety in Healthcare, to present the foundational patient safety principles to a broad global audience of health professionals, learners, and patients interested in patient safety.

OBJECTIVES

To describe the Science of Safety in Healthcare MOOC, its effects on patient safety competence, and the satisfaction of course participants.

METHODS

The five-week video-based course was delivered in 2013 and 2014, and was organized in five modules: 1) overview of science of safety and safety culture, 2) enabling and contextual factors that influence patient safety and quality, 3) methods to improve safety and quality, 4) translating evidence intro practice and leading change, and 5) summary and opportunities for capacity building. Each module had three or four segments. Participants were introduced to key concepts, and tools and skills to promote patient safety. Participants completed the Health Professional Education in Patient Safety Survey (H-PEPSS), which measures patient safety competence, and a course satisfaction survey. Pre- and post- course H-PEPSS scores were compared using paired t-tests. Course satisfaction surveys were administered at the completion of the course and six months later.

RESULTS

A total of 20,957, and 9679 participants enrolled in the course in 2013 and 2014, respectively. About half of participants were 25-44 years old (57%), and female (54%). Participants joined from over 100 countries. The majority were health professionals (61%) or health professionals in training (7%). Mean H-PEPSS scores improved after course completion, with significant increases on all survey domains in both years (p < 0.01). Mean score differences were: Teamwork 0.68 (95% CI: 0.64, 0.71), Communication 0.70 (95% CI: 0.66, 0.73), Managing Risk 0.79 (95% CI: 0.76, 0.82), Human Environment 0.64 (95% CI: 0.61, 0.68), Recognizing and Responding 0.64 (95% CI: 0.61, 0.68), and Culture 0.72 (95% CI: 0.68, 0.75). About 8% of participants in each cohort earned a certificate of completion. At 6-months post-course, the majority of the participants agreed or agreed strongly that the course content was useful (93%) and that the course positively influenced their clinical practice (69%) and communication (84%).

CONCLUSIONS

The MOOC course allowed educators to reach a large, diverse audience. The course was well-received and participants reported a significant increase in patient safety competence. As with most MOOCs, rates of completion were low.

Surgical resident education in patient safety: where can we improve?

BACKGROUND

Effective communication and patient safety practices are paramount in health care. Surgical residents play an integral role in the perioperative team, yet their perceptions of patient safety remain unclear. We hypothesized that surgical residents perceive the perioperative environment as more unsafe than their faculty and operating room staff despite completing a required safety curriculum.

MATERIALS AND METHODS

Surgeons, anesthesiologists, and perioperative nurses in a large academic children's hospital participated in multifaceted, physician-led workshops aimed at enhancing communication and safety culture over a 3-y period. All general surgery residents from the same academic center completed a hospital-based online safety curriculum only. All groups subsequently completed the psychometrically validated safety attitudes questionnaire to evaluate three domains: safety culture, teamwork, and speaking up. Results reflect the percent of respondents who slightly or strongly agreed. Chi-square analysis was performed.

RESULTS

Sixty-three of 84 perioperative personnel (75%) and 48 of 52 surgical residents (92%) completed the safety attitudes questionnaire. A higher percentage of perioperative personnel perceived a safer environment than the surgical residents in all three domains, which was significantly higher for safety culture (68% versus 46%, P = 0.03). When stratified into two groups, junior residents (postgraduate years 1-2) and senior residents (postgraduate years 3-5) had lower scores for all three domains, but the differences were not statistically significant.

CONCLUSIONS

Surgical residents' perceptions of perioperative safety remain suboptimal. With an enhanced safety curriculum, perioperative staff demonstrated higher perceptions of safety compared with residents who participated in an online-only curriculum. Optimal surgical education on patient safety remains unknown but should require a dedicated, systematic approach.

Factor analysis of nursing students' perception of patient safety education

AIM

The aim of this study is to investigate the factor structure of the Health Care Professionals Patient Safety Assessment Curriculum Survey (HPPSACS) when completed by a group of nursing students from one University in the UK.

BACKGROUND

The quality, content and delivery of nursing education can have a significant impact on the future students' safety behaviours in clinical settings. The Health Care Professionals Patient Safety Assessment Curriculum Survey HPPSACS has been developed in the US to establish undergraduate nursing students' perceived awareness, skills, and attitudes toward patient safety education. The instrument has not been reported to be used elsewhere; therefore, some psychometric properties remain untested.

DESIGN

Pre-registration nursing students (n=272) from three campuses of a university in East of England completed the HPPSACS in 2012. Principal component analysis was conducted to explore the factors emerging from the students' responses.

FINDINGS

222 students (82%) returned the questionnaires. Constraining data to a 4-factor solution explained 52% of the variance. Factors identified were: "Willingness to disclose errors", "Recognition and management of medical errors", "The Perceived interprofessional context of patient safety" and "The perceived support and understanding for improving patient safety". The overall Cronbach's alpha was 0.64, indicating moderate internal consistency of the instrument.

LIMITATIONS

Some demographical and descriptive questions on the HPPSACS instrument were modified to accommodate the participants' educational context. However, all items in the HPPSACS which were included in the factor analysis remain identical to the original tool.

CONCLUSION

The study offers empirical findings of how patient safety education is contextualised in the undergraduate, pre-registration nursing curriculum. Further research is required to refine and improve the overall reliability of the Health Care Professionals Patient Safety Assessment Curriculum Survey (HPPSACS' instrument).