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BMJ Open Jan 2016To systematically review interventions that aim to improve the governance of patient safety within emergency care on effectiveness, reliability, validity and feasibility. (Review)
Review
OBJECTIVES
To systematically review interventions that aim to improve the governance of patient safety within emergency care on effectiveness, reliability, validity and feasibility.
DESIGN
A systematic review of the literature.
METHODS
PubMed, EMBASE, Cumulative Index to Nursing and Allied Health Literature, the Cochrane Database of Systematic Reviews and PsychInfo were searched for studies published between January 1990 and July 2014. We included studies evaluating interventions relevant for higher management to oversee and manage patient safety, in prehospital emergency medical service (EMS) organisations and hospital-based emergency departments (EDs). Two reviewers independently selected candidate studies, extracted data and assessed study quality. Studies were categorised according to study quality, setting, sample, intervention characteristics and findings.
RESULTS
Of the 18 included studies, 13 (72%) were non-experimental. Nine studies (50%) reported data on the reliability and/or validity of the intervention. Eight studies (44%) reported on the feasibility of the intervention. Only 4 studies (22%) reported statistically significant effects. The use of a simulation-based training programme and well-designed incident reporting systems led to a statistically significant improvement of safety knowledge and attitudes by ED staff and an increase of incident reports within EDs, respectively.
CONCLUSIONS
Characteristics of the interventions included in this review (eg, anonymous incident reporting and validation of incident reports by an independent party) could provide useful input for the design of an effective tool to govern patient safety in EMS organisations and EDs. However, executives cannot rely on a robust set of evidence-based and feasible tools to govern patient safety within their emergency care organisation and in the chain of emergency care. Established strategies from other high-risk sectors need to be evaluated in emergency care settings, using an experimental design with valid outcome measures to strengthen the evidence base.
Topics: Emergency Medical Services; Feasibility Studies; Humans; Patient Safety; Reproducibility of Results
PubMed: 26826151
DOI: 10.1136/bmjopen-2015-009837 -
International Journal For Quality in... Sep 2016To determine whether clinical supervision (CS) of health professionals improves patient safety. (Meta-Analysis)
Meta-Analysis Review
PURPOSE
To determine whether clinical supervision (CS) of health professionals improves patient safety.
DATA SOURCES
Databases MEDLINE, PsychINFO, CINAHL, EMBASE and AMED were searched from earliest date available. Additional studies were identified by searching of reference lists and citation tracking.
STUDY SELECTION
Two reviewers independently applied inclusion and exclusion criteria. Thirty-two studies across three health professions [medicine (n = 29), nursing (n = 2) and paramedicine (n = 1)] were selected.
DATA EXTRACTION
The quality of each study was rated using the Medical Education Research Study Quality Instrument. Risk ratios (RR) were calculated for patient safety outcomes of mortality, complications, adverse events, reoperation following initial surgery, conversion to more invasive surgery and readmission to hospital.
RESULTS OF DATA SYNTHESIS
Results of meta-analyses provided low-quality evidence that supervision of medical professionals reduced the risk of mortality (RR 0.76, 95% CI 0.60-0.95, I(2) = 76%) and supervision of medical professionals and paramedics reduced the risk of complications (RR 0.69, 95% CI 0.53-0.89, I(2) = 76%). Due to a high level of statistical heterogeneity, sub-group analyses were performed. Sub-group analyses provided moderate-quality evidence that direct supervision of surgery significantly reduced the risk of mortality (RR 0.68, 95% CI 0.50-0.93, I(2) = 33%) and direct supervision of medical professionals conducting non-surgical invasive procedures significantly reduced the risk of complications (RR 0.33, 95% CI 0.24-0.46, I(2) = 0%).
CONCLUSIONS
CS was associated with safer surgery and other invasive procedures for medical practitioners. There was a lack of evidence about the relationship between CS and safer patient care for non-medical health professionals.
Topics: Health Personnel; Patient Safety; Quality Improvement
PubMed: 27283436
DOI: 10.1093/intqhc/mzw059 -
International Journal of Nursing Studies Dec 2022Speaking up about patient safety concerns is critical when bedside nurses encounter unsafe situations. Training programs that encourage nurses' speaking up behavior have... (Review)
Review
BACKGROUND
Speaking up about patient safety concerns is critical when bedside nurses encounter unsafe situations. Training programs that encourage nurses' speaking up behavior have been introduced, but there is limited evidence regarding whether such training leads to behavior change or improves patient safety.
OBJECTIVE
The aim of this review was to identify the effectiveness of speak-up training programs for clinical nurses, focusing on program content and outcomes.
DESIGN
A scoping review was conducted using the Joanna Briggs Institute methodology and reported according to the Cochrane and Preferred Reporting Items for Systematic Review and Meta-Analyses Extension for Scoping Reviews guidelines.
METHODS
This study used bibliographic databases of PubMed, Embase, PsycINFO, Scopus, ProQuest Dissertations and Theses Global for the English language, and NDSL, KCI, RISS, KISS, and DBpia for the Korean language. The literature search used a combination of keywords and subject headings related to speak-up training programs for nurses or any type of nurse training program with an assertiveness component. Training outcomes were evaluated according to the 4-level Kirkpatrick model.
RESULTS
A total of 4808 references were retrieved, of which 21 articles were selected. These 21 studies were conducted in different parts of the world and published from 1981 to 2020. Speak-up training primarily increased some degree of nurses' levels of assertiveness and speak-up behavior, and also led to secondary outcomes such as job stress, work motivation, and communication conflicts. Most studies (n = 19) applied traditional training formats which consisted of multi-session lectures and practice, whereas three studies applied new methodologies such as high-fidelity simulations and online learning. According to the Kirkpatrick model, five studies assessed reactions to speak-up training (level 1), all studies evaluated learning as a result of training (level 2), two studies measured the effect of speak-up training on nurses' behavior (level 3), and one study evaluated nurses' results (level 4) while no studies evaluated patient-level outcomes.
CONCLUSIONS
Speak-up training for nurses can improve their levels of assertiveness or speak-up behaviors. Despite inconsistent or mixed findings, speak-up training has the potential to improve nurses' psychological well-being, leading to positive organizational performance. New training methods are directed at specialized education for clinical situations. Future speak-up training should consist of training programs based on real clinical situations in which team members participate together to comprehensively evaluate the effect of training on behavioral changes of health professionals as well as patient safety.
Topics: Humans; Clinical Competence; Communication; Health Personnel; Nurses; Occupational Stress; Patient Safety
PubMed: 36327680
DOI: 10.1016/j.ijnurstu.2022.104375 -
European Urology Focus May 2022Live surgical broadcast (LSB), also known as live surgery, has become a popular format for many types of surgical education meetings. However, concerns have been raised... (Review)
Review
CONTEXT
Live surgical broadcast (LSB), also known as live surgery, has become a popular format for many types of surgical education meetings. However, concerns have been raised in relation to patient safety, ethical issues, and the actual educational value of LSB.
OBJECTIVE
To summarize current evidence on LSB with a focus on the risks of complications and the educational impact.
EVIDENCE ACQUISITION
We performed a systematic review of the literature according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to identify studies up to December 2020. We identified original articles reporting on patient outcomes, educational value, current use, and development of LSB. We also interrogated surgical society guidelines for position statements on LSB.
EVIDENCE SYNTHESIS
Our literature search identified 46 studies spanning six surgical specialties, with urology being the most frequent. Approximately half of the studies reported on outcomes of surgical procedures during LSB. In urology, the few comparative studies available did not suggest higher complication rates in LSB, whereas data for other surgical fields highlighted evidence of worse outcomes. Four studies assessed the educational value of LSB via survey administration, for which the evidence is limited and of low quality. Thirteen guidelines and position statements on live surgery were identified among major surgical societies, including the European Association of Urology (EAU). Some surgical societies have expressly prohibited the use of LSB at their major meetings. The perspective of surgeons performing and/or attending live surgical sessions was evaluated in six studies, and four studies looked at urologists' perception of LSB compared to semi-LSB. Limitations of this systematic review include the limited number of studies available, the low quality of the evidence, and data heterogeneity.
CONCLUSIONS
Evidence regarding outcomes of LSB is limited. Almost all the studies do not show a higher risk of complications or worse outcomes for patients undergoing a procedure during LSB. Only one study on gastrointestinal surgery reported that LSB outcomes were worse. Ongoing concerns have led to specific guidelines by several scientific societies, including the EAU, with the ultimate aim of minimizing surgical risks and maximizing patient safety.
PATIENT SUMMARY
Live surgery events are often part of surgical conferences. Data in the literature show mixed outcomes for operations performed during live surgery events, but with no increase in complication rates. Safety and ethical concerns remain. Other educational tools, such as prerecorded videos and live surgery transmission from the home institution of the operating surgeon might become preferred options in the future. This review was prospectively registered on the PROSPERO website (www.crd.york.ac.uk/PROSPERO, registration number CRD42020194023).
Topics: Humans; Patient Safety; Risk Assessment; Surgeons; Urologists; Urology
PubMed: 34148861
DOI: 10.1016/j.euf.2021.06.003 -
BMJ Quality & Safety Jul 2016Improving patient safety is at the forefront of policy and practice. While considerable progress has been made in understanding the frequency, causes and consequences of... (Review)
Review
IMPORTANCE
Improving patient safety is at the forefront of policy and practice. While considerable progress has been made in understanding the frequency, causes and consequences of error in hospitals, less is known about the safety of primary care.
OBJECTIVE
We investigated how often patient safety incidents occur in primary care and how often these were associated with patient harm.
EVIDENCE REVIEW
We searched 18 databases and contacted international experts to identify published and unpublished studies available between 1 January 1980 and 31 July 2014. Patient safety incidents of any type were eligible. Eligible studies were critically appraised using validated instruments and data were descriptively and narratively synthesised.
FINDINGS
Nine systematic reviews and 100 primary studies were included. Studies reported between <1 and 24 patient safety incidents per 100 consultations. The median from population-based record review studies was 2-3 incidents for every 100 consultations/records reviewed. It was estimated that around 4% of these incidents may be associated with severe harm, defined as significantly impacting on a patient's well-being, including long-term physical or psychological issues or death (range <1% to 44% of incidents). Incidents relating to diagnosis and prescribing were most likely to result in severe harm.
CONCLUSIONS AND RELEVANCE
Millions of people throughout the world use primary care services on any given day. This review suggests that safety incidents are relatively common, but most do not result in serious harm that reaches the patient. Diagnostic and prescribing incidents are the most likely to result in avoidable harm.
SYSTEMATIC REVIEW REGISTRATION
This systematic review is registered with the International Prospective Register of Systematic Reviews (PROSPERO CRD42012002304).
Topics: Humans; Medical Errors; Patient Safety; Primary Health Care
PubMed: 26715764
DOI: 10.1136/bmjqs-2015-004178 -
The American Journal of Hospice &... Aug 2021Patient safety has gained an increasing profile as a crucial element of healthcare. However, not only is there little evidence on the relevance of the term in the...
BACKGROUND
Patient safety has gained an increasing profile as a crucial element of healthcare. However, not only is there little evidence on the relevance of the term in the palliative and end-of-life care literature but also a lack of a precise and uniform definition.
METHOD
With a text mining approach occurrence of the term patient safety was determined in all available abstracts of 10 palliative and end-of-life care journals. Furthermore, 4 electronic databases (MEDLINE, EMBASE, CINAHL and PSYCINFO) were searched supplemented by hand-searching of relevant literature to identify and conceptualize published definitions of patient safety in the palliative and end-of-life care context. Publications were independently assessed against inclusion criteria by 2 authors.
RESULTS
Our search of 14,351 abstracts yielded 41 hits for "patient safety" ranking 2,345 in the list of most commonly encountered tokens. We identified 11 definitions of patient safety stemming from 11 publications. Definitions differed with regard to the concept of process or outcome. They also allowed distinctive perspectives on the extent to which patient care influences patient safety. Lastly, exact wording led to discrepancies in the understanding of unsafe care and generalizability of definitions.
CONCLUSION
Our results indicate that patient safety has gradually gained importance in palliative and end-of-life care. However, as key elements of definientia varied considerably no consensus definition could be identified. Nevertheless, a universal definition would help to facilitate communication and exchange of information among individuals and organizations involved in palliative and end-of-life care.
Topics: Data Mining; Delivery of Health Care; Humans; Palliative Care; Patient Safety; Terminal Care
PubMed: 33267627
DOI: 10.1177/1049909120971825 -
Journal of Reconstructive Microsurgery Jun 2017Although flap transfer is a popular reconstructive procedure with a high success rate, it is associated with a high complication rate and low salvage rate. During the... (Review)
Review
Although flap transfer is a popular reconstructive procedure with a high success rate, it is associated with a high complication rate and low salvage rate. During the past decade, negative-pressure wound therapy (NPWT) has been increasingly applied to facilitate flap transfer and salvage flaps threatened by complications. It has achieved some success, but its efficacy and safety remain controversial because of the limited number of reports and lack of systematic reviews. English-language articles describing the application of NPWT on flaps were screened using predetermined inclusion and exclusion criteria. The articles were summarized and divided into groups based on the purpose of NPWT application. The complication rate, success rate, and salvage rate were obtained. Among the 3,395 articles searched, 16 articles describing 137 flaps were eligible. NPWT was applied on 105 (76.4%) newly transferred flaps to facilitate flap attachment and on 32 (23.4%) complication-threatened flaps to relieve flap infection and venous congestion. In total, complications developed in six flaps, three of which were lost; thus, the complication rate was 5.7% (6/105) and the success rate was 97.1% (102/105). Only 1 of the 32 threatened flaps was not successfully salvaged; thus, the salvage rate was 96.9% (31/32). NPWT may facilitate flap transfer with few side effects and help to rescue flaps threatened by infection and venous congestion with a high salvage rate. Further studies are needed to test the safety of NPWT application on flaps with arterial compromise.
Topics: Cohort Studies; Humans; Hyperemia; Negative-Pressure Wound Therapy; Patient Safety; Postoperative Complications; Randomized Controlled Trials as Topic; Plastic Surgery Procedures; Salvage Therapy; Surgical Flaps; Surgical Wound Infection; Treatment Outcome
PubMed: 28235220
DOI: 10.1055/s-0037-1599076 -
Systematic Reviews Nov 2016The surgeon volume-outcome relationship has been discussed for many years and its existence or nonexistence is of importance for various reasons. A lot of empirical work... (Review)
Review
BACKGROUND
The surgeon volume-outcome relationship has been discussed for many years and its existence or nonexistence is of importance for various reasons. A lot of empirical work has been published on it. We aimed to summarize systematic reviews in order to present current evidence.
METHODS
Medline, Embase, Cochrane database of systematic reviews (CDSR), and health technology assessment websites were searched up to October 2015 for systematic reviews on the surgeon volume-outcome relationship. Reviews were critically appraised, and results were extracted and synthesized by type of surgical procedure/condition.
RESULTS
Thirty-two reviews reporting on 15 surgical procedures/conditions were included. Methodological quality of included systematic reviews assessed with the assessment of multiple systematic reviews (AMSTAR) was generally moderate to high albeit included literature partly neglected considering methodological issues specific to volume-outcome relationship. Most reviews tend to support the presence of a surgeon volume-outcome relationship. This is most clear-cut in colorectal cancer, bariatric surgery, and breast cancer where reviews of high quality show large effects.
CONCLUSIONS
When taking into account its limitations, this overview can serve as an informational basis for decision makers. Our results seem to support a positive volume-outcome relationship for most procedures/conditions. However, forthcoming reviews should pay more attention to methodology specific to volume-outcome relationship. Due to the lack of information, any numerical recommendations for minimum volume thresholds are not possible. Further research is needed for this issue.
Topics: Humans; Outcome Assessment, Health Care; Patient Safety; Quality of Health Care; Surgeons; Surgical Procedures, Operative
PubMed: 27899141
DOI: 10.1186/s13643-016-0376-4 -
Archives of Physical Medicine and... Nov 2015To investigate the feasibility and safety of cardiopulmonary exercise testing (CPET) in patients with multiple sclerosis (MS). (Review)
Review
OBJECTIVE
To investigate the feasibility and safety of cardiopulmonary exercise testing (CPET) in patients with multiple sclerosis (MS).
DATA SOURCES
PubMed, EMBASE, CINAHL, SPORTDiscus, PsycINFO, ERIC, and the Psychology and Behavioral Sciences Collection were searched up to October 2014. References from retrieved articles were examined to identify additional relevant studies.
STUDY SELECTION
Inclusion of original studies was on the basis of performance of maximal CPET, description of the protocol, and participants with definite MS aged ≥18 years. No language restrictions were applied.
DATA EXTRACTION
The quality of CPET reporting in included studies was scored according to a structured checklist considering 10 feasibility (eg, test abnormalities) and 12 safety quality criteria (eg, adverse events). Structured data extraction was performed for these feasibility and safety features of CPET.
DATA SYNTHESIS
Forty-six studies were included, comprising 1483 patients with MS, with a mean age ± SD of 42.0±5.8 years and a median Expanded Disability Status Scale (EDSS) score of 2.8 (first quartile=2.1; third quartile=3.9; range of average EDSS scores, .75-5.8). Quality of reporting on CPET varied from 3 to 13 out of a possible 22 quality points. The percentage of test abnormalities (feasibility) was 10.0%, primarily because of an inability to maintain pedaling at a specific resistance. The percentage of adverse events (safety) was 2.1%. All adverse events were temporary.
CONCLUSIONS
Based on the available data, we conclude that CPET is feasible provided that the CPET modality is tailored to the physical abilities of the patient. Furthermore, CPET is safe when recommended precautions and safety measures are implemented. However, future optimization of CPET will require protocolized testing and the implementation of standard reporting procedures.
Topics: Disabled Persons; Exercise Test; Humans; Multiple Sclerosis; Patient Safety
PubMed: 25969865
DOI: 10.1016/j.apmr.2015.04.021 -
Surgery For Obesity and Related... 2014Laparoscopic mini-gastric bypass (LMGB) is a relatively new bariatric procedure; published studies are accumulating in various settings. The objective of this study was... (Review)
Review
BACKGROUND
Laparoscopic mini-gastric bypass (LMGB) is a relatively new bariatric procedure; published studies are accumulating in various settings. The objective of this study was to summarize the available evidence about the efficacy and safety of LMGB.
METHODS
A systematic search in the literature was performed , and PubMed and reference lists were scrutinized (end-of-search date: July 15, 2013). For the assessment of the eligible articles, the Newcastle-Ottawa quality assessment scale was used.
RESULTS
Ten eligible studies were included in this study, reporting data on 4,899 patients. According to all included studies, LMGB induced substantial weight and body mass index reduction, as well as substantial excess weight loss. Moreover, resolution or improvement in all major associated medical illnesses and improvement in overall Gastrointestinal Quality of Life Index score were recorded. Major bleeding and anastomotic ulcer were the most commonly reported complications. Readmission rate ranged from 0%- 11%, whereas the rate of revision operations ranged from .3%- 6%. The latter were conducted due to a variety of medical reasons such as inadequate or excessive weight loss, malnutrition, and upper gastrointestinal bleeding. Finally, the mortality rate ranged between 0% and .5% among primary LMGB procedures.
CONCLUSION
LMGB represents an effective bariatric procedure; its safety and minimal postoperative morbidity seem remarkable. Randomized comparative studies seem mandatory for the further evaluation of LMGB.
Topics: Epidemiologic Methods; Gastric Bypass; Humans; Laparoscopy; Obesity, Morbid; Patient Safety; Treatment Outcome
PubMed: 24913595
DOI: 10.1016/j.soard.2014.02.009