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PloS One 2019Hospitals under financial pressure may struggle to maintain quality and patient safety and have worse patient outcomes relative to well-resourced hospitals. Poor...
BACKGROUND
Hospitals under financial pressure may struggle to maintain quality and patient safety and have worse patient outcomes relative to well-resourced hospitals. Poor predictive validity may explain why previous studies on the association between finances and quality/safety have been equivocal. This manuscript employs principal component analysis to produce robust measures of both financial status and quality/safety of care, to assess our a priori hypothesis: hospital financial performance is associated with the provision of quality care, as measured by quality and safety processes, patient outcomes, and patient centered care.
METHODS
This 2014 cross-sectional study investigated hospital financial condition and hospital quality and safety at acute care hospitals. The hospital financial data from the Centers for Medicare and Medicaid Services (CMS) cost report were used to develop a composite financial performance score using principal component analysis. Hospital quality and patient safety were measured with a composite quality/safety performance score derived from principal component analysis, utilizing a range of established quality and safety indicators including: risk-standardized inpatient mortality, 30-day mortality, 30-day readmissions for select conditions, patient safety indicators from inpatient admissions, process of care chart reviews, CMS value-based purchasing total performance score and patient experience of care surveys. The correlation between the composite financial performance score and the composite quality/safety performance score was calculated using linear regression adjusting for hospital characteristics.
RESULTS
Among the 108 New York State acute care facilities for which data were available, there is a clear relationship between hospital financial performance and hospital quality/safety performance score (standardized correlation coefficient 0.34, p<0.001). The composite financial performance score is also positively associated with the CMS Value Based Purchasing Total Performance Score (standardized correlation coefficient 0.277, p = 0.002); while it is negatively associated with 30 day readmission for all outcomes (standardized correlation coefficient -0.236, p = 0.013), 30-day readmission for congestive heart failure (standardized correlation coefficient -0.23, p = 0.018), 30 day readmission for pneumonia (standardized correlation coefficient -0.209, p = 0.033), and a decrease in 30-day mortality for acute myocardial infarction (standardized correlation coefficient -0.211, p = 0.027). Used alone, operating margin and total margin are poor predictors of quality and safety outcomes.
CONCLUSIONS
Strong financial performance is associated with improved patient reported experience of care, the strongest component distinguishing quality and safety. These findings suggest that financially stable hospitals are better able to maintain highly reliable systems and provide ongoing resources for quality improvement.
Topics: Cross-Sectional Studies; Decision Trees; Economics, Hospital; Hospital Mortality; Humans; New York; Patient Care; Patient Readmission; Patient Safety; Principal Component Analysis; Quality of Health Care
PubMed: 31419227
DOI: 10.1371/journal.pone.0219124 -
BMJ Quality & Safety Apr 2020
Topics: Humans; Patient Safety; Quality Assurance, Health Care; Reference Standards; Safety Management
PubMed: 32066571
DOI: 10.1136/bmjqs-2019-009731 -
BMJ Open Quality May 2024Patient safety is crucial in dentistry, yet it has received delayed recognition compared with other healthcare fields. This literature review assesses the current state... (Review)
Review
BACKGROUND
Patient safety is crucial in dentistry, yet it has received delayed recognition compared with other healthcare fields. This literature review assesses the current state of patient safety in dentistry, investigates the reasons for the delay, and offers recommendations for enhancing patient safety in dental practices, dental schools, and hospitals.
METHODS
The review incorporates a thorough analysis of existing literature on patient safety in dentistry. Various sources, including research articles, guidelines and reports, were reviewed to gather insights into patient safety definitions, challenges and best practices specific to dentistry.
RESULTS
The review underscores the importance of prioritising patient safety in dentistry at all levels of healthcare. It identifies key definitions and factors contributing to the delayed focus on patient safety in the field. Additionally, it emphasises the significance of establishing a patient safety culture and discusses approaches such as safety plans, incident management systems, blame-free cultures and ethical frameworks to enhance patient safety.
CONCLUSION
Patient safety is vital in dentistry to ensure high-quality care and patient well-being. The review emphasises the importance of prioritising patient safety in dental practices, dental schools and hospitals. Through the implementation of recommended strategies and best practices, dental organisations can cultivate a patient safety culture, enhance communication, mitigate risks and continually improve patient safety outcomes. The dissemination of knowledge and the active involvement of all stakeholders are crucial for promoting patient safety and establishing a safe dental healthcare system.
Topics: Humans; Patient Safety; Dentistry
PubMed: 38719522
DOI: 10.1136/bmjoq-2023-002502 -
Anaesthesia Nov 2021
Topics: Disaster Planning; Fires; Guidelines as Topic; Intensive Care Units; Patient Safety; Rescue Work; Safety Management
PubMed: 34309007
DOI: 10.1111/anae.15547 -
The International Journal of Health... Oct 2019Patient safety is a fundamental principle of quality health care. In Bhutan, which is a resource poor nation, improving patient safety in the health care context is a...
Patient safety is a fundamental principle of quality health care. In Bhutan, which is a resource poor nation, improving patient safety in the health care context is a challenge. Bhutan requires sound patient safety policies and strategies to mitigate safety issues in the health care system. Drawing upon the available literature on patient safety in Bhutan and the author's own experience, this paper attempts to explore the challenges that the Bhutanese health care system is facing in terms of promoting patient safety. Based upon the challenges identified, this paper offers a roadmap to move forward-ie, suggestions on how Bhutan could promote patient safety.
Topics: Bhutan; Clinical Competence; Decision Making; Delivery of Health Care; Health Policy; Health Resources; Humans; Leadership; Patient Safety; Quality Improvement
PubMed: 30993765
DOI: 10.1002/hpm.2794 -
Journal of Patient Safety Sep 2020Major gaps remain in our understanding of primary care patient safety. We describe a toolkit for measuring patient safety in family practices.
OBJECTIVE
Major gaps remain in our understanding of primary care patient safety. We describe a toolkit for measuring patient safety in family practices.
METHODS
Six tools were used in 46 practices. These tools were as follows: National Health Service Education for Scotland Trigger Tool, National Health Service Education for Scotland Medicines Reconciliation Tool, Primary Care Safequest, Prescribing Safety Indicators, Patient Reported Experiences and Outcomes of Safety in Primary Care, and Concise Safe Systems Checklist.
RESULTS
Primary Care Safequest showed that most practices had a well-developed safety climate. However, the trigger tool revealed that a quarter of events identified were associated with moderate or substantial harm, with a third originating in primary care and avoidable. Although medicines reconciliation was undertaken within 2 days in more than 70% of cases, necessary discussions with a patient/carer did not always occur. The prescribing safety indicators identified 1435 instances of potentially hazardous prescribing or lack of recommended monitoring (from 92,649 patients). The Concise Safe Systems Checklist found that 25% of staff thought that their practice provided inadequate follow-up for vulnerable patients discharged from hospital and inadequate monitoring of noncollection of prescriptions. Most patients had a positive perception of the safety of their practice although 45% identified at least one safety problem in the past year.
CONCLUSIONS
Patient safety is complex and multidimensional. The Patient Safety Toolkit is easy to use and hosted on a single platform with a collection of tools generating practical and actionable information. It enables family practices to identify safety deficits that they can review and change procedures to improve their patient safety across a key sets of patient safety issues.
Topics: Family Practice; Female; Humans; Male; Patient Safety; Primary Health Care
PubMed: 29461334
DOI: 10.1097/PTS.0000000000000471 -
Journal For Healthcare Quality :... 2017The Agency for Healthcare Research and Quality (AHRQ) developed Patient Safety Indicators (PSI) with the goal of detecting and preventing adverse events using... (Review)
Review
The Agency for Healthcare Research and Quality (AHRQ) developed Patient Safety Indicators (PSI) with the goal of detecting and preventing adverse events using administrative data. Use of PSIs to measure safety and quality of care raises questions since they rely heavily on coded data. The goal of this paper is to review literature on AHRQ PSIs, specifically their accuracy in detecting adverse events, and how recent coding changes affect the accuracy of these estimates. The Healthcare Utilization Project (HCUP) National Inpatient Sample (NIS) contains data on more than seven million hospital stays yearly. Trending these estimates over time indicate there has been a decrease in rates for the majority of PSIs, with Accidental Puncture or Laceration, Central Venous Catheter Blood Stream Infections, Iatrogenic Pneumothorax, and Deaths from complications decreasing significantly each year from 2008-2012. Birth Trauma, Retained Foreign Bodies, Post-op Sepsis and Post-Op Respiratory Failure PSIs show no improvement from 2008-2012. A literature review on accuracy of PSIs and the affect of the Present on Admission (POA) indicator on PSI estimates reveals mixed results. PSIs serve as a useful tool in identifying problem areas in quality of care but should be used cautiously in determining hospital performance.
Topics: Health Status Indicators; Humans; Patient Safety; Quality Indicators, Health Care; United States; United States Agency for Healthcare Research and Quality
PubMed: 28658091
DOI: 10.1097/JHQ.0000000000000088 -
Current Opinion in Anaesthesiology Dec 2019Office-based anesthesia (OBA) is rapidly growing across the world. Availability of less invasive interventions has facilitated the opportunity of offering new procedures... (Review)
Review
PURPOSE OF REVIEW
Office-based anesthesia (OBA) is rapidly growing across the world. Availability of less invasive interventions has facilitated the opportunity of offering new procedures in office-based settings to patient populations that would not have been considered in the past. This article provides a practical approach to discuss and analyze newest literature supporting different practices in the field of OBA. In addition, an update of the most recent guidelines and practice management directives is included.
RECENT FINDINGS
Selected procedures may be performed in the office-based scenario with exceedingly low complication rates, when the right patient population is selected, and adequate safety protocols are followed. Current regulations are focused on reducing surgical risk through the implementation of patient safety protocols and practice standardization. Strategies include cognitive aids for emergencies, safety checklists, facility accreditation standards among other.
SUMMARY
New evidence exists supporting procedures in the office-based scenario in areas such as plastic and cosmetic surgery, dental and oral surgery, ophthalmology, endovascular procedures and otolaryngology. Different systematic approaches have been developed (guidelines and position statements) to promote standardization of safe practices through emergency protocols, safety checklists, medication management and surgical risk reduction. New regulations and accreditation measures have been developed to homogenize practice and promote high safety standards.
Topics: Accreditation; Ambulatory Surgical Procedures; Anesthesia; Humans; Patient Safety
PubMed: 31503034
DOI: 10.1097/ACO.0000000000000794 -
Journal of Advanced Nursing Jan 2020To obtain a comprehensive insight of the impact of patient and family engagement on patient safety and identify issues in implementing this approach.
AIMS
To obtain a comprehensive insight of the impact of patient and family engagement on patient safety and identify issues in implementing this approach.
BACKGROUND
Patient and family engagement is increasingly emerging as a potential approach for improving patient safety.
DESIGN
Mixed method multilevel synthesis.
DATA SOURCES
PubMed, CINAHL, Embase, and Cochrance Library (January 2009-April 2018).
REVIEW METHODS
The review was conducted according to the principles recommended by the Cochrane Handbook for Systematic Review and in accordance with the PRISMA guidelines.
RESULTS
Forty-two relevant studies were identified. Common intervention groups included 'direct care' and 'organization' levels with 'consultation' and 'involvement' approaches, while the 'health system' level and 'partnership and shared leadership' approaches were rarely implemented. Findings revealed positive effects of the interventions on patient safety. Most study participants expressed their willingness to engage in or support patient and family engagement. However, existing gaps and barriers in implementing patient and family engagement were identified.
CONCLUSION
Future research should further focus on issuing consensus guidelines for implementing patient and family engagement in patient safety, extending the research scope for all aspects of patient and family engagement and patient safety and identifying priority areas for action that is suitable for each health facility.
IMPACT
Policymakers should issue guidelines for implementing patient and family engagement in healthcare systems which would enable healthcare providers to implement patient and family engagement and improve patient safety appropriately and effectively.
Topics: Family; Female; Humans; Male; Patient Safety; Patients
PubMed: 31588602
DOI: 10.1111/jan.14227 -
Journal of Nursing Management Jan 2019To study how internal medicine patients experienced patient safety during their recent periods of care and to identify explanatory factors for patient participation.
AIMS
To study how internal medicine patients experienced patient safety during their recent periods of care and to identify explanatory factors for patient participation.
BACKGROUND
Patient participation is recognized as one of the main factors promoting quality and safety and the identification of effective interventions that encourage safe care.
METHODS
A cross-sectional survey of patients (n = 462) in the internal medicine wards (n = 18) of all five Finnish university hospitals. Data were analysed using principal component analysis and multiple linear regression.
RESULTS
Most patients (78%) assessed the level of patient safety on their ward as "very good" or "excellent," 20% of patients assessed it as acceptable or worse. The following were considered to be the most important factors explaining higher patient participation: informing patients about the research and encouraging them to participate (β = 0.378, p < 0.001), providing necessary information promptly and comprehensibly (β = 0.393, p < 0.001), and enhancing patients' ability to identify patient safety incident(s) (β = 0.186, p < 0.001).
CONCLUSIONS
Healthcare workers must improve by encouraging patient participation and providing relevant information to patients.
IMPLICATION FOR NURSING MANAGEMENT
Nursing leaders must be competent to support, lead, and allocate resources for the creation of an environment where patient participation can occur and is valued by health care workers.
Topics: Adult; Aged; Aged, 80 and over; Cross-Sectional Studies; Female; Finland; Hospitals, University; Humans; Male; Middle Aged; Patient Participation; Patient Safety; Patients' Rooms; Surveys and Questionnaires
PubMed: 30129073
DOI: 10.1111/jonm.12651