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IEEE Journal of Biomedical and Health... Mar 2019Clinical monitoring systems have been implemented in the inpatient hospital setting for decades, with little attention given to systems analysis or assessment of impact...
Clinical monitoring systems have been implemented in the inpatient hospital setting for decades, with little attention given to systems analysis or assessment of impact on clinician workflow or patient care. This study provides an example of how system-level design and analysis can be applied in this domain, with specific focus on early detection of patient deterioration to mitigate failure to rescue events. Wireless patient sensors and pulse oximetry-based surveillance system monitors with advanced display and information systems capabilities were introduced to 71 general care beds in two units. Nursing workflow was redesigned to integrate use of the new system and its features into patient assessment activities. Patient characteristics, vital sign documentation, monitor alarm, workflow, and system utilization data were collected and analyzed for the period five months before and five months after implementation. Comparison unit data were also collected and analyzed for the same periods. A survey pertaining to staff satisfaction and system performance was administered after implementation. Statistical analysis was performed to examine differences in the before and after data for the target and control units. The enhanced monitoring system received high staff satisfaction ratings and significantly improved key clinical elements related to early recognition of changes in patient state, including reducing average vital signs data collection time by 28%, increasing patient monitoring time (rate ratio 1.22), and availability and accuracy of patient information. Impact on clinical alarms was mixed, with no significant increase in clinical alarms per monitored hour.
Topics: Clinical Alarms; Clinical Deterioration; Humans; Models, Organizational; Monitoring, Physiologic; Oximetry; Patient Safety; Quality Improvement; Vital Signs; Workflow
PubMed: 29993903
DOI: 10.1109/JBHI.2018.2834863 -
The New England Journal of Medicine Jan 2023
Topics: Humans; Patient Safety
PubMed: 36630628
DOI: 10.1056/NEJMe2213567 -
JAMA Jun 2023US hospitals report data on many health care quality metrics to government and independent health care rating organizations, but the annual cost to acute care hospitals...
IMPORTANCE
US hospitals report data on many health care quality metrics to government and independent health care rating organizations, but the annual cost to acute care hospitals of measuring and reporting quality metric data, independent of resources spent on quality interventions, is not well known.
OBJECTIVE
To evaluate externally reported inpatient quality metrics for adult patients and estimate the cost of data collection and reporting, independent of quality-improvement efforts.
DESIGN, SETTING, AND PARTICIPANTS
Retrospective time-driven activity-based costing study at the Johns Hopkins Hospital (Baltimore, Maryland) with hospital personnel involved in quality metric reporting processes interviewed between January 1, 2019, and June 30, 2019, about quality reporting activities in the 2018 calendar year.
MAIN OUTCOMES AND MEASURES
Outcomes included the number of metrics, annual person-hours per metric type, and annual personnel cost per metric type.
RESULTS
A total of 162 unique metrics were identified, of which 96 (59.3%) were claims-based, 107 (66.0%) were outcome metrics, and 101 (62.3%) were related to patient safety. Preparing and reporting data for these metrics required an estimated 108 478 person-hours, with an estimated personnel cost of $5 038 218.28 (2022 USD) plus an additional $602 730.66 in vendor fees. Claims-based (96 metrics; $37 553.58 per metric per year) and chart-abstracted (26 metrics; $33 871.30 per metric per year) metrics used the most resources per metric, while electronic metrics consumed far less (4 metrics; $1901.58 per metric per year).
CONCLUSIONS AND RELEVANCE
Significant resources are expended exclusively for quality reporting, and some methods of quality assessment are far more expensive than others. Claims-based metrics were unexpectedly found to be the most resource intensive of all metric types. Policy makers should consider reducing the number of metrics and shifting to electronic metrics, when possible, to optimize resources spent in the overall pursuit of higher quality.
Topics: Humans; Delivery of Health Care; Hospitals; Quality Improvement; Quality of Health Care; Retrospective Studies; Adult; United States; Insurance Claim Review; Patient Safety; Public Reporting of Healthcare Data; Economics, Hospital
PubMed: 37278813
DOI: 10.1001/jama.2023.7271 -
Issue Brief (Health Policy Tracking... Dec 2018
Topics: Federal Government; Humans; Medical Errors; Patient Safety; State Government; United States
PubMed: 30681318
DOI: No ID Found -
GMS Journal For Medical Education 2019
Topics: Curriculum; Education, Professional; Humans; Patient Safety
PubMed: 30993179
DOI: 10.3205/zma001229 -
The Surgical Clinics of North America Feb 2021"The focus on patient safety offers a new framework not only for delivering health care but also for training physicians. Medical school and surgical graduate medical... (Review)
Review
"The focus on patient safety offers a new framework not only for delivering health care but also for training physicians. Medical school and surgical graduate medical education must transition to a more holistic approach by teaching technical and nontechnical skills. Formalized safety curricula can be developed by adopting recommended guidelines and content from national and international organizations, existing validated practices of training programs, frequent simulation exercises, and objective evaluation tools."
Topics: Humans; Internship and Residency; Patient Safety; Surgical Procedures, Operative
PubMed: 33212075
DOI: 10.1016/j.suc.2020.09.007 -
Transfusion and Apheresis Science :... Aug 2020The present work aims to analyze the impact - from legal and medical perspective - of the recent Italian legislative provisions on the subject of healthcare safety, and... (Review)
Review
The present work aims to analyze the impact - from legal and medical perspective - of the recent Italian legislative provisions on the subject of healthcare safety, and how these affect current transfusion practices, also in light of the accumulation of evidence deriving from the implementation of the Patient Blood Management (PBM) program. The scientific evidence shows that PBM is a bundle of care that improves patient outcomes including mortality and morbidity, improves the quality of life of patients and the population, reduces healthcare costs and decreases consumption of blood components. These aspects should be largely sufficient to carry out an urgent implementation of PBM in Italian hospitals. However, it is now also possible to indicate a further incentive for implementation which is made up of medico-legal aspects and is characterized by the need to decrease the intrinsic risks of the use of blood products so as to protect doctors and hospitals from possible future medico-legal disputes regarding adverse transfusion events that could be effectively avoided.
Topics: Blood Transfusion; Humans; Italy; Patient Safety
PubMed: 32444279
DOI: 10.1016/j.transci.2020.102811 -
The Surgical Clinics of North America Feb 2021This article discusses the processes, interventions, and methods by which health care systems can change the culture of their workplace to promote safety. The importance... (Review)
Review
This article discusses the processes, interventions, and methods by which health care systems can change the culture of their workplace to promote safety. The importance of this culture shift is discussed, as well as an organizational approach, highlighting the importance of investment of time and resources to the cause. Efforts must include an educational focus on patient safety where a culture of patient safety is emphasized. This attitude along with several specific key interventions, including, measurement, teamwork, briefings, checklists, and developmental infrastructure, are discussed.
Topics: Humans; Patient Safety; Safety Management; Surgical Procedures, Operative
PubMed: 33212077
DOI: 10.1016/j.suc.2020.09.008 -
Joint Commission Journal on Quality and... Apr 2016There is limited conformity among patient safety and quality improvement (QI) competencies of the knowledge, skills, and attitudes (KSA), by stage of skill acquisition,... (Review)
Review
BACKGROUND
There is limited conformity among patient safety and quality improvement (QI) competencies of the knowledge, skills, and attitudes (KSA), by stage of skill acquisition, essential for all health professionals. A study was conducted to identify, categorize, critically appraise, and discuss implications of competency recommendations published in influential position papers.
METHODS
A literature search was conducted of competency recommendations in position papers published by national and international professional associations, expert panels, consortia, centers and institutes, and convened committees, in the domain of patient safety and QI. To be included in the analysis, the competency had to be recommended in at least 20% (rounded) of the position papers. Qualitative content analysis was used to identify themes among the published competencies for the skill acquisition levels of competent and expert, using Dreyfus's definitions.
RESULTS
On the basis of the 22 papers that met the inclusion criteria, 17 themes were identified among the 59 competencies for the skill level competent. Among the 23 competencies for the skill level expert, 13 themes were identfied. Competencies within the theme "Evidence-Based Practice" were most frequently recommended across both skill levels. The themes "Interdisciplinary Teamwork and Collaboration" and "Evidence-Based Practice" were the themes identified among the greatest number of position papers for the skill level competent and expert, respectively.
CONCLUSIONS
The identified themes for competencies in patient safety and QI have implications for curriculum development and assessment of competence in education and practice. The findings in this study demonstrate a need to discourage publication of recommendations of yet more competencies and to instead encourage development of an international consensus on the essential KSA for patient safety and QI across all health professions and all levels of skill acquisition.
Topics: Clinical Competence; Health Knowledge, Attitudes, Practice; Humans; Patient Safety; Personnel, Hospital; Quality Improvement
PubMed: 27025576
DOI: 10.1016/s1553-7250(16)42020-9 -
Cadernos de Saude Publica Sep 2014The aim of this study was to identify methodologies to evaluate incidents in primary health care, types of incidents, contributing factors, and solutions to make primary... (Review)
Review
The aim of this study was to identify methodologies to evaluate incidents in primary health care, types of incidents, contributing factors, and solutions to make primary care safer. A systematic literature review was performed in the following databases: PubMed, Scopus, LILACS, SciELO, and Capes, from 2007 to 2012, in Portuguese, English, and Spanish. Thirty-three articles were selected: 26% on retrospective studies, 44% on prospective studies, including focus groups, questionnaires, and interviews, and 30% on cross-sectional studies. The most frequently used method was incident analysis from incident reporting systems (45%). The most frequent types of incidents in primary care were related to medication and diagnosis. The most relevant contributing factors were communication failures among member of the healthcare team. Research methods on patient safety in primary care are adequate and replicable, and they will likely be used more widely, thereby providing better knowledge on safety in this setting.
Topics: Humans; Patient Safety; Primary Health Care; Quality of Health Care; Risk Factors
PubMed: 25317512
DOI: 10.1590/0102-311x00114113