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British Journal of Anaesthesia Dec 2021Safe delivery of patient care in the operating theatre is complex and co-dependent of many individual, organisational, and environmental factors, including patient, task...
Safe delivery of patient care in the operating theatre is complex and co-dependent of many individual, organisational, and environmental factors, including patient, task and technology, individual, and human factors. The Six Sigma approach aims to implement a data-driven strategy to reduce variability and consequently improve safety. Analytical data platforms such as a Black Box ought to be embraced to support process optimisation and ultimately create a higher level of Six Sigma safety performance of the operating theatre team.
Topics: Humans; Operating Rooms; Patient Safety; Quality Control; Quality of Health Care; Safety Management; Total Quality Management
PubMed: 34593216
DOI: 10.1016/j.bja.2021.08.023 -
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 -
BMC Health Services Research Jul 2023Insights around second victims (SV) and patient safety has been growing over time. An overview of the available evidence is lacking. This review aims to describe (i) the... (Review)
Review
BACKGROUND
Insights around second victims (SV) and patient safety has been growing over time. An overview of the available evidence is lacking. This review aims to describe (i) the impact a patient safety incident can have and (ii) how healthcare professionals can be supported in the aftermath of a patient safety incident.
METHODS
A literature search in Medline, EMBASE and CINAHL was performed between 1 and 2010 and 26 November 2020 with studies on SV as inclusion criteria. To be included in this review the studies must include healthcare professionals involved in the aftermath of a patient safety incident.
RESULTS
In total 104 studies were included. SVs can suffer from both psychosocial (negative and positive), professional and physical reactions. Support can be provided at five levels. The first level is prevention (on individual and organizational level) referring to measures taken before a patient safety incident happens. The other four levels focus on providing support in the aftermath of a patient safety incident, such as self-care of individuals and/or team, support by peers and triage, structured support by an expert in the field (professional support) and structured clinical support.
CONCLUSION
The impact of a patient safety incident on healthcare professionals is broad and diverse. Support programs should be organized at five levels, starting with preventive actions followed by self-care, support by peers, structured professional support and clinical support. This multilevel approach can now be translated in different countries, networks and organizations based on their own culture, support history, structure and legal context. Next to this, they should also include the stage of recovery in which the healthcare professional is located in.
Topics: Humans; Health Personnel; Patient Safety; Triage
PubMed: 37525127
DOI: 10.1186/s12913-023-09637-8 -
Intensive Care Medicine Dec 2018
Topics: Cooperative Behavior; Critical Care; Humans; Industry; Patient Safety; Therapies, Investigational
PubMed: 30406806
DOI: 10.1007/s00134-018-5306-6 -
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 -
Journal of Patient Safety Jan 2023Attempts to understand patient safety using administrative data in Korea have been rare. This study develops a Korean patient safety incident code classification system...
OBJECTIVES
Attempts to understand patient safety using administrative data in Korea have been rare. This study develops a Korean patient safety incident code classification system and identifies its characteristics to boost diagnosis code usage for assessing patient safety.
METHODS
Based on existing literature, we selected Korean Standard Classification of Diseases 7 codes for characterizing patient safety incidents using diagnosis codes. We conducted 2 rounds of review to evaluate the codes applicability to different patient safety incidents using the Delphi method. The verified diagnosis codes were then classified by incident type.
RESULTS
Of the 54,259 Korean Standard Classification of Diseases 7 codes, 4509 were applicable for Korean patients, which were divided into 2435 code groups and 2074 candidate groups. The codes were classified into 6 categories (diagnosis, medication, patient care, operation or procedure, infection related, and other) and then further classified into 35 subcategories. The major categories of patient safety incidents, in the order of frequency, involved medication, fluid and blood related (1719, 38.1%), operation and procedure related (1339, 29.7%), and patient care related (991, 22.0%). Meanwhile, there were only 2 codes related to diagnosis.
CONCLUSIONS
Our study provides a basis for estimating patient safety incidents using diagnosis codes. We suggest that gradually increasing the utilization and accuracy of the patient safety incident codes will help develop effective patient safety indicators in Korea similar to other countries. Moreover, clinicians are also needed to be aware of using the developed code classification system.
Topics: Humans; Patient Safety; Republic of Korea
PubMed: 36538337
DOI: 10.1097/PTS.0000000000001083 -
GMS Journal For Medical Education 2019Patient safety has high priority in health care. Since successful interprofessional collaboration is essential for patient safety, the topic should ideally be addressed...
Patient safety has high priority in health care. Since successful interprofessional collaboration is essential for patient safety, the topic should ideally be addressed interprofessionally in the curricula. The aim of the project was the development and implementation of an interprofessional teaching concept "patient safety" for medical students and students of health professions at the Medical Faculty Heidelberg. The learning objectives were formulated on the basis of the "Patient Safety Learning Objective Catalog" ("Lernzielkatalog Patientensicherheit") of the Society for Medical Education (Gesellschaft für Medizinische Ausbildung, GMA) and on the basis of the American Interprofessional Competence Profile "Core Competencies for Interprofessional Collaborative Practice". Two courses were designed for interprofessional groups of approximately 15 participants. The learning content was designed interactively through the development of the project, its application and critical discussion of error reporting systems and security checklists as well as role-plays and video material. The evaluation was carried out by means of descriptive analysis of a structured course evaluation system, which was developed for this study. 28 students took part in the courses. 82% of the students considered the topic "patient safety" to be relevant. In 82% of the cases, the participants rated the interprofessional aspect of the course as valuable. Overall, 73% of students whished for more interprofessional education. The results of the evaluation show that the teaching concept is well accepted by the students and encourage the implementation of further interprofessional courses with a thematic relevance.
Topics: Adult; Curriculum; Female; Humans; Interprofessional Relations; Male; Patient Safety; Surveys and Questionnaires; Teaching
PubMed: 30993171
DOI: 10.3205/zma001221 -
Radiography (London, England : 1995) May 2023Radiographers play a central role in patient safety because of their knowledge of and responsibilities in relation to the imaging process. To maintain safe care, the...
INTRODUCTION
Radiographers play a central role in patient safety because of their knowledge of and responsibilities in relation to the imaging process. To maintain safe care, the workplace must create a safety culture that enables sustainable safety work.
AIM
This study aims to describe radiographers' perceptions of the patient safety culture in radiology units in Sweden.
METHODS
The Swedish Hospital Survey of Patients' Safety Culture (S-HSOPSC) was used to gather descriptive data from 171 Swedish registered radiographers working in five radiology clinics distributed across 15 units. Fifty-one questionnaire items and one open-ended question were analysed, comprising perceptions of the overall safety grade, the frequency of number of reported risks and events, and 14 composites regarding patient safety dimensions.
RESULTS
The radiographers' concerns surrounding the patient safety culture in their workplaces related to weaknesses regarding the safety dimensions "Staffing", "Frequency of error reporting", "Organizational learning - continuous improvement" and "Executive management support for patient safety". They perceived "Teamwork within the unit" to be a strength.
CONCLUSION
Despite some weaknesses in the patient safety culture, the radiographers perceived that the overall patient safety level was good, in part because of their ability to spot risks in time. The executive management, however, needed to improve their feedback on safety measures; and another reason for some weaknesses in the patient safety culture could be staffing issues such as lack of time for meetings for continuous improvement. Managers and leaders have a great responsibility to establish a patient safety culture through support and good leadership.
IMPLICATIONS FOR PRACTICE
An understanding of what creates a safety culture is important to prevent patient safety incidents.
Topics: Humans; Patient Safety; Safety Management; Radiology; Radiography; Perception
PubMed: 37086589
DOI: 10.1016/j.radi.2023.04.005 -
GMS Journal For Medical Education 2019
Topics: Curriculum; Education, Professional; Humans; Patient Safety
PubMed: 30993179
DOI: 10.3205/zma001229 -
BMJ Open Quality Dec 2022Patient safety in home care is a fundamental and complex concept in nursing. This concept includes a number of challenges in patient care. Studies have shown that there...
BACKGROUND
Patient safety in home care is a fundamental and complex concept in nursing. This concept includes a number of challenges in patient care. Studies have shown that there is no clear and uniform definition for this concept.
OBJECTIVE
The objective of the present study was to analyse patient safety in home care in Iran.
METHODS
The study was done using a hybrid model at three phases, including theoretical, field work and the final analysis. We searched valid databases including MEDLIN and CINHAL; electronic references including Web of Science, Scopus, Ovid, ProQuest, PubMed and Persian databases including Magiran, IranDoc and SID during 2008-2022, using these Persian and English keywords: Patient Safety, Safety, Home Care Service, Domiciliary Care, Home Care and Home Health Care. A total of 16 articles were searched in the theoretical phase and then analysed by content analysis. In field work phase, nine participants were interviewed (nurse, family and patient) and then the interviews were analysed by the content analysis method. In the final analysis phase, a general analysis of the previous two phases was performed and after determining the attributes, antecedents and consequences, a final definition of patient safety in home care in Iran was presented.
FINDINGS
Based on different studies, patient safety in home care is a multifaceted concept, which encompasses physical, mental, social and practical dimensions. Evaluation, prevention, participation and commitment to the safety culture are the core features of this concept. The patient care concept depends on the commitment of the involved participants, adequate resources, environmental conditions, support of the involved centres (home care agency, hospital and the insurance), self-efficacy and the ability of the caregivers (nurses).
CONCLUSION
Defining the concept of patient safety in home care provides a basis for the development of a safe patient care system at home. This concept analysis for patient safety in home care could be a guide for future studies.
Topics: Humans; Patient Safety; Home Care Services
PubMed: 36521926
DOI: 10.1136/bmjoq-2022-002077