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International Emergency Nursing Jul 2023Patient safety is a global health priority. Errors of omission, such as missed nursing care in hospitals, are frequent and may lead to adverse events. Emergency... (Review)
Review
BACKGROUND
Patient safety is a global health priority. Errors of omission, such as missed nursing care in hospitals, are frequent and may lead to adverse events. Emergency departments (ED) are especially vulnerable to patient safety errors, and the significance missed nursing care has in this context is not as well known as in other contexts.
AIM
The aim of this scoping review was to summarize and disseminate research about missed nursing care in the context of EDs.
METHOD
A scoping review following the framework suggested by Arksey and O'Malley was used to (1) identify the research question; (2) identify relevant studies; (3) select studies; (4) chart the data; (5) collate, summarize, and report the results; and (6) consultation.
RESULTS
In total, 20 themes were derived from the 55 included studies. Missed or delayed assessments or other fundamental care were examples of missed nursing care characteristics. EDs not staffed or dimensioned in relation to the patient load were identified as a cause of missed nursing care in most included studies. Clinical deteriorations and medication errors were described in the included studies in relation to patient safety and quality of care deficiencies. Registered nurses also expressed that missed nursing care was undignified and unsafe.
CONCLUSION
The findings from this scoping review indicate that patients' fundamental needs are not met in the ED, mainly because of the patient load and how the ED is designed. According to registered nurses, missed nursing care is perceived as undignified and unsafe.
Topics: Humans; Nursing Care; Medication Errors; Patient Safety; Emergency Service, Hospital; Hospitals; Nursing Staff, Hospital
PubMed: 37352646
DOI: 10.1016/j.ienj.2023.101296 -
JAMA Health Forum Jul 2023Disruptions in the hospital clinical workforce threaten quality and safety of care and retention of health professionals. It is important to understand which...
IMPORTANCE
Disruptions in the hospital clinical workforce threaten quality and safety of care and retention of health professionals. It is important to understand which interventions would be well received by clinicians to address the factors associated with turnover.
OBJECTIVES
To determine well-being and turnover rates of physicians and nurses in hospital practice, and to identify actionable factors associated with adverse clinician outcomes, patient safety, and clinicians' preferences for interventions.
DESIGN, SETTING, AND PARTICIPANTS
This was a cross-sectional multicenter survey study conducted in 2021 with 21 050 physicians and nurses at 60 nationally distributed US Magnet hospitals. Respondents described their mental health and well-being, associations between modifiable work environment factors and physician and nurse burnout, mental health, hospital staff turnover, and patient safety. Data were analyzed from February 21, 2022, to March 28, 2023.
MAIN OUTCOMES AND MEASURES
Clinician outcomes (burnout, job dissatisfaction, intent to leave, turnover), well-being (depression, anxiety, work-life balance, health), patient safety, resources and work environment adequacy, and clinicians' preferences for interventions to improve their well-being.
RESULTS
The study sample comprised responses from 15 738 nurses (mean [SD] age, 38.4 [11.7] years; 10 887 (69%) women; 8404 [53%] White individuals) practicing in 60 hospitals, and 5312 physicians (mean [SD] age, 44.7 [12.0] years; 2362 [45%] men; 2768 [52%] White individuals) practicing in 53 of the same hospitals, with an average of 100 physicians and 262 nurses per hospital and an overall clinician response rate of 26%. High burnout was common among hospital physicians (32%) and nurses (47%). Nurse burnout was associated with higher turnover of both nurses and physicians. Many physicians (12%) and nurses (26%) rated their hospitals unfavorably on patient safety, reported having too few nurses (28% and 54%, respectively), reported having a poor work environment (20% and 34%, respectively), and lacked confidence in management (42% and 46%, respectively). Fewer than 10% of clinicians described their workplace as joyful. Both physicians and nurses rated management interventions to improve care delivery as more important to their mental health and well-being than interventions directed at improving clinicians' mental health. Improving nurse staffing was ranked highest among interventions (87% of nurses and 45% of physicians).
CONCLUSIONS AND RELEVANCE
This cross-sectional survey study of physicians and nurses practicing in US Magnet hospitals found that hospitals characterized as having too few nurses and unfavorable work environments had higher rates of clinician burnout, turnover, and unfavorable patient safety ratings. Clinicians wanted action by management to address insufficient nurse staffing, insufficient clinician control over workload, and poor work environments; they were less interested in wellness programs and resilience training.
Topics: Male; Humans; Female; Adult; Patient Safety; Cross-Sectional Studies; Nursing Staff, Hospital; Job Satisfaction; Burnout, Professional; Hospitals; Personnel, Hospital; Physicians
PubMed: 37418269
DOI: 10.1001/jamahealthforum.2023.1809 -
Nature Aug 2023Large language models (LLMs) have demonstrated impressive capabilities, but the bar for clinical applications is high. Attempts to assess the clinical knowledge of... (Comparative Study)
Comparative Study
Large language models (LLMs) have demonstrated impressive capabilities, but the bar for clinical applications is high. Attempts to assess the clinical knowledge of models typically rely on automated evaluations based on limited benchmarks. Here, to address these limitations, we present MultiMedQA, a benchmark combining six existing medical question answering datasets spanning professional medicine, research and consumer queries and a new dataset of medical questions searched online, HealthSearchQA. We propose a human evaluation framework for model answers along multiple axes including factuality, comprehension, reasoning, possible harm and bias. In addition, we evaluate Pathways Language Model (PaLM, a 540-billion parameter LLM) and its instruction-tuned variant, Flan-PaLM on MultiMedQA. Using a combination of prompting strategies, Flan-PaLM achieves state-of-the-art accuracy on every MultiMedQA multiple-choice dataset (MedQA, MedMCQA, PubMedQA and Measuring Massive Multitask Language Understanding (MMLU) clinical topics), including 67.6% accuracy on MedQA (US Medical Licensing Exam-style questions), surpassing the prior state of the art by more than 17%. However, human evaluation reveals key gaps. To resolve this, we introduce instruction prompt tuning, a parameter-efficient approach for aligning LLMs to new domains using a few exemplars. The resulting model, Med-PaLM, performs encouragingly, but remains inferior to clinicians. We show that comprehension, knowledge recall and reasoning improve with model scale and instruction prompt tuning, suggesting the potential utility of LLMs in medicine. Our human evaluations reveal limitations of today's models, reinforcing the importance of both evaluation frameworks and method development in creating safe, helpful LLMs for clinical applications.
Topics: Benchmarking; Bias; Clinical Competence; Comprehension; Computer Simulation; Datasets as Topic; Knowledge; Licensure; Medicine; Natural Language Processing; Patient Safety; Physicians
PubMed: 37438534
DOI: 10.1038/s41586-023-06291-2 -
La Tunisie Medicale Jul 2023Given the potential risks involved in childbirth, patient safety is of utmost importance in maternity care. (Observational Study)
Observational Study
INTRODUCTION
Given the potential risks involved in childbirth, patient safety is of utmost importance in maternity care.
AIM
To compare the level of patient safety culture between physicians and paramedics in public maternity care structures in Sousse, Tunisia.
METHODS
An observational descriptive and cross-sectional study was conducted among health professionals working in all public health maternities of Sousse, Tunisia. A valid Hospital Survey On Patient Safety Culture (HSOPSC) questionnaire was used to gather data, and a score was calculated for each dimension by taking the average of the positive response proportions per item.
RESULTS
The global response rate was 86.4%. Paramedics had a higher response rate compared to physicians (90.6% versus 62.1%). The overall scores for the ten dimensions of patient safety culture showed significantly higher scores for physicians compared to paramedics for the dimensions of "Expectations and actions of superiors regarding care safety" and "healthcare professional-patient relationship and safety culture" (88.43% versus 63.73%; p=0.027 and 75.38% versus 65.73%; p=0.041 respectively). Conversely, a significant difference was found in favor of paramedics compared to physicians regarding the dimension of "Management support for care safety" (37.3% versus 13%; p=0.019).
CONCLUSION
Significant differences in patient safety culture scores among healthcare professionals. It suggest that efforts should be made to improve management support for care safety for physicians, while paramedics could benefit from increased attention to expectations and actions of superiors regarding care safety and healthcare professional-patient relationship.
Topics: Female; Pregnancy; Humans; Patient Safety; Cross-Sectional Studies; Maternal Health Services; Inpatients; Health Personnel
PubMed: 38445426
DOI: No ID Found -
Anesthesia and Analgesia Apr 2024In November of 2022, the Anesthesia Patient Safety Foundation held a Consensus Conference on Hemodynamic Instability with invited experts. The objective was to review...
In November of 2022, the Anesthesia Patient Safety Foundation held a Consensus Conference on Hemodynamic Instability with invited experts. The objective was to review the science and use expert consensus to produce best practice recommendations to address the issue of perioperative hemodynamic instability. After expert presentations, a modified Delphi process using discussions, voting, and feedback resulted in 17 recommendations regarding advancing the perioperative care of the patient at risk of, or with, hemodynamic instability. There were 17 high-level recommendations. These recommendations related to the following 7 domains: Current Knowledge (5 statements); Preventing Hemodynamic Instability-Related Harm During All Phases of Care (4 statements); Data-Driven Quality Improvement (3 statements); Informing Patients (2 statements); The Importance of Technology (1 statement); Launch a National Campaign (1 statement); and Advancing the Science (1 statement). A summary of the recommendations is presented in Table 1 .
Topics: Humans; Patient Safety; Patients; Anesthesia; Consensus; Hemodynamics; Delphi Technique
PubMed: 38153876
DOI: 10.1213/ANE.0000000000006789 -
Dialogues in Health Dec 2023Psychological safety is a multidimensional, dynamic phenomenon that concerns team members' perception of whether it is safe to take interpersonal risks at work. It is... (Review)
Review
Psychological safety is a multidimensional, dynamic phenomenon that concerns team members' perception of whether it is safe to take interpersonal risks at work. It is particularly important within health care teams who need to work interdependently to coordinate safe patient care within a highly complex, variable and high-stakes work environment. High levels of psychological safety have clear benefits for patient safety by improving the delivery of clinical care and promoting health care providers' job satisfaction and well-being. Feeling psychologically safe can enable team members to engage in speaking up behavior, such as asking questions, pointing out mistakes, or reporting errors. Several studies have explored psychological safety in health care teams and its impact on patient safety. These studies have highlighted the importance of psychological safety in health care organizations and provided strategies for promoting psychological safety. Psychological safety in health care involvement with patients can improve patient engagement.
PubMed: 38515810
DOI: 10.1016/j.dialog.2023.100153 -
Frontiers in Digital Health 2023Digital twin technology is revolutionizing healthcare systems by leveraging real-time data integration, advanced analytics, and virtual simulations to enhance patient... (Review)
Review
Digital twin technology is revolutionizing healthcare systems by leveraging real-time data integration, advanced analytics, and virtual simulations to enhance patient care, enable predictive analytics, optimize clinical operations, and facilitate training and simulation. With the ability to gather and analyze a wealth of patient data from various sources, digital twins can offer personalized treatment plans based on individual characteristics, medical history, and real-time physiological data. Predictive analytics and preventive interventions are made possible by machine learning algorithms, allowing for early detection of health risks and proactive interventions. Digital twins can optimize clinical operations by analyzing workflows and resource allocation, leading to streamlined processes and improved patient care. Moreover, digital twins can provide a safe and realistic environment for healthcare professionals to enhance their skills and practice complex procedures. The implementation of digital twin technology in healthcare has the potential to significantly improve patient outcomes, enhance patient safety, and drive innovation in the healthcare industry.
PubMed: 37744683
DOI: 10.3389/fdgth.2023.1253050 -
Cureus Dec 2023Patient safety has become a top priority for healthcare organizations. A better patient safety environment is associated with a lower probability of significant... (Review)
Review
Patient safety has become a top priority for healthcare organizations. A better patient safety environment is associated with a lower probability of significant complications. Training programmers is critical to promoting patient safety and minimizing misunderstandings. The quality, performance, and productivity of the healthcare industry can be dramatically improved by changing the patient safety atmosphere operating within the hospital sector. Hospitals can significantly reduce medical errors and adverse events by implementing the program and training programmers to prioritize patient safety. This will improve patient outcomes and increase efficiency and effectiveness. Creating a patient safety culture within hospitals will contribute to a higher standard of care and improved overall performance in the healthcare industry. Hospitals can identify systemic problems and implement proactive measures to prevent future incidents by creating an environment in which healthcare professionals feel comfortable reporting errors. A patient safety culture encourages collaboration and open communication among healthcare teams leading to more effective and coordinated care.
PubMed: 38283419
DOI: 10.7759/cureus.51159 -
BMJ Open Quality Apr 2024Examine how Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) can be used to manage patient safety and improve the standard of care for...
BACKGROUND
Examine how Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) can be used to manage patient safety and improve the standard of care for patients.
METHODS
In order to improve key medical training in areas like surgical safety management, blood transfusion closed-loop management, drug safety management and identity recognition, we apply the TeamSTEPPS teaching methodology. We then examine the effects of this implementation on changes in pertinent indicators.
RESULTS
Our hospital's perioperative death rate dropped to 0.019%, unscheduled reoperations dropped to 0.11%, and defined daily doses fell to 24.85. Antibiotic usage among hospitalised patients declined to 40.59%, while the percentage of antibacterial medicine prescriptions for outpatient patients decreased to 13.26%. Identity recognition requirements were implemented at a rate of 94.5%, and the low-risk group's death rate dropped to 0.01%. Critical transfusion episodes were less common, with an incidence of 0.01%. The physician's TeamSTEPPS Teamwork Perceptions Questionnaire and Teamwork Attitudes Questionnaire scores dramatically improved following the TeamSTEPPS team instruction course.
CONCLUSION
An evidence-based team collaboration training programme called TeamSTEPPS combines clinical practice with team collaboration skills to enhance team performance in the healthcare industry and raise standards for medical quality, safety, and effectiveness.
Topics: Humans; Patient Safety; Patient Care Team; Surveys and Questionnaires; Quality Improvement; Safety Management
PubMed: 38670556
DOI: 10.1136/bmjoq-2023-002669 -
African Journal of Paediatric Surgery :... 2023The clinical handover process has been directly associated with patient safety. Improving patient handover can improve patients' safety and ultimate outcomes; therefore,... (Review)
Review
INTRODUCTION
The clinical handover process has been directly associated with patient safety. Improving patient handover can improve patients' safety and ultimate outcomes; therefore, this review was conducted to examine the literature available on interventions that make handovers more effective.
METHODS
MEDLINE (EBSCO) was searched for interventions that improve the efficacy of clinical handovers. Studies were excluded if they were irrelevant, not published in peer-reviewed journals, not published in English, or were based on animal studies. A total of 1087 publications were retrieved and sorted by relevance. The eligibility of the articles was determined by reading through the titles and abstracts then full texts, and reference searching. Six studies were selected for this literature review.
RESULTS
A number of handover interventions were explored. One intervention was changing the handover location to patients' bedside; Bradley et al. found that bedside handovers decreased handover time and patient adverse events. Another intervention was providing education on handovers which Sand-Jecklin et al. associated with reductions in adverse events. Moreover, Lee et al. used simulation-based education and found that it significantly improved nurses' knowledge, performance competence, and self-efficacy. Another intervention was the transforming care at the bedside (TCAB) framework which incorporated multidimensional strategies and emphasized handover as part of patient centeredness; these strategies improved patient safety, yet the results cannot be attributed solely to handover modifications. Meanwhile, Hada et al. implemented a mixture of interventions and found that they improved patient safety and reduced adverse events.
CONCLUSION
The interventions explored were bedside handovers, providing education and simulation-based education on handovers, emphasizing patient centeredness as part of TCAB strategies, and implementing a mixture of interventions. All interventions reduced adverse events, although some improvements were not significant. Due to the limited evidence available to support the efficacy of the interventions on improving clinical handovers, the results remain inconclusive.
Topics: Humans; Patient Handoff; Clinical Competence; Educational Status; Patient Safety
PubMed: 37470550
DOI: 10.4103/ajps.ajps_82_22