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BMJ Quality & Safety Jun 2022Despite being implemented for over a decade, literature describing the surgical safety checklist (SSC) is completed by operating room (OR) teams and how this relates to...
BACKGROUND
Despite being implemented for over a decade, literature describing the surgical safety checklist (SSC) is completed by operating room (OR) teams and how this relates to its effectiveness is scarce. This systematic review aimed to: (1) quantify how many studies reported SSC completion versus described the SSC was completed; (2) evaluate the impact of the SSC on provider outcomes (ommunication, case nderstanding, afety ulture, CUSC), patient outcomes (complications, mortality rates) and moderators of these relationships.
METHODS
A systematic literature search was conducted using Medline, CINAHL, Embase, PsycINFO, PubMed, Scopus and Web of Science on 10 January 2020. We included providers who treat human patients and completed any type of SSC in any OR or simulation centre. Statistical directional findings were extracted for provider and patient outcomes and key factors (eg, attentiveness) were used to determine moderating effects.
RESULTS
300 studies were included in the analysis comprising over 7 302 674 operations and 2 480 748 providers and patients. Thirty-eight per cent of studies provided at least some description of how the SSC was completed. Of the studies that described SSC completion, a clearer positive relationship was observed concerning the SSC's influence on provider outcomes (CUSC) compared with patient outcomes (complications and mortality), as well as related moderators.
CONCLUSION
There is a scarcity of research that examines how the SSC is completed and how this influences safety outcomes. Examining how a checklist is completed is critical for understanding why the checklist is successful in some instances and not others.
Topics: Checklist; Humans; Operating Rooms; Patient Safety; Safety Management
PubMed: 35393355
DOI: 10.1136/bmjqs-2021-014361 -
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 Nursing Management Oct 2022The purpose of this review was to evaluate the content, validity and reliability of patient-reported questionnaires on patient participation in patient safety. (Review)
Review
AIM
The purpose of this review was to evaluate the content, validity and reliability of patient-reported questionnaires on patient participation in patient safety.
BACKGROUND
Patient participation in patient safety is one of the key strategies that are increasingly regarded as a critical intervention to improve the quality of safety care.
EVALUATION
A systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The content, reliability and validity of patient-reported questionnaires on patient participation in patient safety were assessed.
KEY ISSUES
Twenty-seven studies were included for data extraction and synthesis. The questionnaire contents most commonly used to describe patient participation in patient safety were 'attitudes and perceptions', 'experience', 'information and feedback' and 'willingness'. Internal consistency was evaluated for 17 questionnaires, and test-retest reliability was tested for four questionnaires. Content validity was assessed among all included questionnaires, and structural validity was evaluated for 12 questionnaires.
CONCLUSIONS
Future research targeting the different safety issues is still indispensable for developing patient-reported questionnaires with great psychometric quality in validity, reliability, feasibility and usability in patient participation in patient safety.
IMPLICATIONS FOR NURSING MANAGEMENT
Clinical nurses should consider the internal consistency, test-retest reliability, content validity and structural validity of the questionnaires that have been positively appraised for methodological quality before use.
Topics: Humans; Reproducibility of Results; Patient Safety; Patient Participation; Surveys and Questionnaires; Psychometrics
PubMed: 35593487
DOI: 10.1111/jonm.13690 -
PloS One 2018Patients are at risk for harm when treated simultaneously by healthcare providers from different healthcare organisations. To assess current practice and improvements of... (Review)
Review
BACKGROUND
Patients are at risk for harm when treated simultaneously by healthcare providers from different healthcare organisations. To assess current practice and improvements of transitional patient safety, valid measurement tools are needed.
AIM AND METHODS
To identify and appraise all measurement tools and outcomes that measure aspects of transitional patient safety, PubMed, Cinahl, Embase and Psychinfo were systematically searched. Two researchers performed the title and abstract and full-text selection. First, publications about validation of measurement tools were appraised for quality following COSMIN criteria. Second, we inventoried all measurement tools and outcome measures found in our search that assessed current transitional patient safety or the effect of interventions targeting transitional patient safety.
RESULTS
The initial search yielded 8288 studies, of which 18 assessed validity of measurement tools of different aspects of transitional safety, and 191 assessed current transitional patient safety or effect of interventions. In the validated measurement tools, the overall quality of content and structural validity was acceptable; other COSMIN criteria, such as reliability, measurement error and responsiveness, were mostly poor or not reported. In our outcome inventory, the most frequently used validated outcome measure was the Care Transition Measure (n = 9). The most frequently used non-validated outcome measures were: medication discrepancies (n = 98), hospital readmissions (n = 55), adverse events (n = 34), emergency department visits (n = 33), (mental or physical) health status (n = 28), quality and timeliness of discharge summary, and patient satisfaction (n = 23).
CONCLUSIONS
Although no validated measures exist that assess all aspects of transitional patient safety, we found validated measurement tools on specific aspects. Reporting of validity of transitional measurement tools was incomplete. Numerous outcome measures with unknown measurement properties are used in current studies on safety of care transitions, which makes interpretation or comparison of their results uncertain.
Topics: Humans; Patient Safety
PubMed: 29864119
DOI: 10.1371/journal.pone.0197312 -
Brazilian Journal of Anesthesiology... 2022Patient safety is a concept of great importance to managers, health professionals, and patients and their families, given patient safety promotes more effective care and... (Review)
Review
INTRODUCTION AND OBJECTIVE
Patient safety is a concept of great importance to managers, health professionals, and patients and their families, given patient safety promotes more effective care and reduces costs. Moreover, while analyzing the area of anesthesiology, one can realize the epidemiological changes, increased complexity and number of procedures, and the adoption of a new matrix of essential skills mandatory for residents of anesthesiology in Brazil. Thus, it is relevant to identify current patient safety competences among anesthesiology residents.
METHODS
A systematic review was elaborated using PubMed, SciELO, BVS, Cochrane Library, LILACS and CAPES databases with the descriptors "anesthesiology", "patient safety", "residency" and "competence".
RESULTS AND CONCLUSIONS
Thirteen articles published in the past 10 years were analyzed. The articles depicted competences grouped into three categories: knowledge (identification, prevention and management of adverse events; use of correct and up-to-date information; understanding of human factors; and continuous learning), skills (efficient communication; teamwork; leadership; decision-making; and self-confidence), and attitude (management of stress and fatigue; and infection control). All these skills can be developed and assessed through simulation and active learning methods, profiting from a multidisciplinary approach. Studies also reveal that residents perform poorly in certain patient safety domains due to lack of effective in-depth understanding, appreciation of the topic and ineffective teaching. As a result, greater investment in the topic is needed by teaching and health institutions and researchers.
Topics: Anesthesiology; Brazil; Clinical Competence; Humans; Internship and Residency; Patient Safety
PubMed: 35124107
DOI: 10.1016/j.bjane.2021.06.029 -
Family Practice Feb 2015Despite the enormous potential for adverse events in primary care, the knowledge base about patient safety in this context is still sparse. The lack of appropriate... (Review)
Review
BACKGROUND
Despite the enormous potential for adverse events in primary care, the knowledge base about patient safety in this context is still sparse. The lack of appropriate measurement methods is a key factor limiting the development of research in this field.
OBJECTIVE
To identify and characterize available patient reported instruments to measure patient safety in primary care.
METHODS
We conducted a systematic literature review. We searched in bibliographic sources for empirical studies describing the development, evaluation or use of patient reported instruments assessing patient safety in primary care. Study selection and data extraction were independently conducted by two researchers.
RESULTS
We identified 28 studies reporting on 23 different instruments. Fifteen instruments were designed for paper-based self-administration, six for phone interview and two consisted in electronic reporting systems. Most instruments focused on specific aspects of patient safety, most commonly on experiences of adverse drug reactions. Face validity was assessed for 10 instruments (43%), three reported construct validity (13%) and three described reliability (13%). Responsiveness was not ascertained.
CONCLUSIONS
Although there is evidence of good psychometric properties for a reduced number of patient reported instruments, currently available instruments do not offer a comprehensive set of resources to measure the effects of interventions to improve patient safety in primary care from a patient perspective. Future research in the field should prioritize (i) the evaluation of the performance of already available instruments and (ii) the development of new instruments that enable an comprehensive assessment of patient safety at general practices.
Topics: Humans; Patient Outcome Assessment; Patient Safety; Primary Health Care; Psychometrics; Reproducibility of Results
PubMed: 25192905
DOI: 10.1093/fampra/cmu052 -
BMJ Open Quality Dec 2022Long-term sustained improvement following implementation of hospital-wide quality and safety initiatives is not easily achieved. Comprehensive theoretical and practical...
BACKGROUND
Long-term sustained improvement following implementation of hospital-wide quality and safety initiatives is not easily achieved. Comprehensive theoretical and practical understanding of how gained improvements can be sustained to benefit safe and high-quality care is needed. This review aimed to identify enabling and hindering factors and their contributions to improvement sustainability from hospital-wide change to enhance patient safety and quality.
METHODS
A systematic scoping review method was used. Searched were peer-reviewed published records on PubMed, Scopus, World of Science, CINAHL, Health Business Elite, Health Policy Reference Centre and Cochrane Library and grey literature. Review inclusion criteria included contemporary (2010 and onwards), empirical factors to improvement sustainability evaluated after the active implementation, hospital(s) based in the western Organisation for Economic Co-operation and Development countries. Numerical and thematic analyses were undertaken.
RESULTS
17 peer-reviewed papers were reviewed. Improvement and implementation approaches were predominantly adopted to guide change. Less than 6 in 10 (53%) of reviewed papers included a guiding framework/model, none with a demonstrated focus on improvement sustainability. With an evaluation time point of 4.3 years on average, 62 factors to improvement sustainability were identified and emerged into three overarching themes: People, Process and Organisational Environment. These entailed, as subthemes, actors and their roles; planning, execution and maintenance of change; and internal contexts that enabled sustainability. Well-coordinated change delivery, customised local integration and continued change effort were three most critical elements. Mechanisms between identified factors emerged in the forms of Influence and Action towards sustained improvement.
CONCLUSIONS
The findings map contemporary empirical factors and their mechanisms towards change sustainability from a hospital-wide initiative to improve patient safety and quality. The identified factors and mechanisms extend current theoretical and empirical knowledgebases of sustaining improvement particularly with those beyond the active implementation. The provided conceptual framework offers an empirically evidenced and actionable guide to assist sustainable organisational change in hospital settings.
Topics: Humans; Patient Safety; Hospitals; Quality of Health Care; Quality Improvement; Health Policy
PubMed: 36549751
DOI: 10.1136/bmjoq-2022-002057 -
The Journal of the American Academy of... Dec 2021Overlapping surgery is defined as two cases occurring in separate operating rooms (ORs), where the same attending surgeon conducts the critical surgical portions of each... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
Overlapping surgery is defined as two cases occurring in separate operating rooms (ORs), where the same attending surgeon conducts the critical surgical portions of each case at different times. Although it has been suggested that this established practice may improve the utilization of resources, allow for more opportunities to teach surgical trainees, and facilitate timely access to care, there is still no consensus on its use in elective orthopaedic surgery, such as total joint arthroplasty (TJA).
METHODS
A systematic review and meta-analysis of the literature was done according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to identify articles investigating the use of overlapping and single operating room TJA. Relevant data, including surgical time, intraoperative complications, postoperative complications, mortality rate, revision rate, and readmission rate, were extracted and recorded.
RESULTS
Six articles were included (35,938 patients: 17,677 overlapping and 18,261 nonoverlapping). Overall revision rates were 1.2% and 1.1% for the overlapping and nonoverlapping cohorts, respectively (odds ratio [OR] = 1.19; 95% confidence interval [CI]: 0.93 to 1.53). The overall intraoperative complication rate was 1.6% for both cohorts (OR = 0.98; 95% CI: 0.79 to 1.23), and the overall postoperative orthopaedic complication rates were 2.0% and 1.95% within the overlapping and nonoverlapping OR cohorts, respectively (OR = 1.07; 95% CI: 0.89 to 1.29). The readmission rate was 4.6% in the overlapping group and 4.2% in the nonoverlapping group (OR = 0.88; 95% CI: 0.70 to 1.11). Two studies with comparable groups reported markedly increased surgical time in the overlapping group compared with the nonoverlapping group.
DISCUSSION
Overlapping surgery was found to be as safe as nonoverlapping surgery in patients undergoing TJA. Although overlapping TJA surgery is associated with satisfactory short-term revision rates, prolonged follow-up is required to further assess the medium-term and long-term outcomes of overlapping surgery compared with nonoverlapping surgery. Finally, although overlapping TJA surgery might be associated with increased OR time, this difference is not clinically relevant.
Topics: Arthroplasty; Arthroplasty, Replacement, Hip; Elective Surgical Procedures; Humans; Operative Time; Patient Safety; Postoperative Complications; Retrospective Studies
PubMed: 34874337
DOI: 10.5435/JAAOS-D-20-01130 -
Journal of Plastic, Reconstructive &... Nov 2022Improved patient safety (PS) in cosmetic breast surgery relies upon high-quality evidence. The objective of this study was to systematically review the existing evidence... (Review)
Review
BACKGROUND
Improved patient safety (PS) in cosmetic breast surgery relies upon high-quality evidence. The objective of this study was to systematically review the existing evidence for PS and quality improvement (QI) in cosmetic breast surgery.
METHODS
A systematic review of published plastic surgery literature from 1965 to 2021 was undertaken through a computerized search following PRISMA guidelines. Publication descriptors, methodological details, and overall results were extracted. Articles were assessed for methodological quality using either the MINORS, Cochrane ROB2, or AMSTAR 2 instrument depending on the type of study.
RESULTS
Sixty studies were included. Most studies were retrospective, and 43.3 percent were from the 3rd level of evidence. Overall, the scientific quality was moderate, with randomized controlled trials and non-comparative non-randomized studies generally being rated of higher quality. Studies investigating approaches to antisepsis (38.3 percent) in cosmetic breast surgery indicated conflicting opinions on prophylactic antibiotics. Studies focusing on risk factor assessment tools (8.3 percent) held possible utility in identifying high-risk patients for cosmetic surgery. Studies assessing anesthesia in cosmetic breast surgery (5 percent) demonstrated a significant benefit to tumescent local anesthesia. Drains for decreasing hematoma and seroma (8.3 percent) largely showed no benefit.
CONCLUSIONS
Overall, PS and QI studies were of moderate quality and investigated numerous interventions. Our review identified a need for additional studies to decrease infection and other breast implant morbidities, specifically breast implant-associated anaplastic large cell lymphoma and capsular contracture.
Topics: Humans; Female; Surgery, Plastic; Retrospective Studies; Patient Safety; Breast Implants; Breast Neoplasms
PubMed: 36123255
DOI: 10.1016/j.bjps.2022.06.099 -
Surgical Endoscopy Aug 2022Live Broadcast of Surgical Procedures (LBSP) has gained popularity in conferences and educational meetings in the past few decades. This is due to rapid advancement in... (Review)
Review
INTRODUCTION
Live Broadcast of Surgical Procedures (LBSP) has gained popularity in conferences and educational meetings in the past few decades. This is due to rapid advancement in both Minimally Invasive Surgery (MIS) that enable transmission of the entire operative field and transmission ease and technology to help broadcast the operation to a live audience. The aim of this study was to update the evidence with specific emphasis on the patient safety issues related to LBSP in MIS.
METHODS
A systematic review of the literature was performed using Medline, Embase and Pubmed using defined search terms related to LBSP in educational events across all surgical specialities, in accordance with the PRISMA guidelines. We also consolidated the prior guidelines and position statements on this topic. Outcomes included reports on the educational value of LBSP as well as patient safety outcomes and ethical issues that were captured by clinical outcomes.
RESULTS
A total 1230 abstracts were identified with 27 papers meeting the inclusion criteria (13 original articles and 14 position statements/guidelines). All studies highlighted the educational benefits of LBSP but without clear measure of these benefits. Clinical outcomes were not compromised in 9 studies but were inferior in the remaining 4, including lower completion rate of endoscopic surgery and higher rate of re-operation. Only nine studies complied with dedicated consent forms for LBSP with no consistent approach of reporting on maintaining patient confidentiality during LBSP. There was a lack of recommendation on standardised approach of reporting on LBSP including the outcomes across the 14 published guidelines and positions statements.
CONCLUSIONS
Live Broadcast of Surgical Procedures can be of educational value but patient safety may be compromised. A standardised framework of reporting on LBSP and its outcomes is required from an ethical and patient safety perspective.
PROSPERO REGISTRATION
CRD42021256901.
Topics: Humans; Minimally Invasive Surgical Procedures; Patient Safety
PubMed: 35604484
DOI: 10.1007/s00464-022-09072-6