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BMJ Open Sep 2014To review the empirical literature to identify the activities, time spent and engagement of hospital managers in quality of care. (Review)
Review
OBJECTIVES
To review the empirical literature to identify the activities, time spent and engagement of hospital managers in quality of care.
DESIGN
A systematic review of the literature.
METHODS
A search was carried out on the databases MEDLINE, PSYCHINFO, EMBASE, HMIC. The search strategy covered three facets: management, quality of care and the hospital setting comprising medical subject headings and key terms. Reviewers screened 15,447 titles/abstracts and 423 full texts were checked against inclusion criteria. Data extraction and quality assessment were performed on 19 included articles.
RESULTS
The majority of studies were set in the USA and investigated Board/senior level management. The most common research designs were interviews and surveys on the perceptions of managerial quality and safety practices. Managerial activities comprised strategy, culture and data-centred activities, such as driving improvement culture and promotion of quality, strategy/goal setting and providing feedback. Significant positive associations with quality included compensation attached to quality, using quality improvement measures and having a Board quality committee. However, there is an inconsistency and inadequate employment of these conditions and actions across the sample hospitals.
CONCLUSIONS
There is some evidence that managers' time spent and work can influence quality and safety clinical outcomes, processes and performance. However, there is a dearth of empirical studies, further weakened by a lack of objective outcome measures and little examination of actual actions undertaken. We present a model to summarise the conditions and activities that affect quality performance.
Topics: Hospital Administrators; Hospitals; Humans; Patient Safety; Professional Role; Quality of Health Care
PubMed: 25192876
DOI: 10.1136/bmjopen-2014-005055 -
International Wound Journal Dec 2023In 2012 the European Medicines Agency approved a pineapple stem-derived Bromelain-based debridement concentrate of proteolytic enzymes (NexoBrid®, MediWound Ltd, Yavne,...
In 2012 the European Medicines Agency approved a pineapple stem-derived Bromelain-based debridement concentrate of proteolytic enzymes (NexoBrid®, MediWound Ltd, Yavne, Israel) for adult deep burns. Over 10 000 patients have been successfully treated with NexoBrid® globally, including in the US. The aim of our study is to perform a systematic review of the current literature on Nexobrid® outcomes. We conducted a literature search in PubMed, Google Scholar, Embase, and other search engines (2013-2023). The online screening process was performed by two independent reviewers with the Covidence tool. The protocol was reported using the Preferred Reporting Items for Systematic Review and Meta-Analyses, and it was registered at the International Prospective Register of Systematic Reviews of the National Institute for Health Research. We identified 103 relevant studies of which 34 were found eligible. The included studies report the positive effects of Nexobrid® on burn debridement, functional and cosmetic outcomes, scarring, and quality of life. Also, they validate the high patient satisfaction thanks to enhanced protocols of analgosedation and/or locoregional anaesthesia during Bromelain-based debridement. Two studies investigate potential risks (coagulopathy, burn wound infection) which concluded there is no strong evidence of these adverse events. NexoBrid® is a safe, selective, non-surgical eschar removal treatment modality. The benefits of Bromelain-based debridement are faster debridement and healing times, reduced operations, length of stay, cases of sepsis, blood transfusions, and prevention of compartment syndrome. Existing evidence suggests that the indications and the role of Bromelain-based debridement are expanding to cover "off-label" cases with significant benefits to the global healthcare economy.
Topics: Adult; Humans; Bromelains; Burns; Debridement; Patient Safety; Quality of Life; Systematic Reviews as Topic
PubMed: 37455553
DOI: 10.1111/iwj.14308 -
Journal of the American Medical... 2012To understand the complex effects of interruption in healthcare. (Review)
Review
OBJECTIVE
To understand the complex effects of interruption in healthcare.
MATERIALS AND METHODS
As interruptions have been well studied in other domains, the authors undertook a systematic review of experimental studies in psychology and human-computer interaction to identify the task types and variables influencing interruption effects.
RESULTS
63 studies were identified from 812 articles retrieved by systematic searches. On the basis of interruption profiles for generic tasks, it was found that clinical tasks can be distinguished into three broad types: procedural, problem-solving, and decision-making. Twelve experimental variables that influence interruption effects were identified. Of these, six are the most important, based on the number of studies and because of their centrality to interruption effects, including working memory load, interruption position, similarity, modality, handling strategies, and practice effect. The variables are explained by three main theoretical frameworks: the activation-based goal memory model, prospective memory, and multiple resource theory.
DISCUSSION
This review provides a useful starting point for a more comprehensive examination of interruptions potentially leading to an improved understanding about the impact of this phenomenon on patient safety and task efficiency. The authors provide some recommendations to counter interruption effects.
CONCLUSION
The effects of interruption are the outcome of a complex set of variables and should not be considered as uniformly predictable or bad. The task types, variables, and theories should help us better to identify which clinical tasks and contexts are most susceptible and assist in the design of information systems and processes that are resilient to interruption.
Topics: Attention; Ergonomics; Humans; Patient Safety; Psychology, Applied; User-Computer Interface
PubMed: 21946236
DOI: 10.1136/amiajnl-2010-000024 -
International Journal For Quality in... Sep 2016To determine whether clinical supervision (CS) of health professionals improves patient safety. (Meta-Analysis)
Meta-Analysis Review
PURPOSE
To determine whether clinical supervision (CS) of health professionals improves patient safety.
DATA SOURCES
Databases MEDLINE, PsychINFO, CINAHL, EMBASE and AMED were searched from earliest date available. Additional studies were identified by searching of reference lists and citation tracking.
STUDY SELECTION
Two reviewers independently applied inclusion and exclusion criteria. Thirty-two studies across three health professions [medicine (n = 29), nursing (n = 2) and paramedicine (n = 1)] were selected.
DATA EXTRACTION
The quality of each study was rated using the Medical Education Research Study Quality Instrument. Risk ratios (RR) were calculated for patient safety outcomes of mortality, complications, adverse events, reoperation following initial surgery, conversion to more invasive surgery and readmission to hospital.
RESULTS OF DATA SYNTHESIS
Results of meta-analyses provided low-quality evidence that supervision of medical professionals reduced the risk of mortality (RR 0.76, 95% CI 0.60-0.95, I(2) = 76%) and supervision of medical professionals and paramedics reduced the risk of complications (RR 0.69, 95% CI 0.53-0.89, I(2) = 76%). Due to a high level of statistical heterogeneity, sub-group analyses were performed. Sub-group analyses provided moderate-quality evidence that direct supervision of surgery significantly reduced the risk of mortality (RR 0.68, 95% CI 0.50-0.93, I(2) = 33%) and direct supervision of medical professionals conducting non-surgical invasive procedures significantly reduced the risk of complications (RR 0.33, 95% CI 0.24-0.46, I(2) = 0%).
CONCLUSIONS
CS was associated with safer surgery and other invasive procedures for medical practitioners. There was a lack of evidence about the relationship between CS and safer patient care for non-medical health professionals.
Topics: Health Personnel; Patient Safety; Quality Improvement
PubMed: 27283436
DOI: 10.1093/intqhc/mzw059 -
Journal of Patient Safety Mar 2021The aims of the study were to evaluate and to quantify the effects of patient and family involvement (PFI) interventions on patient safety by synthesizing the available... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
The aims of the study were to evaluate and to quantify the effects of patient and family involvement (PFI) interventions on patient safety by synthesizing the available global data.
METHODS
Four databases were searched to identify relevant studies that have assessed the impact of PFI on patient safety up to March 2019. Reference lists of potential selected articles were also used to identify additional relevant studies. Effect sizes (ESs) were calculated using random and fixed effects models. Statistical heterogeneity was measured using the I2 test.
RESULTS
Twenty-two studies met the review criteria. The meta-analysis showed that PFI were beneficial in significantly reducing adverse events (ES = -0.240, P < 0.001), decreasing the length of hospital stay (ES = -0.122, P < 0.001), increasing patient safety experiences (ES = 0.630, P = 0.007), and improving patient satisfaction (ES = 0.268, P = 0.004). However, the PFI interventions did not significantly enhance the perception of patient safety (ES = 0.205, P = 0.09) or the quality of life (ES = 0.057, P = 0.61). Moreover, moderate-to-high heterogeneity was found for all impacts except adverse events (I2 = 0%) and length of hospital stay (I2 = 35%). A funnel plot indicated a low degree of publication bias for the adverse event outcome.
CONCLUSIONS
The synthesized evidence in this review demonstrates the benefits of PFI for promoting patient safety. However, further studies should extend the research scope to fill the existing gaps for both the type of PFI interventions and the patient safety outcomes.
Topics: Adult; Humans; Middle Aged; Patient Safety; Prospective Studies; Quality of Life; Young Adult
PubMed: 33208637
DOI: 10.1097/PTS.0000000000000714 -
Journal of Pediatric Surgery Mar 2017Adult surgical patient safety literature is plentiful; however, there is a disproportionate paucity of published safety work in the children's surgical literature. We... (Review)
Review
BACKGROUND
Adult surgical patient safety literature is plentiful; however, there is a disproportionate paucity of published safety work in the children's surgical literature. We sought to systematically evaluate the nature and quality of patient safety evidence pertaining to pediatric surgical practice.
METHODS
Systematic search of MEDLINE and EMBASE databases and gray literature identified 1399 articles. Data pertaining to demographics, methodology, interventions, and outcomes were extracted. Study quality was assessed utilizing formal criteria.
RESULTS
20 studies were included. 14 (70%) comprised peer-reviewed articles. 18 (90%) were published in the last 4years. 13 (65%) described a novel intervention, and 7 (35%) described a modification of an existing intervention. Median patient sample size was 79 (29-1210). A large number (n=55) and variety (n=35) of measures were employed to evaluate the effect of interventions on patient safety. 15 (75%) studies utilized a checklist tool as a component of their intervention. 9 (45%) studies [comprising handoff tools (n=7); checklists (n=1); and multidimensional quality improvement initiatives (n=1)] reported a positive effect on patient safety. Quality assessment was undertaken on 14 studies. Quantitative studies had significantly higher quality scores than qualitative studies (61 [0-89] vs 44 [11-78], p=0.03).
CONCLUSIONS
Pediatric surgical patient safety evidence is in its early stages. Successful interventions that we identified were typically handoff tools. There now ought to be an onus on pediatric surgeons to develop and apply bespoke pediatric surgical safety interventions and generate an evidence base to parallel the adult literature.
LEVEL OF EVIDENCE
Level IV, Case series with no comparison group.
Topics: Checklist; Evidence-Based Medicine; Humans; Patient Safety; Pediatrics; Qualitative Research; Quality Improvement; Specialties, Surgical
PubMed: 27717565
DOI: 10.1016/j.jpedsurg.2016.09.058 -
Journal of Patient Safety Sep 2016Patient safety culture, described as shared values, attitudes and behavior of staff in a health-care organization, gained attention as a subject of study as it is... (Review)
Review
BACKGROUND
Patient safety culture, described as shared values, attitudes and behavior of staff in a health-care organization, gained attention as a subject of study as it is believed to be related to the impact of patient safety improvements. However, in primary care, it is yet unknown, which effect interventions have on the safety culture.
OBJECTIVES
To review literature on the use of interventions that effect patient safety culture in primary care.
METHODS
Searches were performed in PubMed, EMBASE, CINAHL, and PsychINFO on March 4, 2013. Terms defining safety culture were combined with terms identifying intervention and terms indicating primary care. Inclusion followed if the intervention effected patient safety culture, and effect measures were reported.
RESULTS
The search yielded 214 articles from which two were eligible for inclusion. Both studies were heterogeneous in their interventions and outcome; we present a qualitative summary. One study described the implementation of an electronic medical record system in general practices as part of patient safety improvements. The other study facilitated 2 workshops for general practices, one on risk management and another on significant event audit. Results showed signs of improvement, but the level of evidence was low because of the design and methodological problems.
CONCLUSIONS
These studies in general practice provide a first understanding of improvement strategies and their effect in primary care. As the level of evidence was low, no clear preference can be determined. Further research is needed to help practices make an informed choice for an intervention.
Topics: Humans; Organizational Culture; Patient Safety; Primary Health Care; Quality Improvement; Safety Management
PubMed: 24647271
DOI: 10.1097/PTS.0000000000000075 -
Nurse Education in Practice Feb 2023To synthesize and evaluate the cumulative effect of patient safety education intervention for health care professional staff in the hospital setting on their patient... (Meta-Analysis)
Meta-Analysis Review
AIM
To synthesize and evaluate the cumulative effect of patient safety education intervention for health care professional staff in the hospital setting on their patient safety culture.
BACKGROUND
Patient security Culture is an important factor in ensuring patient safety and it is recommended as one of the pillars of preventive strategies in the healthcare system.
DESIGN
Systematic review and meta-analysis were prospectively registered with PROSPERO.
METHODS
This review and meta-analysis were conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We searched PubMed, EMBASE, Ovid, CINAHL, Cochran Library, Web of Science and randomized control trial registration databases from January 1999 to February 2021. Studies on patient safety culture intervention were included. We assessed research quality using the jadad scale for RCTs and the Methodological Index for Non-Randomized Studies RESULTS: Sixteen studies with a total of 3438 participants in the intervention group and 3121 in the control group were included in the final analysis. The random-effect meta-analysis shows significant heterogeneity among studies that assessed patient safety culture as a mean percentage of positive responses or as a mean score of 1-5 scale. (I = 91% and 77%, respectively). Also, there was a significant difference between experimental and control group in the overall pooled effect of patient safety culture in the studies that used the mean percentage of positive response [Mean Difference = 5.24, 95% confidence interval (1.32, 9.16, Z = 2.62; P = 0.009] or the mean score [Mean Difference = 0.08, 95% confidence interval (0.01, 0.15), Z = 2.26; P = 0.02]. The difference was no longer significant in the mean score studies after excluding the studies with low-quality scores. Subgroup analysis showed no change in the pooled effect of the studies with quasi-experimental [Mean Difference = 7.84, 95% confidence interval (2.35, 13.33); Z = 2.80; p = 0.005) or before-after design [MD= 0.11, 95% confidence interval (0.07, 0.14); Z = 5.74; p = 0.000]. However, the patient safety education intervention remained effective after one year of follow-up.
CONCLUSIONS
Our review Provides empirical evidence on current efforts in patient safety education to improve a healthcare professional-patient safety culture. The Patient safety education program could improve the patient safety culture of health care professionals.
Topics: Humans; Patient Safety; Health Personnel; Hospitals; Safety Management
PubMed: 36731258
DOI: 10.1016/j.nepr.2023.103565 -
Ciencia & Saude Coletiva May 2022Patient safety in health care is the cornerstone of quality in nursing care. It is a duty of nurses and an objective of the health organizations. This article aims to...
Patient safety in health care is the cornerstone of quality in nursing care. It is a duty of nurses and an objective of the health organizations. This article aims to analyze the scientific evidence on the nurses' perception and opinion on patient safety in the emergency department. Systematic literature review with 3 steps. 1) Primary search at CINHAL and MEDLINE. 2) A broader search, using the same keywords and search terms in the remaining database of the EBSCOHost platform. 3) Search the bibliographic references of the selected articles. The selected studies were published between 2014 and 2019. Five articles were selected. The nurses' perception reveal that the work environment, teamwork and matters related to the leadership of hierarchical superiors are fundamental factors to improve the quality of care provided and patient safety. Promoting teamwork improves patient care, reduces adverse events and improves quality. Recognizing the nurses' perception on patient safety culture in emergency services, contributes to improving the quality of care provided.
Topics: Emergency Service, Hospital; Hospitals; Humans; Inpatients; Patient Safety; Workplace
PubMed: 35544810
DOI: 10.1590/1413-81232022275.22742021 -
BMJ Open Aug 2016Record review is the most used method to quantify patient safety. We systematically reviewed the reliability and validity of adverse event detection with record review. (Review)
Review
OBJECTIVES
Record review is the most used method to quantify patient safety. We systematically reviewed the reliability and validity of adverse event detection with record review.
DESIGN
A systematic review of the literature.
METHODS
We searched PubMed, EMBASE, CINAHL, PsycINFO and the Cochrane Library and from their inception through February 2015. We included all studies that aimed to describe the reliability and/or validity of record review. Two reviewers conducted data extraction. We pooled κ values (κ) and analysed the differences in subgroups according to number of reviewers, reviewer experience and training level, adjusted for the prevalence of adverse events.
RESULTS
In 25 studies, the psychometric data of the Global Trigger Tool (GTT) and the Harvard Medical Practice Study (HMPS) were reported and 24 studies were included for statistical pooling. The inter-rater reliability of the GTT and HMPS showed a pooled κ of 0.65 and 0.55, respectively. The inter-rater agreement was statistically significantly higher when the group of reviewers within a study consisted of a maximum five reviewers. We found no studies reporting on the validity of the GTT and HMPS.
CONCLUSIONS
The reliability of record review is moderate to substantial and improved when a small group of reviewers carried out record review. The validity of the record review method has never been evaluated, while clinical data registries, autopsy or direct observations of patient care are potential reference methods that can be used to test concurrent validity.
Topics: Analysis of Variance; Humans; Medical Errors; Medical Records; Observer Variation; Patient Safety; Safety Management
PubMed: 27550650
DOI: 10.1136/bmjopen-2016-011078