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Gastroenterology May 2018
Review
Topics: Curriculum; Education, Medical, Graduate; Gastroenterology; Humans; Internship and Residency; Models, Educational; Patient Safety; Program Development; Quality Improvement
PubMed: 29604243
DOI: 10.1053/j.gastro.2018.03.044 -
BMJ Open Quality Sep 2020In the USA over 30% of medication errors occur at the point of administration. Among non-surgical patients in US hospitals exposed to opioids, 0.6% experience a severe...
INTRODUCTION
In the USA over 30% of medication errors occur at the point of administration. Among non-surgical patients in US hospitals exposed to opioids, 0.6% experience a severe opioid-related adverse event. In September 2018, Sierra View Medical Center identified two areas of opportunity for quality improvement: bedside bar code medication administration (BCMA) and pain reassessments. At baseline (April 2018 to September 2018) only 81% of medications were scanned prior to administration with pain reassessments completed only 41% of the time 1 hour postopioid administration.
OBJECTIVE
To improve BCMA scanning rates (goal ≥95%) and pain reassessments within 1 hour postopioid administration (goal ≥90%).
METHODS
Implementation methods included data transparency, weekly dashboards, education and plan-do-study-act (PDSA) cycles informed by feedback from key stakeholders.
RESULTS
Following a series of PDSA cycle implementations, barcode medication administration (BCMA) scanning rates improved by 14% (from 81% to 95%) and pain reassessments improved by 50% (from 41% to 91%), sustained 17 months postproject implementation (October 2018 to February 2019). The number of adverse drug events (ADEs) related to administration errors decreased by 17% (estimated annual cost savings of $120 750-239 725 per year) and opioid-related ADEs decreased by 2.6% (estimated annual cost savings of $72 855-80 928 per year).
CONCLUSION
Adopting John Kotter's model for change, developing performance dashboards and sustaining engagement among stakeholders on a weekly basis improved bar code medication scanning rates and pain reassessment compliance. The stakeholders created momentum for change in both practice and culture resulting in improved patient safety with a favourable financial impact.
Topics: Electronic Data Processing; Hospitals, Community; Humans; Medication Errors; Medication Systems; Medication Systems, Hospital; Pain Measurement; Patient Safety
PubMed: 32958472
DOI: 10.1136/bmjoq-2020-000987 -
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 -
JAMA Feb 2017
Topics: Health Services Misuse; Humans; Patient Safety
PubMed: 28245304
DOI: 10.1001/jama.2017.0896 -
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 -
Lakartidningen Jan 2020Knowledge about safety in complex systems are growing and health care is a complex system that is both developing and under pressure. Therefore, patient safety work also...
Knowledge about safety in complex systems are growing and health care is a complex system that is both developing and under pressure. Therefore, patient safety work also has to develop. Basic conditions for safe performance are important: management that values safety, good working conditions, safety culture, adequate staffing and competence, and equipment that facilitates safe practice. Patients and relatives can play a more active role in patient safety work. Safety-II is a valuable new approach to patient safety. The Swedish National Board of Health and Welfare now launches a national action plan for patient safety that addresses these challenges and opportunities.
Topics: Delivery of Health Care; Humans; Patient Safety; Safety Management; Sweden
PubMed: 32016922
DOI: No ID Found -
Journal of Patient Safety Mar 2021Existing patient safety culture assessment tools are mostly developed in western countries and may not be suitable for Chinese primary health care institutions. Primary...
BACKGROUND
Existing patient safety culture assessment tools are mostly developed in western countries and may not be suitable for Chinese primary health care institutions. Primary care plays an important role in China's medical system, and a targeted tool for its patient safety culture is urgently needed.
OBJECTIVE
The aim of the study was to develop a dependable instrument to assess the patient safety culture in Chinese primary health care institutions.
METHODS
Three phases were undertaken to develop the scale. The first phase developed a pilot scale by literature review, focus groups, and 2-round Delphi expert consultation. The second phase conducted a pilot survey. The third phase carried out a formal survey to test reliability and validity, involving 369 participants from 9 primary health care institutions.
RESULTS
The final scale included 32 items under 7 dimensions. For reliability, the Cronbach α coefficients among dimensions varied from 0.754 to 0.926, and the Cronbach α for the scale was 0.940. For content validity, the corrected item-level content validity varied between 0.64 and 1, the scale-level content validity index/universal agreement was 0.625, and the scale-level content validity index/average was 0.93. For construct validity, the Spearman correlations of dimension-total score varied between 0.129 and 0.851, all Spearman correlations of the dimension-total score were greater than that of interdimensions and the Spearman correlations of item-total score ranged from 0.042 to 0.775. The results of the confirmatory factor analysis indicated that the model fitted well.
CONCLUSIONS
The Patient Safety Culture Scale for Chinese primary health care institutions demonstrated good reliability and acceptable validity; thus, it can be used as an assessment instrument for patient safety culture in Chinese primary health care institutions.
Topics: China; Humans; Patient Safety; Primary Health Care; Psychometrics; Reproducibility of Results; Safety Management; Surveys and Questionnaires
PubMed: 32404850
DOI: 10.1097/PTS.0000000000000733 -
Journal of the American Society of... 2022Patient safety and quality improvement initiatives are integral parts of every cytopathology laboratory. The need to revisit our approaches to patient safety are... (Review)
Review
Patient safety and quality improvement initiatives are integral parts of every cytopathology laboratory. The need to revisit our approaches to patient safety are essential in light of the expanding test menu, ancillary studies, comprehensive diagnostic reports, and emergence of new technologies for augmenting cytologic diagnosis. Our interview with Drs. Yael Heher, Adam Seegmiller, and Paul VanderLaan explores recent developments that have shaped their perspectives in patient safety, test usage, and laboratory quality. The practical strategies presented provide tools for enhanced patient safety and improved outcomes in a new era of ancillary and molecular testing and standardized reporting in the cytopathology laboratory.
Topics: Humans; Laboratories; Patient Safety; Quality Improvement
PubMed: 34996748
DOI: 10.1016/j.jasc.2021.12.001 -
Revista Brasileira de Enfermagem 2018To measure the response time of health professionals before sound alarm activation and the implications for patient safety. (Observational Study)
Observational Study
OBJECTIVE
To measure the response time of health professionals before sound alarm activation and the implications for patient safety.
METHOD
This is a quantitative and observational research conducted in an Adult Intensive Care Unit of a teaching hospital. Three researchers conducted non-participant observations for seven hours. Data collection occurred simultaneously in 20 beds during the morning shift. When listening the alarm activation, the researchers turned on the stopwatches and recorded the motive, the response time and the professional conduct. During collection, the unit had 90% of beds occupied and teams were complete.
RESULT
We verified that from the 103 equipment activated, 66.03% of alarms fatigued. Nursing was the professional category that most provided care (31.06%) and the multi-parameter monitor was the device that alarmed the most (66.09%).
CONCLUSION
Results corroborate the absence or delay of the response of teams, suggesting that relevant alarms might have been underestimated, compromising patient safety.
Topics: Auditory Fatigue; Brazil; Clinical Alarms; Humans; Intensive Care Units; Length of Stay; Monitoring, Physiologic; Patient Safety; Time Factors
PubMed: 30517409
DOI: 10.1590/0034-7167-2017-0481 -
BMC Health Services Research May 2024Strong cultures of workplace safety and patient safety are both critical for advancing safety in healthcare and eliminating harm to both the healthcare workforce and...
BACKGROUND
Strong cultures of workplace safety and patient safety are both critical for advancing safety in healthcare and eliminating harm to both the healthcare workforce and patients. However, there is currently minimal published empirical evidence about the relationship between the perceptions of providers and staff on workplace safety culture and patient safety culture.
METHODS
This study examined cross-sectional relationships between the core Surveys on Patient Safety Culture™ (SOPS®) Hospital Survey 2.0 patient safety culture measures and supplemental workplace safety culture measures. We used data from a pilot test in 2021 of the Workplace Safety Supplemental Item Set, which consisted of 6,684 respondents from 28 hospitals in 16 states. We performed multiple regressions to examine the relationships between the 11 patient safety culture measures and the 10 workplace safety culture measures.
RESULTS
Sixty-nine (69) of 110 associations were statistically significant (mean standardized β = 0.5; 0.58 < standardized β < 0.95). The largest number of associations for the workplace safety culture measures with the patient safety culture measures were: (1) overall support from hospital leaders to ensure workplace safety; (2) being able to report workplace safety problems without negative consequences; and, (3) overall rating on workplace safety. The two associations with the strongest magnitude were between the overall rating on workplace safety and hospital management support for patient safety (standardized β = 0.95) and hospital management support for workplace safety and hospital management support for patient safety (standardized β = 0.93).
CONCLUSIONS
Study results provide evidence that workplace safety culture and patient safety culture are fundamentally linked and both are vital to a strong and healthy culture of safety.
Topics: Humans; Patient Safety; Organizational Culture; Cross-Sectional Studies; Safety Management; Workplace; Surveys and Questionnaires; Female; Male; United States; Hospitals; Adult; Attitude of Health Personnel
PubMed: 38698405
DOI: 10.1186/s12913-024-10984-3