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The Surgical Clinics of North America Feb 2021Implementation science is the study of the translation of evidence-based practices to real-world clinical environments. Implementation is measured with specific outcomes... (Review)
Review
Implementation science is the study of the translation of evidence-based practices to real-world clinical environments. Implementation is measured with specific outcomes including acceptability, adoption, appropriateness, feasibility, fidelity, penetration, sustainability, and implementation cost. There are defined frameworks and models that outline implementation strategies and assist researchers in identifying barriers and facilitators to achieve implementation and conduct implementation research using methods such as qualitative analysis, parallel group, pre-/postintervention, interrupted time series, and cluster or stepped-wedge randomized trials. Deimplementation is the study of how to remove ineffective or unnecessary practices from the clinical setting and is an equally important component of implementation science.
Topics: Humans; Implementation Science; Patient Safety; Surgical Procedures, Operative
PubMed: 33212082
DOI: 10.1016/j.suc.2020.09.009 -
Journal of Patient Safety Apr 2021Little is known about patient safety risks in outpatient surgery. Inpatient surgical adverse events (AEs) risk factors include patient- (e.g., advanced age), process-...
OBJECTIVES
Little is known about patient safety risks in outpatient surgery. Inpatient surgical adverse events (AEs) risk factors include patient- (e.g., advanced age), process- (e.g., inadequate preoperative assessment), or structure-related characteristics (e.g., low surgical volume); however, these factors may differ from outpatient care where surgeries are often elective and in younger/healthier patients. We undertook an exploratory qualitative research project to identify risk factors for AEs in outpatient surgery.
METHODS
We developed a conceptual framework of patient, process, and structure factors associated with surgical AEs on the basis of a literature review. This framework informed our semistructured interview guide with (1) open-ended questions about a specific outpatient AE that the participant experienced and (2) outpatient surgical patient safety risk factors in general. We interviewed nationwide Veterans Health Administration surgical staff. Results were coded on the basis of categories in the conceptual framework, and additional themes were identified using content analysis.
RESULTS
Fourteen providers representing diverse surgical roles participated. Ten reported witnessing an AE, and everyone provided input on risk factors in our conceptual framework. We did not find evidence that patient race/age, surgical technique, or surgical volume affected patient safety. Emerging factors included patient compliance, postoperative patient assessments/instruction, operating room equipment needs, and safety culture.
CONCLUSIONS
Surgical staff are familiar with AEs and patient safety problems in outpatient surgery. Our results show that processes of care undertaken by surgical providers, as opposed to immutable patient characteristics, may affect the occurrence of AEs. The factors we identified may facilitate more targeted research on outpatient surgical AEs.
Topics: Ambulatory Surgical Procedures; Humans; Outpatients; Patient Safety; Perception; Veterans Health
PubMed: 29112029
DOI: 10.1097/PTS.0000000000000311 -
Journal of Medical Radiation Sciences Sep 2017This editorial addresses the importance of incident reporting, checklists and a just culture to patient safety.
This editorial addresses the importance of incident reporting, checklists and a just culture to patient safety.
Topics: Delivery of Health Care; Humans; Medical Errors; Patient Safety
PubMed: 28879689
DOI: 10.1002/jmrs.241 -
BMJ Open Quality May 2024Patient safety is crucial in dentistry, yet it has received delayed recognition compared with other healthcare fields. This literature review assesses the current state... (Review)
Review
BACKGROUND
Patient safety is crucial in dentistry, yet it has received delayed recognition compared with other healthcare fields. This literature review assesses the current state of patient safety in dentistry, investigates the reasons for the delay, and offers recommendations for enhancing patient safety in dental practices, dental schools, and hospitals.
METHODS
The review incorporates a thorough analysis of existing literature on patient safety in dentistry. Various sources, including research articles, guidelines and reports, were reviewed to gather insights into patient safety definitions, challenges and best practices specific to dentistry.
RESULTS
The review underscores the importance of prioritising patient safety in dentistry at all levels of healthcare. It identifies key definitions and factors contributing to the delayed focus on patient safety in the field. Additionally, it emphasises the significance of establishing a patient safety culture and discusses approaches such as safety plans, incident management systems, blame-free cultures and ethical frameworks to enhance patient safety.
CONCLUSION
Patient safety is vital in dentistry to ensure high-quality care and patient well-being. The review emphasises the importance of prioritising patient safety in dental practices, dental schools and hospitals. Through the implementation of recommended strategies and best practices, dental organisations can cultivate a patient safety culture, enhance communication, mitigate risks and continually improve patient safety outcomes. The dissemination of knowledge and the active involvement of all stakeholders are crucial for promoting patient safety and establishing a safe dental healthcare system.
Topics: Humans; Patient Safety; Dentistry
PubMed: 38719522
DOI: 10.1136/bmjoq-2023-002502 -
GMS Journal For Medical Education 2019
Topics: Competency-Based Education; Humans; Interprofessional Relations; Patient Safety; Quality of Health Care
PubMed: 31211227
DOI: 10.3205/zma001240 -
MedEdPORTAL : the Journal of Teaching... Oct 2017Patient safety and quality improvement are essential components of modern medicine. The traditional model of graduate medical education does not lend itself well to...
INTRODUCTION
Patient safety and quality improvement are essential components of modern medicine. The traditional model of graduate medical education does not lend itself well to learning these disciplines. This curriculum encompasses these disciplines across multiple modalities and extends throughout residency.
METHODS
The curriculum includes introductory presentations suitable for naive audiences. Following these is a structured rotation that provides the opportunity both to experience in-depth self-directed learning and to practice skills involved in quality and safety. This rotation includes existing online courses published elsewhere, reflective writing exercises based on self-directed learning, and practice cases. Finally, residents lead a morbidity, mortality, and improvement conference where adverse events are identified and reviewed, specific interventions and outcome objectives are selected, and action teams are identified.
RESULTS
After two presentations on system issues and individual issues, responses to the prompt "This talk will aid in my professional development" were 4.75 and 4.59 out of 5, respectively. Eighty-three percent of residents agreed they had a better understanding of the concepts of patient safety and/or quality improvement than they did before the rotation. Audience members for the resident-led morbidity, mortality, and improvement conference agreed it would lead to a change in their own practice.
DISCUSSION
The contents of this longitudinal curriculum have been incorporated into the core requirements of our general pediatrics residency program and could reasonably be imported into any residency requiring a robust longitudinal experience in quality improvement and patient safety.
Topics: Curriculum; Education, Medical, Graduate; Humans; Internship and Residency; Patient Safety; Program Evaluation; Quality Improvement; Teaching
PubMed: 30800842
DOI: 10.15766/mep_2374-8265.10641 -
BMJ Quality & Safety Jul 2016Improving patient safety is at the forefront of policy and practice. While considerable progress has been made in understanding the frequency, causes and consequences of... (Review)
Review
IMPORTANCE
Improving patient safety is at the forefront of policy and practice. While considerable progress has been made in understanding the frequency, causes and consequences of error in hospitals, less is known about the safety of primary care.
OBJECTIVE
We investigated how often patient safety incidents occur in primary care and how often these were associated with patient harm.
EVIDENCE REVIEW
We searched 18 databases and contacted international experts to identify published and unpublished studies available between 1 January 1980 and 31 July 2014. Patient safety incidents of any type were eligible. Eligible studies were critically appraised using validated instruments and data were descriptively and narratively synthesised.
FINDINGS
Nine systematic reviews and 100 primary studies were included. Studies reported between <1 and 24 patient safety incidents per 100 consultations. The median from population-based record review studies was 2-3 incidents for every 100 consultations/records reviewed. It was estimated that around 4% of these incidents may be associated with severe harm, defined as significantly impacting on a patient's well-being, including long-term physical or psychological issues or death (range <1% to 44% of incidents). Incidents relating to diagnosis and prescribing were most likely to result in severe harm.
CONCLUSIONS AND RELEVANCE
Millions of people throughout the world use primary care services on any given day. This review suggests that safety incidents are relatively common, but most do not result in serious harm that reaches the patient. Diagnostic and prescribing incidents are the most likely to result in avoidable harm.
SYSTEMATIC REVIEW REGISTRATION
This systematic review is registered with the International Prospective Register of Systematic Reviews (PROSPERO CRD42012002304).
Topics: Humans; Medical Errors; Patient Safety; Primary Health Care
PubMed: 26715764
DOI: 10.1136/bmjqs-2015-004178 -
Gaceta Sanitaria 2019To evaluate differences between the need and degree of implementation of safe practices recommended for patient safety and to check the usefulness of traffic sign... (Comparative Study)
Comparative Study
OBJECTIVE
To evaluate differences between the need and degree of implementation of safe practices recommended for patient safety and to check the usefulness of traffic sign iconicity to promote their implementation.
METHOD
The study was developed in two stages: 1) review of safe practices recommended by different organizations and 2) a survey to assess the perceptions for the need and implementation of them and the usefulness of signs to improve their implementation. The sample consisted of professionals from Spain and Latin America working in healthcare settings and in the academic field related to patient safety.
RESULTS
365 questionnaires were collected. All safe practices included were considered necessary (mean and lower limit of confidence interval over 3 out of 5 points). However, in six of the patient safety practices evaluated the implementation was considered insufficient: illegible handwriting, medication reconciliation, standardization of communication systems, early warning systems, procedures performed or equipment used only by trained people, and compliance with patient preferences at the end of life. Improve compliance of with hand hygiene and barrier precautions to prevent infections, ensure the correct identification of patients and the use of checklists are the four practices in which more than 75% of respondents found a high degree of consensus on the usefulness of traffic sings to broaden their use.
CONCLUSION
The differences between perceived need and actual implementation in some safe practices indicate areas for improvement in patient safety. With this aim, the common language and the iconicity of traffic signs could constitute a simple instrument to improve compliance with safe practices for patient safety.
Topics: Guideline Adherence; Health Services Needs and Demand; Humans; Latin America; Patient Safety; Spain
PubMed: 29395125
DOI: 10.1016/j.gaceta.2017.11.003 -
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 -
BMJ Open Quality Apr 2023The implementation and continuous improvement of patient safety learning systems (PSLS) is a principal strategy for mitigating preventable harm to patients. Although...
BACKGROUND
The implementation and continuous improvement of patient safety learning systems (PSLS) is a principal strategy for mitigating preventable harm to patients. Although substantial efforts have sought to improve these systems, there is a need to more comprehensively understand critical success factors. This study aims to summarise the barriers and facilitators perceived by hospital staff and physicians to influence the reporting, analysis, learning and feedback within PSLS in hospitals.
METHODS
We performed a systematic review and meta-synthesis by searching MEDLINE (Ovid), EMBASE (Ovid), CINAHL, Scopus and Web of Science. We included English-language manuscripts of qualitative studies evaluating effectiveness of the PSLS and excluded studies evaluating specific individual adverse events, such as systems for tracking only medication side effects, for example. We followed the Joanna Briggs Institute methodology for qualitative systematic reviews.
RESULTS
We extracted data from 22 studies, after screening 2475 for inclusion/exclusion criteria. The included studies focused on reporting aspects of the PSLS, however, there were important barriers and facilitators across the analysis, learning and feedback phases. We identified the following barriers for effective use of PSLS: inadequate organisational support with shortage of resources, lack of training, weak safety culture, lack of accountability, defective policies, blame and a punitive environment, complex system, lack of experience and lack of feedback. We identified the following enabling factors: continuous training, a balance between accountability and responsibility, leaders as role models, anonymous reporting, user-friendly systems, well-structured analysis teams, tangible improvement.
CONCLUSION
Multiple barriers and facilitators to uptake of PSLS exist. These factors should be considered by decision makers seeking to enhance the impact of PSLS.
ETHICS AND DISSEMINATION
No formal ethical approval or consent were required as no primary data were collected.
Topics: Humans; Patient Safety; Learning
PubMed: 37012003
DOI: 10.1136/bmjoq-2022-002134