International Journal for Quality in Health Care最新文献

Background: Routine clinical debriefings (RCDs) have been shown to improve communication, team reflexivity, and safety in clinical settings. When combined with incident reports (IRs), RCDs offer a potential tool for enhancing quality improvement frameworks. This study aimed to identify and compare healthcare safety-related information captured through RCDs and IRs in a Belgian emergency department operating across two distinct facilities.

Methods: This study employed a quasi-mixed-method design with a monostrand conversion approach. Information was collected from 90 RCDs and 263 IRs. Data were analyzed using two frameworks: the World Health Organization's Incident Report Classification Grid and the Debriefing and Organizational Lessons Learned Grid.

Results: The findings revealed significant differences in the types of information captured by RCDs and IRs. RCDs predominantly highlighted teamwork, internal organization, and procedural issues, while IRs focused more on care processes, patient concerns, and patient flow. These complementary insights demonstrate the value of integrating RCDs and IRs to create a comprehensive understanding of patient and clinician safety.

Conclusions: This study highlights the complementary nature of RCDs and IRs in addressing healthcare safety. RCDs foster team reflexivity and promote open discussions about systemic challenges, directly improving team cohesion, resilience, and learning. Combining RCDs and IRs provides actionable insights for enhancing safety and driving organizational improvements.

Background: Various health screenings are conducted in South Korea, including state-supported national health screenings, privately funded comprehensive health screenings, and employment-related or industry-specific screenings. Given the various risks of patient safety incidents during the health screening process and the lack of studies of incidents in this environment, this study aimed to analyse the types and characteristics of reported patient safety incidents during health screenings, the distribution of harm, and the impact of the incident types on harm.

Methods: We analysed patient safety incidents reported to the Korean Institute for Healthcare Accreditation (2017-22) using the World Health Organization's framework for patient safety. We performed frequency analysis, chi-square tests, and binomial logistic regression analysis to identify the types and characteristics of reported patient safety incidents, the differences in the distribution of harm, and the impact of patient safety incident types on harm during health screenings.

Results: A total of 213 cases were included in the analysis. Over half of the patient safety incidents during health screenings resulted in harm to the patient, and examination-related incidents were the most frequent type of incident. Furthermore, reported patient safety incidents were more likely to occur during regular working hours, in the examination room, in hospitals with over 500 beds, and amongst patients in their 50s, with no significant differences in sex distribution. Significant differences were observed in the distribution of harm according to incident types (P <.001) and patient age (P =.023). Controlling for patient and incident characteristics, the incident type was a determinant of harm. Amongst the incident types, medication/drug administration [adjusted odds ratio (aOR) = 29.730, 95% confidence interval (CI) = 6.081, 145.368], anaesthesia/sedation/treatments and procedures (aOR = 5.121, 95% CI = 1.002, 26.178), falls (aOR = 4.903, 95% CI = 2.022, 11.890), infections/injuries (aOR = 11.898, 95% CI = 1.082, 130.839), and other types of incidents (aOR = 8.719, 95% CI = 2.602, 29.212) increased the probability of harm compared to examination-related incidents.

Conclusion: This study underscores the critical need to manage high-risk patient safety incidents and implement systemic harm reduction strategies during health screenings. Encouraging the reporting of incidents, including near misses, alongside developing targeted interventions, is essential for enhancing patient safety. Future research should leverage larger datasets, consistent classification systems, and standardized data collection to generalize findings and advance prevention strategies, thereby improving the quality and safety of health screening services.

Background: The COVID-19 pandemic significantly affected global healthcare systems, revealing their resilience to crises. Despite this, national-level research on its impact across key healthcare domains-such as acute and chronic disease management, cancer screening and care, mental health, and palliative care-is scarce. This study examines the pandemic's impact on contacts, quality of care, and social disparity in these healthcare domains to guide better preparedness for future health emergencies.

Methods: The study utilized data from the Danish National Clinical Quality Registries, covering January 2015 to June 2022, to create a nationwide cohort for comparing healthcare metrics across the pandemic's phases and the prepandemic period. Healthcare contacts were assessed through descriptive analyses, while the quality of care and social disparities were analysed using multivariable regression models, providing estimated prevalence ratios and 95% confidence intervals.

Results: The first wave of the COVID-19 pandemic in Denmark led to community and healthcare lockdowns, which were associated with fewer hospital contacts and reduced participation in national cancer screening programs. However, a gradual recovery towards prepandemic levels was found, with the exceptions of chronic obstructive pulmonary disease contacts and colorectal cancer incidence. Overall, the quality of care across various healthcare domains in Denmark remained largely unchanged or improved slightly during the pandemic. However, social disparities in contacts were increased across all examined healthcare domains, with patients who were immigrants, living alone, had limited educational level or low income experiencing reduced contact compared to the prepandemic period.

Conclusions: Overall, the Danish healthcare system appeared to be resilient and largely unaffected throughout the pandemic, and the quality of care in several healthcare domains remained high. Nevertheless, the increasing social disparities in healthcare contacts during the pandemic demands attention. In preparing for future health crises, it is important to address and mitigate potential social inequalities, focusing on achieving equity in healthcare.

Background: Medication administration in busy emergency departments (EDs) presents significant challenges due to the high-pressure environment and complexity of processes. Medication administration errors (MAEs) are a critical concern as they can severely impact patient safety and increase healthcare costs. Understanding the prevalence and underlying factors contributing to intravenous MAEs is essential for enhancing patient care and improving hospital services. This study aims to explore and measure the frequency of intravenous MAEs in EDs and identify factors contributing to these errors during their preparation and administration.

Methods: This prospective study utilized the direct observation technique where the preparation and administration of 222 intravenous medications were observed in the EDs of two hospitals in Malaysia. Information on medication preparation, administration, and other procedures was recorded. Error rates were calculated, and multivariable logistic regression was conducted to identify factors contributing to intravenous MAEs.

Results: MAEs were detected in 83.3% (185/222) of the observed medications affecting 86.7% (124/143) patients. Among these, a total of 240 MAEs were identified, with the most common being wrong rate of administration (55.8%), wrong preparation technique (20.8%), and omission error (11.7%). Alimentary tract and metabolism medications accounted for the highest proportion of MAEs (52.0%), followed by anti-infective medications (21.7%) and nervous system medications (15.4%). Excluding wrong time errors reduced the error rate to 80.2% (178/222). Nonverbal orders and inadequate or absence of labelling were significantly associated with MAEs, while factors such as the complexity of preparations, working shift, experience, and high-alert medications showed no significant associations.

Conclusion: The study highlighted a high prevalence of intravenous MAEs in EDs. Nonverbal orders and inadequacy in labelling of medications were significant contributing factors to MAEs in the ED. Implementing an admixture labelling policy, comprehensive training programmes, strict enforcement of existing guidelines and protocols through regular audits, establishing nonpunitive error reporting system, and technological solutions where financially feasible are crucial for mitigating these errors to promote patient safety.

Background: To determine methods of FOBT de-implementation in acute care practice while summarizing the reasons and contraindications for inappropriate FOBT in acute care settings. Fecal occult blood testing is valuable for colorectal cancer screening in ambulatory settings but is not valuable for diagnostics in acute care with consistent indications for discontinuation as a tradition-based practice.

Methods: We included all English language prospective and retrospective evaluation studies of FOBT use in acute care settings with or without de-implementation interventions and published as original research articles in peer-reviewed journals. A meta-analysis of FOBT positivity was conducted using a random effects model. Quality was assessed using Critical Appraisals Skills Programme criteria.

Results: Of 2471 abstract/titles screened, 157 full-text articles were reviewed, and 22 articles met inclusion criteria of measuring prevalence or de-implementation of FOBT use in acute care settings. All 22 studies evaluated either FOBT use or de-implementation. Twenty articles reported FOBT positivity, with some illustrating that FOBT results were inconsequential to subsequent endoscopy decisions (n = 7, 32%). The included studies represent a publication date range spanning 32 years, with limited documentation of de-implementation strategies. Four published studies described system-level disinvestment to administratively eliminate access to inpatient FOBT orders.

Conclusion: Overall, all studies endorse that the use of FOBTs in acute care settings results in increased workload and/or cost without diagnostic benefit. Critical appraisal of low-value tradition-based practices such as FOBT use in acute care settings are essential for deploying deliberate and effective de-implementation strategies.

Background: Medications are a major cause of harm to patients in hospitals, and several studies have found that they cause approximately 20% of injuries that occur in medical institutions. It was found that the rate of adverse drug events (ADEs) in pediatric hospitalizations ranges from 11 to 40 events per 100 hospitalizations and 1% of cases caused death.

Objectives: This is a comparative and retrospective study. The overarching objective is to adapt the Pediatric Trigger Tool (PTT) of the "Child Health Corporation of America" to pediatric wards in Israel, with the intention of using it to assess the rate of adverse events that occur during medication given in pediatric wards. The study characterized ADEs and examined the ability of the PTT to identify ADEs in relation to those that were voluntarily reported by the staff.

Method: This study included internal and surgical pediatric wards at an academic pediatric medical center. The PTT was validated on medical record data from 700 hospitalizations between the years 2015 and 2017. The study also determined, among other things: the stage of drug administration at which the events occurred, the percentage of all events that could have been prevented, the degrees of damage the ADE caused and more.

Results: The Positive Predictive Value of the customized tool stands at 16.91%. The study found 108 ADEs in 78 hospitalizations. The ADE rate per 100 hospitalizations was 15.4, the ADE rate per 1000 drug doses was 3.9, and the ADE rate per 1000 hospitalization days was 22.8, of which 18.5% were preventable. The category of drugs that led to the highest number of ADEs was painkillers. Those ADEs led to a large number of adverse clinical effects: constipation, hypokalemia, vomiting, and rash. The most common reason for coming to the hospital was suspicion or treatment of a hematologic disease, followed by hospitalization due to a burn. The customized tool found 10.8 times more ADEs than those reported voluntarily-subjectively by the clinical staff.

Conclusions: The study found that, properly adapted, the PTT tool can be used to detect ADEs in internal and surgical pediatric wards.

Introduction: Enhancing patient safety and minimizing medical errors are crucial in healthcare. While Root Cause Analysis (RCA) is commonly used to investigate adverse events, its lack of human factors integration limit its effectiveness. The Human Factors Analysis and Classification System (HFACS), adapted from aviation to healthcare, systematically identifies human and organizational factors. However, the integration of HFACS into RCA and the impact of HFACS-RCA implementation remain underexplored. Therefore, this study aims to: provide a practical case of HFACS integration into RCA and explore the effects of HFACS-RCA implementation.

Methodology: This study integrates HFACS into the RCA process at a medical center in Taiwan, examining an incident involving unsterilized instruments distributed from the Central Sterile Supply Room (CSR) to the ICU. This study employed a before-and-after study design to examine the impact of the HFACS-RCA intervention. The primary outcome measures were the changes in scores across the eight dimensions of the Taiwan Patient Safety Culture Survey (TPSC) before and after the intervention.

Results: A one-year follow-up of the CSR case showed no similar incidents. HFACS-RCA significantly improved TPSC scores in unit safety climate (p=0.05), feelings towards management (p=0.05), and job satisfaction (p=0.05), while the other dimensions showed no significant changes.

Conclusion: HFACS-RCA application offers a comprehensive framework for identifying and mitigating factors contributing to medical errors, improving patient safety, and setting a precedent for future healthcare safety management research and practice.

Background: Stroke is globally one of the leading causes of mortality and disability. Adhering to evidence-based guidelines and protocols can improve quality of care for ischemic stroke patients. We aimed to compare the availability and content of specific protocols versus adherence to these key intervention in clinical daily practice among Flemish hospitals. We selected five key interventions for managing ischemic stroke patients. These key interventions encompassed the measurement of body temperature, glycaemia monitoring, screening of Swallowing function according to the Fever, Sugar and Swallowing protocol (FeSS protocol) and depression and Activities of Daily Living (ADL), (FeSS+ key-interventions).

Methods: A systematic quantitative and qualitative approach was designed to analyse specific protocols from 24 hospitals. A predefined data extraction matrix for the five FeSS+ key interventions was utilized for data collection. Using this matrix, protocols were scored according to completeness of content, regarding the FeSS+ interventions. These scores were used to calculate a total protocol content score, i.e. a total score for the five FeSS+ interventions and an individual score for each key intervention separately, ranging between 0 and 1, per hospital. A score of zero indicates absence of the FeSS+ interventions in the protocols, while a score of one signifies complete coverage of these interventions. In addition, we assessed the correlation between the availability and content of these protocols in relation to the adherence to interventions documented for 30 patients per hospital.

Results: The mean total protocol content score was 0.40±0.20, ranging from 0.64±0.25 for glycaemia management to 0.1±0.28 for ADL screening. With regard to the individual FeSS+ key interventions, we identified a correlation between protocol characteristics and adherence for glycaemia (rs = 0.42, p = 0.04), depression screening (rs = 0.43, p = 0.04) and ADL screening (rs = 0.44, p = 0.03). Total FeSS+-protocol content also correlated with adherence (r = 0.6140, p = 0.0014).

Conclusion: Protocol characteristics for the FeSS+ key interventions were variable and rather limited, especially for ADL- and depression screening. The identified relationship between the content of protocols and adherence to interventions underscores the value of defining these activities in hospital documentation to improve stroke care.