International Journal for Quality in Health Care最新文献

Background: The second-victim phenomenon occurs when a healthcare provider experiences trauma after being profoundly affected by a negative medical event. As a work-related phenomenon, it may be influenced by sex and gender-related factors, particularly since women constitute 70% of the health and social sector workforce. This study aims to describe the impact of the second-victim phenomenon on male and female healthcare professionals, identifying differences in their experiences. It also identifies differences in the reactions and behavior of supervisors, colleagues, patients, and their relatives to errors made by male and female healthcare workers.

Methods: A scoping review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension guidelines. Comprehensive searches were performed in the electronic databases BDENF, ProQuest, PsycInfo, PubMed, Scopus, and Web of Science, without filters or time limits. Original articles in Portuguese, English, Spanish, or German that mentioned any aspects concerning differences between male and female healthcare workers in relation to the second-victim phenomenon were selected.

Results: Twenty-seven articles were included, most of which were cross-sectional studies from the USA, China, Germany, and Spain, conducted among physicians and nurses. The findings highlighted that women experienced more intense anxiety responses in the aftermath of severe adverse events than men. Male healthcare workers were more resistant to seeking support compared to their female counterparts. Gender-based discrimination against women was identified in both education and practice, further exacerbating the second victim syndrome experienced by female healthcare professionals.

Conclusion: Understanding male/female differences is essential for comprehending the second-victim phenomenon and designing effective measures to mitigate its impact. Women may be more psychologically affected by adverse events than men. They are judged more negatively than men after making an error and are more likely to seek help.

Background: With increasing job demands, structural reorganization, and lack of support, occupational stress and burnout is on the rise. These conditions can manifest in various manners that can have detrimental physical impacts such as insomnia, weight changes, and chronic fatigue. Additionally, there can be socio-emotional consequences such as strained relationships, increase in depression, and hopelessness. Within the healthcare industry, many studies have focused on physicians and nurses but have failed to investigate other healthcare providers.

Methods: This systematic review was conducted within emergency medical technician (EMT) and paramedic populations. Search terms included '(stress) AND (EMT OR paramedic) AND (manage*)' through the PubMed database. Associated title/abstract screening and subsequent full text review were completed through Covidence. Inclusion criteria for measurements included physiological indices of stress, questionnaires, and/or interviews.

Results: Themes of interest included physical and socioemotional impacts of occupational stress and coping strategies. For example, EMTs and paramedics suffer from higher levels of stress and insomnia than other medical professionals and the general public. Coping strategies such as increased substance use and talking to family/friends were common given the high prevalence of post-traumatic stress disorder and emotional exhaustion.

Conclusion: This systematic review revealed that occupational stress and burnout are highly prevalent among EMTs and paramedics. Given the severity of symptoms, it is imperative to design and implement programs to reduce burnout. Providing greater administrative support along with mindfulness-based interventions has shown to be effective in reducing burnout in the short term. While these interventions are not effective preventative measures, future studies must be done to better understand how organizations can recognize unique stressors of these occupations and provide greater support for their employees.

Introduction: The clinical impact of the implementation of rapid response teams (RRTs) remains controversial in the literature. Furthermore, data on the financial impact of this intervention remain scarce. Therefore, we aim to assess the impact of the implementation of a dedicated RRT on hospital mortality and hospital expenses of patients experiencing acute clinical deterioration requiring an unplanned intensive care unit (ICU) admission.

Methods: We conducted a retrospective single-centre cohort study of adult patients experiencing acute clinical deterioration requiring an unplanned ICU admission before and after the transition of the RRT leadership to a dedicated group on 1 June 2014. Admissions that occurred 30 days before and 30 days after were excluded because they included the training period of the team members. Therefore, the PRE group encompassed patients who required an unplanned ICU admission between 1 May 2012, and 30 April 2014, and the POST group included those admitted to the ICU between 1 July 2014, and 30 June 2016. Patients were matched by propensity score according to a calibration of 0.2 and at a 1:1 ratio using the nearest neighbour matching method. The primary outcome was in-hospital mortality, with secondary outcomes including ICU mortality, hospital and ICU length of stay, ICU readmission rate within 48 h, and hospital expenses.

Results: The study included 977 consecutive patients: 470 in the PRE group and 507 in the POST group. Following propensity score matching, 343 pairs (totalling 686 patients) were identified. Analyses revealed reductions in in-hospital mortality rate (34.7% PRE vs. 22.7% POST; odds ratio 0.590 [95% CI: 0.254-0.927], P < .001) and ICU mortality rate (19.5% PRE vs. 12.8% POST; odds ratio 0.501 [95% CI: 0.087-0.915]; P = .022). Decreases in hospital and ICU length of stay and use of ICU support measures were also observed, accompanied by a 23.2% reduction in hospital expenditure (P < .001).

Conclusion: Transitioning to a dedicated RRT was associated with reduced in-hospital mortality and hospital resource utilization. Future research in diverse settings and cost-effectiveness analyses are warranted to confirm these findings and explore the economic impacts of RRTs.

Background: Inpatient fall assessment and prevention efforts are primarily performed by nursing teams. Operating at high occupancy levels may, therefore, reduce the care team's ability to deliver these efforts in a timely and effective way. We investigated the associations of unit-level hospital occupancy with the rate of inpatient fall and the completion of patient fall-risk assessment.

Methods: We conducted a retrospective cohort study using data from a large teaching hospital network in Ontario, between 2017 and 2020. We used a multi-state semi-Markov model to represent the time from admission to inpatient care to primary outcomes of first inpatient fall, and completion of fall-risk assessment in the presence of other competing events. Unit-level occupancy was defined as the time-dependent maximum ratio of unit census to unit capacity and further categorized based on whether it was below or above a given threshold or "tipping point". We estimated the tipping point as well as the association between unit-level occupancy below and above the tipping point with the cause-specific hazard rate of each outcome, adjusting the estimates for confounders.

Results: The final cohort had 83 839 inpatient stays for the fall outcome and 83 853 inpatient stays for the fall-risk assessment outcome. Unit occupancy levels above the estimated tipping point of 95% were associated with an increased rate of falls [Hazard Ratio (HR): 2.10, 95% Confidence Interval (CI): 1.05-4.20], whereas occupancy levels above the estimated tipping point of 77% were associated with a decreased rate of completion of fall-risk assessment [HR: 0.87, 95% CI: 0.82-0.91].

Conclusions: Our study provides evidence for a significant increase in the rate of falls and decrease in the rate of assessment completion when occupancy levels exceed certain tipping points. The results motivate the design of safety protocols tailored for periods of high-capacity strain to support nursing teams and prioritize delivery of assessments and interventions to patients at high risk of fall.

Background: The quality and equitable accessibility of health services represent basic priorities for health systems. In Mexico, three quarters of patients with diabetes are treated at public health services shown to be heterogeneous as regards the quality of the health-care processes. This notwithstanding, no information has been published on the quality of care provided to patients with diabetes according to their socioeconomic characteristics and ethnicity. Accordingly, the objective of this study was to identify disparities in the quality of care provided to adults medically diagnosed with type 2 diabetes (T2D) according to their socioeconomic levels and ethnicity.

Methods: Cross-sectional analysis based on data drawn from the 2018-19 National Health and Nutrition Survey. Quality of care was assessed from the patients' perspective. Analysis included a nationally representative sample of 4555 adults aged ≥20 years, with diagnosis of diabetes, and a subsample of 1586 adults with Hb1Ac measurements. Two multiple linear regression models were fitted to assess the relationship between the overall quality of care provided vs. the socioeconomic levels and ethnicity of patients, adjusted for covariates.

Results: Nearly one-third of adults with diabetes belonged to low-socioeconomic levels, 7% were indigenous, 92% were ≥40 years old, and 50% had experienced diabetes-related complications. Respondents had been diagnosed with diabetes for 11 years on average. Patients of low-socioeconomic levels showed a higher frequency of complications and inadequate glycemic control than did those of higher levels. After adjusting for covariates, the quality of care received was poorer among T2D patients of low (-4.8 pp, 95% CI: -6.5, -3.0) and medium (-1.5 pp, 95% CI: -3.1, 0.1) socioeconomic levels compared to those in the high tier, and among indigenous (-2.7 pp, 95% CI -5.3, -0.1) vs. nonindigenous individuals.

Conclusions: Overall, adults with diabetes received poor-quality health care. Furthermore, disparities exist by socioeconomic level and ethnicity in the quality of care provided. It is essential to strengthen and renew health-care policies with a view to improving outpatient care for individuals with diabetes, one of the most prevalent chronic diseases in Mexico and around the world. It is vital that efforts to ensure the health and well-being of the most socially vulnerable populations be rooted in an equity approach.