International Journal for Quality in Health Care最新文献

Patients continue to suffer from preventable harm and uneven quality outcomes. Reliable clinical outcomes depend on the quality of robust administrative systems and reliable support processes. Critically ill patient handoffs from the operating room (OR) to the intensive care unit (ICU) are known to be high-risk events. We describe a novel perspective on how risk factors associated with the process of patient handoff communication between the OR and the ICU can lead to flawed communication, degraded team awareness, medical errors, and increased patient harm. Data were collected from two semi-structured focus groups using a five-step risk management approach at a tertiary hospital in São Paulo, Brazil. We conducted a failure modes and effects analysis (FMEA) with multidisciplinary healthcare providers consisting of attending physicians, anesthesiologists, nurses, and physiotherapists involved in patient handoffs. We analyzed the results using a similitude analysis to evaluate the effectiveness of implementing this novel risk management approach. We identified the handoffs risks associated with patients, staff, institution, and potential financial risks. The FMEA identified 12 process failures and 36 causes that generated 12 consequences and pointed to robust needed preventive measures to mitigate handoff risks. The clinical teams reported that this approach allowed them to see the process more completely as a whole not only in their narrow silos, thus understanding the enablers and difficulties of the other team members and how this understanding can shed light on their mental models, actions, and the process reliability. Teams identified key steps in the OR to ICU handoff process that are prone to the highest hazards to patients, the hospital, and staff, and are currently targeted for process improvement. Evidence-driven recommendations intended for reducing the risks associated with patient handoffs are presented. Implementing a dynamic risk management, interdisciplinary approach was used to redesign the OR to ICU patient handoff approach around the patient's and clinician's needs. The risk management program helped healthcare providers identify handoff steps, highlighting risky handoff process failures, making it possible to identify actionable failures, consequences, and define preventative action plans for mitigating the risks to improve the quality and safety of patient handoffs.

Patients continue to suffer from preventable harm and uneven quality outcomes. Reliable clinical outcomes depend on the quality of robust administrative systems and reliable support processes. Critically ill patient handoffs from the operating room (OR) to the intensive care unit (ICU) are known to be high-risk events. We describe a novel perspective on how risk factors associated with the process of patient handoff communication between the OR and the ICU can lead to flawed communication, degraded team awareness, medical errors, and increased patient harm. Data were collected from two semi-structured focus groups using a five-step risk management approach at a tertiary hospital in São Paulo, Brazil. We conducted a failure modes and effects analysis (FMEA) with multidisciplinary healthcare providers consisting of attending physicians, anesthesiologists, nurses, and physiotherapists involved in patient handoffs. We analyzed the results using a similitude analysis to evaluate the effectiveness of implementing this novel risk management approach. We identified the handoffs risks associated with patients, staff, institution, and potential financial risks. The FMEA identified 12 process failures and 36 causes that generated 12 consequences and pointed to robust needed preventive measures to mitigate handoff risks. The clinical teams reported that this approach allowed them to see the process more completely as a whole not only in their narrow silos, thus understanding the enablers and difficulties of the other team members and how this understanding can shed light on their mental models, actions, and the process reliability. Teams identified key steps in the OR to ICU handoff process that are prone to the highest hazards to patients, the hospital, and staff, and are currently targeted for process improvement. Evidence-driven recommendations intended for reducing the risks associated with patient handoffs are presented. Implementing a dynamic risk management, interdisciplinary approach was used to redesign the OR to ICU patient handoff approach around the patient's and clinician's needs. The risk management program helped healthcare providers identify handoff steps, highlighting risky handoff process failures, making it possible to identify actionable failures, consequences, and define preventative action plans for mitigating the risks to improve the quality and safety of patient handoffs.

Lithuania ratified the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD) in 2010 and started deinstitutionalization in 2014. This reform covers segregated social care institutions where persons with mental health conditions, psychosocial, and/or intellectual disabilities live. It aims to move away from institutional care and towards community-based services. Mental healthcare services are also a part of the complex picture, undergoing its own reform since 2022. This study aims to assess the human rights conditions and standards of care in Lithuanian psychiatric and social care facilities in the context of deinstitutionalization. Data collection assessments were conducted in psychiatric hospitals and psychiatric units in general hospitals, segregated social care homes, and community-based group living homes. Independent experts collected data through documentation review, observation, and semistructured interviews with service users and staff. The study followed the World Health Organization's QualityRights Toolkit methodology. In all assessed facilities, regardless of their type, the human rights of service users are often undermined, especially the right to exercise legal capacity, personal liberty and security, freedom from seclusion and restraints, and the right to live independently and be included in the community. The study reveals shortcomings in the implementation of the UNCRPD and Lithuania's attempts at deinstitutionalization. It points to key practical gaps and areas, including the vital need for better collaboration between the social and mental healthcare systems. The Lithuanian government needs to address these issues to make reforms more effective, safeguard human rights, and ensure the quality of mental health and social care services.

Lithuania ratified the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD) in 2010 and started deinstitutionalization in 2014. This reform covers segregated social care institutions where persons with mental health conditions, psychosocial, and/or intellectual disabilities live. It aims to move away from institutional care and towards community-based services. Mental healthcare services are also a part of the complex picture, undergoing its own reform since 2022. This study aims to assess the human rights conditions and standards of care in Lithuanian psychiatric and social care facilities in the context of deinstitutionalization. Data collection assessments were conducted in psychiatric hospitals and psychiatric units in general hospitals, segregated social care homes, and community-based group living homes. Independent experts collected data through documentation review, observation, and semistructured interviews with service users and staff. The study followed the World Health Organization's QualityRights Toolkit methodology. In all assessed facilities, regardless of their type, the human rights of service users are often undermined, especially the right to exercise legal capacity, personal liberty and security, freedom from seclusion and restraints, and the right to live independently and be included in the community. The study reveals shortcomings in the implementation of the UNCRPD and Lithuania's attempts at deinstitutionalization. It points to key practical gaps and areas, including the vital need for better collaboration between the social and mental healthcare systems. The Lithuanian government needs to address these issues to make reforms more effective, safeguard human rights, and ensure the quality of mental health and social care services.

Background: Safety culture development is essential for patient safety in healthcare institution. Perceptions of patient safety and cultural changes are reflected in patient safety reports; however, they were rarely investigated. The aim of this study was to investigate the perception of physicians and to explore the development of safety culture using quantitative content analysis for patient safety reports.

Methods: A retrospective analysis of free descriptions of harmful patient safety reports submitted by physicians was performed. Natural language processing and text analysis were conducted using the "KH Coder." A co-occurrence analysis was performed in each period to identify and analyze the safety concepts. The study period was grouped into three for comparison.

Results: The patient safety reports from physicians were collected between April 2004 and March 2020. Of these, 3351 reports were harmful: 839 reports were included in period 1, 1016 reports in period 2, and 1496 reports in period 3. Natural language processing identified 316 307 words in the free descriptions of 3351 reports. We identified seven concepts from the cluster in co-occurrence analysis as follows: "explanation of adverse event to patients and families," "central venous catheter," "intraoperative procedure and injury," "minimally invasive surgery," "life-threatening events," "blood loss," and "medical emergency team and critical care." These seven concepts showed significant differences among the three periods, except for "blood loss." The "explanation of adverse event to patients and families" decreased in proportion from 11.3% to 8.8% (P < .05). The "central venous catheter" decreased from 17.3% to 11.3% (P < .01). Meanwhile, "minimally invasive surgeries" and "intraoperative procedures" increased from 3.9% to 12.9% (P < .01) and from 10.8% to 14.6% (P < .05), respectively. Focusing on patients' events, "life-threatening events" decreased from 13.0% to 8.1% (P < .01); however, "medical emergency teams and critical care" increased from 3.3% to 10.6% (P < .01).

Conclusion: Free description in patient safety reports is useful for evaluating the safety culture. Co-occurrence analysis revealed multiple concepts of physicians' perceptions. Quantitative content analysis revealed changes in perceptions and attitudes, and a disclosure policy of adverse events and the priority of patient care appeared with the development of safety culture.

Background: Safety culture development is essential for patient safety in healthcare institution. Perceptions of patient safety and cultural changes are reflected in patient safety reports; however, they were rarely investigated. The aim of this study was to investigate the perception of physicians and to explore the development of safety culture using quantitative content analysis for patient safety reports.

Methods: A retrospective analysis of free descriptions of harmful patient safety reports submitted by physicians was performed. Natural language processing and text analysis were conducted using the "KH Coder." A co-occurrence analysis was performed in each period to identify and analyze the safety concepts. The study period was grouped into three for comparison.

Results: The patient safety reports from physicians were collected between April 2004 and March 2020. Of these, 3351 reports were harmful: 839 reports were included in period 1, 1016 reports in period 2, and 1496 reports in period 3. Natural language processing identified 316 307 words in the free descriptions of 3351 reports. We identified seven concepts from the cluster in co-occurrence analysis as follows: "explanation of adverse event to patients and families," "central venous catheter," "intraoperative procedure and injury," "minimally invasive surgery," "life-threatening events," "blood loss," and "medical emergency team and critical care." These seven concepts showed significant differences among the three periods, except for "blood loss." The "explanation of adverse event to patients and families" decreased in proportion from 11.3% to 8.8% (P < .05). The "central venous catheter" decreased from 17.3% to 11.3% (P < .01). Meanwhile, "minimally invasive surgeries" and "intraoperative procedures" increased from 3.9% to 12.9% (P < .01) and from 10.8% to 14.6% (P < .05), respectively. Focusing on patients' events, "life-threatening events" decreased from 13.0% to 8.1% (P < .01); however, "medical emergency teams and critical care" increased from 3.3% to 10.6% (P < .01).

Conclusion: Free description in patient safety reports is useful for evaluating the safety culture. Co-occurrence analysis revealed multiple concepts of physicians' perceptions. Quantitative content analysis revealed changes in perceptions and attitudes, and a disclosure policy of adverse events and the priority of patient care appeared with the development of safety culture.