Journal of Healthcare Quality Research最新文献

Introduction: Surgery is a fundamental component of healthcare, with over 300 million procedures performed annually. At least half of adverse events are considered preventable through tools such as the Surgical Safety Checklist (SSC). However, adherence to the SSC is often incomplete. Simulation-based training offers a meaningful learning methodology that can effectively improve compliance. This study aims to evaluate the use of simulation as a strategy to increase SSC adherence at our hospital.

Methods: We conducted a retrospective, quasi-experimental quantitative intervention study, analyzing pre- and post-simulation data collected between the second half of 2021 and the second half of 2023. The target population included operating room healthcare professionals, and the SSC endorsed by the WHO was used. Clinical simulations were carried out that had been previously designed to imitate real situations in operating rooms with natural equipment and their respective post-debriefings as guided reflection for learning.

Results: Simulation participation rates by department were as follows: 40% for Anesthesiology, 55.5% for Surgery, 75% for Orthopedics, and 76.5% for surgical nurses. The impact of the intervention was assessed by retrospectively reviewing SSC compliance before and after the simulation training. The results showed a significant increase in SSC compliance at the entry phase and during the surgical pause (P=.000), while no significant change was observed at the surgical exit phase.

Conclusion: The findings suggest that implementing simulation-based interventions in the operating room can enhance compliance with the Surgical Safety Checklist, thereby contributing to improved patient safety.

Background: DC cardioversion (DCCV), when performed early, effectively restores sinus rhythm in patients with atrial fibrillation (AF). This audit aimed to evaluate the outcomes of patients undergoing DCCV at our institution and assess the factors predicting restoration of sinus rhythm.

Methods: This retrospective audit included patients who underwent elective DCCV in 2021 at our hospital. We excluded patients where data was incomplete. Data was collected from the electronic case records of the patients.

Results: Two hundred forty-three patients (mean age 67.5±11.7 years, 67.1% male) were included in the analysis. The median delay from DCCV decision was 265 (108-826) days. Patients who were initially managed with rate control (158 (65%) patients) had longer DCCV wait times compared to those where DCCV was considered as the first line treatment (308 vs. 114 days, p<0.001). DCCV was immediately successful in 232 (93.1%) patients, with 226 (91.5%) maintaining sinus rhythm at discharge, 120 (48.6%) at 6 months and 98 (39.7%) at one year. Fewer shocks predicted sinus rhythm maintenance at discharge, 6 months, and one year (p<0.001). Amiodarone continued post-DCCV also predicted maintenance of sinus rhythm at one year (p=0.01). No significant differences were found in demographics, risk factors, DCCV delay, or LA size between those who maintained sinus rhythm and those who reverted to AF.

Conclusion: At our institution, most patients experienced significant delays before elective cardioversion. Decision to perform DCCV should be taken early and not after an initial trial of rate control. In our patients, amiodarone helped maintain sinus rhythm after successful DCCV.

Background and objective: Float nurses are frequently assigned to unfamiliar settings where they must perform a wide range of tasks, often without prior orientation, specific training, or knowledge of local protocols and equipment. Given the widespread use of floating as a staffing strategy, it is essential to allocate resources that support their integration while prioritising patient safety. This study aimed to develop a self-administered Integration Checklist for float nurses, highlighting key aspects to address before delivering direct patient care.

Materials and methods: A three-phase approach was employed, integrating brainstorming sessions with nurses and patient safety experts alongside a literature review: (A) identification of key barriers encountered by float nurses; (B) critical analysis of literature-based solutions; and (C) development of the Integration Checklist.

Results: After identifying core challenges and reviewing solutions at the institutional-level, a practical Integration Checklist was created using a reverse approach to conventional orientation programmes. The tool comprised three sections: administrative, unit-specific, and patient care. Each section included targeted questions to ensure that float nurses were aware of the critical information relevant to each area before delivering care.

Conclusions: The implementation of a Safety Integration Checklist for float nurses has the potential to enhance the onboarding process into new units by optimising transition time, increasing professional confidence, and reducing staff-related stress. However, further research is needed to assess its practical value and effectiveness in improving both patient and staff outcomes across diverse clinical settings.