Journal of healthcare risk management : the journal of the American Society for Healthcare Risk Management最新文献

Incorrect assessment of the performance shaping factors (PSFs), especially in health care systems, may lead to irreversible consequences such as death. The current study aimed to adapt PSFs taxonomy given in standardized plant analysis risk human reliability analysis (SPAR-H) technique to surgical context. PSFs taxonomy of the SPAR-H technique was revised, and more contextspecific definitions to surgical context were suggested. Step-wise weight assessment ratio analysis (SWARA) and eleven-digit numerical scale were used for quantification of the weight and negative influence rate of the PSFs during surgical processes, respectively. Nine PSFs were proposed following the SPAR-H taxonomy. The order of the importance of the PSFs was quietly conflicting in terms of weight and negative influence rate. From the perspective of experts, fatigue and threat stress were assessed as the most important PSFs in terms of both weight and negative influence rate. Current study has offered a domain-based understanding of the PSFs, particularly in the surgical context. Results of this study could be used to evaluate human error behaviors during the performance of tasks in the operating room. Moreover, these results could be used for improving patient safety programs in health care systems.

Just as the general population of the United States is aging, so, too, is the population of active physicians. Training to become a physician and practice medicine is an arduous process. The competition to gain admission to medical school is fierce, the price tag of medical education is high, and waiting to learn about matching to a residency program is stressful. No wonder that physicians equate their profession with their identity. This sentiment, along with other factors, has resulted in many physicians continuing to practice well beyond the average retirement age. While each individual ages differently, there is evidence that the aging of physicians and length of time since medical school and residency is associated with deficiencies in history-taking, physical examination, record-keeping, and the ability to problem-solve. For late-career surgeons performing complex surgical procedures, there is a higher mortality rate for patients. Unlike other professions that have a mandatory retirement age, medicine does not. Health systems are grappling with how to fairly assess the competence of late-career practitioners. This article will explore that challenge from different perspectives, identify best practices, and describe how a risk manager can facilitate stakeholder discussion focused on implementing a competency-assessment process that is fair and effective.

Risk managers and ethicists monitor adherence to codes of conduct in the delivery of medical services and proactively participate with providers to create protocols that minimize the moral, ethical, and legal risks inherent in many commonly used medical protocols. “Code/no code” medical orders work well for patients at the extremes who always or never want to undergo a procedure, but they create troubling uncertainties for others by preventing them from expressly requesting procedures under some circumstances but not others. Obeying binary orders such as DNAR (Do Not Attempt Resuscitation) can allow deaths that a patient might want to delay or can expose patients to prolonged suffering they wish to avoid. These risks can be reduced by: (1) fully explaining the nature of proposed interventions and their possible beneficial and adverse effects in varying circumstances; and (2) replacing the traditional dichotomy with a continuum of options from always, through conditionally sometime, to never orders adapted to a range of situations and preferences. The Conditional Medical Orders (CMO) form summarizes patients’ preferences regarding resuscitation, ventilation, and artificial hydration and nutrition (ANH) is an efficient way to increases the chance that patients will undergo only the treatments they want.