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

The United States has the highest rate of maternal mortality of all industrialized countries. Maternal mortality is considered the “tip of the iceberg” and about 80% of cases are considered preventable. Approximately, 60,000 birthing people experience severe maternal morbidity each year. These cases provide hospitals an opportunity to identify areas to improve the quality and safety of care provided. Due to the highly specialized nature of obstetric care, the specialty is fraught with risk and associated with the most paid claims driving high organizational overhead costs related to legal defense, awards, and settlements. Risk Managers are well-positioned to support their organizations in improving the safety of perinatal care by advocating for the need to prioritize and intentionally focus and invest resources toward mitigating obstetric risk. This paper provides an overview of the strategies risk managers can deploy to support the development of a comprehensive obstetric safety program that can decrease malpractice claims, reduce health care costs, and ultimately improve patient outcomes specifically, via a proactive perinatal risk assessment.

The transition to a new emergency department (ED) facility can pose significant challenges to patient safety. This study utilized Colman et al.’s simulation-based clinical systems testing approach to identify latent safety threats (LSTs), ensure operational readiness, and enhance staff confidence in a newly constructed ED at an urban hospital. A three-stage framework comprising development, implementation, and evaluation phases was employed. A large-scale “day in a life” in situ simulation was conducted to test system integration and identify LSTs. Data from participants, observers, and facilitators were collected and analyzed to develop action plans. The simulation included 63 scenarios over 4 h, engaging 125 participants and 50 standardized patients. A total of 113 LSTs were identified, leading to the development of a detailed action plan. Feedback from staff was positive, with participants reporting increased confidence in providing safe patient care in the new facility. This approach successfully identified safety threats and enhanced staff preparedness, potentially informing future operational plans for transitions in healthcare facilities. The methodology and findings are generalizable to other healthcare facilities undergoing similar transitions, where system integration, safety evaluation, and staff readiness are key concerns.

Traditional fall prevention activities are not effective in preventing inpatient falls or injuries from falls. A knowledge of the five steps of Enterprise Risk Management (ERM) provides risk professionals with opportunities to apply them on an organization-wide basis to existing risks. The authors demonstrate how to apply the five steps of ERM to the common risk/patient safety issue of fall injury prevention. The authors completed a comprehensive literature review and identified predictors of injuries from falls. A comprehensive framework emerged which assists in predicting and preventing falls with injury in the inpatient setting. In combination of two or more, the following have been shown to predict injuries after falls: the use of oral anticoagulants, being born female, dementia, polypharmacy, the use of Fall Risk Increasing Drugs, urologic co-morbidities, and HIV positive status. When the ERM Process is applied to injury from falls, a Strategic Risk Response is created which assists the risk professional with application of the ERM process. Shifting focus from fall prevention to fall injury prevention, with the application of the ERM Process, creates value for the patient and the organization, and contributes to program success and sustainability.

Given the responsibility of healthcare organizations to promote positive workplace cultures, the development of appropriate teaching material focused on professionalism is of relevance. A longitudinal evidence-based educational curriculum was thus constructed to equip participants with tools to enhance team-based care and to create an inclusive, respectful environment. Core themes on which to center the curriculum were identified based on the preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) statement. A MEDLINE search was undertaken to identify original peer-reviewed works using terms associated with professionalism in healthcare with the goal of building a foundational basis. Articles published from January 2014 to January 2024 and restricted to the English language were included. Based on the search results, a 12-month curriculum designed to promote workforce engagement and discussion was established. The 537 peer-reviewed publications selected to develop this thematic framework were broadly categorized as follows: ethics/accountability (N = 131); conflict resolution (N = 120); collaboration (N = 107); interpersonal communication (N = 70); empathy (N = 57); and wellness (N = 52). Between November 2023 and November 2024, a total of 12 sessions were scheduled. The feasibility of developing a standardized, evidence-based curriculum on workplace professionalism was demonstrated. The practical implications are discussed.

Health Information Exchanges (HIEs) are revolutionizing healthcare by facilitating secure and timely patient data sharing across diverse organizations. However, their rapid expansion has introduced significant legal and ethical challenges, particularly regarding privacy, informed consent, and liability risks. This paper critically assesses the effectiveness of existing legal frameworks, including Health Insurance Portability and Accountability Act (HIPAA) and General Data Protection Regulation (GDPR), in addressing these challenges, revealing gaps in their application within HIEs. It argues that current consent models fail to provide meaningful control for patients, while privacy protections are weakened by issues such as re-identification and jurisdictional inconsistencies. Moreover, liability in data breaches remains complex due to ambiguous responsibility among stakeholders. The study concludes that reforms are needed, including dynamic consent models, standardized liability frameworks, and enhanced data governance structures, to ensure secure, ethical, and effective data sharing. These changes are essential to fostering patient trust, improving healthcare delivery, and aligning with Sustainable Development Goal (SDG) 3—ensuring healthy lives and promoting well-being for all.

This study investigates the factors contributing to the decline in obstetrics and gynecology (OB/GYN) malpractice claims in Japan and highlights professional attitudes, institutional support systems, clinical practices, and policies that can further reduce such claims, while comparing these findings with malpractice data from the United States. We analyzed OB/GYN closed malpractice claims from the Supreme Court of Japan, along with data on maternal and neonatal mortality rates from the Ministry of Health, Labour and Welfare. We used Jonckheere-Terpstra tests to evaluate trends, considering p-values < 0.05 as statistically significant. In Japan, the proportion of medical malpractice claims in OB/GYN dropped significantly from 15.1% in 2004 to 5.2% in 2022 (p < 0.001). The number of claims per 100 OB/GYN physicians also significantly decreased from 0.9 in 2007 to 0.4 in 2016 (p < 0.001). Despite an increase in the cesarean delivery rate, both maternal and neonatal mortality rates have significantly decreased (p < 0.001 and p < 0.05, respectively). Japan's OB/GYN field saw a dramatic reduction in claims due to heightened awareness after a wrongful criminally charge, the establishment of financial compensation for cerebral palsy, standardized clinical guidelines, and adverse event investigation system.