Journal of Patient Safety最新文献

Objectives: The increased use of respiratory protective equipment (RPE) during and since the COVID-19 pandemic has highlighted its adverse impact on communication, particularly in high-stakes environments such as anesthesia and surgery, where clear verbal exchange is essential. This study examines how different types and combinations of RPE-including surgical masks, FFP-3 masks, and powered air-purifying respirators (PAPRs)-affect speech intelligibility in the anesthetic setting.

Methods: Twenty-one NHS theater staff participated in speech intelligibility testing conducted in a standard anesthetic room. Performance was assessed using single-word, consonant-nucleus-consonant (CNC) tests under various RPE conditions, including combinations of masks and PAPRs.

Results: Significant reductions in word recognition accuracy were observed when speakers wore RPE, with FFP-3 masks producing a more pronounced reduction than surgical masks. Communication was further impaired when listeners used PAPRs, particularly when speakers simultaneously wore FFP-3 masks. In contrast, intelligibility was not significantly affected when speakers used PAPRs alone.

Conclusions: RPE, principally devices that obscure the mouth, substantially impairs verbal communication in the anesthetic environment, with FFP-3 masks causing the greatest reduction in speech clarity. PAPRs introduce additional barriers, especially for listeners. To mitigate these effects, health care professionals should select RPE that balances protection with communication needs. Additional strategies, such as reducing background noise, enhancing RPE design, and implementing alternative communication methods may further improve verbal exchanges in critical care settings.

Background: Before opening new clinical facilities, the optimal preparation of health care personnel is essential. A simulation-based clinical systems testing (SbCST) using simulation is a valid instrument for reaching this goal. During SbCST, so-called latent safety threats (LSTs) can be identified that endanger patient safety. LSTs should be addressed before actual patient harm occurs. The aim of this study was to compare the outcomes and the categories of identified LSTs in 2 simulation types of SbCST, in situ full-scale simulation and process simulation.

Methods: We conducted SbCST at the newly built LMU University Hospital using in situ full-scale simulation and process simulation. To evaluate SbCST, we used a pre-session and post-session survey. The participants also mapped the identified LSTs into risk matrices according to their probability of occurrence and their impact on patient safety and staff strain.

Results: In total, 120 participants were included in the analysis. Regardless of the simulation type, most participants rated the simulation as (very) good and highlighted the usefulness of SbCST before the opening of new clinical facilities. In both simulation types, the majority of the identified LSTs included equipment, followed by team aspects, room layout, and accessibility. Regarding patient safety and staff strain, fewer LSTs were rated as highly severe in full-scale simulation than in process simulation.

Conclusion: Our study showed that, depending on the construction progress, in situ full-scale and process simulation are both appropriate tools for identifying LSTs and preparing health care professionals to work in new clinical facilities. To support hospital administrators in prioritizing these items, the use of an existing risk management tool is valuable.

Objective: Effective communication between surgeons and anesthesiologists in the operating room (OR) is essential for patient safety, but communication deficits remain a leading cause of medical errors.

Methods: An anonymous, interdisciplinary online survey was conducted to assess communication in the OR at a single university hospital. The target population included all surgeons and anesthesiologists, regardless of career level (n=837). The questionnaire consisted of 28 items covering 5 thematic domains. It was distributed via email and available from January to March 2024. No incentives were provided. Data were analyzed descriptively and comparatively using the χ2 test.

Results: A total of 183 participants (55% anesthesiologists, 45% surgeons) were eligible. A desire for more or substantially more communication in the OR was expressed by 67% of respondents. Preventable incidences caused by communication deficits were reported by 65% of participants, with anesthesiologists being significantly more likely to report both. Gender-based discrimination in the OR was experienced by 36% of respondents with both anesthesiologists and female physicians being significantly more often affected.

Conclusions: This interdisciplinary survey revealed communication gaps, preventable incidents linked to poor communication, and perceived gender-based discrimination between anesthesiologists and surgeons in the OR. Sixty-five percent of respondents link these deficits to preventable patient safety incidents. These results can serve as an exemplary case for similar hospital organizations or acute care settings and help promote gender equality. These findings underscore the need for respectful dialogue and strong interdisciplinary collaboration in operating rooms.

Background: Accurate detection of adverse events (AEs) and patient harm is fundamental for improving patient safety in hospitals. The primary objective of this study is to evaluate the sensitivity of the Institute for Healthcare Improvement (IHI), the Global Trigger Tool (GTT) in detecting adverse events compared with the Assurance of Quality in Surgery (AQC) surgical database and the voluntary Critical Incident Reporting System (CIRS) in a Swiss hospital setting. Specifically, we aim to quantify the detection gap between these 3 systems.

Methods: A retrospective review was conducted over a 12-month period between January 1st and December 31st, 2024. Analyzing data from 3 distinct surveillance methods: (1) Voluntarily submitted reports via the Critical Incident Reporting System (CIRS) were reviewed for all reported incidents; (2) For the GTT, 20 monthly randomly selected medical records of surgical inpatients (aged 18+, minimum 24-h stay, excluding orthopedics) were reviewed monthly; (3) Assurance of Quality in Surgery (AQC) data was manually entered for all operated surgical inpatients (excluding orthopedics), with rigorous quality checks performed by the authors. The findings from these systems were then compared.

Results: An evaluation of CIRS for 2024 revealed only one reported case within the surgical department. Concurrently, AQC statistics indicated 283 completed surgical inpatient procedures, with 17 (6.01%) resulting in complications (surgical and nonsurgical). Furthermore, among 596 stationary patients treated in 2024, the GTT identified 58 patients (9.73%) with at least one AE. Number of overlapping cases between the GTT and the AQC reporting systems was 14.

Conclusion: AQC is a particularly valuable tool, especially for operated patients. The Global Trigger Tool (GTT) boasts a wider range of applicability. Its strength lies in its ability to systematically identify potential adverse events through the review of patient records of operated and not operated patients. Sole reliance on voluntary reporting is insufficient for comprehensive adverse event detection. We advise the hospitals to adopt an additional system to complement the voluntary reporting CIRS system.

Objectives: National policies and efforts of medical associations have promoted patient safety management systems mainly in acute care hospitals. However, evidence on the long-term impact of these initiatives in Japan remains limited. This study assessed trends in patient safety systems and their implementation in Japanese acute care hospitals.

Methods: We conducted a secondary analysis of nationwide biennial surveys of patient safety managers from 2015 to 2023. Surveys targeted a stratified random sample of hospitals based on bed size and examined the implementation of systems for detecting and analyzing medical incidents, along with experiences of serious adverse events. Trend analyses by hospital size were conducted using the Cochran-Armitage test. Analyses were conducted as exploratory trend analyses using available-case data.

Results: The organizational commitment to patient safety was well maintained, as reflected in the assignment of a safety manager and department. Adverse event reporting systems were widely adopted throughout the period, and systematic reviews of all inpatient deaths rose significantly (25.0% in 2015 to 70.5% in 2023). However, advanced incident analysis methods remained underutilized, particularly in small hospitals (<200 beds). The proportion of hospitals experiencing serious medical accidents increased, especially among large hospitals (≥400 beds).

Conclusions: Over the past decade, Japanese acute care hospitals have made notable progress in developing patient safety infrastructures. While foundational systems were widely implemented, adoption of advanced analytical tools remains uneven. The rise in reported serious events may reflect improved detection and identification capabilities, or a simple increase in medical accidents. Sustained policy support and customized strategies for smaller hospitals are essential for continued advancement.

Background: This systematic review and meta-analysis aimed to assess patient safety culture among health care professionals in Ethiopia. In addition, the study identifies key factors associated with patient safety culture.

Methods: We systematically searched PubMed, HINARI, ScienceDirect, Cochrane Library, Google Scholar, and African Journals Online on March 4, 2025, to identify relevant primary research articles. The quality of the included studies was assessed using the Newcastle-Ottawa Scale checklist. We estimated the pooled prevalence of patient safety culture using a random-effects model. We calculated the aggregated prevalence of patient safety culture using a random-effects model. Heterogeneity across studies was evaluated using the I² statistic. Publication bias was assessed through the visual inspection of funnel plots and confirmed by Egger test.

Results: The pooled prevalence of patient safety culture in Ethiopia was 44.24% (95% CI: 39.31-49.17; I²=94%). Participation in patient safety programs (OR=1.56; 95% CI: 1.27-1.93; I²=85%), adverse event reporting (OR=1.55; 95% CI: 1.2-8.10; I²=40.33%), training (OR=3.30; 95% CI: 1.20-9.07; I²=95.08%), age (OR=0.24; 95% CI: 0.13-0.85; I²=91.94%), work experience (OR=2.10; 95% CI: 4.30-9.45; I²=74.1%), and educational status (OR=3.70; 95% CI: 1.22-11.28; I²=67.6%) were associated factors of patient safety culture.

Conclusions: The pooled prevalence of patient safety culture in Ethiopia was found to be low. Therefore, the Ministry of Health should take action by giving special attention to the identified factors, providing training, and encouraging active participation in patient safety initiatives.

Background: Excessive workload is associated with degraded operator performance and outcomes. The construct of surgical "team workload" is poorly specified, and anesthesiologist workload has rarely been measured concurrent with that of operating room nurses and surgeons during the same cases. We sought to measure workload, operationalized as individual and team "case difficulty," as well as the occurrence of non-routine events, from all surgical team members.

Methods: This multicenter prospective observational study at 5 Veterans Affairs medical centers involved 1107 non-cardiac surgical procedures. Individual and team "case difficulty" ratings (1 "very easy" to 10 "very difficult") and the reported occurrence of non-routine events (ie, deviations from optimal care) were independently collected through facilitated survey from surgeons, anesthesia professionals, and operating room nurses before incision (pre-case) and again after skin closure (post-case).

Results: At least one non-routine event was reported by at least one team member in 464 (42.0%) of the cases. Overall, nurses were the most likely to report an NRE (in 57% of NRE-containing cases), whereas surgeons were the least likely (40%). Anesthesia professionals and nurses had similar ratings for both the pre-case and post-case difficulty ratings. Surgeons' pre-case and post-case difficulty ratings were at least one unit greater than either of the other two OR team members (P<0.01). Post-case, anesthesia and nursing team difficulty ratings were at least 0.4 units higher than individual ratings (P<0.01), whereas surgeons' pre-case and post-case ratings were similar. Only nurses' individual case difficulty ratings were significantly lower post-case versus pre-case. Individual role and team case difficulty ratings were both associated with the reporting of non-routine events.

Conclusions: Capturing surgical team case difficulty ratings and non-routine events is feasible and may shed insight into factors affecting surgical performance. In particular, pre-case difficulty ratings may be a complementary predictor of surgical risk.

Objectives: Surgical safety checklists (SSCs) are widely used tools aimed at reducing postoperative complications and mortality. While compliance is generally high, adherence to individual checklist sections and completeness can vary. This study aimed to assess compliance and completion rates of a locally modified 6-section SSC.

Methods: We conducted a retrospective analysis of all inpatient and outpatient surgeries performed at a secondary-level hospital in northeastern Switzerland between January 1 and March 31, 2023. The presence and completeness of the scanned SSCs in the electronic medical records were evaluated. Multivariable logistic regression models were used to identify factors associated with missing or incomplete SSCs.

Results: A total of 2376 surgeries were analyzed. Overall ,SSC compliance was high, with a scanned checklist present in 98% (n=2329) of cases; however, only 73% (n=1734) were fully completed. Missing or incomplete SSCs were more frequent in emergency procedures, outpatient surgeries, cases with local anesthesia, procedures performed on Fridays, certain surgical departments, lower-volume operating rooms, and earlier positions in the surgical schedule. Multivariable analysis confirmed that emergency procedures and the use of local anesthesia were independently associated with lower odds of full SSC completion. No clear associations were found with age, sex, health insurance type, or whether procedures were performed during regular operating hours. The "Sign-In" and "Team Time-Out" sections had the highest completion rates, whereas "Patient Ready for Operating Room" and "Sign-Out" were most frequently omitted.

Conclusions: This study demonstrated a high overall rate of SSC compliance, though variation among checklist sections was observed. Specific contexts-particularly emergency and outpatient settings-were associated with reduced completeness, indicating opportunities for targeted quality improvement.

Objectives: Previous literature suggest that female physicians have better patient outcomes, following guidelines and evidence-based practices. This study explored the potential roles of workload and psychological burden in shaping the association between gender and patient safety incidents among early career resident physicians. This study aims to improve training environments during early medical careers.

Methods: We analyzed cross-sectional data from the 2022 General Medicine In-Training Examination (GM-ITE) in Japan, including 6063 resident physicians in their first or second postgraduation year. Serious patient safety incidents were collected via anonymous questionnaire, defined as deaths or serious adverse events resulting from medical errors made by the resident physicians themselves occurring during the past 12 months. Multilevel mixed-effects logistic regression accounted for hospital differences and additionally examined working conditions, including working hours, night shifts, burnout, and co-worker disruption.

Results: Female resident physicians had a lower risk of serious patient safety incidents (odds ratio (OR) 0.71, 95% CI: 0.59-0.85) after considering co-worker disruption as a mediator. Males had a U-shaped association between weekly working hours and patient safety incidents (<45 h: OR 2.07, 95% CI: 1.39-3.09, ≥80 h: OR 1.35, 95% CI: 1.05-1.74), while females showed a dose-response association, especially with ≥80 hours (OR 2.10, 95% CI: 1.43-3.09). There was no significant interaction of physician gender with burnout or night shift frequency.

Conclusions: Female resident physicians experienced fewer serious patient safety incidents. Reducing working hours may benefit female resident physicians in preventing serious patient safety incidents.

Objective: To explore health care professionals' descriptions of near-miss events and assess the validity using the World Health Organization (WHO) patient safety classification framework.

Methods: A total of 2805 near-miss reports were reviewed from a tertiary hospital from 2021 to 2024 using a retrospective, mixed-methods approach. Descriptive statistics were used to examine reporting trends and patterns. Qualitative analysis was performed through evaluating each report's narrative using a structured decision-making process based on WHO criteria to determine whether it qualified as a near miss, adverse event, no-harm incident, or reportable circumstances.

Results: Eighty-four percent were validated as true near misses, mostly related to medication safety. However, significant misclassification was observed in patient care and workplace safety reports, where many events were incorrectly labeled as near misses despite involving patient harm or reaching the patient without causing harm.

Conclusion: The findings reveal substantial near-miss detection and reporting by the pharmacy department, in particular, which signifies the pharmacists' role in validating prescriptions for patient safety. It simultaneously identifies critical reporting gaps related to the misunderstanding of safety event taxonomy by the reporting staff, which limits the accuracy of reported data and the potential resolution. Therefore, the study emphasizes the need for adopting a near-miss reporting framework that is comprehensive and standardized with a transparent definition, a structured analytical methodology, and a robust feedback mechanism to streamline the reporting process to ensure consistency of near-miss reporting across departments and optimize patient safety efforts.