Journal of Patient Safety最新文献

Objectives: The early recognition of sepsis and septic shock is crucial for improved patient outcomes. Quality improvement programs have ameliorated processes and outcomes in the care of patients with sepsis and septic shock. This study aimed to improve the proportion of patients receiving antibiotics within 1 hour of triage and compliance with sepsis bundles.

Methods: A multidisciplinary sepsis task force was created to monitor and improve sepsis care. The program lasted 24 months from January 1, 2018, to December 31, 2019. A unique screening criterion was created by combining items from the systemic inflammatory response syndrome, quick sequential organ failure assessment, and National Early Warning Score systems. Thereafter, a sepsis flowsheet was implemented in the emergency department for monitoring. The measures between the first 12 months and the last 12 months were compared.

Results: The proportion of patients receiving antibiotics within 1 hour of triage improved from 44% to 84%, intravenous crystalloid administration within 3 hours improved from 62% to 94%, serum lactic acid measurement within 3 hours improved from 62% to 94%, and vasopressor initiation within 6 hours improved from 76% to 94%. The mortality rates decreased from 32% to 21% between the 2 study periods.

Conclusions: This program emphasizes the impact of a structured quality improvement program on the process and outcomes of care.

Abstract: Patient safety advocates identify concerns for the impact of AI on patient safety. Patients identified the following 4 main areas that AI developers, regulatory bodies, and clinical users of AI are asked to consider: data integrity and bias, efficacy, payment, and transparency toward shared learning. Increased patient involvement in the development, use assessment and oversight of the technology is critical to ensure trust and trustworthiness in the use of AI in patient care.

Objectives: Quality improvements (QIs) in dynamic and complex health care contexts require resilience and take variability into account in quality improvement. The Functional Resonance Analysis Method (FRAM) helps us understand resilience and gain insight into (un)desirable variability in the complex system of daily practice. We explored how using FRAM in the Deming cycle of a QI project can help professionals and researchers learn from, reflect upon, and improve complex processes. We used FRAM in a Dutch hospital to study a QI: Critical Care Outreach Service (CCOS).

Methods: The aim was to use FRAM before and after implementation to create a FRAM model and reflect to health care professionals the mismatch between Work As Imagined (WAI) and Work As Done (WAD). The WAI FRAM model was co-created with professionals before the implementation of CCOS. We used descriptions of tasks and processes for ICU nurses and verified them in 30-minute semistructured interviews (N = 2). WAD was created by input of semistructured interviews with key professionals in CCOS (N = 21) and 3 nonparticipant observations of trained CCOS nurses. We validated WAD in 2 dialogue sessions with key professionals (N = 11). Data collection continued until saturation.

Results: Juxtaposing the WAI and WAD models showed that WAD contained additional functions and highlighted unexpectedly complex functions. Reflecting on the application of FRAM with health care professionals revealed opportunities and challenges, especially time investment.

Conclusions: FRAM helps professionals outline processes and tasks (WAI), learn from, and reflect upon their daily practice (WAD). FRAM models help professionals identify variability proactively to improve practices that enhance resilient performance.

Objectives: Older adults' (ages ≥65) inappropriate over-the-counter medications (OTC) use is prevalent, comprising Drug-Age, Drug-Drug, Drug-Disease, and Drug-Label types. Given that pharmacies sell many OTCs, structurally redesigning pharmacy aisles for improving patient safety (Senior Safe) was conceived to mitigate older adult OTC misuse, using Stop Signs and Behind-the-Counter Signs for high-risk OTCs. This study determined whether Senior Safe reduced high-risk OTCs misuse, while secondarily evaluating misuse changes for all OTCs.

Methods: A randomized controlled trial design matched and randomly allocated 20 health system community pharmacies to control or intervention groups. All 288 study participants completed an OTC choice task in which they chose a hypothetical symptom scenario (pain, sleep, cough/cold/allergy), selected an OTC, and described how they would use it at symptom onset and if symptoms persisted or worsened. Reported OTC use was evaluated for each misuse type. Intervention and control sites were compared for each misuse type using multivariate modeling.

Results: For high-risk OTCs, Drug-Age and Drug-Drug misuse were more likely in control sites (OR = 2.752, P = 0.004; OR = 6.199, P = 0.003, respectively), whereas Drug-Disease and Drug-Label misuse had too few occurrences in intervention sites for statistical comparisons. For all OTCs, only Drug-Age misuse was more likely for control sites (OR = 5.120, P = 0.001). Adults aged 85+ years had the greatest likelihood of all misuse types.

Conclusions: Results demonstrated that older adults frequently reported multiple misuse types, highlighting safety concerns. Senior Safe reduced high-risk OTC misuse, especially for older adults younger than 85 years. Cumulatively, these findings provide insights into practice recommendations supported through regulatory guidance.

Objective: Healthcare workers involved in, and negatively affected by, patient safety incidents are referred to as second victims. The Second Victim Experience and Support Tool-Revised (SVEST-R) can reveal the second victim's degree of negative experiences and the desirability of the support options. However, a Japanese version of the SVEST-R (J-SVESTR) has not yet been developed. This study aimed to translate and adapt the SVEST-R into Japanese and validate its psychometric properties.

Methods: We performed forward and back translations of the SVEST-R and evaluated its clarity and content validity. Subsequently, we administered a cross-sectional questionnaire survey to evaluate the construct validity, internal consistency, and retest reliability of the J-SVESTR.

Results: The J-SVESTR was finalized with clarity and content validity supported by a pilot test and an expert panel. In total, 224 healthcare workers responded to the J-SVESTR survey. The 9 factors and 35 items model indicated an acceptable fit (χ 2 / df = 1.811, root mean square error of approximation = 0.060, comparative fit index = 0.871, Tucker-Lewis index = 0.854, standardized root mean squared residual = 0.077). Cronbach's α values ranged from 0.68 to 0.85. The intraclass correlation coefficients ranged from 0.63 to 0.87.

Conclusions: The J-SVESTR retained 9 factors and 35 items, with no item changes from the original. The psychometric properties of the J-SVESTR are acceptable. The J-SVESTR can help investigate the actual situation and desired support options for second victims in Japan.

Background: The impact of a patient safety incident (PSI) on nurses and doctors in hospital settings has been studied in depth. However, the impact of a PSI on general practitioners and how those health care professionals can be supported are less clear.

Objectives: The objective of this study is to investigate the prevalence of GPs (in training) being personally involved in a PSI, as well as the impact, the support needed, and open disclosure in the aftermath of these PSIs.

Methods: A cross-sectional study, conducted between January 3, 2022, and March 5, 2022, led to a sample of 78 GPs or GPs in training in Flanders (Belgium). Participants filled in more than 80% of a questionnaire that measured the involvement in a PSI during the prior year and their entire career, and the impact in terms of emotional symptoms, attitudes, the support needed, and open disclosure were included.

Results: In total, 78 responses of GPs (in training) filled in the questionnaire, of which 87.2% were involved in a PSI over the course of their entire career and 55.1% during the prior year. Often, such a PSI resulted in permanent patient harm or patient death. The PSI that stuck with the GPs the most had many negative consequences for the GP in question, such as hypervigilance (88.2%) and feelings of guilt (82.4%), stress (79.4%), and shame (75.0%). More than half of the respondents involved want substantive clarity (64.4%), and in case of 51.7% of the respondents, an open discussion with the patient and/or family took place afterwards.

Conclusions: This study shows that GPs, even in training, can be negatively impacted after a PSI. Only half of the respondents were involved in an open disclosure process, but the ones involved had a positive feeling after disclosure. More support is needed for health care professionals in the aftermath of a PSI in primary care, and this support could enhance their involvement in the open disclosure process.

Objectives: This study aimed to develop a taxonomy for classifying corrective actions following health care incidents in a Portuguese tertiary hospital.

Methods: The study utilized a multimethods design, combining qualitative and quantitative analyses of real-world data. Thematic analysis was performed, drawing on inductive and deductive approaches. The latter was informed by the PRISMA Medical Classification/Action Matrix and the COM-B theory.

Results: A total of 4644 incidents were reported between January 1, 2021 and December 31, 2022. Each incident report is accompanied by an unstructured free-text conclusion section, whose content was manually coded using NVivo QRS. A total of 910 corrective actions were found. The process of classifying these actions, in addition to the deductive approach, served as the foundation for the development of the proposed taxonomy-the Corrective Actions Taxonomy for Healthcare Incidents (CATHI). CATHI included themes such as technology, medical devices, equipment and infrastructure, procedures, information and communication, and training, among others. The taxonomy was structured into 3 levels to allow for a more detailed classification of corrective actions. A glossary was developed to improve usability, including definitions and examples derived from real-world data.

Conclusions: CATHI provides a standardized approach to action implementation, allowing for prioritization of improvement efforts. This study has practical implications for enhancing patient safety and quality of care. Future research should validate this taxonomy in diverse health care settings.

Objectives: Hypomagnesemia early diagnosis and consequently early, timely magnesium supplementation is of utmost benefit, but it often goes underdiagnosed. The objective was to show and monitor an intervention to identify hypomagnesemia in patients with arrhythmia.

Methods: A cross-sectional study was designed in the laboratory. In primary care patients, the Laboratory Information System would automatically add a serum magnesium test when sample availability is present in any request when a diagnosis of arrhythmia is made. We counted the number of detected patients with hypomagnesemia (serum magnesium <1.7 mg/dL, <0.7 mmol/L), and calculated the cost in reagent of each identified case.

Results: In 430 patients with arrhythmia, serum magnesium was measured, and 41 (9.5%) had hypomagnesemia results. One patient showed severe hypomagnesemia values (<1.2 mg/dL and <0.49 mmol/L). Patients with a deficit were significantly (P<0.01) older than the total group of patients with normal magnesium values (66.3±13.2 versus 61.6±12.5). Each case represented a cost of 3.15€ in reagent.

Conclusions: The automated computer-based intervention to identify patients with hypomagnesemia was useful and affordable, given the cost per detected case.

Objectives: The aims of the study are to investigate differences in rates of adverse safety events between nonelderly adult patients with Medicaid and those with private insurance and to assess whether differences are driven by differences in access to quality hospitals or differences in the quality of care delivered within hospitals.

Data source: Inpatient records from 26 states in 2017 were collected from the Agency for Health Care Research and Quality's Hospital Cost and Utilization Project.

Study design: This study measures differences in 11 patient safety indicators between patients with Medicaid coverage and patients with private insurance coverage. I use regression analysis to investigate differences in adverse safety events within hospitals. I further establish hospital-level quality based on overall rates of adverse safety events and use regression analysis to evaluate the difference in the probability of admission to high-quality hospitals.

Data collection/extraction: This study uses hospital discharge data that is restricted to adults ages 19-64 with Medicaid or private coverage.

Principal findings: Relative to privately insured patients, Medicaid patients had significantly higher rates of adverse safety events on 8 of 11 patient safety indicators, including on 6 of 7 surgery-related patient safety indicators. Medicaid patients experience respiratory failure and sepsis infections at rates that are 2.9 and 2.5 cases per 1000 greater than rates experienced by privately insured patients. After adjusting for demographic characteristics, patient diagnostic classifications and comorbidities, and geographic factors, 6 of 11 differences in patient safety indicators remained large and statistically significant. These differences were unchanged when further including hospital indicators, indicating that Medicaid and privately insured patients receive different quality of care within hospitals. There is little association between overall hospital quality and differences in the probability of admission between Medicaid and privately covered patients.

Conclusions: Medicaid patients received lower quality of care, based on patient safety metrics, relative to privately insured patients within the same hospitals. Reducing payer disparities in adverse safety events requires reforming staffing and treatment patterns for Medicaid and privately insured patients within hospitals.

Study date and location: Analysis for this study was conducted in 2023 at the Urban Institute and at Loyola University Chicago.

Objectives: The objective of this study was to determine the incidence and types of adverse events (AEs), including preventable and ameliorable AEs, in patients transitioning from the emergency department (ED) to the inpatient setting. A second objective was to examine the risk factors for patients with AEs.

Methods: This was a prospective cohort study of patients at risk for AEs in 2 urban academic hospitals from August 2020 to January 2022. Eighty-one eligible patients who were being admitted to any internal medicine or hospitalist service were recruited from the ED of these hospitals by a trained nurse. The nurse conducted a structured interview during admission and referred possible AEs for adjudication. Two blinded trained physicians using a previously established methodology adjudicated AEs.

Results: Over 22% of 81 patients experienced AEs from the ED to the inpatient setting. The most common AEs were adverse drug events (42%), followed by management (38%), and diagnostic errors (21%). Of these AEs, 75% were considered preventable. Patients who stayed in the ED longer were more likely to experience an AE (adjusted odds ratio = 1.99, 95% confidence interval = 1.19-3.32, P = 0.01).

Conclusions: AEs were common for patients transitioning from the ED to the inpatient setting. Further research is needed to understand the underlying causes of AEs that occur when patients transition from the ED to the inpatient setting. Understanding the contribution of factors such as length of stay in the ED will significantly help efforts to develop targeted interventions to improve this crucial transition of care.