Global journal on quality and safety in healthcare最新文献

Introduction: As healthcare organizations strive to improve the quality and safety of their services, there is growing recognition of the importance of fostering a patient safety culture to enhance patient safety and improve patient care outcomes. This study aims to evaluate healthcare professionals' perceptions of patient safety culture in accredited vs nonaccredited hospitals within a network of 68 hospitals in Brazil.

Methods: This cross-sectional, multicenter study included 68 hospitals from a private network. The Hospital Survey on Patient Safety Culture (HSOPSC) was administered across all participating hospitals in September 2022. Hospitals that had been formally recognized for their quality and safety standards were compared with nonaccredited hospitals. Scores for various dimensions of patient safety culture were compared between groups. A logistic regression model was applied to assess the association between the frequency of event reporting in the past 12 months and participant characteristics.

Results: A total of 31,919 healthcare professionals responded to the survey. Compared with nonaccredited hospitals, accredited hospitals reported higher scores in communication openness (3% higher, p = 0.04), frequency of events reported (4% higher, p = 0.02), and overall perception of patient safety (4% higher, p = 0.02). Accreditation was associated with a reduced likelihood of event underreporting (odds ratio = 0.80; 95% CI, 0.74-0.87), and physicians were more likely to underreport compared with nursing staff.

Conclusion: Although accreditation enhances patient safety culture, its effect may be more limited in healthcare networks with robust quality management systems already in place. To drive meaningful improvements, policymakers should go beyond accreditation and prioritize the reinforcement of ongoing institutional safety initiatives. Particular attention should be given to persistent challenges, such as fostering a nonpunitive approach to errors and addressing underreporting of adverse events. A graphical abstract is provided in the supplemental material.

Introduction: Telemedicine, also known as e-health, utilizes computer technology to deliver clinical healthcare remotely. Since its inception in the 1960s, telemedicine has evolved significantly, offering several advantages to both patients and healthcare providers, including remote care and monitoring. This study contributes to existing literature by exploring the effectiveness of telemedicine and patient satisfaction in managing health conditions in Canada, with a focus on service delivery, accessibility, efficiency, doctor-patient relationships, and network interconnectivity. The study aims to identify key challenges and barriers to telemedicine efficacy, including patient experience, technologic and accessibility issues, healthcare provider perspectives, and potential future improvements.

Methods: The research population comprises Canadians, including family doctors, specialists, pharmacists, and patients. A questionnaire featuring closed-ended questions was used to collect primary data.

Results: The study found that telehealth is widely accepted in Canada, with 73.1% of respondents reporting ease of use, and 48.1% disagreeing that telehealth is time-consuming. Additionally, the findings indicate high satisfaction levels regarding expertise and technical challenges on telehealth platforms, with 47.4% of participants stating that it provided easier access to instructions. The study underscores the necessity for a robust legal framework and increased patient education on privacy risks.

Conclusion: The study concludes that telehealth can help reduce costs, decrease waiting times, and support regional reference centers. However, its broader societal impact remains uncertain. The COVID-19 pandemic improved telemedicine measures, yet effective use requires reliable smartphone or computer connectivity.

The misuse of emergency landings by passengers fabricating medical crises presents serious healthcare quality and patient safety challenges in aviation. Such incidents undermine the integrity of medical protocols, divert critical healthcare resources, and erode trust in emergency response systems. This article examines the ethical, operational, and legal implications of these exploitations, applying the Ethical Decision-Making Model and drawing parallels to patient safety policies in healthcare systems. It highlights how the misuse of emergency protocols in aviation mirrors the misuse of emergency medical services in hospitals, leading to resource misallocation and potential harm to genuine patients. The discussion explores existing aviation and healthcare policies, including Federal Aviation Administration regulations, International Civil Aviation Organization guidelines, and hospital triage models, to propose policy interventions that reinforce safety without compromising access to emergency care. Strengthening penalties for fraudulent claims, enhancing telemedicine verification, and improving data collection on in-flight medical incidents are crucial steps toward ensuring passenger safety, maintaining trust in emergency systems, and protecting public health.

Introduction: Stroke is a prevalent health issue that poses substantial challenges for individuals and healthcare providers alike. It not only results in physical disabilities but also significantly affects the overall quality of life (QoL) for stroke survivors. Addressing these challenges necessitates a comprehensive approach that prioritizes improving functional abilities, fostering independence, and enhancing overall well-being of stroke survivors. A critical issue was observed at Al Hada Armed Forces Hospital (Taif, Saudi Arabia), where the average modified Rankin Scale (mRS) score for ischemic stroke survivors was estimated at 3.33, reflecting a poor QoL in terms of holistic limitations and, more importantly, limitations in daily activities.

Methods: This improvement project, conducted from May 2022 to July 2023, focused on establishing a comprehensive case management approach for patients with ischemic stroke, involving evidence-based best practices. The study was conducted in three phases: performing a literature review, development of an intervention protocol, and implementation and evaluation to assess feasibility and effectiveness. The evaluation used a quasi-experimental preintervention and postintervention evaluation approach, with qualitative data assessing the effect of the case management strategies on patient QoL as well as qualitative data estimating patient compliance and satisfaction.

Results: The target population of the study consisted of 136 patients diagnosed with ischemic stroke. This project yielded significant improvements in the QoL of patients with ischemic stroke, evident by the reduction in the average mRS score from 3.33 to 0.91 (p < 0.001). The effective implementation of case management services also had a positive effect on postdischarge patient satisfaction, which rose from 45% to 94%, as well as on readmission rates secondary to stroke, reduced from an average of 6.2% to 4%. Additionally, improving the QoL of patients with ischemic stroke resulted in a gain of approximately 0.41 quality-adjusted life-years per patient, with estimated cost savings of 76,897-153,794 Saudi riyals (20,467-40,935 US dollars [USD]).

Conclusion: This study highlights the effectiveness of an evidence-based case management intervention in improving outcomes for individuals facing poststroke challenges. Our findings support the importance of case management-based interventions in addressing the unique needs of this population.

Introduction: Nurses are integral to the healthcare delivery team (multidisciplinary team). They are involved and play vital roles with responsibilities to ensure the quality of healthcare for their patients. The key to those varied roles is the administration of medication. Depending on the clinical setting, nurses spend up to 40% of their hours on medication administration and its management processes. They are liable to identify and prevent medication administration errors (MAEs) and their consequences. This study aimed to explore the barriers and facilitators to the reporting behavior for MAEs among nurses in Ghana.

Methods: A descriptive qualitative cross-sectional study was conducted among nurses in a district catholic hospital in Ghana. The level of nurses' knowledge of MAEs, causes of such errors, barriers to reporting, and strategies for minimizing errors were assessed. Purposive sampling was used to select a total sample of 20 nurses interviewed face-to-face using an in-depth method. The interviews were recorded, transcribed, and analyzed thematically.

Results: The study found that all nurses are aware of MAEs, which serve as the basis for decision-making. However, some nurses do not report these errors when they occur. Factors such as workload, stress and tiredness, staff shortage, difficulty calculating drug dosage, inadequate knowledge about specific medications, distractions during administration, and patient-related factors were identified as common causes of MAEs. The study also revealed that hospital management and the potential negative consequences of reporting errors, such as unpleasant reactions, lawsuits, and loss of a job, are significant barriers to reporting.

Conclusion: Regular training workshops should be conducted to update nurses' knowledge about the importance of reporting medication errors, the reporting process, new medications and their administration, to develop a policy document that promotes a nonblaming, nonpunitive, and supportive learning culture for MAE medic reporting.