Global journal on quality and safety in healthcare最新文献

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.

Introduction: Integrating process improvement tools into healthcare has shown promising results, yet the application of "training within industry" (TWI) still needs to be explored in this context. This study focuses on implementing job instruction (JI), one of the three components of TWI, within a large breakthrough series collaborative (BTS) in a middle-income country.

Methods: We evaluated the deployment of JI during a nationwide initiative aimed at reducing three critical healthcare-associated infections (HAIs)-central line-associated bloodstream infections (CLABSI), ventilator-associated pneumonia (VAP), and catheter-associated urinary tract infections (CAUTI)-across 189 Brazilian public intensive care units (ICUs). Our quality improvement (QI) project outlines the integration of JI to enhance the reliability of care bundles and empower frontline teams to reduce variation, one fundamental condition to maintain ongoing improvements.

Results: The implementation strategy included structured JI training for the hub's leaders, which facilitated the gradual adoption and customization of JI and visual management techniques into daily ICU care. We detailed the four stages of JI training, the content of each session, and how they were incorporated into the existing BTS framework alongside visual management tools. The mean compliance to prevention bundles exceeded 90%, and the project results reached an overall reduction of 44%, 52%, and 54% for CLABSI, VAP, and CAUTI, respectively.

Conclusion: Our findings suggest that JI can be seamlessly integrated into routine QI activities. This structure promotes consistency in carrying out each aspect of care bundles, preventing HAI and strengthening patient safety.

Introduction: Generalized anxiety disorder (GAD) is a common mental health condition encountered in primary care settings. GAD screening, diagnosis, and management are challenging, among other issues that capture the attention of primary care physicians (PCPs). Measurement-based care (MBC) involves the systematic assessment of patients' symptoms and treatment progress using standardized tools. Generalized Anxiety Disorder 7-Item (GAD-7) is a well-known screening and symptom-monitoring tool for GAD. It quantifies subjective symptoms objectively by measuring the patient's anxiety level. We aimed to increase utilization of GAD-7 in outpatient clinics to improve diagnosis and management of GAD through educational interventions and by educating PCPs to access the GAD-7 tool in the EPIC electronic medical record (EMR) with ease.

Methods: This study employed a quasi-experimental interrupted time series design over 12 months. The intervention involved displaying posters educating family physicians on accessing GAD-7 screening tools in EMR and using smart phrases to document GAD-7 results in two outpatient family medicine clinics. SlicerDicer measured total anxiety encounters and GAD-7 utilization 3 months before and 9 months after intervention. Statistical process control was used, and control charts were created using the statistical software JMP Pro-16. A Poisson regression model was used to detect statistically significant differences using statistical software SAS 9.4.

Results: GAD-7 utilization increased from 4.5 in the preintervention period to 20.5 in the postintervention period. There was a significant increase in GAD-7 utilization over time after implementing our QI intervention. The control chart phase analysis showed a shift in the process with an increase in the average rate of GAD-7 utilization from 11.5 per 100 encounters per week in the preintervention phase to an average of 35.8 per 100 encounters per week postintervention phase. The effect was sustained over a year postintervention. The Poisson regression model also showed a 21% increase (p < 0.0001) in the incidence rate ratio in the post-intervention period as compared with the preintervention.

Conclusion: Utilization of GAD-7 as an application of MBC improved with the implementation of a bundled intervention using quality improvement tools. Other programs may replicate this in their similar quality improvement endeavors.

Medication or medical mistakes, the third highest cause of death in the United States, occur from prescription writing to administering the therapy, with serious clinical and cost repercussions. Digital health technologies, such as connected healthcare systems, have the potential to reduce pharmaceutical errors and increase patient safety. This systematic review was conducted to find literature evidence to improve patient safety and reduce medication errors with connected healthcare interventions. This systematic review was conducted using the PRISMA 2020 guidelines. PubMed, SCOPUS, EBSCO, and Google Scholar databases were searched from January 1, 2000 to June 30, 2024 using keywords: medication errors, patient safety, and connected healthcare. A qualitative narrative analysis was conducted for the review. The detailed search yielded 9524 papers in total. In the process of duplicate removal, 4856 duplicate articles were found. After the removal of duplicate articles, 4615 were found not suitable or relevant to the topic of this study and were removed. Finally, 53 articles were chosen for the review study after screening and duplication removal. Ten of the 53 articles were review articles (18.9%), and 43 (81.1%) were original. The research indicates that various connected healthcare system technologies are more effective in minimizing errors and enhancing care quality. Integrating computerized physician order entry and clinical decision support systems may further reduce medical errors. However, many areas require additional research, and the outcomes are mixed. A balanced strategy that combines innovation, practical safety, and outcome evaluation is preferable.