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Showing results for tags 'Data'.
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Content ArticleThe purpose of this study from Klevens et al. was to provide a national estimate of the number of healthcare-associated infections and deaths in United States hospitals
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- Healthcare associated infection
- USA
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Content Article
What is clinical audit? (2009)
Patient-Safety-Learning posted an article in Clinical governance and audits
This guide by the University Hospitals Bristol clinical audit team provides a brief summary of what clinical audit is, and what it isn't. It outlines the main stages of clinical audit and describes how it can be used, how to engage patients in the process and which staff members should be involved.- Posted
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- Clinical governance
- Audit
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Content ArticleBasic assessment tracking form for nursing home residents from the Centers for Medicare and Medicaid Services.
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- Care home
- Assessment
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Content ArticleEffective teamwork is critical to successful outcomes in pediatric cardiac surgery. Unfortunately, lapses in professional performance and conduct by those who treat paediatric cardiac patients pose threats to quality and safety. One hallmark of a profession is self regulation. Therefore, healthcare leaders need specific means for identifying and addressing those lapses and indicators of unsafe systems or individuals. This article from Pichert et al. describes an initial “near miss” event involving a paediatric cardiac surgeon. While fictional, the case represents a composite of events involving several paediatric cardiac surgeons who practice at different medical centers throughout the US.
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- Leadership
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Content Article
NHS England: Never Events data
Patient Safety Learning posted an article in Data and insight
NHS England publishes provisional Never Events data every month as an update of the cumulative total for the current financial year. The data is published in the following formats: the overall provisional number of Never Events reported in the current financial year to date – these are displayed by month. the provisional number of each type of Never Event reported, with a more detailed breakdown of sub categories of Never Event. the provisional number of each type of Never Event reported by an organisation. -
Content ArticleThis document from the World Health Organization (WHO) is to urge the readers to understand the purpose, strengths and limitations of patient safety incident reporting. Data derived from incident reports can be very valuable in understanding the scale and nature of harm arising from health care, provided that the properties of the data are reviewed carefully and conclusions are drawn with caution. The use of incident reporting systems for true learning in order to achieve sustainable reductions in risk and improvements in patient safety is still work in progress. It can be and has been done, but not yet on the scale and with the speed that compares with some other high-risk industries. That is what we must all strive for. This technical guidance will help the journey to a position where we can show patients and their families how we used this learning to give them care that is safe and dependable, every time they need it.
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- Patient safety incident
- Reporting
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Content ArticleVideo recording technologies offer a powerful way to document what happens in clinical areas. Cameras, and to a lesser extent, microphones, can be found in a growing number of modern operating rooms in the USA, UK and other parts of the world. While they could be used to create a detailed record of what happens in and around the operating table, this is still rarely being done; the vast majority of operations are still only documented in written operation notes. In this paper, Bezemer et al. discuss using microanalysis of videos from the operating room.
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- Operating theatre / recovery
- Surgery - General
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Content ArticleWe need less research, better research, and research done for the right reasons says D G Altman in this BMJ editorial.
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Content Article
Less research is needed (25 June 2012)
Patient Safety Learning posted an article in Research, data and insight
Guest blogger for PLOS Blogs 'Speaking of Medicine', Trish Greenhalgh, suggests its time for less research and more thinking. -
Content ArticleTraditionally, clinicians present complications at surgical morbidity and mortality (M&M) conferences, and the AHRQ Patient Safety Indicators (PSIs) use inpatient administrative data to identify certain adverse outcomes. Although both methods are used to identify adverse events and inform quality improvement efforts, these two methods might not overlap. This is a retrospective observational study from Anderson et al. of all hospitalisations at a single academic department of surgery (including subspecialties) in 2016 involving a PSI-defined event identified by surgery faculty and residents for review by departmental M&M conference or administrative data. The authors analysed the degree to which these two processes captured PSI-defined events and reasons for exclusion by each process. The study found that surgical M&M and the PSIs are complementary approaches to identifying complications. Both case-finding processes should be used to inform quality improvement efforts.
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- Quality improvement
- Surgeon
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Content ArticlePreventable adverse events are an ongoing challenge in healthcare. International studies demonstrate that 3%–17% of admissions are associated with an adverse event (defined as an injury caused by healthcare management resulting in prolonged hospitalisation, disability on discharge or death). Approximately half of the adverse events are preventable. Little is known about adverse events in the Irish healthcare system.Therefore, recommendations on improving patient safety at a national level are being made on limited information. The aim of the Irish National Adverse Events Study (INAES) from Rafter et al. was to quantify the frequency and nature of adverse events in acute hospitals in the Republic of Ireland for the first time using an internationally recognised retrospective patient chart review methodology.