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Content ArticleHealth Services Research (HSR) conceptual models examine the complexity and “basic science” of patient safety. HSR methods can help quantify patient safety problems, enhance their understanding, and develop and test solutions. However, preventable harm persists and even worsened during the pandemic. One reason is inadequate attention and investment in patient safety over the past two decades. Significant investments are still needed to measure the burden of different patient safety events across settings and to address emerging safety threats. Solutions need to be developed, evaluated, and implemented through rigorous research to ensure widespread, effective adoption. Multidisciplinary strategies are required both to mitigate safety threats before they lead to patient harm, and to close the implementation gap. Outside of AHRQ and VA funding, patient safety research in the United States is underfunded. Efforts to translate HSR to patient care, policy, and clinical practice is essential for patient safety improvements. These efforts require health services researchers to go beyond publishing a paper; they must work closely with healthcare organizational leaders, clinicians, policymakers, and patients to ensure their findings are acted upon, and to help propose and test solutions. The National Center for Patient Safety (NCPS) offers an excellent model to do so by funding dedicated patient safety centres of inquiry (PSCIs) nationally. PSCIs focus on research and implementation activities that promote organization-wide learning. The PSCI model adds significant value to creating a learning health system for safety that invests in patient safety data gathering, analysis, learning, and actionable improvements.
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Content ArticleIn this episode, Dr Paul Grime, Chairman of the Safer Healthcare and Biosafety Network, speaks to Jonathan Pearce, Chief Executive of Antibiotic Research UK. Jonathan has nearly 20 years’ experience as a CEO in the UK charity sector and has led a number of national organisations, including DKMS UK, Lymphoma Action and Adoption UK. Safety Talks is a podcast series as part of the Safety for All Campaign, launched to shine a light on the symbiotic relationship and benefits of integrating the approach to deliver healthcare worker safety and patient safety.
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- Antimicrobial resistance (AMR)
- Health education
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Content ArticleThis Lancet article highlights three challenges to measuring and analysing social determinants of health (SDoH) for which data science—a cross-disciplinary set of skills to make judgements and decisions with data by using it responsibly and effectively—can be harnessed. The three challenges the authors examine are: Data necessary for capturing the exposure of interest at multiple levels appropriately are not always available nor easy to measure. SDoH are distal to individual health outcomes compared to biomedical determinants such as comorbidities. The distal placement of SDoH in relation to health outcomes results in requires long periods of time to observe their effect.
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- Health inequalities
- Health Disparities
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News ArticleWhile the importance of translating evidence into policies and practices is widely acknowledged by evidence producers, intermediaries, users, and funders, there is much less agreement on suitable mechanisms for promoting effective evidence use. As a response, the World Health Organization (WHO) has initiated an extensive and inclusive research priority-setting exercise in Knowledge Translation (KT) and Evidence-informed Policy-making (EIP) through a series of technical consultations. This priority-setting initiative, coordinated by the Evidence to Policy and Impact Unit in WHO’s Science Division, involves national and international researchers, practitioners, and organizations across all WHO regions. Collectively, they will assess the evidence base for effective research utilization in decision-making. The overarching goal of this project is to maximize the impact of KT and EIP research to promote the translation of evidence into effective policies that enhance population health and well-being. Key objectives include: Efficiency and Synergy: Streamlining research efforts in KT and EIP. Strategic Funding: Directing research funding toward identified priority areas. Effective Approaches: Enhancing understanding of evidence use for policy-making. Collaboration: Promoting cross-sectoral collaboration in KT and EIP research. Awareness: Championing for evidence-informed policy-making at all levels. In the first half of the 2024, global experts – selected during an open call – are now actively participating in a series of consultations to identify gaps and opportunities in KT and EIP research. The consultations provide a pivotal opportunity for participants to discuss current research gaps, harmonize terminology and chart a course toward shared priorities. Read full story Source: WHO, 22 March 2024
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Content ArticleThis article analyses the phenomenon of epistemic injustice within contemporary healthcare. It begins by detailing the persistent complaints patients make about their testimonial frustration and hermeneutical marginalisation, and the negative impact this has on their care. The authors offer an epistemic analysis of this problem using Miranda Fricker's account of epistemic injustice. They detail two types of epistemic injustice, testimonial and hermeneutical, and identify the negative stereotypes and structural features of modern healthcare practices that generate them. They claim that these stereotypes and structural features render ill persons especially vulnerable to these two types of epistemic injustice. The authors end by proposing five avenues for further work on epistemic injustice in healthcare. "Without the narrative acts of telling and being heard, the patient cannot convey to anyone else – or to self – what he or she is going through. More radically and perhaps equally true, without these narrative acts, the patient cannot himself or herself grasp what the events of illness mean."
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Content ArticleImproving maternity care is a key Government and National Institute for Health and Care Research (NIHR) priority. In March 2024, an NIHR Evidence webinar showcased research from their recent Collection, Maternity services: evidence to support improvement. This summary includes videos of researchers’ presentations and captures some of the points raised in the webinar Q&A. It highlights seven features of safety in the maternity units, kind and compassionate care around the induction of labour, and the role of hospital boards in improving maternity care.
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Content ArticleResearch conducted by a team at the University of Birmingham delves into the intricate dynamics of empathy towards patients and colleagues, revealing insights that challenge conventional wisdom. Empathy is widely recognised as a cornerstone of medical care. Increased physician empathy has been linked to better patient outcomes and satisfaction, yet there has been little exploration of its presence in surgical training. The study involved interviews with 10 surgical trainees at various stages of their careers to uncover a nuanced understanding of empathy within the profession. Contrary to the widely documented decline in empathy among medical students and professionals, participants described their experiences as a balance between empathy and the demands of surgical practice. Participants acknowledged the importance of empathy in patient care but highlighted the challenges of maintaining it amid the pressures of a surgical environment. They described a delicate balance between understanding patients’ needs and the efficiency required to manage high patient volumes and demanding workloads. The study revealed how empathy evolves throughout a surgeon’s career. Whilst some trainees experienced desensitisation to emotional stimuli, many described increased empathy as they gained more experience and exposure to patient care.
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- Organisational culture
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Content ArticleThe aim of this study from Aiken et al. was to determine the well-being of physicians and nurses in hospital practice in Europe, and to identify interventions that hold promise for reducing adverse clinician outcomes and improving patient safety. The study found that poor work/life balance (57% physicians, 40% nurses), intent to leave (29% physicians, 33% nurses) and high burnout (25% physicians, 26% nurses) were prevalent. Rates varied by hospitals within countries and between countries. Better work environments and staffing were associated with lower percentages of clinicians reporting unfavourable health indicators, quality of care and patient safety. The effect of a 1 IQR improvement in work environments was associated with 7.2% fewer physicians and 5.3% fewer nurses reporting high burnout, and 14.2% fewer physicians and 8.6% fewer nurses giving their hospital an unfavourable rating of quality of care. Improving nurse staffing levels (79% nurses) and reducing bureaucracy and red tape (44% physicians) were interventions clinicians reported would be most effective in improving their own well-being, whereas individual mental health interventions were less frequently prioritised.
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- Staff safety
- Fatigue / exhaustion
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Content ArticleThe aim of this study was to quantify the difference in weekday versus weekend occupancy, and the opportunity to smooth inpatient occupancy to reduce crowding at children's hospitals. They study found that hospitals do have substantial unused capacity, and smoothing occupancy over the course of a week could be a useful strategy that hospitals can use to reduce crowding and protect patients from crowded conditions.
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Content ArticleDoctors working in temporary positions (known as locums) are a key component of the medical workforce and provide necessary flexibility and additional capacity for NHS organisations and services. There have been concerns about the quality and safety of locum practice and the way NHS uses locum doctors. The number of doctors working as locums, and the costs of this to the NHS have caused some concerns nationally in recent years. It has also been suggested that locum doctors may not provide as good a quality of care as permanent doctors. Research carried out by a team at the University of Manchester provided important new information on these issues. The findings indicated that locum working and how locums were integrated into organisations could pose significant challenges for patient safety and quality of care.
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Content ArticleSafetyNet brings together the collective efforts of the six NIHR Patient Safety Research Collaborations (NIHR PSRCs).across England in addressing patient safety challenges of strategic importance. The quarterly SafetyNet newsletter offers you the opportunity to find out about the exciting research and collaborations that are happening across the safety centres and wider organisations.
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Content Article
NIHR Patient Safety Research Collaborations
Patient Safety Learning posted an article in Research, data and insight
NIHR Patient Safety Research Collaborations (PSRCs) are partnerships between universities and NHS trusts that support patient safety research. There are six PSRCs in England, aiming to bring patient safety discoveries to frontline NHS services. -
Content ArticleAround 1 in 5 children have eczema (also known as atopic eczema or atopic dermatitis). They typically have inflamed and dry, itchy skin. During flare-ups (periods of worsening symptoms), their skin becomes vulnerable to cracks, bleeding and infection. Eczema impacts quality of life; it can impair sleep, ability to concentrate at school, self-confidence and mood. The condition is usually long-term (chronic), although it improves, or even clears completely, in some children as they get older. Even so, it is one of the most common reasons for children and young people to seek medical care. Community pharmacists and GPs are the first port of call and, while there is no cure, treatments can soothe sore skin, reduce itching, improve the appearance of the eczema, and reduce infections.
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- Medicine - Dermatology
- Research
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Content ArticleDiagnostic errors cause significant patient harm. The clinician’s ultimate goal is to achieve diagnostic excellence in order to serve patients safely. This can be accomplished by learning from both errors and successes in patient care. However, the extent to which clinicians grow and navigate diagnostic errors and successes in patient care is poorly understood. Clinically experienced hospitalists, who have cared for numerous acutely ill patients, should have great insights from their successes and mistakes to inform others striving for excellence in patient care.
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- Diagnosis
- Diagnostic error
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Content ArticleWomen and people born biologically female have unique health needs across the life span, and their health outcomes often differ from those of men. Although women make up greater than half of the world’s population, these unique needs remain both insufficiently understood, due to decades of exclusion from scientific and medical research, and inadequately addressed, due to systems and cultures that often dismiss or devalue their experiences. This article discusses highlights from the National Academy of Medicine's Annual Meeting Scientific Symposium in October 2023 on the subject of women’s health. It looks at improving representation in research, bridging the gap in terms of social determinants of health and the need to reassess and research the female chromosomal makeup.
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- Womens health
- Health inequalities
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Content ArticleDiagnostic delays in the emergency department (ED) are a serious patient safety concern. This retrospective cohort study included children treated at 954 EDs across 8 states, and examined the association between ED volume and delayed diagnosis of first-time diagnosis of an acute, serious conditions (e.g., bacterial meningitis, compartment syndrome, stroke). The researchers found that EDs with lower pediatric volume had higher rates of delayed diagnosis across 23 serious conditions.
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- Paediatrics
- Emergency medicine
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Content ArticleThe Health Research Authority, the National Institute for Health and Care Research and a host of organisations across the UK have been working together to bring about changes which will drive up standards in health and social care research. Together they have signed up to a Shared Commitment to public involvement.
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- Person-centred care
- Patient engagement
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Content ArticleThis blog looks at evidence around the impact of universal masking in healthcare settings on infection rates. Highlighting a recent study carried out at St. George’s Hospital in London that showed universal to have a negligible benefit on infection control amongst patients, the author argues that it is time to move away from universal masking to masks being worn really carefully as part of PPE for dealing with respiratory symptoms.
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- Pandemic
- Infection control
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Content ArticleMedication errors in ambulatory care settings present unique patient safety challenges. This systematic review explored the prevalence of medication errors in outpatient and ambulatory care settings. Findings indicate that prescribing errors (e.g., dosing errors) are the most common type of medication error and are often attributed to latent factors, such as knowledge gaps.
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- Medication
- Prescribing
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Top picks: 12 research papers on Long Covid
Patient Safety Learning posted an article in Blogs
We are seeing more and more people who have been devastated by the long-lasting impact of Covid-19. Long Covid is a relatively new condition which is still being studied and the need for more awareness and advocacy has never been greater. Scientists are carrying out large-scale clinical trials and researchers are on the hunt for new therapies in the hope that patients with Long Covid will finally see improvements in treatment and support for their symptoms. In this Top picks blog, shared on International Long Covid Awareness Day, we highlight 12 recent research papers on Long Covid.- Posted
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- Long Covid
- Post-virus support
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Content ArticleThe theme of this year’s International Long Covid Awareness Day is ‘Confront Long Covid: Recognise, prevent, act’. In this interview, we speak to retired occupational physician Dr Clare Rayner about her work in understanding Long Covid and its impact on individuals, the health service and the wider economy. She talks about recent guidance she has developed on people with Long Covid returning to work and outlines the impact Long Covid has on the workforce. She calls on healthcare leaders and the Government to invest in treatment-related research as well as highlighting the significant health risks associated with Covid reinfection.
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- Long Covid
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Content ArticleMore than 3 years after the onset of the Covid-19 global pandemic, a wave of evidence suggests that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection can lead to postacute sequelae in pulmonary and broad array of extrapulmonary organ systems—including increased risks and burdens of cardiovascular disorders, neurologic and mental health disorders, metabolic disorders (diabetes and dyslipidemia), kidney disorders and gastrointestinal disorders. However, up until now, evidence is mostly limited to the first year postinfection. Bowe et al. built a cohort of 138,818 individuals with SARS-CoV-2 infection and 5,985,227 noninfected control group from the US Department of Veterans Affairs and followed them for 2 years to estimate the risks of death and 80 prespecified postacute sequelae of Covid-19 (PASC) according to care setting during the acute phase of infection. They found that the increased risk of death was not significant beyond 6 months after infection among nonhospitalised but remained significantly elevated through the 2 years in hospitalised individuals. Within the 80 prespecified sequelae, 69% and 35% of them became not significant at 2 years after infection among nonhospitalised and hospitalised individuals, respectively. In summary, while risks of many sequelae declined 2 years after infection, the substantial cumulative burden of health loss due to PASC calls for attention to the care needs of people with long-term health effects due to SARS-CoV-2 infection.
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- Long Covid
- Recovery
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Content ArticleThis is part of our series of Patient Safety Spotlight interviews, where we talk to people working for patient safety about their role and what motivates them. Joy talks to us about why we need to reduce the use of restrictive practices in healthcare, the role of research in identifying unsafe practices and how the Restraint Reduction Network shares and helps organisations implement safer approaches to care.
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- Restrictive practice
- Mental health
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Content ArticleSome studies suggest a higher incidence of diagnosis of autoimmune inflammatory rheumatic diseases (AIRDs) among patients with a history of Covid-19 compared with uninfected patients. This binational cohort study of patients in Korea and Japan aimed to investigate the effect of Covid-19 on long-term risk for incident AIRD over various follow-up periods. The authors found that Covid-19 infection was associated with increased risk for incident AIRD compared with matched patients without Covid-19 infection or with influenza infection. The risk for incident AIRD was higher with greater severity of acute Covid-19.
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- Long Covid
- Pandemic
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Content ArticleEnthusiasm has grown about using patients’ narratives—stories about care experiences in patients’ own words—to advance organisations’ learning about the care that they deliver and how to improve it, but studies confirming association have not been published. This study assessed whether primary care clinics that frequently share patients’ narratives with their staff have higher patient experience survey scores. It found that sharing narratives with staff frequently is associated with better patient experience survey scores, conditional on confidence in knowledge. Frequently sharing useful patient narratives should be encouraged as an organizational improvement strategy. However, organisations need to address how narrative feedback interacts with their staff’s confidence to realize higher experience scores across domains.
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- Patient engagement
- Research
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