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Content ArticleDespite progress on patient safety since the publication of the Institute of Medicine’s 1999 report, To Err Is Human, significant problems remain. Human factors and systems engineering (HF/SE) has been increasingly recognized and advocated for its value in understanding, improving, and redesigning processes for safer care, especially for complex interacting sociotechnical systems. However, broad awareness of HF/SE and its adoption into safety improvement work have been frustratingly slow. We provide an overview of HF/SE, its demonstrated value to a wide range of patient safety problems (in particular, medication safety), and challenges to its broader implementation across health care. We make a variety of recommendations to maximise the spread of HF/SE, including formal and informal education programmes, greater adoption of HF/SE by health care organisations, expanded funding to foster more clinician-engineer partnerships, and coordinated national efforts to design and operationalise a system for spreading HF/SE into health care nationally.
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Content ArticleProlonged length of stay (LOS) in emergency departments (ED) is a widespread problem in every hospital around the globe. Multiple factors cause it and can have a negative impact on the quality of care provided to the patients and the patient satisfaction rates. This project aimed to ensure that the average LOS of patients in a tertiary care cancer hospital stays below 3 hours.
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Content ArticleAlthough disparities in surgical outcomes are well-documented, understanding of how socioecological factors drive these disparities remains limited. This US study’s objective was to develop and assess the acceptability and feasibility of a comprehensive tool to evaluate socioecological determinants of health in patients requiring colorectal surgery. The authors developed an 88-item assessment tool measuring 31 socioecological determinants of health. It was assessed as having high acceptability and feasibility for patients who required colorectal surgery. The authors concluded that this work will help to identify what research is needed to understand and address surgical disparities.
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Content ArticleThe Patient Safety Indicators (PSIs) are a set of quality indicators developed by the Agency for Healthcare Research and Quality (AHRQ) providing information on potential hospital complications and adverse events after surgeries, procedures, and childbirth. They have been used for the past two decades in the USA for monitoring potentially preventable patient safety events in the inpatient setting through the automated screening of readily available administrative data. However, these indicators are also used for hospital benchmarking and cross-country comparisons in other nations with different health-care settings and coding systems as well as missing present on admission (POA) flags in the administrative data. This study sought to comprehensively assess and compare the validity of 16 PSIs in Switzerland, where they have not been previously applied.
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Content Article
An innovative approach to managing behaviour in the operating room (OR) using posters with eye symbols has seen positive results. A team of Australian researchers conducted a successful trial to address offensive and impolite remarks within ORs by implementing ‘eye’ signage in surgical rooms. These posters, placed on the walls of an Adelaide orthopaedic hospital’s operating theatre without explanation, effectively reduced poor behaviour among surgical teams. The lead researcher, Professor Cheri Ostroff from the University of South Australia, attributed this outcome to a sense of being ‘watched’, even though the eyes are not real. The three-month experiment targeted a prevalent culture of bullying and misconduct in surgical settings, a problem pervasive not only in healthcare but across various high-stress industries. Professor Ostroff emphasised that besides affecting staff morale and productivity, rude behaviour also has a detrimental impact on patients, particularly in compromising teamwork and communication during surgery, potentially leading to poorer outcomes. -
Content ArticleThe aim of this study was to investigate the incident reporting process (IR1s), to calculate the costs of reporting incidents in this context and to gain an indication of how economic the process was and whether it could be improved to yield better outcomes.
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Content ArticleEmergency surgical patients are at high risk for harm because of errors in care. Quality improvement methods that involve process redesign, such as “Lean,” appear to improve service reliability and efficiency in healthcare. This study found that lean can substantially and simultaneously improve compliance with a bundle of safety related processes. Given the interconnected nature of hospital care, this strategy might not translate into improvements in safety outcomes unless a system-wide approach is adopted to remove barriers to change.
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Event
Reducing antibiotic use in primary care
Patient Safety Learning posted an event in Community Calendar
If you work in primary care or primary care research, this one-hour NIHR Evidence webinar is for you. This webinar will cover NIHR research that could help reduce antibiotic prescribing in primary care. Speakers will present actionable evidence on antibiotic stewardship, and safe and effective prescribing. Presentations will be followed by a Q&A session, giving you a unique opportunity to quiz the researchers on how this research could be implemented at your organisation and reflect on potential barriers and facilitators. The webinar will cover: making decisions about who is in most need of antibiotics if antibiotics are needed for children with chest infections how digital tools can help reduce antibiotic prescribing. Register -
Content ArticleHealth-compromising behaviours such as cigarette smoking and poor dietary habits are difficult to change. Most social-cognitive theories assume that the intention to change is the best predictor of actual change, but people often do not behave in accordance with their intentions. Unforeseen barriers emerge, or people give in to temptations. Therefore, intentions should be supplemented by more proximal predictors that might facilitate the translation of intentions into action. Some self-regulatory mediators have been identified, such as perceived self-efficacy and strategic planning. They help to bridge the intention-behavior gap. The Health Action Process Approach (HAPA) suggests a distinction between (1) a preintentional motivation process that leads to a behavioural intention and (2) a postintentional volition process that facilitates the adoption and maintenance of health behaviours. In this article, two studies are reported that examine mediators between intentions and two behaviours. One behaviour is smoking reduction in young adults, the other is dietary restraint in overweight patients with chronic disease. A structural equation model, specified in terms of the HAPA, was in line with both data sets but it explained more variance of dietary behaviours among middle-aged or older individuals with a health condition whereas variance of smoking reduction in healthy young adults was less well accounted for. The findings contribute to the elucidation of psychological mechanisms in health behaviour change and point to the particular role of mediator variables.
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Content ArticleOperating room black boxes are a way to capture video, audio, and other data in real time to prevent and analyse errors. This article from Campbell et al. presents the results of two studies on operating room staff's perspectives of black boxes. Quality improvement, patient safety, and objective case review were seen as the greatest potential benefits, while decreased psychological safety and loss of privacy (both staff and patient) were the most common concerns.
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Content ArticleA new MIT study identifies six systemic factors contributing to patient hazards in laboratory diagnostics tests. By viewing the diagnostic laboratory data ecosystem as an integrated system, MIT researchers have identified specific changes that can lead to safer behaviours for healthcare workers and healthier outcomes for patients.
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Content ArticleRecurring problems with patient safety have led to a growing interest in helping hospitals’ governing bodies provide more effective oversight of the quality and safety of their services. National directives and initiatives emphasize the importance of action by boards, but the empirical basis for informing effective hospital board oversight has yet to receive full and careful review. This article presents a narrative review of empirical research to inform the debate about hospital boards’ oversight of quality and patient safety.
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Content ArticlePeople taking methotrexate (for inflammatory conditions such as rheumatoid arthritis) have regular blood tests to check for certain side effects. Researchers have developed a tool to predict the likelihood of them discontinuing methotrexate due to these side effects, which could in future lead to less frequent testing for most people (68%) on methotrexate. The tool uses information routinely collected by GPs. The study found that it could predict people’s risk of discontinuing methotrexate because of side effects. It was accurate for most people across different ages, inflammatory conditions, methotrexate doses and routes of administration. The researchers say the tool could in future be used by GPs to identify people who need more or less frequent blood tests. This article refers to the original research study Risk stratified monitoring for methotrexate toxicity in immune mediated inflammatory diseases: prognostic model development and validation using primary care data from the UK
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Content ArticleThis study from Jalilian et al., published in the BMJ, evaluated the length of stay difference and its economic implications between hospital patients and virtual ward patients. It found that the use of a 40-bed virtual ward was clinically effective in terms of survival for patients not needing readmission and allowed for the freeing of three hospital beds per day. However, the cost for each day freed from hospital stay was three-quarters larger than the one for a single-day hospital bed. This raises concerns about the deployment of large-scale virtual wards without the existence of policies and plans for their cost-effective management.
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News Article
Virtual ward costs twice that of inpatient care, study finds
Patient Safety Learning posted a news article in News
Researchers have found the costs of treating patients in a 40-bed virtual ward were double that of traditional inpatient care. The study’s authors said the findings should raise concerns over a flagship NHS England policy, which has driven the establishment of 10,000 virtual ward beds. Virtual wards, sometimes described as “hospital at home”, are cited as a safe way to reduce pressure on hospitals, by reducing length of stay and enabling quicker recovery. The study at Wrightington Wigan and Leigh Teaching Hospitals, in Greater Manchester, found a clear reduction in length of stay but also found higher rates of readmission. The authors said this led to additional costs, with the cost of a bed day in the virtual ward estimated at £1,077, compared to £536 in a general inpatient hospital bed. “This raises concerns [over] the deployment of large-scale virtual wards without the existence of policies and plans for their cost-effective management. This evidence should be taken into consideration by [the] NHS in planning the next large deployment of virtual wards within the UK… “Virtual wards must be cost effective if they are to replace traditional inpatient care, the costs must be comparable or lower than the costs of hospital stay to be economically sustainable in the medium to long terms.” To break even, the paper said the virtual ward would need to double its throughput, but warned this would risk lowering the standard of care. Read full story (paywalled) Source: HSJ, 25 January 2024 -
Content ArticleThe first UK geriatric oncology service at a tertiary cancer centre was established at the Royal Marsden Hospital in London. Its purpose is to conduct comprehensive geriatric assessments of patients with cancer on order to make referrals to multidisciplinary care. This descriptive study aimed to track its progress. It found that the service made a median of three referrals for each patient, most commonly to physiotherapy and occupational therapy. The frequency of referrals indicates that there is a high level of unmet need in older patients with cancer.
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Content ArticleFew interventions that succeed in improving healthcare locally end up becoming spread and sustained more widely. This indicates that we need to think differently about spreading improvements in practice. Drawing on a focused review of academic and grey literature, the authors outline how spread, scale-up, and sustainability have been defined and operationalised, highlighting areas of ambiguity and contention. Following an overview of relevant frameworks and models, they focus on three specific approaches and unpack their theoretical assumptions and practical implications: the Dynamic Sustainability Framework, the 3S (structure, strategy, supports) infrastructure approach for scale-up, and the NASSS (non-adoption, abandonment, and challenges to scale-up, spread, and sustainability) framework. Key points are illustrated through empirical case narratives and the Element concludes with actionable learning for those engaged in improvement activities and for researchers.
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Content ArticleAppropriate care escalation requires the detection and communication of in-hospital patient deterioration. Although deterioration in the ward environment is common, there continue to be patient deaths where problems escalating care have occurred. Learning from the everyday work of health care professionals (work-as-done) and identifying performance variability may provide a greater understanding of the escalation challenges and how they overcome these. The aims of this study from Ede et al. were to i) develop a representative model detailing escalation of care ii) identify performance variability that may negatively or positively affect this process and iii) examine linkages between steps in the escalation process.
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News Article
Blood test could revolutionise diagnosis of Alzheimer’s, experts say
Patient Safety Learning posted a news article in News
A blood test for detecting Alzheimer’s disease could be just as accurate as painful and invasive lumbar punctures and could revolutionise diagnosis of the condition, research suggests. Measuring levels of a protein called p-tau217 in the blood could be just as good as lumbar punctures at detecting the signs of Alzheimer’s, and better than a range of other tests under development, experts say. The protein is a marker for biological changes that happen in the brain with Alzheimer’s disease. Dr Richard Oakley, an associate director of research and innovation at the Alzheimer’s Society, said: “This study is a hugely welcome step in the right direction as it shows that blood tests can be just as accurate as more invasive and expensive tests at predicting if someone has features of Alzheimer’s disease in their brain. “Furthermore, it suggests results from these tests could be clear enough to not require further follow-up investigations for some people living with Alzheimer’s disease, which could speed up the diagnosis pathway significantly in future. However, we still need to see more research across different communities to understand how effective these blood tests are across everyone who lives with Alzheimer’s disease.” Read full story Source: The Guardian, 23 January 2024 -
Content ArticleNorthumbria University is exploring the experiences of NHS Trusts taking steps to move towards a Restorative Just Culture to develop and share an informative ‘how to’ guide. They would like to hear your views if you are you an NHS Trust who has attended the Northumbria University and Mersey Care NHS FT programme: Principles and Practices of Restorative Just Culture and have implemented, or attempted to implement, restorative just culture. It will take approximately 45 minutes of your time to take part in an online interview/focus group. If you are interested in participating or have any questions please contact bl.rjc@northumbria.ac.uk. Download the attachment below for more information.
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Content ArticleDiagnostic errors contribute to patient harm, though few data exist to describe their prevalence or underlying causes among medical inpatients. The aim of this study published by Jama Internal Medicine was to determine the prevalence, underlying cause, and harms of diagnostic errors among hospitalised adults transferred to an intensive care unit (ICU) or who died. The results showed that diagnostic errors were common and associated with patient harm. Problems with choosing and interpreting tests and the processes involved with clinician assessment are high-priority areas for improvement efforts.
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Content ArticleThis study published in the BMJ evaluated the effect of chair placement on length of time physicians sit during a bedside consultation and patients’ satisfaction. The study concluded that chair placement is a simple, no cost, low tech intervention that increases a physician’s likelihood of sitting during a bedside consultation and resulted in higher patients’ scores for both satisfaction and communication.
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Content ArticleUndervaccination—receiving fewer than the recommended number of Covid-19 vaccine doses—could be associated with increased risk of severe Covid-19 outcomes including hospitalisation or death compared with full vaccination. This study aimed to determine the factors associated with undervaccination and to investigate the risk of severe Covid-19 outcomes in people who were undervaccinated in each UK nation, and across the UK. The authors found that rates of undervaccination against Covid-19 ranged from 32·8% to 49·8% across the four UK nations in summer 2022. They also concluded that undervaccination was associated with an elevated risk of severe Covid-19 outcomes.
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Content ArticleThe Academy for Healthcare Science is the single overarching body for the entire UK Healthcare Science (HCS) workforce, working alongside the healthcare science professional bodies, and also professionals from the life science industry and clinical research practitioners, helping to strengthen the visibility of the contribution of those workforces. Could you play an important role by becoming a Lay Assessor for the Academy for Healthcare Science? Are you able to demonstrate professionalism and strong interpersonal skills? Do you have a sound understanding of assessment principles and a keen sense of objectivity and consistency? Then this may be the perfect opportunity for you. Follow link for full role description and how to apply. Deadline: 31 January 2024
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Content ArticleCoercive or restrictive practices such as compulsory admission, involuntary medication, seclusion and restraint impinge on individual autonomy. International consensus mandates reduction or elimination of restrictive practices in mental healthcare. To achieve this requires knowledge of the extent of these practices. This study is the most comprehensive overview of rates of coercive practices between countries attempted to date.
