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News ArticleMylissa Farmer’s pregnancy was doomed. But no one would help her end it. Over the course of a few days in August 2022, Farmer visited two hospitals in Missouri and Kansas, where doctors agreed that because the 41-year-old’s water had broken just 18 weeks into her pregnancy, there was no chance that she would give birth to a healthy baby. Continuing the pregnancy could risk Farmer’s health and life – yet the doctors could not act. Weeks earlier, the US supreme court had overturned Roe v Wade and abolished the national right to abortion. It was, legal counsel at one hospital determined, “too risky in this heated political environment to intervene”, according to legal filings. In immense pain and anguish, Farmer ultimately traveled several hours to Illinois, where abortion is legal. There, doctors were able to end her pregnancy. Farmer’s account is detailed in a legal complaint she filed against the hospitals, arguing that they broke a federal law that requires hospitals to treat patients in medical emergencies. In a first-of-its-kind investigation, the US government sided with Farmer and declared that the two hospitals had broken the law. The future of the government’s ability to invoke that law to protect women seeking emergency abortions is now in question. The law, the Emergency Medical Treatment and Labor Act (Emtala), is at the heart of the US supreme court’s latest blockbuster abortion case, which comes out of Idaho. Read full story Source: The Guardian, 9 January 2024
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Content ArticlePatient safety is a US national priority, yet lacks a comprehensive assessment of progress over the past decade. The aim of this study from Eldridge et al. was to determine the change in the rate of adverse events in hospitalised patients. The study found that in the US between 2010 and 2019, there was a significant decrease in the rates of adverse events abstracted from medical records for patients admitted for acute myocardial infarction, heart failure, pneumonia, and major surgical procedures, and there was a significant decrease in the adjusted rates of adverse events between 2012 and 2019 for all other conditions. Further research is needed to understand the extent to which these trends represent a change in patient safety.
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Content ArticleThe maternal mortality rate (MMR) in the United States continues to increase despite medical advances and is exacerbated by stark racial disparities. Black women are disproportionately affected and are three times more likely to experience a pregnancy-related death (PRD) compared to Non-Hispanic White (NHW) women. Keisha E. Montalmant and Anna K. Ettinger carried out a literature review to examine the racial disparities in the United States' MMR, specifically among pregnant Black women. The review highlights that maternal health disparities for Black women are further impacted by both structural racism and racial implicit biases. Cultural competence and educational courses targeting racial disparities among maternal healthcare providers (MHCP) are essential for the reduction of PRDs and pregnancy-related complications among this target population. Additionally, quality and proper continuity of care require an increased awareness surrounding the risk of cardiovascular diseases for pregnant Black women.
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Content ArticleThis article provides an overview of the proposed Patient Safety Structural Measure on the Centers for Medicare and Medicaid Services (CMS) list of Measures Under Consideration (MUC) 2023 and summarises the public comment submitted by Patient Safety Learning on this.
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Content ArticleSentinel Event Alert newsletters identify specific types of sentinel and adverse events and high risk conditions, describes their common underlying causes, and recommends steps to reduce risk and prevent future occurrences. Accredited organisations should consider information in a Sentinel Event Alert when designing or redesigning processes and consider implementing relevant suggestions contained in the alert or reasonable alternatives.
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Content ArticleThe US Food and Drug Administration (FDA) list of drug names with recommended tall man (mixed case) letters was initiated in 2001 with the agency’s Name Differentiation Project. Tall man lettering (TML) is a technique that uses uppercase lettering to help differentiate look-alike drug names. Starting on the left side of a drug name, TML highlights the differences between similar drug names by capitalizing dissimilar letters (e.g., vinBLAStine versus vinCRIStine and CISplatin versus CARBOplatin). TML can be used along with colour or bolding to draw attention to the dissimilarities between look-alike drug names, and alert healthcare providers that the drug name can be confused with another drug name. The Institute for Safe Medication Practices (ISMP) 'Look-alike drug names with recommended tall man (mixed case) letters' contains drug name pairs or larger groupings with recommended, bolded uppercase letters to help draw attention to the dissimilarities in look-alike drug names. The list includes mostly generic-generic drug names, although a few brand-brand or brand-generic names are included. See also our Medication error traps gallery
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Content ArticleThis observational cross-sectional study in the American Journal of Surgery aimed to quantify the association between US state trauma funding and both in-hospital mortality and transfers of injured patients. The authors concluded that Increased state trauma funding is associated with decreased adjusted in-hospital mortality and fewer interfacility transfers to a second acute care hospital.
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Content ArticleAs part of the 21st Century Cures Act (April 2021), electronic health information (EHI) must be immediately released to patients in the USA. This study in the American Journal of Surgery sought to evaluate clinician and patient perceptions regarding this immediate release of results and reports. Interviews with patients and clinicians found differences in perceived patient distress and comprehension, emphasising the impersonal nature of electronic release and necessity for therapeutic clinician-patient communication.
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Content ArticleIn 2022 the Center for Medicare & Medicaid Services (CMS) launched the CMS National Quality Strategy (NQS), an ambitious long-term initiative that aims to promote the highest quality outcomes and safest care for all. This document gives an overview of the strategy, using infographics to explain its four priority areas: Outcomes and alignment Equity and engagement Safety and resiliency Interoperability and scientific advancement
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News Article
Nearly 1.7 million Texans lose Medicaid as state nears end of “unwinding”
Patient Safety Learning posted a news article in News
Nearly 1.7 million Texans have lost their health insurance — the largest number of people any state has removed — in the months since Texas began peeling people from Medicaid as part of the post-pandemic “unwinding.” Around 65% of these removals occurred because of procedural reasons, according to the state. Texas’ Health and Human Services Commission has neared the end of a chaotic and overburdened process to remove people from state Medicaid insurance who became ineligible during the coronavirus pandemic. The state had not unenrolled people before this year because of federal pandemic rules, which forbid states from cutting coverage. As a result, more than 5 million Texans had continuous access to healthcare throughout the pandemic through Medicaid, the joint federal-and-state-funded insurance program for low-income individuals. In Texas, the program’s eligibility criteria is so restrictive, it mainly covers poor children, their mothers while pregnant and post partum, and disabled and senior adults. But the effects of speedrunning this process have reverberated: Still-eligible Texans were kicked off both in error and for procedural reasons, adding to backlogs of hundreds of thousands of Medicaid applications and pushing wait times back several months. “The state handled this with an incredible amount of incompetence and indifference to poor people,” U.S. Rep. Lloyd Doggett, D-Austin, told The Texas Tribune. “It's really appalling.” Read full story Source: The Texas Tribune, 14 December 2023 -
Content ArticleThe Belmont Report was written by the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research. The Commission, created as a result of the National Research Act of 1974, was charged with identifying the basic ethical principles that should underlie the conduct of biomedical and behavioral research involving human subjects and developing guidelines to assure that such research is conducted in accordance with those principles. Informed by monthly discussions that spanned nearly four years and an intensive four days of deliberation in 1976, the Commission published the Belmont Report, which identifies basic ethical principles and guidelines that address ethical issues arising from the conduct of research with human subjects.
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Content ArticlePatient safety is a US national priority, yet lacks a comprehensive assessment of progress over the past decade. This study determined the change in the rate of adverse events in hospitalised patients. The study found that in the US between 2010 and 2019, there was a significant decrease in the rates of adverse events abstracted from medical records for patients admitted for acute myocardial infarction, heart failure, pneumonia, and major surgical procedures and there was a significant decrease in the adjusted rates of adverse events between 2012 and 2019 for all other conditions. Further research is needed to understand the extent to which these trends represent a change in patient safety.
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Content ArticleSince the Covid-19 pandemic, there has been a significant increase in telehealth use for patient evaluations. The US Veteran Health Administration (VHA) has tripled phone and video visits across several specialties. Although there are hesitations in phone-call-based communication for procedural subspecialties, phone calls to veterans have proven safe and efficacious after general surgery procedures. Telehealth has additional benefits, including reducing transportation barriers, improving access to care and reducing delays in medical care. This article in the journal Surgery aimed to evaluate clinic access after the establishment of routine telehealth use through phone calls by the surgeon.
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Content ArticleIncreasing interest in general surgery from students who are Under-Represented in Medicine (URiM) is vital to advancing diversity, equity and inclusion efforts. This study in The American Journal of Surgery examined medical student third year surgery clerkship evaluations quantitatively and qualitatively to understand the experiences of URiM and non-URiM learners. The authors found that URiM students are less likely than non-URiM students to see surgical residents and faculty as positive role models. They highlight that integrating medical students into the team, taking time to teach and allowing students to feel valued in their roles improves the clerkship experience for trainees and can contribute to recruitment efforts.
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Content ArticleThe NHS’s deal with the US tech company Palantir raises privacy concerns, but a unified database could be a medical gamechanger writes Martha Gill in an article for the Observer. Governments have been trying to stitch together our patchwork system for decades. Billions have been lost in these attempts. However, they always run up against the same problem: people just don’t want to share their medical data, even when assured it will be anonymised. When the government aimed to build a collection of anonymous GP health records, around a million patients opted out. The latest of these attempts has closed a loophole: patients cannot now opt out. But this has enraged civil liberties groups, which are concerned about the company chosen to merge, clean and provide tools for sorting through the data.
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Content ArticleOver the past two years, AHRQ has examined equity and its connections to agency activities in alignment with its mission to improve healthcare for all Americans. A new special issue of Health Services Research sponsored by AHRQ summarises the state of evidence and identifies opportunities to drive more equitable care.
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Content ArticleHow would you feel if your doctor offered you a treatment your health condition with good results and very little risk? You might snap it up. But what if you subsequently found out your doctor took thousands of pounds from the treatment makers to write a scientific paper promoting it, attend an all-expenses paid conference to talk about it, or spent time working as their expert consultant? In America, industry must log payments which are published on the open database system. Reporting to this is backed up by law following the American Sunshine Payment Act (2013). Sling the Mesh is calling for similar legislation in the UK to provide up-to-date evidence on industry money exchanging hands we Kath Sansom discusses in a blog on the Patient Safety Commissioner website.
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Content ArticleHospital and health system CEOs have a lot of issues dominating their thoughts, including questions about navigating financial, operational and workforce challenges in the industry. Some of these problems may not have an obvious or immediate solution, leaving leaders with unanswered questions. To gain more insight into executives' top concerns, Becker's asked hospital and health system leaders to share the questions they need answered right now.
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Content ArticleThe COVID-19 pandemic highlighted systemic weaknesses in the healthcare system. This survey of 3,067 registered nurses working in New Jersey used the Donabedian framework to identify challenges related to providing safe care during the pandemic. Respondents identified several organisational factors, including inadequate resources and staffing, which adversely impacted their ability to adhere to patient safety and infection prevention and control protocols during the pandemic.
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News Article
Patient privacy fears as US spy tech firm Palantir wins £330m NHS contract
Patient Safety Learning posted a news article in News
The NHS has sparked controversy by handing the US spy tech company Palantir a £330m contract to create a huge new data platform, leading to privacy concerns around patients’ medical details. The move immediately prompted concerns about the security and privacy of patient medical records and the suitability of Palantir to be given access to and oversight of such sensitive material. NHS England has given Palantir and four partners including Accenture a five-year contract to set up and operate the “federated data platform” (FDP). The British Medical Association, which had previously voiced concern about the NHS’s alleged lack of scrutiny of bidders on “ethical” grounds, said Palantir’s winning bid was “deeply worrying”. NHS England sought to allay such concerns. It stressed that none of the companies in the winning consortium would be able to access health and care data without its explicit consent; that it would retain control of all data within the platform; and that it would not include GP data. It said the new software would be protected by the highest possible standards of security through the deployment of “privacy enhancing technology”. Read full story Source: The Guardian, 21 November 2023 -
News Article
USA: Despite decades of promises, health research still overlooks women
Patient Safety Learning posted a news article in News
Women are underrepresented in clinical trials, and even lab mice are predominantly male – and the effects show up in almost every aspect of human health Women are twice as likely as men to die from heart attacks; when a nonsmoker dies of lung cancer, it’s twice as likely to be a woman as a man; and women suffer more than men from Alzheimer’s and autoimmune disease. Yet research into these conditions, and many more, generally fails to examine women separately. It’s even less likely to look at disparities affecting women of color – why, for instance, Black women are nearly three times more likely to die in pregnancy than white women are. It’s been 30 years since the US Congress ordered the National Institutes of Health to make sure women were included equally in clinical trials. Despite some progress, research on women still lags, and there’s growing evidence that women and girls are paying the price. “Research on women’s health has been underfunded for decades, and many conditions that mostly or only affect women, or affect women differently, have received little to no attention,” the first lady Jill Biden said in announcing a new White House initiative on women’s health research on 13 November. “Because of these gaps, we know far too little about how to manage and treat conditions like endometriosis, and autoimmune diseases like rheumatoid arthritis. These gaps are even greater for communities that have historically been excluded from research – including women of color and women with disabilities.” Not only do researchers fail to include enough women in clinical trials, they often don’t look for differences between how men and women respond to treatments. Read full story Source: The Guardian, 20 November 2023 Further reading on the hub Dangerous exclusions: The risk to patient safety of sex and gender bias Gender bias: A threat to women’s health Animal testing doesn't work, we need to find new ways of testing the safety of medicines—a blog by Pandora Pound -
Content ArticleUS healthcare organisations continue to grapple with the impacts of the nursing shortage—scaling back of health services, increasing staff burnout and mental-health challenges, and rising labour costs. While several health systems have had some success in rebuilding their nursing workforces in recent months, estimates still suggest a potential shortage of 200,000 to 450,000 nurses in the United States, with acute-care settings likely to be most affected.1 Identifying opportunities to close this gap remains a priority in the healthcare industry. This article highlights research conducted by McKinsey in collaboration with the ANA Enterprise on how nurses are actually spending their time during their shifts and how they would ideally distribute their time if given the chance. The research findings underpin insights that can help organizations identify new approaches to address the nursing shortage and create more sustainable and meaningful careers for nurses.
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News ArticleA new report by US healthcare communications agency GCI Health found that Black women aren't avoiding clinical trials due to mistrust. The reasons for their underrepresentation are “more layered and nuanced.” The report is based on a recent summer survey with 500 responses from Black women across the USA. It reveals that, while the majority (80%) are "open" to participating in a clinical trial, 73% have never been asked to do so. While it's commonly believed that Black women are unwilling to participate in trials due to mistrust of the healthcare and biopharma systems, GCI's survey responses unveiled a more complex perspective. The data suggest “that access to information is the largest barrier to participation, rather than mistrust in the medical establishment, as commonly believed,” GCI Health’s report found. “We often hear that Black women are missing from clinical research because they are ‘hard-to-reach’ or reluctant to participate due to mistrust of the medical establishment,” said Kianta Key, group senior vice president and head of identity experience at GCI Health, in a press release. “In talking with women, we heard something more layered and nuanced that deserved exploration.” “Our industry has a responsibility to reverse years of underrepresentation in clinical trials and do more to support better healthcare outcomes for Black women,” said Kristin Cahill, global CEO of GCI Group, in the release. “Equity is critical to ensure new treatments and health interventions work for everyone. This research helps get us closer to understanding what needs to be done to make positive changes that will save lives and create healthier communities.” Read full story Source: Fierce Pharma, 14 November 2023
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Content ArticleNurse bullying has been an issue for decades and continued during the Covid-19 pandemic. Now, in the post-pandemic era, allegations of toxic behaviour are continuing to climb. Becker's spoke with Jennifer Woods, vice president and chief nursing officer at Baptist Health Hardin in Elizabethtown, Pennsylvania, and Jamie Payne, chief human resources officer at Saint Francis Health System in Tulsa, Oklahoma, to understand the increase in nurse bullying and how their health systems are working to address it.
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Content ArticleA BMJ investigation has raised concerns that the Vaccine Adverse Event Reporting System (VAERS) isn’t operating as intended and that signals are being missed. VAERS is supposed to be user friendly, responsive, and transparent. However, investigations by The BMJ have uncovered that it’s not meeting its own standards. Not only have staffing levels failed to keep pace with the unprecedented number of reports since the rollout of covid vaccines but there are signs that the system is overwhelmed, reports aren’t being followed up, and signals are being missed. The BMJ has spoken to more than a dozen people, including physicians and a state medical examiner, who have filed VAERS reports of a serious nature on behalf of themselves or patients and were never contacted by clinical reviewers or were contacted months later.
