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Showing results for tags 'USA'.
Found 653 results
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Content ArticlePrevious research suggests that surgical safety checklists (SSCs) are associated with reductions in postoperative morbidity and mortality as well as improvement in teamwork and communication. These findings stem from evaluations of individual or small groups of hospitals. Studies with more hospitals have assessed the relationship of checklists with teamwork at a single point in time. The objective of this study from Molina et al. was to evaluate the impact of a large-scale implementation of SSCs on staff perceptions of perioperative safety in the operating room. They concluded that a large-scale initiative to implement SSCs is associated with improved staff perceptions of mutual respect, clinical leadership, assertiveness on behalf of safety, team coordination and communication, safe practice, and perceived checklist outcomes.
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Content ArticleHospitals across the US are grappling with nurse shortages as the pandemic continues to change the healthcare system as we know it. Two intensive care unit nurses who left their jobs shared their experiences in Becker's Hospital Review.
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Content ArticleIn the United States many areas have returned to a 'new normal,' as the COVID-19 pandemic has come under control. In this blog, Dr Michael Ramsay, Chairman of the Board, Patient Safety Movement Foundation looks at what we learned and where we failed.
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Content ArticleThe ISMP Targeted Medication Safety Best Practices for Hospitals (TMSBP) were developed to identify, inspire, and mobilise widespread, national adoption in the US of consensus-based best practices for specific medication safety issues that continue to cause fatal and harmful errors in patients, despite repeated warnings in ISMP publications. The best practice recommendations presented in this guidance document are based on error reports received through the ISMP National Medication Errors Reporting Program (ISMP MERP) and have been reviewed by an external expert advisory panel and approved by the ISMP Board of Trustees. This initiative was first launched in 2014 and is updated with additional best practices, as needed, every two years. While targeted for the hospital-based setting, some best practices are applicable to other healthcare settings. Facilities can focus their medication safety efforts on these Best Practices, which are realistic and have been successfully adopted by numerous organisations.
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Content Article
ECRI: Top 10 patient safety concerns 2021
Patient Safety Learning posted an article in International patient safety
ECRI Institute's Top 10 patient Safety concerns for 2021 report highlights patient safety concerns across the continuum of care because patient safety strategies increasingly focus on collaborating with other provider organisations, community agencies, patients or residents, and family members. Each patient safety concern on this list may affect more than one setting and involve a wide range of personnel. -
Content Article“Sunshine” policy, aimed at making financial ties between health professionals and industry publicly transparent, has gone global. Given that transparency is not the sole means of managing conflict of interest, and is unlikely to be effective on its own, it is important to understand why disclosure has emerged as a predominant public policy solution, and what the effects of this focus on transparency might be.
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Content ArticleHealthcare workers are among the heroes of the pandemic. One year in, many of us are experiencing stress, fatigue, and grief. But this can pale in comparison to the toll faced by those caring for the sick and dying on a daily basis. On the latest episode of The Dose, we listen to the stories of one group of frontline health workers: nurses. Often dealing with inadequate PPE and staff shortages, nurses are putting their own lives at risk — and many are experiencing burnout and exhaustion. In this podcast, guest, Mary Wakefield, takes us on a journey from rural hospitals to clinics in underserved areas, all through the eyes of nurses.
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Content ArticleWhile the US healthcare system is considered one of the best in the world, many American’s may not realise the potential risks they face when seeking and receiving healthcare. The most recent figures put the rate of preventable healthcare deaths at around 400,000 each year. To put this in perspective, that is more than Alzheimer’s disease, lung cancer, and breast cancer combined kill each year and means that healthcare is the third leading cause of death in the US. That figure does not even reflect the hundreds of thousands of patients who are harmed during their care but do not die. In this article for The Hill, Jill Steiner Sanko explores how we can address preventable healthcare deaths.
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Content ArticlePennsylvania is the only state that requires acute healthcare facilities to report all events of harm or potential for harm. With over 3.6 million acute care event reports, the Pennsylvania Patient Safety Reporting System (PA-PSRS) is the largest repository of patient safety data in the United States and one of the largest in the world. This report analyses the serious events and incidents from the database.
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Content ArticleHealthcare organisations strive to improve patient care experiences. One way is to use one-on-one provider counselling (shadow coaching) to identify and target modifiable provider behaviours. Quigley et al. examined whether shadow coaching improves patient experience across 44 primary care practices in a large urban US health centre. They found that shadow coaching improved providers' overall performance and communication immediately after being coached. However, these gains disappeared after 2.5 years. Regularly planned shadow coaching "booster" sessions might maintain or even increase the improvement gained in patient experience scores, but research examining additional coaching and optimal implementation is needed.
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Content Article
Patients For Patient Safety US
Patient Safety Learning posted an article in International patient safety
Patients for Patient Safety US (PFPS US) is a network of people and organisations aligned with the World Health Organization (WHO) and focused on making healthcare safe in the United States. It is led by people who have experienced medical error as a patient or in their families, and is committed to implementing the World Health Organization Global Patient Safety Action Plan in the USA. Read their 'Stories That Impacted Change' -
Content Article
AHRQ: Toolkit for engaging patients to improve diagnostic safety
Mark Hughes posted an article in Diagnostic error
Research suggests that a key factor contributing to diagnostic errors is the breakdown of communication between patients and healthcare professionals. The Agency for Healthcare Research and Quality (AHRQ) in the United States has developed this toolkit to promote enhanced communication and information sharing between patients and healthcare professionals. It is designed to help patients, families, and health professionals work together as partners to improve diagnostic safety. -
Content ArticleNo two countries are alike when it comes to organising and delivering healthcare for their people, creating an opportunity to learn about alternative approaches. Schneider et al. compared the performance of 11 high-income countries healthcare systems.
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Content Article
Health equity resource series
PatientSafetyLearning Team posted an article in Health inequalities
To support hospitals and health systems starting from different points on their journey to strengthen health equity, the American Health Association's Institute for Diversity and Health Equity (IFDHE) is preparing four new guidance and resource toolkits to share evidence-based practices to inform organisational next steps. -
Content ArticleThis article reviews the Missouri Quality Initiative, which aims to reduce hospital admissions among nursing home residents. It involves placing an advanced practice registered nurse within the nursing home, supported by an interdisciplinary team of long-term care specialists, to identify when a resident may be experiencing a functional decline. Results from this initiative showed statistically significant decreases in hospitalisations.
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Content ArticleIn addition to older individuals and those with underlying chronic health conditions, maternal and newborn populations have been identified as being at greater risk from COVID-19. It became critical for hospitals and clinicians to maintain the safety of individuals in the facility and minimise the transmission of COVID-19 while continuing to strive for optimised outcomes by providing family-centered care. Rapid change during the pandemic made it appropriate to use the plan–do–study–act (PDSA) cycle to continually evaluate proposed and standard practices. Patrick and Johnson describe how their team established an obstetric COVID-19 unit for women and newborns, developed guidelines for visitation and for the use of personal protective equipment, initiated universal COVID-19 testing, and provided health education to emphasize shared decision making.
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Content ArticleDespite widespread recognition and known harms, serious surgical errors, known as surgical never events, endure. The California Department of Public Health (CDPH) has developed an oversight system to capture never events and a platform for process improvement that has not yet been critically appraised. This study examined surgical never events occurring in hospitals in California and summarize recommendations to prevent future events.
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Content ArticleAlthough most current medication error prevention systems are rule-based, these systems may result in alert fatigue because of poor accuracy. Previously, we had developed a machine learning (ML) model based on Taiwan’s local databases (TLD) to address this issue. However, the international transferability of this model is unclear. This study examines the international transferability of a machine learning model for detecting medication errors and whether the federated learning approach could further improve the accuracy of the model. It found that the ML model has good international transferability among US hospital data. Using the federated learning approach with local hospital data could further improve the accuracy of the model.
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Content ArticleIn this article in Inforisk Today, Marianne McGee looks at warnings from patient safety experts and federal authorities around cyberattacks on the public health sector. She looks at emerging trends in the way that cybercriminals target healthcare, recent work to bring down cybercriminal gangs and the impact of ransomware attacks on healthcare systems.
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Content Article
BMJ: Raining in Los Angeles (14 January 2022)
Patient Safety Learning posted an article in Blogs
Amid climbing covid case numbers and with scarce resources, Tara Vijayan describes what it has been like in the US to triage treatments that aim to prevent patients being hospitalised with COVID-19 -
Content Article
Hospitals are in serious trouble (7 January2022)
Patient Safety Learning posted an article in Blogs
Omicron is inundating a healthcare system that was already buckling under the cumulative toll of every previous surge, writes Ed Yong in an article for the Atlantic. When a healthcare system crumbles, this is what it looks like. Much of what’s wrong happens invisibly. At first, there’s just a lot of waiting. Emergency rooms get so full that “you’ll wait hours and hours, and you may not be able to get surgery when you need it,” says Megan Ranney, an emergency physician in Rhode Island. When patients are seen, they might not get the tests they need, because technicians or necessary chemicals are in short supply. Then delay becomes absence. The little acts of compassion that make hospital stays tolerable disappear. Next go the acts of necessity that make stays survivable. Nurses might be so swamped that they can’t check whether a patient has their pain medications or if a ventilator is working correctly. People who would’ve been fine will get sicker. Eventually, people who would have lived will die. This is not conjecture; it is happening now, across the United States. -
Content Article
Bleed Out: HBO documentary (2018)
Patient Safety Learning posted an article in Investigations and complaints
Medical error is the third leading cause of death in the U.S. After a routine partial hip replacement operation leaves the mother of filmmaker and comedian Steve Burrows in a coma with permanent brain damage, what starts as a personal video diary becomes a citizen’s investigation into the state of American healthcare. -
Content Article"To healthcare workers in the COVID era, holidays mean death, and we knew Omicron was coming before it had a name. The wave caused by this variant has barely begun, rapidly gathering steam, and we are exhausted, attempting to pull from reserves badly drained by earlier surges." Kathryn Ivey, a critical care nurse at a medical center in Nashville, Tennessee, confronts the Omicron surge filling her hospital.
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Content ArticleIn this opinion piece for The Hill, the authors argue that urgent action is needed to prevent huge amounts of avoidable harm in the American healthcare system. They point to successful strategies under the Obama administration to demonstrate that the right political will can both improve patient safety and save money. They highlight actions that policy makers, official bodies and patients should take to promote the patient safety agenda.
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Content ArticleThis study in The Journal of Minimally Invasive Gynecology applied a structured human factors analysis to understand the factors that contribute to vaginal retained foreign objects (RFOs). Trained human factors researchers looked at 45 incidents that occurred between January 2000 and May 2019 at an academic medical centre in Sothern California. The narrative of each incident was reviewed to identify contributing factors, classified using the Human Factors Analysis and Classification System for Healthcare (HFACS-Healthcare). The authors of the study concluded that the top two contributing factors in vaginal RFO incidents were skill-based errors and communication breakdowns. Both types of errors can be addressed and improved with human factors interventions, including simulation, teamwork training, and streamlining workflow to reduce the opportunity for errors.
