Incident investigation remains a cornerstone of patient safety management and improvement, with recommendations meant to drive action and improvement. However, there is little empirical evidence about how—in real-world hospital settings—recommendations are generated or judged for effectiveness.
Delirium is a common but underdiagnosed state of disturbed attention and cognition that afflicts one in four older hospital inpatients. It is independently associated with a longer length of hospital stay, mortality, accelerated cognitive decline and new-onset dementia.
Risk stratification models enable clinicians to identify patients at high risk of an adverse event and intervene where appropriate. The advent of wearables, genomics, and dynamic datasets within electronic health records (EHRs) provides big data to which machine learning (ML) can be applied to individualise clinical risk prediction. ML is a subset of artificial intelligence that uses advanced computer programmes to learn patterns and associations within large datasets and develop models (or algorithms), which can then be applied to new data in rapidly producing predictions or classifications, including diagnoses.
The objectives of this review from Strating et al. were to: (1) provide a more contemporary overview of research on all ML delirium prediction models designed for use in the inpatient setting; (2) characterise them according to their stage of development, validation and deployment; and (3) assess the extent to which their performance and utility in clinical practice have been evaluated.
Waiting for procedures delayed by COVID-19 may cause anxiety and related adverse consequences.
This study from Gagliardi et al. looked at the research on the mental health impact of waiting and patient-centred mitigation strategies that could be applied in the COVID-19 context.
Findings revealed patient-centred strategies to alleviate the mental health impact of waiting for procedures. Ongoing research should explore how to optimize the impact of those strategies for diverse patients and caregivers, particularly in the COVID-19 context.
Corporate interests have the potential to influence public debate and policymaking by influencing the research agenda, namely the initial step in conducting research, in which the purpose of the study is defined and the questions are framed. Fabbri et al. conducted a scoping review to identify and synthesise studies that explored the influence of industry sponsorship on research agendas across different fields.
The authors concluded that corporate interests can drive research agendas away from questions that are the most relevant for public health. Strategies to counteract corporate influence on the research agenda are needed, including heightened disclosure of funding sources and conflicts of interest in published articles to allow an assessment of commercial biases. The authors also recommend policy actions beyond disclosure such as increasing funding for independent research and strict guidelines to regulate the interaction of research institutes with commercial entities.
Targeting the analysis of socio-technical complexity, the System-Theoretic Accident Model and Processes (STAMP) was developed to engineer safer systems. Since its inception in the early 2000s, STAMP and its associated techniques, namely the System-Theoretic Process Analysis (STPA) and the Causal Analysis based on System Theory (CAST), have attracted increasing interest as suitable approaches for safety studies. Nonetheless, a literature review on their applications is lacking. This paper from Patriarca et al. fills this gap via a scoping literature survey on contributions indexed in academic journals and conference proceedings.
Safety and quality of care for psychiatric patients is a relatively understudied area of patient safety research. This scoping review explores patient safety strategies used in psychiatry. The review identified seven key strategies that rely on staff performance, competence, and compliance: 1) risk management, (2) healthcare practitioners, (3) patient observation, (4) patient involvement, (5) computerised methods, (6) admission and discharge, and (7) security. These strategies primarily target reductions in suicide, self-harm, violence and falls.
This scoping paper explores the question ‘what would it take to build a culture of learning at scale?’. It focuses on systems-wide learning that can help to inform systems change efforts in complex contexts. To answer this question, literature was reviewed from across diverse disciplines and the realms of education, innovation systems, systems thinking and knowledge management. This inquiry was also supported by in-depth interviews with numerous specialists from the for-purpose sector and the examination of several case studies of learning across systems. The goal was to derive common patterns to inform a ‘learning for systems change’ framework.
In this paper, a ‘learning networks’ approach is proposed, one that draws upon individual, group and systems-wide learning to build capacity and resilience for systems change in uncertain environments. This fills a gap in the literature where the focus is largely on learning within organisations. Instead, the focus here is on what is required to support learning to occur across scales and boundaries - from the individual to system-wide. A simple meta-framework for developing learning networks is proposed that includes high level guidance on the enabling conditions - the mindsets, relationships, processes and structures - that would enable learning networks to flourish.
The COVID-19 pandemic is placing unprecedented pressure on a nursing workforce that is already under considerable mental strain due to an overloaded system. Convergent evidence from the current and previous pandemics indicates that nurses experience the highest levels of psychological distress compared with other health professionals. Nurse leaders face particular challenges in mitigating risk and supporting nursing staff to negotiate moral distress and fatigue during large-scale, sustained crises.
This paper from Sriharan et al. aims to (1) synthesise existing literature on COVID-19-related burnout and moral distress among nurses and (2) identify recommendations for nurse leaders to support the psychological needs of nursing staff.
Although midwifery-led continuity of care is associated with superior outcomes for mothers and babies, it is not available to all women. Issues with implementation and sustainability might be addressed by improving how it is led and managed – yet little is known about what constitutes the optimal leadership and management of midwifery-led continuity models. Hewitt et al. carried out a scoping review on leadership and management in midwifery-led continuity of care models.
Safety is a key concern in older adult care homes. However, it is a less developed concept in older adult care homes than in healthcare settings. As part of a study of the collection and application of safety data in the care home sector in England, a scoping review of the international literature was conducted by Rand et al.
The findings indicate that there are a range of available safety measures used for quality monitoring and improvement in older adult care homes. These cover all five domains of safety in the Safety Measurement and Monitoring Framework. However, there are potential gaps. These include user experience, psychological harm related to the care home environment, abusive or neglectful care practice and the processes for integrated learning. Some of these gaps may relate to challenges and feasibility of measurement in the care home context.
In North America, although pharmacists are obligated to ensure prescribed medications are appropriate, information about a patient’s reason for use is not a required component of a legal prescription. The benefits of prescribers including the reason for use on prescriptions is evident in the current literature. However, it is not standard practice to share this information with pharmacists.The aim of this study was to characterise the research on how including the reason for use on a prescription impacts pharmacists.The results suggest that including the reason for use on a prescription can help the pharmacist catch more errors, reduce the need to contact prescribers, support patient counseling, impact communication, and improve patient safety. Reasons that may prevent prescribers from adding the reason for use information are concerns about workflow and patient privacy.
Marginalised groups (‘populations outside of mainstream society’) experience severe health inequities, as well as increased risk of experiencing patient safety incidents. To date however no review exists to identify, map and analyse the literature in this area in order to understand 1) which marginalised groups have been studied in terms of patient safety research, 2) what the particular patient safety issues are for such groups and 3) what contributes to or is associated with these safety issues arising.
This review from Cheraghi-Sohi et al. in the International Journal for Equity in Health highlights that marginalised patient groups are vulnerable to experiencing a variety patient safety issues and points to a number of gaps. The findings indicate the need for further research to understand the intersectional nature of marginalisation and the multi-dimensional nature of patient safety issues, for groups that have been under-researched, including those with mental health problems, communication and cognitive impairments.
The National Audit of Inpatient Falls (NAIF) has a new approach which focuses on the continuous audit of the care and management of patients who sustain a hip fracture in an inpatient setting. The new process involves the identification of inpatient hip fractures by the National Hip Fracture Database (NHFD).
This first report of the continuous NAIF focuses on patients in England and Wales who sustained an isolated hip fracture (IHF) between January and August 2019. Data on organisational policy and practice with respect to inpatient fall prevention and management were collected via a facilities audit, and the data from 2018 NHFD were explored to identify differences between IHF and non-IHF processes and outcomes.
Design is a structured process for identifying problems and developing and evaluating user-focussed solutions. It has been successfully used to transform products, services, systems and even entire organisations. Based on the extensive experience of the aviation, military and nuclear industries, it is clear that effective design thinking can facilitate the delivery of products, services, processes and environments that are intuitive, simple to understand, simple to use, convenient, comfortable and consequently less likely to lead to error and accidents. Confusing, complex and unwieldy designs, which are all too often present in healthcare, are at best less effective than they could be. At worst, they are potentially dangerous to medical staff or the patient - or both. The contribution of design to improving safety in the context of medical systems is an area which remains relatively unexplored.
This scoping review is a joint report from the Robens Centre for Health Ergonomics at the University of Surrey; The Helen Hamlyn Research Centre at the Royal College of Art; and The Cambridge Engineering Design Centre at the University of Cambridge to identify how the effective use of design could help to reduce medical accidents.