Relevant bibliographies by topics / Patient safety and quality in healthcare

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  1. Journal articles
  2. Dissertations / Theses
  3. Books
  4. Book chapters
  5. Conference papers
  6. Reports

Academic literature on the topic 'Patient safety and quality in healthcare'

Author: Grafiati
Published: 4 June 2021
Last updated: 1 February 2022

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Journal articles on the topic "Patient safety and quality in healthcare"

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Arries, Ebin J. "Patient safety and quality in healthcare." Nursing Ethics 21, no. 1 (January 29, 2014): 3–5. http://dx.doi.org/10.1177/0969733013509042.

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Slavinska, Andreta, Evita Grigorovica, Karina Palkova, Nora Jansone-Ratinika, Matiss Silis, Oļegs Sabeļņikovs, and Aigars Pētersons. "SKILLS MONITORING IN HEALTHCARE STUDIES – FOR PATIENT SAFETY AND HEALTHCARE QUALITY." SOCIETY. INTEGRATION. EDUCATION. Proceedings of the International Scientific Conference 1 (May 28, 2021): 611–30. http://dx.doi.org/10.17770/sie2021vol1.6448.

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The competence of healthcare professionals is crucial in ensuring patient safety and the quality of healthcare. Skills are one of the most important aspects of competence, but often health care employers, when assessing the readiness of young professionals, point out that the ability to implement skills in a real work environment are unclear, insufficient and even inadequate.The paradigm shift in education intends bringing skills to the foreground. In order to promote skills management, Rīga Stradiņš University (RSU) already in 2016 started work on the institutional level project “Skills Monitoring System” (hereinafter - SMS), focusing primarily on work and profession specific skills in the field of health care studies.Visible and demonstrable monitoring of skills in education is an innovation. The aim of this article is to analyze and reflect the coherence of the RSU Skills Monitoring System concept with the current principles of education policy development, legal framework and basic principles of higher education pedagogy in skills acquisition and evaluation in health care education, as well as to evaluate the initial results of the newly developed system.In order to achieve the goal, an interdisciplinary, qualitative study was conducted, where analytical and descriptive, inductive, deductive and synthesis research and legal (translation) norm methods were implemented, as well as interviews to evaluate initial results.The results of the research show that the components and solutions included in SMS have been developed in accordance with the legal framework and the main educational guidelines, in accordance with the theoretical concepts of pedagogy. An education approach based on simulation integrated in the acquisition of skills allows to systematically evaluate the amount and quality of theoretical knowledge, to determine the actual level of abilities and to predict the quality of performance and compliance with the real work environment. The management of skills acquisition in Higher Education Institutions should be supported and promoted from the point of view of educators, employees and sectoral professional associations and employers.
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Shah, Mairaj, and Shagufta Perveen. "STATE OF HEALTHCARE QUALITY AND PATIENT SAFETY IN PAKISTAN." Pakistan Journal of Public Health 6, no. 4 (December 1, 2016): 1–4. http://dx.doi.org/10.32413/pjph.v6i4.3.

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Many low and middle income countries have developed their own national accreditation standards and accreditation systems for regulating and improving the quality of healthcare services. Healthcare quality is defined as the degree to which health services to individuals and populations increases the likelihood of desired health outcomes and are consistent with current professional knowledge. This paper attempts to assess the state of Pakistan's healthcare quality and patient safety in a structured way using Donabedian's model. Some of the key specific challenges identified for Pakistan's healthcare quality initiatives are lack of national healthcare accreditation system and integrated national guidelines, policies and procedures on healthcare quality and patient safety. Lack of national quality care indicators. Absence of an organizational culture that holds people accountable and lack of pre-service and in-service training for health staff in quality care management and leadership with little contextual research on quality care initiatives. Possible ways to improve the state of health care quality in Pakistan may include (i) up gradation and implementation of policies and procedures that regulate quality and patient safety issues in healthcare settings across the country (ii) introduction of a national healthcare accreditation programme across the nation (iii) development of networks and consortia between public and private sectors in Pakistan (iv) capacity building of health care professionals in quality and patient safety (v) Formulation of quality improvement teams at national and provincial level (vi) development of a culture of accountability and ownership (vii) learning from experiences of other countries and implementation quality care tools and locally validated indicators.
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Fatima, Taqdees, Shahab Alam Malik, and Asma Shabbir. "Hospital healthcare service quality, patient satisfaction and loyalty." International Journal of Quality & Reliability Management 35, no. 6 (June 4, 2018): 1195–214. http://dx.doi.org/10.1108/ijqrm-02-2017-0031.

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Purpose The purpose of this paper is to explain the patients’ views towards private healthcare service providers. The study focussed on hospital service quality and analysed the relative significance of quality measurements in anticipating the patients’ satisfaction and loyalty. The mediating role of patient satisfaction is assessed between quality of hospital healthcare services and patient loyalty. Design/methodology/approach A total 611 patients (both indoor and outdoor) participated in a questionnaire survey from the six private hospitals of capital city, Islamabad, Pakistan. Data were analysed through descriptive statistics, common method variance, reliability, correlation and regression in order to investigate customer perceived service quality and how the quality of services stimulates loyalty intentions towards private service suppliers. Findings Findings depict that private healthcare service providers are attempting to deliver well improved healthcare services to their customers. Results confirmed that better quality of healthcare services inclines to build satisfaction and loyalty among patients. The healthcare service quality aspects (i.e. physical environment, customer-friendly environment, responsiveness, communication, privacy and safety) are positively related with patient loyalty which is mediated through patient satisfaction. Practical implications Findings will help the hospital managers to articulate effective strategies in order to ensure superior quality of healthcare services to patients. The study will induce hospital management to deliver attentions towards the quality of private healthcare service systems and improvements towards the deficient healthcare services. Furthermore, the study will present a clear picture of patient’s behavioural attitudes; satisfaction and loyalty intentions towards the quality of healthcare services. Originality/value The study provides the views and perceptions of patients towards the quality of healthcare services. The healthcare service quality dimensions, i.e., physical environment, customer-friendly environment, responsiveness, communication, and privacy and safety were assessed. Hospital healthcare service quality was examined in order to find out its effect on patient satisfaction and patient loyalty.
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Carayon, Pascale. "Sociotechnical systems approach to healthcare quality and patient safety." Work 41 (2012): 3850–54. http://dx.doi.org/10.3233/wor-2012-0091-3850.

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Mohiuddin, AK. "Framework for Patient Safety." INNOVATIONS in pharmacy 10, no. 1 (February 7, 2019): 6. http://dx.doi.org/10.24926/iip.v10i1.1637.

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A commitment on quality objectives is a crucial element of quality policy in HROs, such as hospitals and other healthcare institutions. The quality of care includes objectives related to effectiveness, efficiency, and a patient’s experience. Healthcare organizations are also aware of the importance of promoting safety practices and the resiliency analysis of the clinical practice in order to improve quality. Patient Safety Culture has been defined as the product of individual and group values, attitudes, competencies, and patterns of behavior that determines their commitment, style, and proficiency with the organization’s health and safety programs. The safety culture of a health center offers an indirect means for its involvement in quality. Poor involvement of professionals in safety has negative consequences for patients. Envisioning the future of patient safety is more than an academic exercise. Appealing visions can help channel human energies, set new directions, and open the doors to alternative approaches. An outside observer is struck by three characteristics that are very different from the culture of the early 21st century: a deep sense of individual and institutional accountability for safety, an emphasis on fairness and transparency, and pervasive collaboration and teamwork based on mutual respect. Speaking up is important for patient safety, but healthcare professionals often hesitate to voice their concerns. Direct supervisors have an important role in influencing speaking up. However, good insight into the relationship between managers' behavior and employees' perceptions about whether speaking up is safe and worthwhile is still lacking. The evaluation should cover the following areas in both instruments: strategy (inquiry on their commitment to the quality and safety strategy, indicators’ feedback, and risks maps), support systems for clinical decisions (digital record algorithms to make decisions and for accessibility to patient clinical information), equipment (adequacy), follow-up (availability of tests when needed), person-centered care (respect of patients’ values and preferences), evidence-based practice (practices in accordance with guidelines), delays (on scheduled tests, surgery, and outpatient care), and cost-effective treatments (adequacy). Article Type: Commentary
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Santa, Ricardo, Silvio Borrero, Mario Ferrer, and Daniela Gherissi. "Fostering a healthcare sector quality and safety culture." International Journal of Health Care Quality Assurance 31, no. 7 (August 13, 2018): 796–809. http://dx.doi.org/10.1108/ijhcqa-06-2017-0108.

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Purpose Quality issues, increasing patient expectations and unsatisfactory media reports are driving patient safety concerns. Developing a quality and safety culture (QSC) is, therefore, crucial for patient and staff welfare, and should be a priority for service providers and policy makers. The purpose of this paper is to identify the most important QSC drivers, and thus propose appropriate operational actions for Saudi Arabian hospital managers and for managers in healthcare institutions worldwide. Design/methodology/approach Quantitative data from 417 questionnaires were analyzed using structural equation modeling. Respondents were selected from various hospitals and managerial positions at a national level. Findings Findings suggest that error feedback (FAE) and communication quality (QC) have a strong role fostering or enhancing QSC. Findings also show that fearing potential punitive responses to mistakes made on the job, hospital staff are reluctant to report errors. Practical implications To achieve a healthcare QSC, managers need to implement preemptive or corrective actions aimed at ensuring prompt and relevant feedback about errors, ensure clear and open communication and focus on continuously improving systems and processes rather than on failures related to individual performance. Originality/value This paper adds value to national healthcare, as Saudi study results are probably generalizable to other healthcare systems throughout the world.
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Deliverska, Mariela, and Andrey Kehayov. "Improving patient safety and quality of healthcare through prevention of healthcare associated infections." Journal of Medical and Dental Practice 3, no. 2 (November 4, 2016): 480–83. http://dx.doi.org/10.18044/medinform.201632.480.

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Percival, Alison. "Healthcare Quality Improvement Partnership." Bulletin of the Royal College of Surgeons of England 90, no. 10 (November 1, 2008): 351. http://dx.doi.org/10.1308/147363508x371787.

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The white paper, Trust, Assurance and Safety, called for clinical audit to be revitalised. In response, in April 2008 the Department of Health appointed the Healthcare Quality Improvement Partnership (HQIP) to manage the National Clinical Audit and Patient Outcomes Programme (NCAPOP) and to support local clinical audit activity. HQIP is led by a consortium of the Academy of Medical Royal Colleges, the Royal College of Nursing and the Long-term Conditions Alliance. Its purpose is to promote better health care by providing support and advice to those responsible for managing quality improvement work.
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Hannawa, Annegret F., Brian H. Spitzberg, Marcia D. Childress, Richard Frankel, Julius C. Pham, and Albert W. Wu. "Communication science lessons for patient safety and quality care." Journal of Patient Safety and Risk Management 25, no. 5 (October 2020): 197–204. http://dx.doi.org/10.1177/2516043520926424.

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At a time when patient-centered care is a goal and patient safety is a paramount concern across the spectrum of health care, renewed and rigorous attention to interpersonal communication skills makes good sense. In this interdisciplinary article, we share lessons from communication science that can help clinicians communicate more appropriately and effectively with each other and with their patients in healthcare encounters.
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Dissertations / Theses on the topic "Patient safety and quality in healthcare"

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Echeverri, Ana Lucia Hincapie. "Relationship between Perceived Healthcare Quality and Patient Safety." Diss., The University of Arizona, 2013. http://hdl.handle.net/10150/283602.

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The objectives of this study were to examine the association between patient perceived healthcare quality and self-reported medical, medication, and laboratory errors using cross-sectional and cross-national questionnaire data from eleven countries. In this research, quality of care was measured by a multi-faceted construct, which adopted the patient's perspectives. Five separated quality of care scales were assessed: Access to Care, Continuity of care, Communication of Care, Care Coordination, and Provider's Respect for Patients' Preferences. The findings from this investigation support a number of other published studies suggesting that Coordination of Care is an important predictor of perceived patient safety. After adjusting for potentially important confounding variables, an increase in peoples' perceptions of Coordination of Care decreased the likelihood of self-reporting medical errors (OR =0.605, 95% CI: 0.569 to 0.653), medication errors (OR =0.754, 95% CI: 0.691 to 0.830), and laboratory errors (OR =0.615, 95% CI: 0.555 to 0.681). Finally, results showed that the healthcare system type governing care processes modifies the effect of Coordination of Care on self-reported medication errors.
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Veerkamp, Celeste Goff. "Gatekeepers to healthcare quality and patient safety| Veritas Credentials." Thesis, California State University, Long Beach, 2016. http://pqdtopen.proquest.com/#viewpdf?dispub=10158999.

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The current environment of healthcare requires organizations to look at each department and each employee from an economic vantage and to consider at all viable options for cost containment. An organization’s Medical Staff Office has traditionally taken responsibility for providing the credentials and privileging function for organizations. The amount of work and time as well as seasonal fluctuations in the number of applicants proves difficult for an organization from a staffing and budgetary standpoint. For many organizations, the ability to outsource its credentialing functions to a Credentials Verification Organization may prove a cost efficient option.

Veritas Credentials seeks to remedy this difficulty for healthcare organizations by allowing the credential and privilege function to be outsourced. This business plan will show how Veritas Credentials intends to provide an array of services to ensure that healthcare organizations provide privileges to high quality providers which will ensure patient safety.

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Nadhrah, Nada Ali. "Managing workarounds in a healthcare context : a framework to improve quality and patient safety." Thesis, University of Reading, 2016. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.701961.

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The use of workarounds has been mentioned in various healthcare discipline by different approaches. However, there has been limited research thoroughly investigating the workaround phenomena and none provided a comprehensive approach that considered all stakeholders involved. The aim of this thesis is to develop a framework that can be used to enhance the understanding and knowledge of workarounds that occur in hospitals and consequently improve hospital management's ability to manage those workarounds. That is obtained by considering workarounds main elements; nature as a process, factors behind their existences, and their impact so that the level of patient safety and service quality can be improved. In order to understand the workarounds, the above can be investigated as three aspects: the process aspect of workarounds, the factors influencing professionals to use workarounds, and the impact of workarounds. First, workarounds are analysed in terms of the existing and alternative process, roles of users and the number of people involved, and time consumed to complete the process compared to the original formal work process. Data was obtained by an exploratory study conducted by semi-structured interviews at early stage of this research and six workaround cases were collected and mapped using Business Process Modelling Notation (BPMN). The exploratory study conducted, an extensive literature review, lead to the identifications of the factors influencing the use workarounds. Based on the findings a conceptual model, Workaround Motivational Model (WAMM), was formed based on the Theory of Interpersonal Behaviour (TIB) in order to investigate professional' behaviour intentions to use workarounds. A questionnaire has been developed to examine the following factors: attitude, social factors, perceived consequences (personal value), perceived consequences (patient value), perceived behavioural controls, ease of use, usefulness, facilitating conditions, and habits. Exploratory factor analysis was applied to detect the main factors followed by a linear regression analysis to identify the most significant ones. The main factors identified that have a significant influence on professionals' intention to use workaround were: social influence, habit, perceived ease of use, and perceived consequences (patient value). Finally, in order to evaluate the impact of workarounds, a Workaround Assessment Sheet (WA-AS) was developed based on the earlier findings and applied to the workaround cases. The theoretical contribution of this thesis was identifying four different types of workarounds based on their process structure. There are four types: simple workaround, process workaround, compound workaround, and consequential workaround. In addition, the workaround Motivational Model (WAMM) is a statistical model that theories professionals' intention to use workaround in healthcare context. The practical and methodological contribution was a Workaround Conceptual Knowledge Framework (WACKF) that can be applied by quality specialised and decision makers to understand workarounds used in their organisations and consequently be able to manage them. The framework has got three main components. First component is the use of process techniques to analyse workarounds and identify activities, role and number of people involved, and time consumed to complete the process and compare it to the formal work process. Second, the use of the WAMM questionnaire to identify the factors that influence professionals to use workarounds. Third, the use of the Workaround Assessment Sheet (WA-AS) to evaluate the upside and downside from workaround use in the organisation. The framework provides guidelines, underpinned by theory, that enables management level to have a holistic view of workaround in their organisation and then decide whether to adopt this workaround or strongly eliminate it. In Delphi study experts in quality and hospital management were used to assess and confirm that the components of the framework are appropriate and logically lead to better understanding of workarounds. Results of the framework validation by the decision makers also indicated that the WACKF contributes in understanding the workarounds and consequently improve the patient safety and service quality.
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Akins, Ralitsa B. "Critical processes and performance measures for patient safety systems in healthcare institutions: a Delphi study." Texas A&M University, 2004. http://hdl.handle.net/1969.1/1042.

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This dissertation study presents a conceptual framework for implementing and assessing patient safety systems in healthcare institutions. The conceptual framework consists of critical processes and performance measures identified in the context of the 2003 Malcolm Baldrige National Quality Award (MBNQA) Health Care Criteria for Performance Excellence. Methodology: The Delphi technique for gaining consensus from a group of experts and forecasting significant issues in the field of the Delphi panel expertise was used. Data collection included a series of questionnaires where the first round questionnaire was based on literature review and the MBNQA criteria for excellence in healthcare, and tested by an instrument review panel of experts. Twenty-three experts (MBNQA healthcare reviewers and senior healthcare administrators from quality award winning institutions) representing 18 states participated in the survey rounds. The study answered three research questions: (1) What are the critical processes that should be included in healthcare patient safety systems? (2) What are the performance measures that can serve as indicators of quality for the processes critical for ensuring patient safety? (3) What processes will be critical for patient safety in the future? The identified patient safety framework was further transformed into a patient safety tool with three levels: basic, intermediate, and advanced. Additionally, the panel of experts identified the major barriers to the implementation of patient safety systems in healthcare institutions. The identified "top seven" barriers were directly related to critical processes and performance measures identified as "important" or "very important" for patient safety systems in the present and in the future. This dissertation study is significant because the results are expected to assist healthcare institutions seeking to develop high quality patient safety programs, processes and services. The identified critical processes and performance measures can serve as a means of evaluating existing patient safety initiatives and guiding the strategic planning of new safety processes. The framework for patient safety systems utilizes a systems approach and will support healthcare senior administrators in achieving and sustaining improvement results. The identified patient safety framework will also assist healthcare institutions in using the MBNQA Health Care Criteria for Performance Excellence for self-assessment and quality improvement.
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Bajorek, Zofia. "The management of temporary staff in healthcare emergency departments : implications for patient safety and service quality." Thesis, King's College London (University of London), 2013. https://kclpure.kcl.ac.uk/portal/en/theses/the-management-of-temporary-staff-in-healthcare-emergency-departments(9a9b3de6-8976-4344-9719-7e9a807d8aea).html.

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The use of temporary staff in healthcare presents a management challenge. There is a case for minimising their use to reduce the risks associated with their limited familiarity with the context and knowledge of protocols. However, staff shortages can negatively affect patient outcomes. Consequently, temporary staff are required but need to be carefully managed. This thesis uses the analytic framework of the psychological contract to explore the previously neglected management of the employment relationship with temporary staff. The empirical research consisted of two studies. The first explored the management of temporary staff in Emergency Departments (ED), analysing management perspectives at macro, meso and micro levels. The second studied the management of the launch of a Major Trauma Centre introducing a Consultant Resident On-Call for trauma, which required temporary contracts. The research was conducted through case studies utilising semi-structured interviews. The ED was specifically chosen because of its high use of temporary staff, and its particular challenges associated with patient care. Results indicated a conflict between the priorities of senior management to minimise staff costs, and department level management, concerned with staffing levels to maintain patient care and service delivery. Risks to patient safety, particularly when ad-hoc agency staff were recruited, were identified. Study 2 revealed a shift from relational to transactional psychological contracts when consultants were placed on temporary contracts due to the protracted management of the change process and perceived psychological contract breach. The results highlighted the distinctive characteristics of temporary staffing in healthcare, and the hierarchy of preferences between the types of temporary staff identified. The research also revealed the consequences of the competing priorities between different management levels in the hospital. Finally, the studies revealed that the psychological contracts of temporary staff were predominantly transactional, whereas a more relational contract could improve temporary staff use and patient outcomes.
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Gardner, John Wallace. "Improving Hospital Quality and Patient Safety - An Examination of Organizational Culture and Information Systems." The Ohio State University, 2012. http://rave.ohiolink.edu/etdc/view?acc_num=osu1348805699.

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Schmitt, Mathias. "Leadership and Healthcare Performance." Diss., Virginia Tech, 2012. http://hdl.handle.net/10919/77975.

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The U.S. health care delivery system faces serious challenges such as an increasing demand for services due to an aging population, unhealthy lifestyles, growth in the number of uninsured individuals, and an increase in chronic diseases. At the same time, the system has to cope with a limited supply of money, physicians, and nurses inferior quality of care delivered by U.S. hospitals. While the U.S. hospital industry is adapting to address these issues, not much progress in improving the quality of care delivered has been made over the last decade. However, theories exist that management systems, organizational traits, and leadership are key factors for hospitals to improve quality of care outcomes. This study takes a holistic look at these factors to identify and analyze critical drivers for better quality of care outcomes of U.S. hospitals. The study also aims to identify differences between chief executive officers' (CEOs) leadership traits among lean (mediocre performance), high (top 20th percentile), and low performing (bottom 20th percentile) U.S. hospitals in regards to their quality of care measures. Two separate online surveys were conducted. The first online survey was targeted at all 4,697 U.S. hospitals that are required to disclose quality of care measures to the Federal government. Results of this first survey revealed that two management system factors drive quality of care outcomes of U.S. hospitals. Furthermore, findings also show that critical access hospitals have a lower quality of care performance than acute care hospitals. Thus, based on the results from this survey, we concluded that management system factors are main drivers of hospital performance, whereas organizational trait and leadership factors did not significantly contribute to hospital performance. A second survey to CEOs and CEO followers in 9 selected hospitals found significant differences between CEO traits leading lean and low performing hospitals, and, to a lesser degree, significant differences among high and low performing hospitals. However, the study did not find any significant differences in CEO traits between lean and high performing hospitals. Findings also include that some management system factors differed significantly between lean and high performing hospitals, but no evidence for such differences could be found between lean and high and high and low performing hospitals, respectively. These results suggest that management systems and CEO leadership traits play an important role in determining U.S. hospital performance as measured by their quality of care.
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Parkkonen, Armas. "Vietnamese Nurses’ and Nursing students’ conceptions about healthcare associated infections : An empirical research study in patient safety and quality of care." Thesis, Karlstads universitet, Fakulteten för hälsa, natur- och teknikvetenskap (from 2013), 2019. http://urn.kb.se/resolve?urn=urn:nbn:se:kau:diva-70739.

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Introduction: Healthcare associated infections (HAIs) are a global problem and lead to a large burden for the patients, healthcare systems and society. In low and middle-income countries the burden and prevalence is higher than in high-income countries. It is possible with good prevention to reduce the prevalence and burden of healthcare associated infections. Aim: Investigate Vietnamese Nurses’ and Nursing students’ conceptions about healthcare associated infections and their role in prevention of healthcare associated infections. Method: Qualitative research with a cross-sectional design and the data was collected through eight semi-structured interviews and unstructured observations. The data was analyzed by content analysis. Results: Four categories were identified in the data analysis: Understanding and conceptions about HAI, Hinders for the prevention of HAI, How to work in a preventive way for HAI, Responsibility for patient safety. Conclusion: The study showed hinders for the nurses to perform their work correctly, limitations in the environment, lack of time, and equipment and supplies. The need for improvements are more nurses, make equipment and supplies more available and more rooms for patients. The participants acknowledge about responsibility and the importance of following guidelines at the hospitals are identified in the result.
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Robbins, Julie. "Speaking Up is Hard to Do:What Can Management Do to Help When Patient Safety is on the Line?" The Ohio State University, 2013. http://rave.ohiolink.edu/etdc/view?acc_num=osu1365424400.

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Moberg, Anne-May. "Från lag till handling : En fallstudie av hur lagkravet om patientsäkerhetsberättelse nyttiggjordes i Stockholms läns landsting." Thesis, Hälsohögskolan, Högskolan i Jönköping, HHJ. Kvalitetsförbättring och ledarskap inom hälsa och välfärd, 2013. http://urn.kb.se/resolve?urn=urn:nbn:se:hj:diva-21511.

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Bakgrund: Enligt patientsäkerhetslagen 2010:659 ska vårdgivare årligen skriva en patientsäkerhetsberättelse. Granskning av 76 patientsäkerhetsberättelser i Stockholms läns landsting (SLL) visade bristande kunskap om hur den skrivs och bristfällig förståelse för patientsäkerhet, främst bland mindre vårdgivare. Hälso- och sjukvårdsadministratörer kunde inte besvara vårdgivarnas frågor om patientsäkerhetsberättelsen, varför ett förbättringsprojekt initierades för att skapa stödmaterial samt nyttiggöra patientsäkerhetsberättelsen.   Syfte: Att belysa hur ett statligt styrinitiativ hanterades i praktiken i SLL och vilka erfarenheter som kunde knytas till praktikprojektet i hälso-och sjukvårdsadministrationen, hos vårdgivare och i interaktionen dem emellan samt om insatserna bidrog till ökad förståelse för patientsäkerhet.   Metod: Studien var en deskriptiv fallstudie. Datainsamlingen bestod av intervjuer med vårdgivare och hälso-och sjukvårdsadministratörer och dokumentanalys. Analyserna var kvalitativ och kvantitativ innehållsanalys.   Resultat: I uppföljning av vårdgivare nyttiggjordes patientsäkerhetsberättelsen med stöd av mall och manual. Interaktionen mellan vårdgivare och hälso- och sjukvårdsadministratör gick från kontroll till dialog. Lärande, och i viss mån förståelse för patientsäkerhet, ökade.   Slutsats: Genom att vara proaktiv och bereda stöd för vårdgivare att fullfölja sitt åtagande avseende patientsäkerhetsberättelse kunde flera vårdgivare bli varse sitt ansvar och skyldigheter. Förbättringsprojektet genomfördes med stöd av förbättringskunskap och hög delaktighet, ett arbetssätt som rekommenderas. Fortsatt forskning av styrningens effekter föreslås.
Background: Caregivers shall according to the patient safety act 2010:659 annually write a patient safety declaration. Review of 76 patient safety declarations in Stockholm County Council (SCC), Sweden, showed a lack of knowledge about how to write and inadequate understanding of patient safety, particularly among smaller caregivers. Healthcare administrators could not answer caregivers’ questions on the patient safety declaration, why an improvement project was initiated to create support and to make the patient safety declaration useful.       Aim: To illustrate how a state steering initiative was handled in practice in the SCC and the experiences associated with the improvement project in health care administration, among caregivers and the interaction between them, and whether the efforts contributed to increased understanding of patient safety.     Method: The study was a descriptive case study. The data collection was interviews of caregivers and healthcare administrators and document analysis. The analysies performed were qualitative and quantitative content analysis.     Results: The patient safety declaration was made useful in the follow up process of caregivers with support of a template and a manual. The interaction between caregivers and healthcare administrators went from monitoring to dialogue. Learning increased and also understanding of patient safety to some degree.   Conclusion: By being proactive and prepare support for caregivers to fulfill their commitment on patient safety declarations, several caregivers became aware of their responsibilities and obligations. The improvement project was accomplished with improvement knowledge and high level of participation, an approach that is recommended. Further research on the steering effects is suggested.
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Books on the topic "Patient safety and quality in healthcare"

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Shah, Rahul K., and Sandip A. Godambe, eds. Patient Safety and Quality Improvement in Healthcare. Cham: Springer International Publishing, 2021. http://dx.doi.org/10.1007/978-3-030-55829-1.

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Patient safety: The heart of healthcare quality. Chichester, West Sussex: Wiley-Blackwell, 2010.

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Levett, James M. Using ISO 9001 in healthcare: Applications for quality systems, performance improvement, clinical integration, accreditation, and patient safety. Milwaukee, WI: ASQ Quality Press, 2014.

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Simpson, Ned J., and Kenneth A. Kleinberg. Implementation guide to bar coding and auto-ID in healthcare: Improving quality and patient safety. Chicago, IL: HIMSS, 2009.

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Murashko, Mikhail, Igor Ivanov, and Nadezhda Knyazyuk. THE BASICS OF MEDICAL CARE QUALITY AND SAFETY PROVISION. ru: Advertising and Information Agency "Standards and quality», 2020. http://dx.doi.org/10.35400/978-5-600-02711-4.

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SUMMARY Current monograph represents and reviews key approaches to creating an effective internal quality and safety control system for an organization, based on patient-oriented approach, process approach, risk management, continuous process improvement and other methods including definition of all applied terms, a number of examples and step by step manuals on executing key measures and events to create and develop a quality control system and local documentation samples. Target audience for this monograph: hospital leadership, including CMO, deputy CMO on quality, head of quality control committee or designated quality control specialist, other medical workers. ABOUT «THE BASICS OF MEDICAL CARE QUALITY AND SAFETY PROVISION» All changes and reforms in healthcare should provide for medical care quality improvement, preservation of life and health of all citizens. Once an abstract word “quality” has its’ own specific meaning today, acquired by means of legislative validation of the term “medical care quality and safety”. Providing healthcare quality and safety is one of the key priorities within the confines of Russian Federation national policy for citizens’ health protection. Current issue represents actual knowledge and practical experience in terms of medical care quality and safety control, continuous medical organization efficiency improvement. Current issue addresses the matters of theoretical and practical aspects of introducing management and internal quality and safety control system in medical care. It also contains the methodological description of Proposals (practical recommendations) of Federal Service for Supervision in the Sphere of Healthcare, developed based on global experience generalization, adapted to Russian specificity, aimed at quality and safety provision. Current issue represents a large number of samples, examples, templates and check-list tables. Data, accumulated in the monograph, allows the reader create a proper system of measures in a medical organization to comply with the order № 381-н of Ministry of Health of Russian Federation «On approving Requirements towards organizing and executing medical care internal quality and safety control». TARGET AUDIENCE Current issue is intended for a wide range of readers, interested in management: for healthcare organization leaders, CMOs and deputy CMOs, deputy CMOs on quality, quality control committee leaders or designated quality control specialists, physicians, nurses, medical academicians and students, and all specialists, interested in medical organizations’ stable development and improvement.
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Advances in human factors and ergonomics in healthcare. Boca Raton: CRC Press, 2011.

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Eric, Vohr, ed. Safe patients, smart hospitals: How one doctor's checklist can help us change healthcare from the inside out. New York, N.Y: Hudson Street Press, 2010.

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Riccardo, Tartaglia, ed. Healthcare systems ergonomics and patient safety: Human factor, a bridge between care and cure : proceedings of the International Conference HEPS 2005, Florence, Italy, 30th-March 2nd April 2005. Leiden: Taylor & Francis, 2005.

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Associated Chambers of Commerce & Industry of India. Quality & safety in healthcare. New Delhi: Associated Chambers of Commerce and Industry of India, 2012.

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Moody-Williams, Jean. A Journey towards Patient-Centered Healthcare Quality. Cham: Springer International Publishing, 2020. http://dx.doi.org/10.1007/978-3-030-26311-9.

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Book chapters on the topic "Patient safety and quality in healthcare"

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Bundy, Joel T., and Mary M. Morin. "Workforce Safety." In Patient Safety and Quality Improvement in Healthcare, 335–52. Cham: Springer International Publishing, 2020. http://dx.doi.org/10.1007/978-3-030-55829-1_21.

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Bigham, Michael T., Michael W. Bird, and Jodi L. Simon. "Quality Methodology." In Patient Safety and Quality Improvement in Healthcare, 173–92. Cham: Springer International Publishing, 2020. http://dx.doi.org/10.1007/978-3-030-55829-1_9.

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Sheridan, Susan, Heather Sherman, Allison Kooijman, Evangelina Vazquez, Katrine Kirk, Nagwa Metwally, and Flavia Cardinali. "Patients for Patient Safety." In Textbook of Patient Safety and Clinical Risk Management, 67–79. Cham: Springer International Publishing, 2020. http://dx.doi.org/10.1007/978-3-030-59403-9_6.

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AbstractUnsafe care results in over 2 million deaths per year and is considered one of the world’s leading causes of death. In 2019, the 72nd World Health Assembly issued a call to action, The Global Action on Patient Safety, that called for Member States to democratize healthcare by engaging with the very users of the healthcare system—patients, families, and community members—along with other partners—in the “co-production” of safer healthcare.The WHO’s Patients for Patient Safety (PFPS) Programme, guided by the London Declaration, addresses this global concern by advancing co-production efforts that demonstrate the powerful and important role that civil society, patients, families, and communities play in building harm reduction strategies that result in safer care in developing and developed countries. The real-world examples from the PFPS Programme and Member States illustrate how civil society as well as patients, families, and communities who have experienced harm from unsafe care have harnessed their wisdom and courageously partnered with passionate and forward-thinking leaders in healthcare including clinicians, researchers, policy makers, medical educators, and quality improvement experts to co-produce sustainable patient safety initiatives. Although each example is different in scope, structure, and purpose and engage different stakeholders at different levels, each highlights the necessary building blocks to transform our healthcare systems into learning environments through co-production of patient safety initiatives, and each responds to the call made in the London Declaration, the WHO PFPS Programme, and the World Health Assembly to place patients, families, communities, and civil society at the center of efforts to improve patient safety.
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Moody-Williams, Jean. "A Quest for Patient Safety." In A Journey towards Patient-Centered Healthcare Quality, 37–45. Cham: Springer International Publishing, 2019. http://dx.doi.org/10.1007/978-3-030-26311-9_4.

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Wolf, Laurie, Sarah Henrickson Parker, and Jonathan L. Gleason. "Human Factors in Healthcare." In Patient Safety and Quality Improvement in Healthcare, 319–33. Cham: Springer International Publishing, 2020. http://dx.doi.org/10.1007/978-3-030-55829-1_20.

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Melo, Sara, and Matthias Beck. "Models of Patient Safety and Critique." In Quality Management and Managerialism in Healthcare, 105–52. London: Palgrave Macmillan UK, 2014. http://dx.doi.org/10.1057/9781137351999_4.

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Gutzeit, Michael F., Holly O’Brien, and Jackie E. Valentine. "Organizational Safety Culture: The Foundation for Safety and Quality Improvement." In Patient Safety and Quality Improvement in Healthcare, 15–35. Cham: Springer International Publishing, 2020. http://dx.doi.org/10.1007/978-3-030-55829-1_2.

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Guise, Veslemøy, Anne Marie Lunde Husebø, Marianne Storm, Kirsti Lorentsen Moltu, and Siri Wiig. "Telecare in Home Healthcare Services." In Researching Patient Safety and Quality in Healthcare, 177–93. Taylor & Francis Group, 6000 Broken Sound Parkway NW, Suite 300, Boca Raton, FL 33487-2742: CRC Press, 2016. http://dx.doi.org/10.1201/9781315605609-13.

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Leape, Lucian L. "The Government Responds: The Agency for Healthcare Research and Quality." In Making Healthcare Safe, 143–58. Cham: Springer International Publishing, 2021. http://dx.doi.org/10.1007/978-3-030-71123-8_10.

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AbstractWhen the IOM report started the patient safety movement by converting the safety interest of a few into the concern of the many, those who wished to enter this emerging field had little to work with: few measures, few proven safe practices, and few standards. For the patient safety movement to blossom in the ways envisioned by the IOM, a substantial amount of foundational work would be necessary. Only the government could provide the resources that were needed to accomplish this work.
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Pember, Marvin. "Clarian Health: Clinical Excellence Through Quality and Patient Safety." In Healthcare Information Management Systems, 53–62. New York, NY: Springer New York, 2004. http://dx.doi.org/10.1007/978-1-4757-4041-7_5.

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Conference papers on the topic "Patient safety and quality in healthcare"

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Majid, Alsahafi, Jamal Ragad, Nagadi Sarah, Alrashid Hussa, Alrabghi Lujain, Aldoobie Lamees, Aldauig Badreyah, and Hashem Anwar. "68 The practice and attitude of healthcare workers towards stethoscope cleaning: a patient safety quality improvement project." In Patient Safety Forum 2019, Conference Proceedings, Kingdom of Saudi Arabia, Ministry of National Guard Health Affairs. British Medical Journal Publishing Group, 2019. http://dx.doi.org/10.1136/bmjoq-2019-psf.68.

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Kale, Aditya, and Ross Millar. "69 Operating theatre quality improvement for sustainable increases in patient safety and efficiency: a realist review." In Leadership in Healthcare conference, 14th to 16th November 2018, Birmingham, UK. BMJ Publishing Group Ltd, 2018. http://dx.doi.org/10.1136/leader-2018-fmlm.67.

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Simpson, Nicola, and Wayne Robson. "0227 Using The Ihi Open School Chapter Model To Encourage Multiprofessional Collaboration In Patient Safety And Quality Improvement." In Association for Simulated Practice in Healthcare Annual Conference 11–13 November 2014 Abstracts. The Association for Simulated Practice in Healthcare, 2014. http://dx.doi.org/10.1136/bmjstel-2014-000002.206.

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Nguyen, Anhtai, Helena Walo, Carolyn Clancy, Julie Navarro, Temesia High, and Sheryl Reed. "IHI ID 21 A comprehensive PBM program emphasizes focused feedback to improve patient safety and decrease costs." In Institute for Healthcare Improvement (IHI) Scientific Symposium on Improving the Quality and Value of Health Care. British Medical Journal Publishing Group, 2018. http://dx.doi.org/10.1136/ihisciabs.21.

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Silva, Geeth, Aiken Yam, Jessica Court, and Rabia Imtiaz. "57 Fatigue & facilities at kettering general hospital the importance of high-quality rest to maximise the performance of junior doctors and ensure patient safety." In Leaders in Healthcare Conference, 17–20 November 2020. BMJ Publishing Group Ltd, 2020. http://dx.doi.org/10.1136/leader-2020-fmlm.57.

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Coles, Garill A., and Jonathan Young. "Use of Failure Modes Effects and Criticality Analysis to Improve Patient Safety." In ASME 2002 International Mechanical Engineering Congress and Exposition. ASMEDC, 2002. http://dx.doi.org/10.1115/imece2002-32453.

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The Joint Commission for Accreditation of Healthcare Organizations recently approved revisions to their accreditation standards that are intended to support improvements in patient safety and reduce medical errors. Key among these is the requirement to perform a Failure Modes, Effects, and Criticality Analysis (FMECA) on one high-risk process each year and propose measures to address the most critical failures. Because FMECA was developed for other industries such as nuclear, aerospace, and chemical, some adaptation of its form and use is needed. The FMECA process is normally performed by analyzing each element of an engineered system as represented on a process flow diagram. Medical processes, in contrast, are usually defined procedurally. The key elements of a medical process are more likely to be actions than equipment and components. A community project was put together to develop and test the FMECA adaptation and had good results. This collaboration consisted of safety analysts at Pacific Northwest National Laboratory in Richland, Washington and the Quality and Performance Improvement managers of the three local hospitals. This paper describes this adaptation.
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Ansari, U., B. Baxendale, J. Tanner, and N. Woodier. "P38 Combining a simulation fellowship with a MSC in patient safety and quality improvement. reflections on the opportunity to enhance personal and professional development." In Abstracts of the Association for Simulation Practice in Healthcare Annual Conference, 6th to 7th November 2017, Telford, UK. The Association for Simulated Practice in Healthcare, 2017. http://dx.doi.org/10.1136/bmjstel-2017-aspihconf.122.

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Cloutier, Aimee, James Yang, Debajyoti Pati, Shabboo Valipoor, Brandon Snailer, and Jerrod Hollers. "Identifying Possible Patient Slips and Falls Using Motion Capture Experiments." In ASME 2015 International Design Engineering Technical Conferences and Computers and Information in Engineering Conference. American Society of Mechanical Engineers, 2015. http://dx.doi.org/10.1115/detc2015-46635.

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The Centers for Disease and Control report that falls are the most common cause of injury in older adults. Moderate to severe fall-related injuries significantly interfere with independent living and reduce quality of life, and it is necessary to prevent these falls whenever possible. The present study seeks to identify factors within a hospital bedroom and bathroom setting that may lead to falls. A motion capture experiment was conducted in a laboratory setting on thirty subjects over the age of seventy using one bedroom and two bathroom mockups designed to match the dimensions and layout of a representative room drawn from the archives of a large healthcare design firm. Data were post processed using Cortex and Visual3D software. A potential fall was defined as a period of time during which the jerk trajectory of the upper body’s center of mass remained consistently high. Preliminary results suggest that falls are more likely to occur when a patient is reaching, taking backwards steps, or turning. Future work includes locating each potential fall in a video recording to be analyzed by healthcare professionals including healthcare designers, clinicians, and a kinesiology expert. Identifying potential falls may lead to safer designs for hospital bedrooms and bathrooms and improved education for elderly adults about how to prevent falls.
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Penney, Lisa, David Fogg, Scott Russell, Laurence Boss, and Peter Isherwood. "0046 Handover in recovery; a high fidelity in-situ simulation training package to improve the quality of theatre recovery handover and patient safety." In Conference Proceedings of the Association for Simulation Practice in Healthcare (ASPiH) Annual Conference. 3rd to 5th November 2015, Brighton, UK. The Association for Simulated Practice in Healthcare, 2015. http://dx.doi.org/10.1136/bmjstel-2015-000075.101.

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Poigai Arunachalam, Shivaram, Mustafa Sir, Gomathi Marisamy, Annie Sadosty, David Nestler, Thomas Hellmich, and Kalyan S. Pasupathy. "Optimizing Emergency Department Workflow Using Radio Frequency Identification Device (RFID) Data Analytics." In 2017 Design of Medical Devices Conference. American Society of Mechanical Engineers, 2017. http://dx.doi.org/10.1115/dmd2017-3402.

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Emergency Department (ED) is a complex care delivery environment in a hospital that provides time sensitive urgent and lifesaving care [1]. Emergency medicine is an unscheduled practice and therefore providers experience extreme fluctuations in their workload. ED crowding is a major concern that affects the efficacy of the ED workflow, which often is challenged by long wait times, overuse of observation units, patients either leaving without being seen by a provider and non-availability of inpatient beds to accommodate patients after diagnosis [2]. Evaluating ED workflow is a challenging task due to its chaotic nature, with some success using time-motion studies and novel capacity management tools are nowadays becoming common in ED to address workflow related issues [3]. Several studies reveal that Electronic Medical Record (EMR) adoption has not resulted in significant ED workflow improvements nor reduced the cost of ED operations. Since raw EMR data does not offer operational and clinical decision making insights, advanced EMR data analytics are often sought to derive actionable intelligence from EMR data that can provide insights to improve ED workflow. Improving ED workflow has been an important topic of research because of its great potential to optimize the urgent care needed for the patients and at the same time save time and cost. Radio Frequency Identification Device (RFID) is a wireless automatic identification and data capture technology device that has the potential for improving safety, preventing errors, saving costs, and increasing security and therefore improving overall organizational performance. RFID technology use in healthcare has opened a new space in healthcare informatics research that provides novel data to identify workflow process pitfalls and provide new directions [4]. The potential advantages of RFID adoption in healthcare and especially in ED has been well recognized to save costs and improve care delivery [5]. However, the large upfront infrastructure costs, need for an integrated health information technology (HIT), advanced analytical tools for big data analysis emerging from RFID and skilled data scientists to tackle the data to derive actionable intelligence discourage many hospitals from adoption RFID technology despite its potential advantages. Our recent pilot study on the RFID data analytics demonstrated the feasibility of quantifying and analyzing two novel variables such as ‘patient alone’ time defined as the total time a patient spends alone without interaction with a health care staff in the ED and ‘provider time’ defined as the total time a patient spends interacting with any health care staff [6]. The study motivated a more comprehensive big data analytics of RFID data which can provide better insights into optimizing ED workflow which can improve the quality of care in the ED and also reduce cost. In this work, the authors attempt to describe the RFID adoption in the ED at the Saint Mary’s Hospital at Mayo Clinic, in Rochester, MN, a level one trauma center both for children and adults as a step towards optimizing ED workflow.
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Reports on the topic "Patient safety and quality in healthcare"

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Singh, Karandeep Singh, Kaitlin Drouin Drouin, Lisa P. Newmark Newmark, and Ronen Rozenblum Rozenblum. Developing a Framework for Evaluating the Patient Engagement, Quality, and Safety of Mobile Applications. New York, NY United States: Commonwealth Fund, February 2016. http://dx.doi.org/10.15868/socialsector.25066.

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Greene, Anne, Kelly Waldron, and Nuala Calnan. Quality Risk Management: State of the Industry—Part 1. Has the Industry Realized the Full Value of ICH Q9? Institute of Validation Technology, January 2014. http://dx.doi.org/10.1080/21507090.ar1152014agkwnc-qrmsoi.

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This paper summarizes research designed to characterize the current state of pharmaceutical and biotechnology industries with respect to the adoption of Quality Risk Management as per ICH Q9. The research supports the hypotheses that the full value of QRM with respect to product quality and patient safety has not yet been realized. In addition, industry appears to be lagging behind regulatory expectations with respect to QRM maturity, indicating that current approaches to QRM require significant improvement.
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Gidengil, Courtney, Matthew Bidwell Goetz, Margaret Maglione, Sydne J. Newberry, Peggy Chen, Kelsey O’Hollaren, Nabeel Qureshi, et al. Safety of Vaccines Used for Routine Immunization in the United States: An Update. Agency for Healthcare Research and Quality (AHRQ), May 2021. http://dx.doi.org/10.23970/ahrqepccer244.

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Objective. To conduct a systematic review of the literature on the safety of vaccines recommended for routine immunization in the United States, updating the 2014 Agency for Healthcare Research and Quality (AHRQ) report on the topic. Data sources. We searched MEDLINE®, Embase®, CINAHL®, Cochrane CENTRAL, Web of Science, and Scopus through November 9, 2020, building on the prior 2014 report; reviewed existing reviews, trial registries, and supplemental material submitted to AHRQ; and consulted with experts. Review methods. This report addressed three Key Questions (KQs) on the safety of vaccines currently in use in the United States and included in the Centers for Disease Control and Prevention’s (CDC) recommended immunization schedules for adults (KQ1), children and adolescents (KQ2), and pregnant women (KQ3). The systematic review was supported by a Technical Expert Panel that identified key adverse events of particular concern. Two reviewers independently screened publications; data were extracted by an experienced subject matter expert. Studies of vaccines that used a comparator and reported the presence or absence of adverse events were eligible. We documented observed rates and assessed the relative risks for key adverse events. We assessed the strength of evidence (SoE) across the existing findings from the prior 2014 report and the new evidence from this update. The systematic review is registered in PROSPERO (CRD42020180089). Results. A large body of evidence is available to evaluate adverse events following vaccination. Of 56,608 reviewed citations, 189 studies met inclusion criteria for this update, adding to data in the prior 2014 report, for a total of 338 included studies reported in 518 publications. Regarding vaccines recommended for adults (KQ1), we found either no new evidence of increased risk for key adverse events with varied SoE or insufficient evidence in this update, including for newer vaccines such as recombinant influenza vaccine, adjuvanted inactivated influenza vaccine, and recombinant adjuvanted zoster vaccine. The prior 2014 report noted a signal for anaphylaxis for hepatitis B vaccines in adults with yeast allergy and for tetanus, diphtheria, and acellular pertussis vaccines. Regarding vaccines recommended for children and adolescents (KQ2), we found either no new evidence of increased risk for key adverse events with varied SoE or insufficient evidence, including for newer vaccines such as 9-valent human papillomavirus vaccine and meningococcal B vaccine. The prior 2014 report noted signals for rare adverse events—such as anaphylaxis, idiopathic thrombocytopenic purpura, and febrile seizures—with some childhood vaccines. Regarding vaccines recommended for pregnant women (KQ3), we found no evidence of increased risk for key adverse events with varied SoE among either pregnant women or their infants following administration of tetanus, diphtheria, and acellular pertussis vaccines during pregnancy. Conclusion. Across this large body of research, we found no new evidence of increased risk since the prior 2014 report for key adverse events following administration of vaccines that are routinely recommended. Signals from the prior report remain unchanged for rare adverse events, which include anaphylaxis in adults and children, and febrile seizures and idiopathic thrombocytopenic purpura in children. There is no evidence of increased risk of adverse events for vaccines currently recommended in pregnant women. There remains insufficient evidence to draw conclusions about some rare potential adverse events.
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Tipton, Kelley, Brian F. Leas, Nikhil K. Mull, Shazia M. Siddique, S. Ryan Greysen, Meghan B. Lane-Fall, and Amy Y. Tsou. Interventions To Decrease Hospital Length of Stay. Agency for Healthcare Research and Quality (AHRQ), September 2021. http://dx.doi.org/10.23970/ahrqepctb40.

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Background. Timely discharge of hospitalized patients can prevent patient harm, improve patient satisfaction and quality of life, and reduce costs. Numerous strategies have been tested to improve the efficiency and safety of patient recovery and discharge, but hospitals continue to face challenges. Purpose. This Technical Brief aimed to identify and synthesize current knowledge and emerging concepts regarding systematic strategies that hospitals and health systems can implement to reduce length of stay (LOS), with emphasis on medically complex or vulnerable patients at high risk for prolonged LOS due to clinical, social, or economic barriers to timely discharge. Methods. We conducted a structured search for published and unpublished studies and conducted interviews with Key Informants representing vulnerable patients, hospitals, health systems, and clinicians. The interviews provided guidance on our research protocol, search strategy, and analysis. Due to the large and diverse evidence base, we limited our evaluation to systematic reviews of interventions to decrease hospital LOS for patients at potentially higher risk for delayed discharge; primary research studies were not included, and searches were restricted to reviews published since 2010. We cataloged the characteristics of relevant interventions and assessed evidence of their effectiveness. Findings. Our searches yielded 4,364 potential studies. After screening, we included 19 systematic reviews reported in 20 articles. The reviews described eight strategies for reducing LOS: discharge planning; geriatric assessment or consultation; medication management; clinical pathways; inter- or multidisciplinary care; case management; hospitalist services; and telehealth. All reviews included adult patients, and two reviews also included children. Interventions were frequently designed for older (often frail) patients or patients with chronic illness. One review included pregnant women at high risk for premature delivery. No reviews focused on factors linking patient vulnerability with social determinants of health. The reviews reported few details about hospital setting, context, or resources associated with the interventions studied. Evidence for effectiveness of interventions was generally not robust and often inconsistent—for example, we identified six reviews of discharge planning; three found no effect on LOS, two found LOS decreased, and one reported an increase. Many reviews also reported patient readmission rates and mortality but with similarly inconsistent results. Conclusions. A broad range of strategies have been employed to reduce LOS, but rigorous systematic reviews have not consistently demonstrated effectiveness within medically complex, high-risk, and vulnerable populations. Health system leaders, researchers, and policymakers must collaborate to address these needs.
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Carney, Nancy, Tamara Cheney, Annette M. Totten, Rebecca Jungbauer, Matthew R. Neth, Chandler Weeks, Cynthia Davis-O'Reilly, et al. Prehospital Airway Management: A Systematic Review. Agency for Healthcare Research and Quality (AHRQ), June 2021. http://dx.doi.org/10.23970/ahrqepccer243.

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Objective. To assess the comparative benefits and harms across three airway management approaches (bag valve mask [BVM], supraglottic airway [SGA], and endotracheal intubation [ETI]) by emergency medical services in the prehospital setting, and how the benefits and harms differ based on patient characteristics, techniques, and devices. Data sources. We searched electronic citation databases (Ovid® MEDLINE®, CINAHL®, the Cochrane Central Register of Controlled Trials, the Cochrane Database of Systematic Reviews, and Scopus®) from 1990 to September 2020 and reference lists, and posted a Federal Register notice request for data. Review methods. Review methods followed Agency for Healthcare Research and Quality Evidence-based Practice Center Program methods guidance. Using pre-established criteria, studies were selected and dual reviewed, data were abstracted, and studies were evaluated for risk of bias. Meta-analyses using profile-likelihood random effects models were conducted when data were available from studies reporting on similar outcomes, with analyses stratified by study design, emergency type, and age. We qualitatively synthesized results when meta-analysis was not indicated. Strength of evidence (SOE) was assessed for primary outcomes (survival, neurological function, return of spontaneous circulation [ROSC], and successful advanced airway insertion [for SGA and ETI only]). Results. We included 99 studies (22 randomized controlled trials and 77 observational studies) involving 630,397 patients. Overall, we found few differences in primary outcomes when airway management approaches were compared. • For survival, there was moderate SOE for findings of no difference for BVM versus ETI in adult and mixed-age cardiac arrest patients. There was low SOE for no difference in these patients for BVM versus SGA and SGA versus ETI. There was low SOE for all three comparisons in pediatric cardiac arrest patients, and low SOE in adult trauma patients when BVM was compared with ETI. • For neurological function, there was moderate SOE for no difference for BVM compared with ETI in adults with cardiac arrest. There was low SOE for no difference in pediatric cardiac arrest for BVM versus ETI and SGA versus ETI. In adults with cardiac arrest, neurological function was better for BVM and ETI compared with SGA (both low SOE). • ROSC was applicable only in cardiac arrest. For adults, there was low SOE that ROSC was more frequent with SGA compared with ETI, and no difference for BVM versus SGA or BVM versus ETI. In pediatric patients there was low SOE of no difference for BVM versus ETI and SGA versus ETI. • For successful advanced airway insertion, low SOE supported better first-pass success with SGA in adult and pediatric cardiac arrest patients and adult patients in studies that mixed emergency types. Low SOE also supported no difference for first-pass success in adult medical patients. For overall success, there was moderate SOE of no difference for adults with cardiac arrest, medical, and mixed emergency types. • While harms were not always measured or reported, moderate SOE supported all available findings. There were no differences in harms for BVM versus SGA or ETI. When SGA was compared with ETI, there were no differences for aspiration, oral/airway trauma, and regurgitation; SGA was better for multiple insertion attempts; and ETI was better for inadequate ventilation. Conclusions. The most common findings, across emergency types and age groups, were of no differences in primary outcomes when prehospital airway management approaches were compared. As most of the included studies were observational, these findings may reflect study design and methodological limitations. Due to the dynamic nature of the prehospital environment, the results are susceptible to indication and survival biases as well as confounding; however, the current evidence does not favor more invasive airway approaches. No conclusion was supported by high SOE for any comparison and patient group. This supports the need for high-quality randomized controlled trials designed to account for the variability and dynamic nature of prehospital airway management to advance and inform clinical practice as well as emergency medical services education and policy, and to improve patient-centered outcomes.
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Brown, Yolanda, Twonia Goyer, and Maragaret Harvey. Heart Failure 30-Day Readmission Frequency, Rates, and HF Classification. University of Tennessee Health Science Center, December 2020. http://dx.doi.org/10.21007/con.dnp.2020.0002.

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30 Day Hospital Readmission Rates, Frequencies, and Heart Failure Classification for Patients with Heart Failure Background Congestive heart failure (CHF) is the leading cause of mortality, morbidity, and disability worldwide among patients. Both the incidence and the prevalence of heart failure are age dependent and are relatively common in individuals 40 years of age and older. CHF is one of the leading causes of inpatient hospitalization readmission in the United States, with readmission rates remaining above the 20% goal within 30 days. The Center for Medicare and Medicaid Services imposes a 3% reimbursement penalty for excessive readmissions including those who are readmitted within 30 days from prior hospitalization for heart failure. Hospitals risk losing millions of dollars due to poor performance. A reduction in CHF readmission rates not only improves healthcare system expenditures, but also patients’ mortality, morbidity, and quality of life. Purpose The purpose of this DNP project is to determine the 30-day hospital readmission rates, frequencies, and heart failure classification for patients with heart failure. Specific aims include comparing computed annual re-admission rates with national average, determine the number of multiple 30-day re-admissions, provide descriptive data for demographic variables, and correlate age and heart failure classification with the number of multiple re-admissions. Methods A retrospective chart review was used to collect hospital admission and study data. The setting occurred in an urban hospital in Memphis, TN. The study was reviewed by the UTHSC Internal Review Board and deemed exempt. The electronic medical records were queried from July 1, 2019 through December 31, 2019 for heart failure ICD-10 codes beginning with the prefix 150 and a report was generated. Data was cleaned such that each patient admitted had only one heart failure ICD-10 code. The total number of heart failure admissions was computed and compared to national average. Using age ranges 40-80, the number of patients re-admitted withing 30 days was computed and descriptive and inferential statistics were computed using Microsoft Excel and R. Results A total of 3524 patients were admitted for heart failure within the six-month time frame. Of those, 297 were re-admitted within 30 days for heart failure exacerbation (8.39%). An annual estimate was computed (16.86%), well below the national average (21%). Of those re-admitted within 30 days, 50 were re-admitted on multiple occasions sequentially, ranging from 2-8 re-admissions. The median age was 60 and 60% male. Due to the skewed distribution (most re-admitted twice), nonparametric statistics were used for correlation. While graphic display of charts suggested a trend for most multiple re-admissions due to diastolic dysfunction and least number due to systolic heart failure, there was no statistically significant correlation between age and number or multiple re-admissions (Spearman rank, p = 0.6208) or number of multiple re-admissions and heart failure classification (Kruskal Wallis, p =0.2553).
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Garsa, Adam, Julie K. Jang, Sangita Baxi, Christine Chen, Olamigoke Akinniranye, Owen Hall, Jody Larkin, Aneesa Motala, Sydne Newberry, and Susanne Hempel. Radiation Therapy for Brain Metasases. Agency for Healthcare Research and Quality (AHRQ), June 2021. http://dx.doi.org/10.23970/ahrqepccer242.

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Objective. This evidence report synthesizes the available evidence on radiation therapy for brain metastases. Data sources. We searched PubMed®, Embase®, Web of Science, Scopus, CINAHL®, clinicaltrials.gov, and published guidelines in July 2020; assessed independently submitted data; consulted with experts; and contacted authors. Review methods. The protocol was informed by Key Informants. The systematic review was supported by a Technical Expert Panel and is registered in PROSPERO (CRD42020168260). Two reviewers independently screened citations; data were abstracted by one reviewer and checked by an experienced reviewer. We included randomized controlled trials (RCTs) and large observational studies (for safety assessments), evaluating whole brain radiation therapy (WBRT) and stereotactic radiosurgery (SRS) alone or in combination, as initial or postoperative treatment, with or without systemic therapy for adults with brain metastases due to non-small cell lung cancer, breast cancer, or melanoma. Results. In total, 97 studies, reported in 190 publications, were identified, but the number of analyses was limited due to different intervention and comparator combinations as well as insufficient reporting of outcome data. Risk of bias varied; 25 trials were terminated early, predominantly due to poor accrual. Most studies evaluated WBRT, alone or in combination with SRS, as initial treatment; 10 RCTs reported on post-surgical interventions. The combination treatment SRS plus WBRT compared to SRS alone or WBRT alone showed no statistically significant difference in overall survival (hazard ratio [HR], 1.09; confidence interval [CI], 0.69 to 1.73; 4 RCTs; low strength of evidence [SoE]) or death due to brain metastases (relative risk [RR], 0.93; CI, 0.48 to 1.81; 3 RCTs; low SoE). Radiation therapy after surgery did not improve overall survival compared with surgery alone (HR, 0.98; CI, 0.76 to 1.26; 5 RCTs; moderate SoE). Data for quality of life, functional status, and cognitive effects were insufficient to determine effects of WBRT, SRS, or post-surgical interventions. We did not find systematic differences across interventions in serious adverse events radiation necrosis, fatigue, or seizures (all low or moderate SoE). WBRT plus systemic therapy (RR, 1.44; CI, 1.03 to 2.00; 14 studies; moderate SoE) was associated with increased risks for vomiting compared to WBRT alone. Conclusion. Despite the substantial research literature on radiation therapy, comparative effectiveness information is limited. There is a need for more data on patient-relevant outcomes such as quality of life, functional status, and cognitive effects.
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