Impact of Target Management Card on Patient Safety in the Emergency Department: A Mixed Methods Study.

BackgroundThis study contributes to a small but growing body of literature on how context influences perceptions of patient safety in healthcare settings. We examine the impact of senior leadership support for safety, supervisory leadership support for safety, teamwork, and turnover intention on overall patient safety grade. Interaction effects of predictors on perceptions of patient safety are also examined.MethodsIn this mixed methods study, cross-sectional survey data (N = 185) were collected from nurses and non-physician healthcare professionals. Semi-structured interview data (N = 15) were collected from nurses. The study participants worked in intensive care, general medicine, mental health, or the emergency department of a large community hospital in Southern Ontario.ResultsHierarchical regression analyses showed that staff perceptions of senior leadership (p < 0.001), teamwork (p < 0.01), and turnover intention (p < 0.01) were significantly associated with overall patient safety grade. The interactive effect of teamwork and turnover intention on overall patient safety grade was also found to be significant (p < 0.05). The qualitative findings corroborated the survey results but also helped expand the characteristics of the study’s key concepts (e.g., teamwork within and across professional boundaries) and why certain statistical relationships were found to be non-significant (e.g., nurse interviewees perceived the safety specific responsibilities of frontline supervisors much more broadly compared to the narrower conceptualization of the construct in the survey).ConclusionsThe results of the current study suggest that senior leadership, teamwork, and turnover intention significantly impact nursing staff perceptions of patient safety. Leadership is a modifiable contextual factor and resources should be dedicated to strengthen relational competencies of healthcare leaders. Healthcare organizations must also proactively foster inter and intra-professional collaboration by providing teamwork educational workshops or other on-site learning opportunities (e.g., simulation training). Healthcare organizations would benefit by considering the interactive effect of contextual factors as another lever for patient safety improvement, e.g., lowering staff turnover intentions would maximize the positive impact of teamwork improvement initiatives on patient safety.

The electronic health record: An essential tool for advancing patient safety

Nurses heavily influence patient care quality and safety. This paper aims to examine socioeconomic and organizational/system factors affecting patient safety and quality perceptions. A questionnaire was constructed to gather demographic, managerial support, information technology implementation and integration information. Data were collected from nurses in five Riyadh hospitals, Saudi Arabia. Registered nurses working in hospital departments participated in the survey. A total of 566 completed questionnaires were returned. Subsequent data were analyzed through binary logistic regression. Factors that improve patient safety and the likelihood that nurses use their own facility include: fewer visible errors; ability to communicate suggestions; information technology support and training; and a confidential error reporting system. The survey was a cross-sectional study. Consequently, it is difficult to establish causation. Furthermore, nursing in these hospitals is dominated by foreign nationals. Also, as with all surveys, this research may be subject to response bias. Although the questionnaire was randomly distributed, there were no mechanisms to assure privacy and minimize peer influence. The high positive patient safety perceptions may be influenced by either individual or peer biases. Nurses are important communicators; especially about hospital safety and quality. The research informs leaders about areas that need considering and improving. Findings indicate that system factors, including functional feedback, suggestions, and error reporting significantly affect patient safety improvements. Likewise, nurse education to operate their information systems has positive effects. Healthcare leaders need to understand factors that affect patient safety perceptions when creating a patient safety culture. Few international articles examine the factors that influence nurses' patient safety perceptions or examine those factors that affect these perceptions. This paper adds value by researching what influences patient safety perceptions among Riyadh nurses.

Background Patient safety is defined as the absence of preventable patient harm. Despite significant advances, enhancing the safety of pediatric patients is of particular importance. Thus, this study aimed to diagnose the current situation of patient safety and plan, implement, and evaluate patient safety initiatives in the emergency department (ED) of Ali Asghar Pediatrics Hospital. Methods Two action research cycles were conducted during 2023–2024 in the ED of Ali Asghar Hospital. Participants were nurses, physicians, and medical residents. In the first cycle, actions such as providing equipment and training in patient safety were carried out. In the second cycle, handoff standardization by I-PASS and continuing staff training were implemented. Data were collected using the Hospital Survey on Patient Safety Culture (HSOPSC), semi-structured interviews, and incident reports. Quantitative data were analyzed using the T-Test, and the Wilcoxon signed-rank test. Qualitative data were analyzed using content analysis. Results In the first cycle, the patient safety culture score was 48.1%. After training sessions, the patient safety test score significantly increased from 65.5% to 87.83% ( P &lt; .001). In the second cycle, according to interviewees’ opinion, handoffs and in-service training were improved. The patient safety culture score increased to 62.6%, and overall patient safety perception, communication openness, staffing, handoff, and nonpunitive responses to errors significantly improved ( P &lt; .05). Conclusion During this study, patient safety knowledge and culture among ED staff improved. Moreover, the standardization of handoff using the I-PASS tool improved the process by comprehensive information transfer, prioritizing critical patients, and reducing information loss.

In recent years, patient safety activities have shifted from being centered on healthcare providers to involving patients themselves. Health literacy of inpatients has a direct impact on patient participation behavior. Patient safety perception was also associated with willingness to participate in patient safety and patient participation behavior. Therefore, this study aimed to investigate the mediating effects of patient safety perception and willingness to participate in patient safety on the relationship between health literacy and patient participation behavior among inpatients. This cross-sectional study was conducted to confirm the relationship between study variables. A total of 262 inpatients were recruited from patients admitted to the ward of a tertiary general hospital between October and November 2023. Participants were invited to complete self-reported questionnaires that measured health literacy, patient safety perception, willingness to participate in patient safety, patient participation behavior, and demographic information. Data were analyzed using a dual mediation model applying the PROCESS macro (Model 6) with 95% bias-corrected bootstrap confidence intervals. This study analyzed the direct effects of health literacy on patient safety perceptions and patient participation behavior. Health literacy indirectly affected patient participation behavior through patient safety perceptions and willingness to participate in patient safety. Regarding the relationship between health literacy and patient participation behavior, patient safety perceptions and willingness to participate in patient safety showed a significant dual mediating effect. This study identified the factors that promote patient participation behavior among inpatients. The mediating effect of patient safety perception on the relationship between health literacy and patient participation behavior was found to be strong. Building health literacy among inpatients ensures patient safety by increasing patient safety perceptions.

BackgroundLay press investigations have been published that describe pharmacist errors and the workplace environment in the community pharmacy setting. However, recent studies that explore pharmacists' perceptions of patient safety in the workplace are limited. Objectives1) To describe pharmacists' perceptions of workplace patient safety; 2) To compare pharmacists' perceptions of workplace patient safety across practice setting type, pharmacist roles, average hours worked per shift, and average hours worked per week. MethodsActively licensed Tennessee pharmacists were recruited from January 1 and June 30, 2019 to complete a 13-item survey of workplace patient safety perceptions (N=1391). Descriptive statistics were calculated, and nonparametric statistical tests employed to compare differences in perceptions across practice setting type, pharmacist roles, and hours worked per shift and per week. ResultsStatistically significant differences in workplace patient safety perceptions were noted across practice setting type (p values <.001) and pharmacist roles (p values <.001). The extent to which pharmacists agreed/strongly agreed that their employer provides a work environment that allows for safe patient care ranged from 29.7% of chain community pharmacists to 85% of compounding pharmacists. Fifty-two percent of staff pharmacists, 56.5% of relief pharmacists, and 58.5% of managers/pharmacists in charge agreed or strongly agreed that their employer provides a work environment that allows for safe patient care, whereas 89.3% of regional managers/directors/vice-presidents and 72.5% of clinical/specialty pharmacists indicated the same. Average hours per shift was inversely correlated with perceptions of workplace patient safety (p values <.001). ConclusionTennessee pharmacists' perceptions of workplace patient safety varied widely across practice setting type and pharmacist roles. Perceptions of safety were notably lower in the chain community pharmacy setting. Additional research is warranted to better understand the relationship between pharmacist perceptions and quantifiable patient safety metrics, particularly in the chain community pharmacy setting.

Shaping Up: Unit‐to‐Unit Handoffs with a Lean Six Sigma Work Out

Patient safety is a significant concern worldwide. The Emergency Departments (EDs) are vulnerable to adverse events. Europe, with its diverse healthcare systems, differs in patient safety. This study aimed to identify safety challenges through a comparative analysis of healthcare professionals’ perceptions of patient safety in European EDs. In early 2023, a validated questionnaire was distributed to European ED professionals, meeting specific response rate criteria. The questionnaire included five safety domains and additional questions about infection control and team morale, with 36 ordinal scale questions. Responses ranged in five levels from “Never” to “Always,” and the scores were summed to calculate the total safety score (TSS). The study examined the impact of per capita healthcare expenditure on safety perceptions using descriptive statistics, correlation assessments and SPSS 17 used for the analysis. The analysis of 1048 valid responses from 24 European countries revealed significant variability in safety perceptions. Teamwork scored highest, signifying effective collaboration. Common safety issues included overcrowding, patient flow management, understaffing, limited training and facilities for mental illnesses. TSS showed correlation with team morale and infection control, but no correlation with per capita healthcare expenditure. This comparative study underlines the disparities in patient safety perceptions across European EDs. Each country displayed unique safety concerns. Safety perceptions did not align with per capita healthcare expenditure, indicating that addressing ED safety needs multifaceted strategies. Policymakers can leverage these findings to inform strategic planning, encouraging targeted interventions to enhance patient safety at both the national and European levels.

Public Health Initiatives in the Emergency Department: Not So Good for the Public Health?

The Emergency Department (ED) is a hospital service unit that provides the first service for patients with disease conditions that threaten their lives or can cause disability for 24 hours. Implementation of patient safety in the ED should be applied to minimize the risk of error handling for the patient. ED staff perceptions related to the implementation of patient safety is a factor that directly-related to his behavior in applying the implementation of patient safety. This study aimed to analyze the relationship between perceptions of staff ED and patient safety by implementing patient safety at the Regional Hospital Emergency Department Cirebon. This study was a correlational study with the cross-sectional approach of 99 emergency staff with total sampling at Cirebon. Collecting data used questionnaires of patient safety. Based on the results of the univariate analysis showed that the majority (80%) of respondents either category on the implementation of the sub-variables of patient safety team collaboration and communication, only a small proportion of respondents less category (20%) on the implementation of the sub-variables of patient safety team collaboration and communication. In addition, less than half (49.5%) category lacking in implementing patient safety, only half (50.5%) categories, both in the implementation of patient safety. Based on the results of the bivariate analysis showed that the relationship implementation of patient safety with all the variables, namely teamwork (p-value = 0.000), communications (p-value = 0.005), the concept of patient safety (p-value = 0.005), and perception (p-value = 0.005). Based on the results of the study, the researchers concluded that the relationship between staff perceptions of the emergency department (ED) on patient safety by implementing patient safety at the Regional Hospital emergency department (RSD) Cirebon. IGD support staff perceptions of patient safety, but still found lacking in the category of health workers implementation of patient safety, so the need for patient safety education and training with simulation methods to illustrate the approach in the implementation of patient safety.

Patient handoffs have long been identified as a potentially challenging time for patients because poor communication produces numerous complications. This is especially true with regards to patient care handoffs between areas such as the emergency department (ED) and inpatient setting. The purpose of this systematic review is to analyze existing literature pertaining to standardized handoffs between the ED and inpatient setting and its effect on perceived patient safety to guide future research, clinical practice, and patient safety. A review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies were selected using predetermined inclusion/exclusion criteria: primary research and patient handoff from the ED to the inpatient setting. Quality assessment of the studies was completed using The Joanna Briggs Institute critical appraisal tool. Existing studies demonstrate the potential for increased perception of patient safety as well as provider satisfaction when appropriate staff education and standardized handoff tools are implemented. There is a lack of data on the standardization of handoff tools between the ED and inpatient setting and their impact on perceived patient safety. The combination of provider education and implementation of standardized handoff tools in the ED positively affects perceptions of patient safety and provider satisfaction. Hospital administrations should strongly consider incorporating standardized handoff tools into practice.

To develop and test the psychometric properties of a survey to measure students' perceptions about patient safety as observed on clinical rotations. In 2012, the authors surveyed 367 graduating fourth-year medical students at three U.S. MD-granting medical schools. They assessed the survey's reliability and construct and concurrent validity. They examined correlations between students' perceptions of organizational cultural factors, organizational patient safety measures, and students' intended safety behaviors. They also calculated percent positive scores for cultural factors. Two hundred twenty-eight students (62%) responded. Analyses identified five cultural factors (teamwork culture, safety culture, error disclosure culture, experiences with professionalism, and comfort expressing professional concerns) that had construct validity, concurrent validity, and good reliability (Cronbach alphas > 0.70). Across schools, percent positive scores for safety culture ranged from 28% (95% confidence interval [CI], 13%-43%) to 64% (30%-98%), while those for teamwork culture ranged from 47% (32%-62%) to 74% (66%-81%). They were low for error disclosure culture (range: 10% [0%-20%] to 27% [20%-35%]), experiences with professionalism (range: 7% [0%-15%] to 23% [16%-30%]), and comfort expressing professional concerns (range: 17% [5%-29%] to 38% [8%-69%]). Each cultural factor correlated positively with perceptions of overall patient safety as observed in clinical rotations (r = 0.37-0.69, P < .05) and at least one safety behavioral intent item. This study provided initial evidence for the survey's reliability and validity and illustrated its applicability for determining whether students' clinical experiences exemplify positive patient safety environments.

Background: Patient safety is considered an important issue in the field of healthcare, and most advanced countries. Purpose: This study was designed to evaluate a patient safety education program among hospitalized patients. Of the 69 participants, 33 completed the patient safety education program while the 36 remaining participants were given educational booklets. The program was used to measure knowledge about patient safety, patient safety perception, and willingness to participate in patient safety. Methods: Patient safety education was developed by the analysis–design–development–implementation–evaluation model considering expert advice, patient needs, and an extensive literature review. Data were collected from 20 July to 13 November 2020. Data were analyzed using SPSS statistical program. The effectiveness of the experimental and control groups before and after education was analyzed using paired t-tests, and the difference in the amount of increase in the measured variables for each group was analyzed using independent t-tests. Results: The experimental group had significantly higher patient safety scores (t = 2.52, p = 0.014) and patient safety perception (t = 2.09, p = 0.040) than those of the control group. However, there was no significant difference between the two groups regarding the willingness to participate in patient safety. Conclusion: The patient safety education program developed using mobile tablet PCs could be an effective tool to enhance patient involvement in preventing events that may threaten the safety of patients. Further studies are recommended to develop a variety of educational interventions to increase patient safety knowledge and perceptions of patients and caregivers.

To assess the present patient safety culture of three general hospitals in Saudi Arabia, as perceived by nurses. This study utilized a descriptive, cross-sectional design. A convenience sample of 351 nurses working in three general hospitals in the central region of Saudi Arabia was surveyed in this study using the Hospital Survey of Patients' Safety Culture (HSOPSC) from October 2016 to April 2017. From the 12 composites of the HSOPSC, the nurses perceived only the following two patient safety areas as strengths: teamwork within units and organizational learning-continuous improvement. Six areas of patient safety were identified as weaknesses, namely overall perception of patient safety, handoffs and transitions, communication openness, staffing, frequency of events reported, and nonpunitive response to errors. Nationality, educational attainment, hospital, length of service in the hospital, work area or unit, length of service in the current work area or unit, current position, and direct patient contact or interaction were significant predictors of the nurses' perceived patient safety culture. The findings in this study clarify the current status of patient safety culture in three hospitals in the Kingdom of Saudi Arabia. The present findings should be considered by policymakers, hospital leaders, and nurse executives in creating interventions aimed at improving the patient safety culture in hospitals. A multidimensional network intervention targeting the different dimensions of patient safety culture and involving different organizational levels should be implemented to improve patient safety.

173 Patient Safety Concerns for Emergency Department Severe Sepsis Patients Downgraded to Non-Intensive Care Unit Beds