Long-Term Effects of Structured Microbreak Interventions on Musculoskeletal Health, Psychological Wellbeing, and Patient Safety Among Operating Room Nurses: A Multicenter Longitudinal Cohort Study

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

Patient Safety: Grantmakers Join The Effort To Reduce Medical Errors

Patient Safety Metrics Monitoring Across Harvard-Affiliated Hospitals: A Mixed Methods Study.

The Wisdom of Crowds.

To evaluate the impact of the Affordable Care Act's Medicaid expansion on patient safety metrics at the hospital level by expansion status, across varying levels of safety-net burden, and over time. Medicaid expansion has raised concerns over the influx of additional medically and socially complex populations on hospital systems. Whether increases in Medicaid and uninsured payor mix impact hospital performance metrics remains largely unknown. We sought to evaluate the effects of expansion on Centers for Medicare and Medicaid Services-endorsed Patient Safety Indicators (PSI-90). Three hundred fifty-eight hospitals were identified using State Inpatient Databases (2012-2015) from 3 expansions (KY, MD, NJ) and 2 nonexpansion (FL, NC) states. PSI-90 scores were calculated using Agency for Healthcare Research and Quality modules. Hospital Medicaid and uninsured patients were categorized into safety-net burden (SNB) quartiles. Hospital-level, multivariate linear regression was performed to measure the effects of expansion and change in SNB on PSI-90. PSI-90 decreased (safety improved) over time across all hospitals (-5.2%), with comparable reductions in expansion versus nonexpansion states (-5.9% vs -4.7%, respectively; P = 0.441) and across high SNB hospitals within expansion versus nonexpansion states (-3.9% vs -5.2%, P = 0.639). Pre-ACA SNB quartile did not predict changes in PSI-90 post-ACA. However, when hospitals increased their SNB by 5%, they incurred significantly more safety events in expansion relative to nonexpansion states (+1.87% vs -14.0%, P = 0.013). Despite overall improvement in patient safety, increased SNB was associated with increased safety events in expansion states. Accordingly, Centers for Medicare and Medicaid Services measures may unintentionally penalize hospitals with increased SNB following Medicaid expansion.

Patient safety metrics are recurrent headlines. Intentional or not, they are often sensationalized, conflated, or misconstrued to tell a story in which patients are frequently harmed by irresponsible, negligent clinicians. The truth is far less dramatic. Although medical error does occur and real people suffer real harm, the vast majority of encounters go as expected. So it’s crucial to understand how to interpret patient safety metrics to distinguish true areas of concern from embellished front-page stories. It is also important to understand that each database has its own reporting criteria and each research study its own methodology, and while there is no universal definition for medical error, medical error is not synonymous with patient harm. Reported  events  do not necessarily equate to instances of medical error, nor are all instances of harm preventable. For example, a patient may have a serious allergic reaction to a medication that they have never taken previously. The Patient Safety Authority (PSA) is charged with capturing every occurrence of harm or potential harm to patients in Pennsylvania, whether attributable to medical error or not, and providing tools to prevent its recurrence. Since its inception in 2004, more  than 3.8 million confidential event reports have been added to the PSA’s database, the Pennsylvania Patient Safety Reporting System (PA-PSRS)—the largest event reporting database in the United States and one of the largest in the world. The number of events reported into PA-PSRS has increased from 2004 to 2018; however, this was anticipated as a result of a maturing safety culture, and one cannot conclude from the data whether the actual number of events went up or the uptick is solely due to increased reporting. Caution should be given to inferences like “medical error is increasing" that cannot be substantiated from event  reports.  It may seem counterintuitive, but a facility with a low number of reports may be more concerning than one with a  higher number, as  this could indicate  a culture where safety and transparency are not supported. What is certain is that since 2004 in Pennsylvania, the number of reported incidents (events without harm) has increased; the number of reported serious events (events with some level of harm) has not trended up or down; and the number of high- harm events (those causing life-threatening injury, irreversible harm, or death) has declined. Approximately 97% of the reports in PA-PSRS are incidents. These types of events are often overlooked in healthcare, as Pennsylvania continues to be the only state that requires healthcare facilities to report no-harm events. Incidents often indicate potential patient harm, and the difference between a “near miss" and a “serious event" may have been happenstance or an intervention not guaranteed to recur. Though PA-PSRS cannot conclusively address medical error incidence, its millions of datapoints provide insights into emerging trends that are  unapparent  to individual facilities. As such, it provides the framework for a larger system that transforms data into actionable information to reduce harm. Thorough ongoing analyses drive an education agenda, identify opportunities for collaborative improvement projects, and prioritize issues across Pennsylvania and the United States—in healthcare facilities and in individual practice. The PSA’s work in these areas is published and shared in Patient Safety and elsewhere, and read by healthcare providers in 49 states and 44 countries.

Background Musculoskeletal disorders (MSDs) are affecting up to 95% of teachers and are considered a primary occupational health hazard leading to absenteeism, early retirement, and lower quality of life and teaching quality. Aim The current study is aimed at exploring the prevalence and risk factors of MSDs among the schoolteachers in Hail, Saudi Arabia. Methods A cross-sectional study was conducted online among the teachers in Hail City using the Nordic Musculoskeletal Questionnaire. Teachers were randomly selected from randomly selected high schools. Teachers with at least 1 year experience were recruited for the study. Descriptive statistics, Cochran's Q test, and binominal regression were used to investigate the prevalence of MSDs among such teachers and to determine if the percentage of MSDs differed by anatomical region and risk factor (one hundred forty-five males and 106 females filled out the questionnaires). Results The prevalence of MSDs in the last 12 months was 93.63% (235 of 251 teachers). Interestingly, 91% of the affected participants (214 of 235 teachers) complained of MSDs in more than one anatomical region. The most affected site was the lower back (183 of 251 teachers, 72.91%), followed by the shoulders (168 of 251 teachers, 66.93%), and the least affected sites were the elbows (45 of 251 teachers, 17.93%). The females showed a higher prevalence of MSDs than the males. Only gender was a significant risk factor for shoulder and neck MSDs (p < 0.02). Conclusion Overall, the findings of the current study suggest a high prevalence of MSDs among teachers, especially in the lower back and shoulders. The affected teachers should learn more about biomechanics and ergonomics and should engage in exercise to improve their health. Future studies should focus on identifying the biomechanical and ergonomic risk factors of MSDs and on designing MSD prevention programmes to reduce the burden of MSDs.

Patient safety is not a luxury

Objective: Work-related musculoskeletal disorders are one of the major causes of lost working time, increased costs, human injuries and burnout. The International Labor Organization estimates that about 160 million work-related illnesses occur worldwide each year, where the highest prevalent illnesses are musculoskeletal disorders. Several studies have been conducted In Iran to investigate the prevalence of these disorders, each providing different statistics. Therefore, considering the importance of these disorders, it is necessary to obtain accurate results with high statistical power and validate them. The aim of this study was to investigate the prevalence of work-related musculoskeletal disorders in Iran in order to obtain more accurate results by conducting a meta-analysis. Materials &amp; Methods: For this meta-analysis, searching was conducted in SID, MagIran, IranMedex, Google Scholar, Scopus, Web of Science, and PubMed databases using the keyword “work-related musculoskeletal disorders“ in both Persian and English on studies conducted during 2001-2016 in various cities of Iran. Inclusion criteria were: investigating the prevalence of musculoskeletal disorders in a period of one year, being a cross-sectional or descriptive-analytical study, publication in Persian or English, availability of full-texts, assessment using standard methods (e.g. Nordic Musculoskeletal Questionnaire) and considering the prevalence of musculoskeletal disorders throughout the body (upper and lower extremities). The heterogeneity of the articles was evaluated using the I2 statistics and the data were analyzed in STATA software using meta-analysis and random-effects model. Results: In this study, 45 papers on work-related musculoskeletal disorders were studied. The overall sample size of these studies was 9813, with a mean number of 218 for each study. Most of studies were descriptive-analytical and cross-sectional. In all of them, the prevalence of musculoskeletal disorders in different parts of the body had been investigated. According to their results, the most prevalent work-related musculoskeletal disorder in lower extremity was low back pain (0.49%) and in upper extremity, it was neck pain (39.3%). The prevalence of musculoskeletal disorders in other parts of the body were 39.32% in the neck, 36.9% in shoulders, 36.8% in the back, 34% in the wrist, 26.9% in legs, 20.5% in thighs and hips, and 16.2% in elbows.

The national nosocomial surveillance network in Hungary: results of two years of surgical site infection surveillance

The Overarching Themes From the CLER National Report of Findings 2018.

National Quality Program Achieves Improvements in Safety Culture and Reduction in Preventable Harms in Community Hospitals

Bedside whiteboards are ubiquitous fixtures in hospitalized patients' rooms and present unique, low-cost opportunities to improve patient care. Specifically, bedside whiteboards may enhance communication practices, safety standards, and patient education. Despite their commonality at the bedside, the direct impact of whiteboards on patient care remains unclear. To perform a scoping review of medical literature to synthesize available evidence and identify gaps regarding the impact of bedside whiteboards on patient communication, safety, and education. Published articles evaluating the impact of physical, patient-facing whiteboards on patient communication, safety, and education for adult patients hospitalized on medical-surgical floors and intensive care units. MEDLINE via PubMed, Google Scholar, Embase, Web of Science, and CINAHL databases. We performed a scoping review using Mak and Thomas' Steps for Conducting a Scoping Review and PRISMA-ScR guidelines. Two reviewers independently performed database searches on relevant publications that evaluated the impact of whiteboard-based interventions on communication practices, safety standards, and patient education. Thirteen articles were included in the final analysis. Studies were conducted on general medicine-specific units (n = 9, 69%) or medicine-surgery inpatient units (n = 3, 23%). Twelve of the 13 studies evaluated patient communication metrics, including provider identification (n = 9), patient engagement in care plan (n = 6), patient-provider communication (n = 3), interprofessional communication (n = 1), and discharge date estimation (n = 4). Six of these studies showed a statistically significant improvement in some aspect of patient communication. Patient safety metrics and education efforts were rarely included in whiteboard-based interventions, with only 2 studies exploring each aspect, respectively. Most studies focused on whiteboards to facilitate patient communication, with 4 studies showing 6 statistically significant improvements. Our scoping review highlights a paucity of research evaluating how whiteboard-based interventions could enhance patient safety and education, and future studies are necessary to explore this potential.

Assessment of Work-Related Musculoskeletal Pain in Urologic Microsurgeons

Assessment of work-related musculoskeletal pain in urologic microsurgeons