Address Patient Safety Research Articles

Attitudes, fears and experiences of medical scientists towards using AI tools in their work routine

Abstract Background Artificial intelligence (AI) has experienced an explosive growth in the healthcare sector and the scientific field. Large Language Models (LLMs) are investigated as potential tool to be used in medical treatment, by e.g. producing doctor’s reports, supporting personalized medicine or educating patients. However, limitations are broadly discussed addressing patient safety and ethical concerns due to false and misleading content. Therefore, LLMs face criticism among users not only towards their integration in the patient-provider-interaction, but also in its use in medical research and health care education. In the ongoing EXPOLS (Exploring the Potential of LLMs in Statistical Consulting) study, we address the question ‘What are the attitudes, fears and experiences regarding the integration of AI tools in the clinical/scientific work routine?’ Methods We implemented an online survey that will be accessible in 07/2024. All employees at the University and Medical Center Freiburg will be asked to participate in the survey via online media. We expect a sample size of n = 600-1,200. The survey combines published measurements (e.g. TRI 2.0, result expectation measure), as well as a self-designed instrument with 15 items aiming to measure fears and attitudes towards AI. Latter was developed within a multidisciplinary team making use of ChatGPT as item generator. We will investigate its psychometric properties using exploratory factor analysis and describe distribution characteristics. Results At the time of the conference, the project will be completed and both psychometric insights and content-related results will be reported. The results could have important public health implications, since attitudes towards AI will steer its integration in the medical and clinical routine. Conclusions The EXPOLS study makes a current inventory among medical scientists in Freiburg following a modern approach in instrument development by including ChatGPT as collegial advisor. Key messages • This study explores attitudes, fears and experiences towards the integration of AI tools in the work routine from medical and scientific staff at the University of Freiburg. • The findings might be crucial in determining the integration of AI based tools in the medical and clinical work routine.

Australian Dentists' Knowledge of the Consequences of Interpretive Errors in Dental Radiographs and Potential Mitigation Measures.

Dental radiographs, typically taken and interpreted by dentists, are essential for diagnosis and effective treatment planning. Interpretive errors in dental radiographs, stemming from failures of visual and cognitive processes, can affect both patients and clinicians. This survey aimed to assess the dental practitioners' perceptions of the consequences of these errors and potential measures to minimize them. This online anonymized survey assessed Australian dental practitioners' perceptions of the consequences of these errors and potential mitigation measures using ranking, Likert scale, and open-ended questions. The data were analyzed using descriptive statistics and bivariate analysis. Participants identified undertreatment (72%) and legal implications (82%) as the most significant consequences of interpretive errors, whereas severe harm to patients was deemed the least likely. Dental practitioners placed a greater emphasis on maintaining a high level of competence and the well-being of their patients. Utilizing high-quality images (63.9%) and appropriate radiographs (59.7%) were identified as the most effective measures to minimize interpretive errors. Participants showed hesitancy regarding the reliance on machine learning as a clinical decision-making tool. The survey provides valuable practical insights into the consequences and targeted measures to minimize the occurrence of interpretive errors. Efforts to minimize interpretive errors should address patient safety and practitioners' concerns about professional reputation and business viability. The study also suggests further research into the role of machine learning algorithms in reducing interpretive errors in dentistry.

Caring in crisis: Addressing patient safety, burnout, and long hours in healthcare.

Madam, The World Health Organization defines patient safety as preventing errors and adverse effects to patients associated with health care and “to do no harm to patients”. Specifically, in low and middle-income countries (LMICs), about 134 million adverse events occur each year due to unsafe care in hospitals, resulting in 2.6 million deaths annually. [1] Along with other determining factors, professional well-being, long hours, and burnout syndromes also influence patient care. [2] Burnout is a condition directly linked to workplace environment, stemming from occupational stress and extended working hours. Garcia, C.L. et al., through meta-analysis, found a relationship between the development of burnout and patient safety actions, with a probability of superiority of 66.4%. High levels of burnout and worsening patient safety are related to external factors such as high workload, long working hours, lack of a secure environment, and interpersonal relationships. [3] These findings raise concerns, particularly in a country like Pakistan, where the extent of understaffing and high workload can be inferred from the following statistics: The doctor-to-population ratio in Pakistan was 1:1000 in 2018 [4]. In contrast, the doctor-to-population ratio in Malaysia was 2.2:1000 in 2018 [5]. As a result of this shortage, the current workforce in Pakistan is negatively affected. In a study by Kasi PM et al. on postgraduate trainees in Pakistan, individuals under stress were more likely to report longer working hours. This increased workload made them prone to medical errors, which ultimately undermines the patient safety culture. A study conducted at a tertiary care hospital in Pakistan using the Hospital Survey on Patient Safety Culture (HSOPSC) compared the benchmarks from hospitals in the USA and discovered that high staff workload is a significant concern among staff [6] In Pakistan, where healthcare resources are limited, fostering a culture of effective work-hour management and breaks is essential for creating a healthier and safer environment for health professionals and patients. Ensuring adequate staffing levels to distribute the workload and prevent overburdening is essential. Providing designated areas for relaxation, offering mental health resources and mindfulness programmes like yoga or meditation can help doctors to cope with stress. Furthermore, promoting a culture of multidisciplinary teamwork, a mentorship program, and effective handover protocols during shift changes can ensure continuity of care. Medical institutes should invest in technology that can streamline administrative tasks and reduce paperwork burden. ---Continue

Free Text as Part of Electronic Health Record Orders: Context or Concern?

Background When placing orders into the electronic health record (EHR), prescribers often use free-text information to complement the order. However, the use of these free-text fields can result in patient safety issues. The objective of our study was to develop a deeper understanding of the conditions under which free-text information, or special instructions, are used in the EHR and the patient safety issues associated with their use, through an analysis of patient safety event (PSE) reports. Methods We identified 847 PSE reports submitted to the Pennsylvania Patient Safety Reporting System (PA-PSRS) between January 1, 2021, and December 31, 2022; this dataset was reduced to 677 after controlling for oversampling from particular facilities. After limiting to reports that mentioned the terms “special instructions,” “order instructions,” “order comments,” or “special comments,” we analyzed a total of 329 reports. A physician and human factors expert independently reviewed the reports and assigned each a code from the following categories: general care process, medication class, information expressed in the special instruction, special instruction issue, department or staff for which special instruction was intended, and whether the error reached the patient. Results Almost three quarters of the special instruction reports were related to Medication (n=233 of 329, 70.8%), followed by Laboratory/Blood Bank (n=54, 16.4%), and Radiology (n=23, 7.0%). Medication classes most frequently associated with special instructions included infectious disease medications (n=51 of 230, 22.2%), antithrombotic/antithrombotic reversal agents (n=32, 13.9%), and nutritional/electrolytes/intravenous fluids (n=32, 13.9%). Nearly one quarter each of medication-related special instructions were about timing (n=58 of 233, 24.9%) and dosing (n=54, 23.2%); most about laboratory/blood bank were related to the site of the blood draw (n=33 of 54, 61.1%), and many involving radiology were related to radiology/echocardiography instructions (n=16 of 23, 69.6%). The most frequent issues associated with special instructions were containing information contradictory to the order or other information (n=62 of 329, 18.8%); being confusing, incorrect, or used incorrectly (n=58, 17.6%); and not seen (n=25, 7.6%), not viewable (n=11, 3.3%), or instructions absent (n=11, 3.3%). In more than half of the reports, special instructions were intended for nursing staff (n=184 of 329, 55.9%), followed by pharmacy (n=49, 14.9%), radiology (n=21, 6.4%), and laboratory/blood bank (n=20, 6.1%). The error reached the patient in roughly three quarters (n=243 of 329, 73.9%) of the reports reviewed. Conclusion Special instructions are frequently used to provide additional context about medication orders and laboratory and radiology procedures and are often intended for nurses and pharmacists. However, these instructions can result in errors and may cause patient harm. Based on our analysis, we provide EHR design strategies and policies and protocols to address patient safety issues associated with free text to enable safer and more resilient care delivery.

Regulation of the sonography profession and patient safety: A comparative study between Australia and New Zealand with implications for statutory regulation

IntroductionThe primary aim of statutory regulation in healthcare is patient safety. Few studies examine health professionals’ perceptions of statutory regulation and its impact on patient safety. Statutory regulation of sonographers is different in Australia and New Zealand which affords a unique opportunity to compare and contrast regulation and its impact. MethodsAn interpretive policy analysis investigated how statutory regulation in the sonography profession addresses patient safety in Australia and New Zealand. A framework analysis explored relevant statutory regulatory policy as well as interviews from sonographers. ResultsFour policy documents were included. Thirty-one sonographers in Australia and nine in New Zealand took part in semi-structured interviews. Four themes described statutory regulation and its impact on patient safety: how statutory regulation is implemented in practice to address patient safety; factors contributing to implementation of statutory regulation; impact of statutory regulation on sonographers; and considerations for regulation. ConclusionStatutory regulation provides a reference point for safe practice but can be non-specific in defining sonographers’ roles and outlining strategies that address patient safety.Sonographers' perspectives of how regulation of practice addresses patient safety was mixed. A gap exists in sonographers’ understanding of the role of statutory regulation in patient safety. Implications for practiceRegulatory authorities must consider how to effectively engage and educate both patients and practitioners about their role in patient safety.Practitioners should also take the opportunity to engage in understanding the role of statutory regulation in enhancing patient safety.A broader view of how Fitness-to-Practice in sonography is managed should be considered in light of the findings.

Barriers to Incident Reporting by Physicians: A Survey of Surgical Residents and Attending Physicians.

Objectives Incident reporting is vital to a culture of safety; however, physicians report at an alarmingly low rate. This study aimed to identify barriers to incident reporting among surgeons at a quaternary care center. Methods A survey was created utilizing components of the Agency for Healthcare Research and Quality (AHRQ) validated survey on patient safety culture. This tool was distributed to residents and attending physicians in general surgery and urology at a single academic medical center. Responses were de-identified and recorded for data analysis using REDCap (Research Electronic Data Capture) database tool (Vanderbilt University, Nashville, Tennessee, United States). Results We received 39 survey responses from 116 residents and attending physicians (34% response rate), including nine urologists and 30 general surgeons (24 attendings, 15 residents). Residents and attendings feel the person is being written up and not the issue (67%) and that there is a lack of feedback after changes are implemented (64%), though most believe adequate action is taken to address patient safety concerns (72%). Most do not report near-misses (64%), only significant adverse events (59%). Residents are likely to stay silent when patient safety events involve those in authority (60%).Faculty feel those in authority are open to patient safety concerns (67%), though residents feel neutral (47%) or disagree (33%). Conclusion Underreporting of incidents among physicians remains multifaceted and complex, from fear of retaliation to lack of feedback. Residents tend to feel less comfortable addressing authority figures when concerned about patient safety. While misunderstanding still exists about the applications and utility of incident reporting, a focus on quality over quantity could afford more meaningful progress toward high reliability in healthcare.

Speaking Up: Exploring Mental Health Care Workers' Patient Safety Concerns.

To explore the perspectives and experiences of mental health care workers (MHCWs) when speaking up about patient safety concerns. A qualitative study was performed at Farshchian (Sina) Hospital in Iran, involving the purposive sampling of MHCWs from three inpatient psychiatric wards. From July to October 2022, semi-structured interviews were conducted with 23 participants. Data were analyzed using conventional content analysis. Three major patient safety themes were identified: (a) Voicing Concerns for Daily Safety (subthemes: daily safety check-ins and speaking up to prevent patient harm); (b) Speaking Up to Save Future Lives (subthemes: whistleblowing, leadership, and being open to communication); and (c) Hesitating to Speak Up (sub-themes: ineffectiveness of raising one's voice and whispering). MHCWs have various concerns about speaking up or staying silent. Failure to communicate can result in adverse events and missed opportunities to address patient safety. [Journal of Psychosocial Nursing and Mental Health Services, xx(x), xx-xx.].

Assessment and evaluation of patient safety reports: When should we intervene?

ObjectiveThe impact of medical errors on patient outcomes has been well-described. Multiple avenues for documenting and addressing patient safety events have been created, including quality outcome registries and adverse event databases. MethodsThis paper summarizes key data and definitions related to medical errors, as well as systems for monitoring them. We also offer considerations for how to interpret and act on these reports, at the hospital- or vascular surgery division-specific level. ResultsSeveral methods and systems exist for characterizing, cataloging, and addressing medical errors and quality of care. ConclusionsSafety report review and adjudication should be timely and conducted according to principles of root cause analysis. Strategies to address systems-level factors should follow a defined improvement model. Division-level quality officers should meet as a group with hospital-level safety officers on a routine basis to discuss themes of safety that may resonate across the institution.

Patient safety: a flipped classroom curriculum for family medicine residents.

Addressing patient safety incidents is a complicated and challenging issue for physicians. At present, there is little training in residency programs to help prepare learners to tackle situations where harm arises as a result of healthcare delivery. In response to new accreditation mandates, we piloted a flipped classroom patient safety curriculum to help train family medicine residents to identify and address patient safety incidents in practice. Family medicine programs could consider similar case-based training for their learners to help prepare them to respond to these events and address contributory factors.

Deep inspiratory breath-hold radiotherapy on a Helical Tomotherapy unit: Workflow and early outcomes in patients with left-sided breast cancer

IntroductionThe clinical implementation of deep inspiratory breath-hold (DIBH) radiotherapy to reduce cardiac exposure in patients with left-sided breast cancer is challenging with helical tomotherapy(HT) and has received little attention. We describe our novel approach to DIBH irradiation in HT using a specially designed frame and manual gating, and compare cardiac substructure doses with the free-breathing (FB) technique. Material and methodsThe workflow incorporates staggered junctions and a frame that provides tactile feedback to the patient and monitoring for manual cut-off. The treatment parameters and clinical outcome of 20 patients with left-sided breast cancer who have undergone DIBH radiotherapy as a part of an ongoing prospective registry are reported. All patients underwent CT scans in Free Breathing (FB) and DIBH using the in-house Respiframe, which incorporates a tactile feedback-based system with an indicator pencil. Plans compared target coverage, cardiac doses, synchronizing treatment with breath-hold and avoiding junction repetition. MVCT scans are used for patient alignment. ResultsThe mean dose (Dmean) to the heart was reduced by an average of 34 % in DIBH-HT compared to FB-HT plans (3.8 Gy vs 5.7 Gy). Similarly, 32 % and 67.8 % dose reduction were noted in the maximum dose (D0.02 cc) of the left anterior descending artery, mean 12.3 Gy vs 18.1 Gy, and mean left ventricle V5Gy 13.2 % vs 41.1 %, respectively. The mean treatment duration was 451.5 sec with a median 8 breath-holds; 3 % junction locations between successive breath-holds were replicated. No locoregional or distant recurrences were observed in the 9-month median follow-up. ConclusionOur workflow for DIBH with Helical-Tomotherapy addresses patient safety, treatment precision and challenges specific to this treatment unit. The workflow prevents junction issues by varying daily breath-hold durations and avoiding junction locations, providing a practical solution for left-sided breast cancer treatment with HT.

"Good Care Is Slow Enough to Be Able to Pay Attention": Primary Care Time Scarcity and Patient Safety.

There is growing, widespread recognition that expectations of US primary care vastly exceed the time and resources allocated to it. Little research has directly examined how time scarcity contributes to harm or patient safety incidents not readily capturable by population-based quality metrics. To examine near-miss events identified by primary care physicians in which taking additional time improved patient care or prevented harm. Qualitative study based on semi-structured interviews. Twenty-five primary care physicians practicing in the USA. Participants completed a survey that included demographic questions, the Ballard Organizational Temporality Scale and the Mini-Z scale, followed by a one hour qualitative interview over video-conference (Zoom). Iterative thematic qualitative data analysis was conducted. Primary care physicians identified several types of near-miss events in which taking extra time during visits changed their clinical management. These were evident in five types of patient care episodes: high-risk social situations, high-risk medication regimens requiring patient education, high acuity conditions requiring immediate workup or treatment, interactions of physical and mental health, and investigating more subtle clinical suspicions. These near-miss events highlight the ways in which unreasonably large patient panels and packed schedules impede adequate responses to patient care episodes that are time sensitive and intensive or require flexibility. Primary care physicians identify and address patient safety issues and high-risk situations by spending more time than allotted for a given patient encounter. Current quality metrics do not account for this critical aspect of primary care work. Current healthcare policy and organization create time scarcity. Interventions to address time scarcity and to measure its prevalence and implications for care quality and safety are urgently needed.

Metrics Matter

There is limited evidence to substantially describe the state of Patient Safety (PS) in the Philippines.1,2 With most publications reflecting respondent-based assessments of institutional patient safety culture, patient-sensitive and records-based indicators are scarce. 3 Despite the Institute of Medicine’s4 call to action to address preventable errors and the publication of patient safety indicators5 , there has been slow progress in patient safety in the country.
 The Department of Health’s release of the National Policy on Patient Safety (Administrative Order 2008-0023) 6 and the creation of the National Patient Safety Committee (NPSC) were pivotal in elevating patient safety as priority in Philippine healthcare facilities. The creation of PS committees across hospitals and the mainstreaming of patient safety through campaigns and conferences helped push institution-level research and design programs to reduce events.7,8 The National Policy on Patient Safety in Health Facilities (Administrative Order 2020-0007) 9 presented specific guidelines and strategies for the full implementation of PS programs, including directives on the roles and responsibilities of patient safety officers, strategies to address patient safety issues, and indicators for monitoring. The above national and institutional efforts to promote patient safety strategies are gaining momentum, but without metrics, it is impossible to determine if these initiatives result in real-world changes.
 Accurate, reliable, and timely patient safety-sensitive indicators feed learning systems. 10,11 Metrics for patient safety allow for accurate analysis that translate to responsive actions to mitigate risks, ensure continuous improvement, monitor progress, and impact patient-, organization-, and health worker-related outcomes. However, the findings of incapacitated patientsafety committees, missing risk management and patient-centered initiatives, and inconsistent reporting systems are highly concerning.
 While hospitals have complied with the activities stipulated in the national policies, the superficial compliance reflects the lack of investment in patient safety architecture. The committee chairs and members are burdened with competing priorities, leaving them with little time to fulfil their roles in policy development, data analysis, and system improvements. These responsibilities are mere add-ons to their already brimming schedules, and the meager budget, if any, further hinders program implementation and their engagement in essential training.
 Inadequate time dedicated to engaging in patient safety-focused activities of frontline healthcare personnel 12 could also explain why some patient and direct care indicators receive lower reporting than others like falls, medication errors, adverse drug events, and missed care. Reporting and contributing to learning systems can become a burden for nurses and physicians with inhumane workloads, 13-15 further exacerbating the issue.
 Inconsistencies in available data can be attributed to the lack of a mature patient safety culture, resulting in reluctance to report indicators. These indicators are often regarded as a reflection of poor performance or incompetence.16,17 Moreover, commendations for low adverse event reports and high patient satisfaction ratings perpetuate the practice of not disclosing an organization’s shortcomings. A reliable baseline that indicates the severity of the situation is crucial for good results to have any significance. Without a balanced system that encourages reporting, feedback, and actionable practice changes, reports will continue to be inconsistent.
 The study makes sound recommendations to use a unified set of patient safety indicators and protocols for regular measurement, analysis, and improvements integrated into a national reporting system. This system would guide collection, collation, classification, and analysis of patient safety problems that will guide improvements.10 It starts with investing in reliable structures (personnel, funding, policies) and clear processes at the country and facility level. A culture and mindset shift are also essential to optimize patient safety structures and processes that includes a blame-free environment, the practice of enhanced feedback, champions and role models, and education and training 12,18 on core concepts in patient safety and how to analyze data to generate meaningful outcomes.
 Our goal of establishing a comprehensive patient safety learning system is an arduous and complex undertaking. Achieving a high-reliability learning system necessitates the cultivation of a safety-oriented culture, which takes time to develop. However, implementing a metric for reporting and monitoring patient safety issues in hospitals would be a vital initial step toward this goal. Ultimately, the establishment of a patient safety learning system that addresses the needs of patients and healthcare workers would result in a significant improvement in patient safety outcomes.

Ethical, legal, and information management aspects in the context of patient safety

Health systems around the world currently generate diverse health data related to their patients; their potential for use in the routine of health professionals is recognized; however, at the same time, patient safety is also widely discussed since, over the years, the patient's electronic medical record absorbs sensitive information, accumulated over time. In this sense, this study aimed to address ethical, legal, and information management aspects in the context of patient safety. This is a scoping review, conducted based on the methodological structure developed by the Joanna Briggs Institute and the checklist Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews, set in five stages: 1) identification of the research question, 2) bibliographic survey to search for relevant studies, 3) selection of studies, according to the criteria defined in this review, 4) data mapping and 5) presentation of results. The results showed that a) the articles, in general, pay much attention to patient safety, both in terms of data and also in terms of health; b) International patient safety goals were created to standardize care in private and public hospitals, c) The articles address patient safety by international patient safety goals and d) information leakage is becoming increasingly common, and actions are needed to minimize these situations. The conclusion shows that there is a lack of objective studies regarding the use of information technology in patient safety and that, due to the importance of these topics, both in public health and economic issues, more studies are necessary for an effective implementation that can generate practical results to patients and the country's healthcare system.

Big data research in nursing: A bibliometric exploration of themes and publications.

To comprehend the current research hotspots and emerging trends in big data research within the global nursing domain. Bibliometric analysis. The quality articles for analysis indexed by the science core collection were obtained from the Web of Science database as of February 10, 2023.The descriptive, visual analysis and text mining were realized by CiteSpace and VOSviewer. The research on big data in the nursing field has experienced steady growth over the past decade. A total of 45 core authors and 17 core journals around the world have contributed to this field. The author's keyword analysis has revealed five distinct clusters of research focus. These encompass machine/deep learning and artificial intelligence, natural language processing, big data analytics and data science, IoT and cloud computing, and the development of prediction models through data mining. Furthermore, a comparative examination was conducted with data spanning from 1980 to 2016, and an extended analysis was performed covering the years from 1980 to 2019. This bibliometric mapping comparison allowed for the identification of prevailing research trends and the pinpointing of potential future research hotspots within the field. The fusion of data mining and nursing research has steadily advanced and become more refined over time. Technologically, it has expanded from initial natural language processing to encompass machine learning, deep learning, artificial intelligence, and data mining approach that amalgamates multiple technologies. Professionally, it has progressed from addressing patient safety and pressure ulcers to encompassing chronic diseases, critical care, emergency response, community and nursing home settings, and specific diseases (Cardiovascular diseases, diabetes, stroke, etc.). The convergence of IoT, cloud computing, fog computing, and big data processing has opened new avenues for research in geriatric nursing management and community care. However, a global imbalance exists in utilizing big data in nursing research, emphasizing the need to enhance data science literacy among clinical staff worldwide to advance this field. This study focused on the thematic trends and evolution of research on the big data in nursing research. Moreover, this study may contribute to the understanding of researchers, journals, and countries around the world and generate the possible collaborations of them to promote the development of big data in nursing science.

Parkinson's disease physical therapy services during COVID-19: A phenomenological study.

Parkinson's disease (PD) is the most rapidly increasing movement disorder globally. Physical therapies improve the motor and non-motor symptoms of PD. During the COVID-19 pandemic, telehealth was the primary method of physical therapy service adaptation in response to restrictions preventing in-person therapy attendance. This study explores the perspectives of people with PD and their therapists who experienced physical therapy service delivery before and during the COVID-19 pandemic in Melbourne, Australia. A phenomenological study that purposively recruited patients and therapists from a movement disorders service at an outer metropolitan rehabilitation hospital. Participants completed in-depth interviews, and data were analysed using reflexive thematic analysis. Ten people with PD and five therapists completed interviews. Six themes were identified: patients value access to therapy, a key mechanism is trust, an opportunity to empower patients, ticking boxes for telehealth, contrasting experiences of telehealth and something is better than nothing. This study explored the experiences of people with PD and their therapists by contrasting their prepandemic and in-pandemic experiences. People with PD valued telehealth access during the pandemic, but extra support was initially required to use telehealth successfully. Empowering aspects of telehealth included patients learning new skills and self-management strategies from telehealth interactions with therapists. Therapists at this health service were motivated to continue with telehealth beyond the pandemic. Despite finding it challenging initially, they were surprised by how well people with PD managed telehealth using locally developed procedures based on clinical judgement and staff training that addressed patient safety while supporting people with PD to utilise telehealth.

Quality and Safety Considerations in Image Guided Radiation Therapy: An ASTRO Safety White Paper Update

This updated report on image guided radiation therapy (IGRT) is based on a consensus-based white paper previously published by the American Society for Radiation Oncology (ASTRO) addressing patient safety. In the past decade, IGRT technology and procedures have progressed significantly and are now more commonly used. The use of IGRT has now extended beyond high-precision treatments, such as stereotactic radiosurgery and stereotactic body radiation therapy, and into routine clinical practice for many treatment techniques and anatomic sites. Therefore, quality and treatment planning and delivery considerations for these techniques are paramount for patient safety. In 2021, ASTRO convened an interdisciplinary task force to assess the original IGRT white paper and update content where appropriate. Recommendations were created using a consensus-building methodology, and task force members indicated their level of agreement based on a 5-point Likert scale from "strongly agree" to "strongly disagree." A prespecified threshold of ≥75% of raters who selected "strongly agree" or "agree" indicated consensus. The IGRT white paper was published (Pract Radiat Oncol. 2022 Dec) and endorsed by the American Association of Physicists in Medicine (AAPM), American Association of Medical Dosimetrists, and American Society of Radiologic Technologists. Since the first IGRT paper was published by ASTRO in 2013, significant technological advancement has taken place. New and updated considerations in personnel requirements, staffing, education and training, equipment and technological requirements, quality management and assurance, IGRT program management, and safety considerations were reported. A 17-point consensus was reached and recommended in 5 areas surrounding program development, quality assurance, quality management, treatment delivery, and vendor engagement (Table 5, Summary of key recommendations). This IGRT white paper builds on the previous version and uses other guidance documents to primarily focus on processes related to quality and safety. IGRT requires an interdisciplinary team-based approach, staffed by appropriately trained specialists, as well as significant personnel resources, specialized technology, and implementation time. A thorough feasibility analysis of resources is required and should be discussed with all personnel before undertaking new imaging techniques. A comprehensive quality-assurance program must be developed to ensure IGRT is performed safely and effectively. As IGRT technologies continue to improve or emerge, existing practice guidelines should be updated regularly according to the latest AAPM Task Group reports. Patient safety in the application of IGRT is everyone's responsibility, and professional organizations, regulators, vendors, and end-users must demonstrate strong commitments to ensure that the highest levels of safety are achieved.

42 Enacting Meaningful Change in the Face of Adversity – Use of a Sentinel Event to Pilot the Creation of a Rapid Response System in a Tertiary Paediatric Care Centre

Abstract Introduction/Background Although rare, in-hospital paediatric mortality occurs at a rate of 12.66 per 1000 admissions. Delayed recognition of clinical deterioration is a modifiable factor in such adverse events. In paediatric patients, subtle changes in vital signs often precede acute deterioration and provide an opportunity for early intervention and prevention of further deterioration. Based on this rationale, rapid response systems (RRS), which include a critical care response team (CCRT) and a Paediatric Early Warning Score (PEWS), have been established to facilitate the detection of clinical deterioration and mobilize resources for timely treatment. There is evidence that RRS can significantly decrease inpatient clinical deterioration events and PICU utilization. Objectives At our institution, serious patient safety events identified system failures in recognition, communication, and escalation of care in response to clinical deterioration. The root cause analysis led to a quality improvement and patient safety initiative to implement an RRS at our tertiary paediatric care centre. Design/Methods Process implementation of this pilot project required consultations with key stakeholders and designation of unit champions to mobilize resources and promote buy-in. Based on other successful implementation strategies, we adopted the Modified Brighton PEWS, defined a response algorithm, created bedside tools, constructed an interdisciplinary CCRT, and organized simulation activities to implement the new process. We used the Plan-Do-Study-Act method to carry out change based on weekly feedback from frontline workers. To assess the feasibility and acceptability of this initiative, all CCRT activations during the pilot phase were reviewed and a survey was distributed pre- and post-implementation. The number of code blues and mortality data will also be measured. Results The pilot period spanned June to September 2022 on our medical inpatient unit. Average response time to CCRT activation was 12 minutes (IQR 7-13.5), a median of three therapeutic interventions were required per activation, and 33% of activations resulted in PICU admissions. Among the 27 post–implementation survey respondents, 87% identified CCRT as a useful addition to optimize care and address patient safety concerns. Qualitatively, it has created a shared safety culture and empowered junior members of healthcare teams to escalate care. Conclusion This quality improvement initiative pilot study has demonstrated feasibility and acceptability of RRS implementation with a positive impact on patient safety culture and earlier detection and intervention for deteriorating patients. Further prospective comparative clinical benefits and cost-benefit analyses are needed to support hospital-wide implementation.

Physician engagement in organisational patient safety through the implementation of a Medical Safety Huddle initiative: a qualitative study

BackgroundEfforts to increase physician engagement in quality and safety are most often approached from an organisational or administrative perspective. Given hospital-based physicians’ strong professional identification, physician-led strategies may offer a...

475 Co-designing an intervention to support safe medicines self-management for older people living with frailty and polypharmacy

Abstract Introduction Older people face numerous challenges and safety risks when managing multiple medicines. They are required to cope with complex and changing regimens and co-ordinate input from multiple healthcare professionals. If not well managed, medicines can cause harm, and older people are more susceptible to errors. Some older people can devise and implement strategies to manage their medicines, e.g. creating checklists, ensuring timely supplies, solving problems, and seeking help (1). However, no interventions address the multiple tasks polypharmacy patients must perform to safely manage their regimens. Aim To develop an intervention to support medicines self-management for older people living with frailty and polypharmacy using experience-based co-design (EBCD) (2). Methods Following video or audio-recorded qualitative interviews with 32 older people taking 5 or more medicines, a ‘trigger film’ of patients’ medicines management experiences was produced and used during EBCD to facilitate priority setting. Separate meetings were held (1) with 16 staff (2 GPs, 4 GP practice administrators, 4 GP practice pharmacists, 1 practice lead, 2 senior nurses, 2 pharmacy technicians, 1 community pharmacist) and (2) with 13 patients and 2 family members, followed by a joint meeting with 8 older people and 9 staff where a shared set of three priorities was agreed. Two subsequent co-design workshops with 6 patients, 2 family members and 7 staff developed three candidate interventions. Workshop 1 explored key themes from the trigger film to develop solutions. Workshop 2 reviewed solutions and further developed design ideas. Intervention components were merged and those addressing patient safety challenges were retained to form the prototype intervention. Ethical approval was obtained for the interviews included in the trigger film, but not required for EBCD. EBCD meetings and workshops were conducted as quality improvement: people involved were collaborators, personal information was not captured, discussions were not recorded or analysed. Results Co-design priorities were to support patients in: day-to-day practical medicines management; understanding the wider medicines management system; communication with healthcare teams. The three solutions were: a quick-start guide to managing multiple medicines including talking about medicines and managing new routines; tips and tricks to support day-to-day management, including planning and adherence tools; a tool supporting preparation for medication reviews and asking questions about medicines. After merging intervention components and identifying those addressing medicines-self-management patient safety challenges, five areas were retained for the prototype intervention: checking what you get; keeping on top of supplies; monitoring how you take your medicines; times when problems are more likely; and how do I know if I need help? Discussion/Conclusion Through EBCD patients and staff worked together to improve people’s experiences of managing medicines and to enhance safety. The prototype intervention addresses five areas where older people with complex medicines regimens require support. The intervention requires feasibility testing and subsequent robust evaluation. Strengths and limitations: • A variety of staff roles joined the co-design, offering multiple different perspectives on medicines management • EBCD meetings and workshops were run online to avoid Covid infections. This may have excluded older people with no access to internet.

Pressing issues in healthcare digital technologies and AI

John Tingle Lecturer in Law, Birmingham Law School, University of Birmingham, discusses several reports addressing patient safety, ethical and legal issues in healthcare digital technologies and artificial intelligence.