Safety Improvement Research Articles

Evaluation of the effect of DRG payment policy based on interrupted time series modeling: evidence from a tertiary hospital in Anhui Province

BackgroundThe payment methodology for diagnosis-related groups (DRG) has implications for both society and medical institutions. Our study aims to analyse the impact of the reform of the payment policy according to the DRG on the operation of a tertiary hospital in Anhui Province.MethodsMonthly data were collected from April 2020 to September 2023 during the reform period for a tertiary hospital on nine types of operational indicators, including average length of stay (ALOS), number of discharges, number of outpatient visits, percentage of discharged patients undergoing level III or IV surgery, bed turnover rate, inpatient essential drug utilization rate, low-risk group mortality, outpatient subaverage cost and inpatient subaverage cost. The data were divided into two phases according to the time of DRG implementation: pre-reform (April 2020–December 2021) and post-reform (January 2022–September 2023), and the segmented regression model with interrupted time series data was used to analyse the changes in the trend of each type of indicator before and after the reform. Statistical analysis was performed using R software (4.3.1).ResultsAfter the implementation of the DRG, the number of discharges increased by 112 800 patients (95% confidence interval [CI] 31.125–194.484, P = 0.008), the bed turnover rate rose by 1.403% (95% CI 1.028–1.778, P = 0.022) and the percentage of discharged patients undergoing level III or IV surgery decreased by 0.098% (95% CI −0.181 to −0.015, P = 0.022). The low-risk group mortality decreased by 0.016% (95% CI −0.027 to −0.005, P = 0.007), and the inpatient subaverage cost decreased by 81.514 CNY (95% CI −121.782 to −41.245, P < 0.001). However, there were no significant differences in the trends of average length of stay, outpatient visits, inpatient essential drug utilization rate and outpatient subaverage cost after the DRG implementation.ConclusionsThe findings show that the DRG reform has positively impacted hospital functioning, including quality, safety, efficiency and costs. Although the average length of stay remained unchanged, there was an increase in discharged patients and outpatient visits, indicating hospitals adapted to the new payment model. The reduction in low-risk group mortality suggests improvements in patient safety and care quality. However, challenges remain, as evidenced by decreased surgical complexity and initial drops in bed turnover rates. While the DRG reform holds promise for enhancing healthcare efficiency and controlling costs, potential negative effects such as patient selection bias and coding changes need to be monitored. Future research should focus on the long-term effects of the DRG policy across different healthcare institutions.

Comparison of Accident Prevention Procedures and Safety Management Systems At Commercial Air Transport Operator and ATO

This article focuses on the prevention of aviation accidents and incidents. It starts by defining the basic concepts and the regulatory basis, the current methods of prevention at the state and air operator level.The main part of the paper contains a detailed analysis of the Safety Management System (SMS) of the air transport company and the ATO/DTO training organisation. The analysis is supplemented by guided interviews with safety personnel and a comparison of the two safety management systems. The information gathered is used to suggest possible improvements in operational safety, which are explained in the final part of the paper.

Effectiveness of a New Microprocessor-Controlled Knee–Ankle–Foot System for Transfemoral Amputees: A Randomized Controlled Trial

Background: Advances in prosthetic technology, especially microprocessor-controlled knees (MPKs), have helped enhance gait symmetry and reduce fall risks for individuals who have undergone transfemoral amputation. However, challenges remain in walking in constrained situations due to the limitations of passive prosthetic feet, lacking ankle mobility. This study investigates the benefits of SYNSYS®, a new microprocessor-controlled knee–ankle–foot system (MPKA_NEW), designed to synergize knee and ankle movements. Methods: A randomized crossover trial was conducted on 12 male participants who had undergone transfemoral amputation who tested both the MPKA_NEW and their usual MPK prosthesis. Biomechanical parameters were evaluated using quantitative gait analysis in various walking conditions. Participants also completed self-reported questionnaires on their quality of life, locomotor abilities, and prosthesis satisfaction. Results: The MPKA_NEW showed a significant reduction in the risk of slipping and tripping compared to standard MPK prostheses, as evidenced by increased flat-foot time and minimum toe clearance during gait analysis. The MPKA_NEW also improved physical component scores in quality-of-life assessments (Short-Form 36 General Health Questionnaire), suggesting enhanced stability and reduced cognitive load during walking. Conclusions: The MPKA_NEW offers significant improvements in gait safety and quality of life for people who have undergone TFA, particularly in challenging conditions. Further studies are needed to assess the long-term benefits and adaptability across diverse amputee populations.

Functionally Graded Impact Attenuator Using Bonded Construction

ABSTRACTAutomotive collisions are one of the major causes of death in the European Union, especially in childhood and adolescence. However, improvements in vehicle safety cannot be achieved only by increasing the size and dimensions of the structures, as this demands more materials and more costly manufacturing processes, which leads to an increased resource expenditure and lowered sustainability. Moreover, the increase of the structure size raises the vehicle's weight, leading to added fuel consumption, which cannot be accepted considering modern environmental regulations. To solve these issues, the application of bonded joints using the combination of several adherends materials, such as steel and aluminium alloys and fibber‐reinforced polymers with crash‐resistant adhesives presents itself as a novel solution, allowing to attain enhanced joint strength, energy absorption and weight reduction. The present works introduce a novel concept of an impact attenuator using bonded, geometrically optimized using the concept of functionally graded adherends to maximize energy absorption by ensuring that a load‐bearing path is kept during impact, converting the impact energy into the plastic deformation of panels with variable mechanical properties, tailored to withstand specific load cases, fulfilling a gap in the literature regarding impact absorption devices that combines graded materials and bonded construction. The results obtained present an increase in the energy absorption values of the graded impact attenuators above 200% when compared to the homogenous materials.

Healthcare Workers’ Perceptions of Patient Safety Culture in United States Hospitals: A Systematic Review and Meta-Analysis

Background: Despite leading in healthcare spending, the United States sees only marginal improvements in patient outcomes among developed nations. Assessing patient safety culture (PSC) through the Hospital Survey on Patient Safety Culture (HSOPSC) provides insights into overall patient safety and attitudes toward medical errors. This study aims to examine PSC in U.S. hospitals across professional categories via a systematic review and meta-analysis of published literature. Methods: Embase, PubMed (Medline), Web of Science, Scopus, and AHRQ’s Bibliography were consulted for identifying studies. A total of 31 articles met the eligibility criteria for inclusion, which garnered 608,443 survey participants in a national population of hospital healthcare professionals. For each professional category of PSC, a fixed and random-effects meta-analysis was performed, and a subgroup analysis was also conducted to measure differences in perceptions of PSC based on type of healthcare professional. Results: The HSOPSC composite average across all the studies was 61.3% positive responsiveness, indicating a need for improvement in patient safety. “Teamwork within units” had the highest positive PSC perception while “nonpunitive response to error” and “handoffs and transitions” scored the lowest. Furthermore, healthcare trainees and physicians seemed to have overall worse perceptions of patient safety culture compared to other professional subgroups, indicating the potential impacts of inexperience and a culpability culture on patient safety and medical error in hospitals. Discussion: To strengthen weak aspects of patient safety culture, hospitals should implement interventions such as teamwork training and error-reporting systems, thereby enhancing patient safety measures and reducing medical errors.

An International Consensus Practical Guide on Left Atrial Appendage Closure for the Non-implanting Physician: Executive Summary.

Many patients with atrial fibrillation (AF) who are in need of stroke prevention are not treated with oral anticoagulation or discontinue treatment shortly after its initiation. Despite the availability of direct oral anticoagulants (DOACs), such undertreatment has improved somewhat but is still evident. This is due to continued risks of bleeding events or ischemic strokes while on DOAC, poor treatment compliance, or aversion to anticoagulant therapy. Because of significant improvements in procedural safety over the years left atrial appendage closure (LAAC), using a catheter-based, device implantation approach, is increasingly favored for the prevention of thromboembolic events in AF patients who cannot have long-term oral anticoagulation. This article is an executive summary of a practical guide recently published by an international expert consensus group, which introduces the LAAC devices and briefly explains the implantation technique. The indications and device follow-up are more comprehensively described. This practical guide, aligned with published guideline/guidance, is aimed at those non-implanting physicians who may need to refer patients for consideration of LAAC.

Use of individualized starting dose and niraparib hematologic adverse event management costs in ovarian cancer.

Aim: To understand the impact of the niraparib individualized starting dose (ISD), compared with fixed starting dose (FSD), on the cost of hematologic adverse event (AE) management from a US payer perspective. Methods: The frequencies of grade ≥3 hematologic AEs that occurred in >1% of patients treated with niraparib were obtained from the primary analysis results of the phase III PRIMA/ENGOT-OV26/GOG-3012 trial. US unit costs for each grade ≥3 AE in the base case were obtained from the 2017 Agency for Healthcare Research and Quality Healthcare Cost and Utilization Project database; unit costs were adjusted to 2020 US dollars. AE management costs per patient were calculated by multiplying AE unit cost by the frequency of each AE by niraparib starting dose. Because AEs were assumed to occur independently of one another, costs were added to derive the total cost. Results: For niraparib, the estimated AE management cost per patient was lower for the ISD than the FSD for all hematologic AEs (FSD vs ISD: thrombocytopenia, $4701.87 vs $1921.89; anemia, $2784.00 vs $1760.59; platelet count decreased, $2103.47 vs $922.51; neutropenia, $2112.50 vs $1369.56; neutrophil count decreased, $1285.87 vs $770.38). The total mean calculated AE management cost per patient was $12,987.71 with the FSD and $6744.93 with the ISD. Conclusion: For niraparib, the cost of managing hematologic AEs in the US was reduced by almost half with the ISD compared with the FSD. The cost reduction and improvements in safety associated with the niraparib ISD support its use in clinical practice.

MRgFUS subthalamotomy in Parkinson’s disease: an approach aimed at minimizing Lesion Volume

Idiopathic Parkinson’s Disease (PD) is a neurodegenerative disorder characterized by tremor, rigidity, bradykinesia, and postural instability. Magnetic Resonance-guided high-intensity focused ultrasound (MRgFUS) of the subthalamic nucleus (STN) is gaining recognition as a minimally invasive surgical option. This study assesses the safety and efficacy of unilateral MRgFUS subthalamotomy, aiming to create the smallest effective lesion. Between June 2021 and October 2023, twelve PD patients underwent the procedure, with primary outcomes focused on safety and motor improvements after six months. Results indicated significant motor improvements, with over 50% reduction in tremor, rigidity, and bradykinesia, while balance and gait remained stable. Quality of life also improved. Side effects were generally mild and transient, though some patients experienced involuntary movements, managed through medication adjustments. Despite limitations, this technique appears to offer a promising, less-invasive alternative for managing PD symptoms with a favorable risk-benefit profile. Further research is necessary to refine the procedure and assess long-term outcomes.

Scientometric Insights into Rechargeable Solid-State Battery Developments

Solid-state batteries (SSBs) offer significant improvements in safety, energy density, and cycle life over conventional lithium-ion batteries, with promising applications in electric vehicles and grid storage due to their non-flammable electrolytes and high-capacity lithium metal anodes. However, challenges such as interfacial resistance, low ionic conductivity, and manufacturing scalability hinder their commercial viability. This study conducts a comprehensive scientometric analysis, examining 131 peer-reviewed SSB research articles from IEEE Xplore and Web of Science databases to identify key thematic areas and bibliometric patterns driving SSB advancements. Through a detailed analysis of thematic keywords and publication trends, this study uniquely identifies innovations in high-ionic-conductivity solid electrolytes and advanced cathode materials, providing actionable insights into the persistent challenges of interfacial engineering and scalable production, which are critical to SSB commercialization. The findings offer a roadmap for targeted research and strategic investments by researchers and industry stakeholders, addressing gaps in long-term stability, scalable production, and high-performance interface optimization that are currently hindering widespread SSB adoption. The study reveals key advances in electrolyte interface stability and ion transport mechanisms, identifying how solid-state electrolyte modifications and cathode coating methods improve charge cycling and reduce dendrite formation, particularly for high-energy-density applications. By mapping publication growth and clustering research themes, this study highlights high-impact areas such as cycling stability and ionic conductivity. The insights from this analysis guide researchers toward impactful areas, such as electrolyte optimization and scalable production, and provide industry leaders with strategies for accelerating SSB commercialization to extend electric vehicle range, enhance grid storage, and improve overall energy efficiency.

Patient complaints are not common in emergency medical services: A mixed methods study

IntroductionPatient safety has become a central research theme in emergency medical services (EMS). The population age structure is changing in high-income countries, potentially causing increases in the need for EMS. As the number of EMS missions is growing, the safety of non-conveyance has become the topic of wide discussion. Managing adverse events is part of quality management and safety improvement. This study aimed to examine the incidence, reasons, and process of complaints related to EMS. MethodsA retrospective mixed methods study was conducted on EMS-related complaints that were evaluated by Regional State Administrative Agency during 2013–2019. The data was classified according to conveyance and authority’s decision, and finally analysed thematically. ResultsThe data included 73 complaints, 39 of which were included in the study. There were more complaints related to non-conveyance than conveyance. The authority provided administrative guidance in approximately half of the cases in both groups. One of the most common event types in both groups was related to ethical competence and conduct. ConclusionsThe number of complaints was very low. A considerable portion of the complaints related to paramedics’ behavior and patient treatment. Respecting and actively listening to patients may further decrease these complaints. No administrative caveats to paramedics were observed in our data.

Road safety management system optimization methodology

Abstract In this study, a traffic safety management system (TSMS) for asphalt surfaced roads is developed to improve safety on different classes of roads in Bulgaria. TSMS is a strategic and systematic procedure to improve traffic safety when funding is limited and it is important to determine the most appropriate combinations of traffic safety improvement projects to provide maximum benefits to the population in terms of reducing traffic accidents. The factors included in the developed optimization methodology are the annual report on traffic accidents of the National Institute of Statistics, a study of the roads, a functional classification of the same, historically established, countermeasures to improve safety, costs and determinants of crash reduction in relation to measures to positively modify safety and average daily traffic (ADT). This study demonstrates how the proposed model can determine the best combination of activities to increase safety in order to maximize the benefits in terms of reducing overall crash frequency. The proposed methodology has been applied to highways in Bulgaria. It can be modified for application to roads in a particular city, region and district.

Intelligent Transport System for Lane Detection and Pothole Detection using YOLO

This paper aims to develop an automated system for pothole and lane marking detection on roads using the YOLOv4- tiny model with a supporting database. The traditional methods of detecting road conditions are slow and inefficient, as they are based on manual processing. With computer vision, our system will identify potholes and lanes much more quickly and accurately. The YOLOv4-tiny model is chosen because it provides a good balance between speed and accuracy, making it suitable for real-time applications. The database of images of roads with potholes and lanes will support training and testing of the models to achieve reliable detection. It is anticipated that this paper will be helpful in the improvement of road safety and maintenance as it will be able to provide timely information about road conditions.

Battery Thermal Management System Using Phase Change Materials

This research paper explores the integration of Phase Change Materials (PCMs) into Electric Vehicle (EV) battery packs for enhanced thermal management. Through a comprehensive study involving design, simulation, and analysis using tools like ANSYS, the effectiveness of PCM integration in managing temperature profiles and heat dissipation within EV battery packs is evaluated. The research highlights the advantages of PCM-based thermal management over traditional air and water cooling methods, emphasizing improvements in battery performance, lifespan, and overall safety. The findings contribute valuable insights to advancing EV technology and sustainability, paving the way for more efficient and reliable electric mobility solutions.

Intelligent Vehicle Accident Detection System

Road traffic accidents in Nigeria represent a significant public safety concern, with thousands of lives lost annually. The Intelligent Vehicle Accident Detection System (IVADS) addresses this issue by providing a system that detects accidents automatically and instantly notifies emergency responders with real-time location information. IVADS integrates multiple sensors, GPS, and GSM technologies to achieve accurate accident detection and rapid communication. This paper provides a comprehensive review of the system’s design, implementation, testing results, and potential implications for road safety improvements in Nigeria. This work builds upon existing research on accident detection, using innovative sensor integration and machine learning for precise detection.

NEEDLE STICK INJURIES AMONG NURSES IN LAHORE

Needle stick injuries (NSIs) are a significant occupational hazard for healthcare workers, particularly nurses, as they increase the risk of transmitting bloodborne pathogens such as hepatitis B (HBV), hepatitis C (HCV), and HIV. Objective: This study aimed to assess the prevalence, risk factors, and contributing practices associated with NSIs among nurses at Lahore General Hospital, Pakistan. Methods: A cross-sectional quantitative study was conducted from June to September 2024. A structured, pre-tested questionnaire was used to collect data from 257 nurses selected through non-probability consecutive sampling. Data were analyzed using SPSS version 20, employing descriptive and logistic regression analyses to identify associated factors. Results: The annual prevalence of NSIs among participants was 37.4%, with 12.1% reporting an NSI in the past month. Younger nurses (&lt;30 years) and those with less than five years of experience were at higher risk. High-risk departments, such as ICU/OR (48.2%) and maternal units (44.4%), reported the highest incidence of NSIs. Unsafe practices, including needle recapping (73.2%) and inadequate infection control training (60.3%), were significant contributors. Nurses who received infection control training had a lower prevalence of NSIs (28.8%) compared to untrained staff (43.4%). Conclusion: The study highlights the urgent need for enhanced infection control training, implementation of universal safety protocols, and the use of safety-engineered devices to reduce NSI prevalence among nurses in Pakistan. Targeted interventions in high-risk departments and systemic improvements in workplace safety are critical to mitigating occupational risks for healthcare workers.

Measuring improvements in occupational health and safety in the artificial stone benchtop industry.

Workers in the stone benchtop industry in Australia are at high risk of silicosis due to exposure to respirable crystalline silica (RCS) from the dry processing of artificial stone. In Victoria, Australia, a multifaceted response including education, regulatory changes, inspection site visits, and occupational health screening programme began in 2019. We aimed to review the success of this approach to safety practices in the industry. Data were available from 2 sources: first, responses provided by workers during their occupational health screening (2019 to 2024), which included a systematic occupational history. Jobs examined included roles in the stone benchtop industry with RCS exposure and were analysed in relation to reported safety practices pre and postregulatory changes in August 2019, which prohibited unrestricted dry cutting. Second, data were obtained from the Regulator describing the numbers of visits to industry worksites and the numbers and types of compliance notices issued between 2018 and 2024. In total, 1921 jobs from 1007 workers were eligible for analysis, of which 869 were prior to the 2019 regulatory change and 557 commenced after. The proportion of workers reporting "never" dry cutting rose from 17.3% to 67.2% (P < 0.001), use of recommended ventilation and respirator increased from 26.0% to 36.5% (P < 0.001), and 44.9% to 86.5% (P < 0.001), respectively. Of the 543 worksites visited (2757 site visits in total), 352 (64.8%) received at least one compliance notice and the types of notices varied over time. Administrative controls/housekeeping and health monitoring notices were the most common in 2019 to 2021 but tools/equipment notices increased substantially in 2022 onwards. Prior to the changes, a large proportion of jobs involved unrestricted dry processing of artificial stone with inadequate protection. After the changes, practices improved although some jobs continued to involve dry processing without adequate control of dust. This multifaceted approach vastly improved safety practices in the stone benchtop industry over 5 years. These data are relevant to occupational health and safety professionals and regulators in countries where artificial stone is used and potentially for implementation of new measures in response to a new workplace hazard in future.

Review of artificial intelligence applications in construction management over the last five years

PurposeThis paper provides a thorough examination of the advancements and impacts of artificial intelligence (AI) on construction management (CM) over the past five years, particularly focusing on its role in mitigating prevalent challenges such as inefficiency and ensuring quality. By methodically reviewing and synthesizing the body of research conducted in this period, it underscores key contributions and breakthroughs in the application of AI within construction management (AICM). Additionally, the study aims to shed light on emerging trends and forecast future directions for technological innovation in the construction management sector.Design/methodology/approachGuided by the preferred reporting items for systematic reviews and meta-analyses (PRISMA) framework, this research conducts a bibliometric analysis of 176 relevant publications from the past five years. The analysis focuses on the adoption of AICM across three critical areas: construction equipment management, improvement of construction safety and construction cost optimization. Additionally, the study systematically identifies and examines 14 emerging themes within this domain, ensuring a comprehensive exploration aligned with PRISMA guidelines.FindingsThis manuscript summarizes recent research from the past five years in three key areas: construction equipment management, construction safety management and construction cost management within the realm of AICM. It identifies key gaps and outlines future research directions, including enhancing AI-driven equipment integration, developing sophisticated AI-based safety systems and optimizing cost management with advanced data analytics. These findings and directions are essential for steering the field toward greater digital innovation and sustainability.Originality/valueThis research provides a detailed analysis of the literature within the AICM domain, thoughtfully compiling significant findings and highlighting the importance of addressing user needs. The insights and recommendations shared aim to be beneficial for both academic researchers and industry professionals, contributing to the ongoing development of AICM as it moves toward a future characterized by digital innovation and sustainability.

Traffic safety improvement method for highway tunnel entrances based on linear guiding − An engineering practice from China

To improve traffic safety at the entrance of highway tunnels, a comparative analysis of the traffic environment inside and outside the tunnel was conducted, and an improvement scheme based on “linear visual guiding” was developed by considering the human factors. Before and after the improvement of nine experimental tunnels, two batches of vehicle experiments were conducted to analyze the improvement effect of linear guiding scheme on traffic safety. The results show that the linear guiding scheme warns drivers and enables them to make preparations to enter the tunnel earlier. After improvement, the starting position for deceleration (SPD) was 61% earlier and the length of the deceleration section (LDS) has increased by 42%; the starting position for trajectory change (SPTC) was 153% earlier and the length of the trajectory change section (LTCS) has increased by 44%. The improved deceleration and trajectory change are earlier and smoother, and the dramatic changes in speed and trajectory in the tunnel entrance are resolved. When entering the tunnel, drivers sequentially complete deceleration, vehicle trajectory adjustment, and visual adaptation to black-hole effect, disperses driving tasks, reducing the coupling of driving risks. And use linear guiding facilities to enhance the local brightness of the tunnel, enhancing the driver’s visual perception ability in the black-hole effect area. Linear guiding scheme has good results during day, night, and fog, and is able to improve traffic safety at tunnel entrances in all-weather and multiple time periods.

Lithium Dendrite Deflection at Mixed Ionic–Electronic Conducting Interlayers in Solid Electrolytes

AbstractSolid state lithium metal batteries using garnet solid electrolytes such as LLZTO (Li6.4La3Zr1.5Ta0.5O12) promise substantial improvements in energy density and safety. However, practical implementation is hindered by lithium dendrite penetration at high current densities. Recent work shows that internal electrochemically induced mechanical stresses are large enough to propagate lithium dendrites and subsequently fracture solid electrolytes. This study builds on this understanding and demonstrates that stress‐driven dendrite propagation can be controlled via deflection at weakly bonded internal interfaces. This approach, based on a fracture‐mechanics analysis of multilayered composites, is investigated with a variety of interlayer materials that are embedded into LLZTO. The viability and effectiveness of dendrite deflection are most clearly evident with reduced graphene oxide where the critical current density increased from 0.6 to 3.8 mA cm−2. In this material, both the weak interface with LLZTO and the mixed ionic–electronic conducting nature of the interlayer appear to contribute to the improved performance. Additional insight into the mechanics of multilayered electrolytes is also obtained with finite element modeling. The overall results present a promising proof‐of‐concept demonstration along with important generalized design guidelines for creating multilayered solid electrolyte architectures that can enable high‐performance solid‐state batteries.

Electric Engine Stand with Trolley

This study focused on the fabrication of an electric engine stand with trolley. This study aimed to fabricate electric engine stand with trolley and assess its efficiency in terms of safety, dura-bility and functionality. The project followed a systematic approach including planning and designing, gathering all the materials, con-struction, testing, revision and finalization phases. The finish device Electric, Engine Stand with Trolley, demonstrated capabilities such as that the engine stand can lessen the time consumption in assem-bling and disassembling of an engine and it is safe for automotive technician to avoid accidents. The project evaluation revealed High-ly Efficient that the Electric Engine Stand with Trolley fulfilled its purpose of providing safe, durable, and functional equipment that automotive student can use effectively when assemble and disas-semble of engine. In terms of safety, the design incorporates several features aimed at minimizing risks associated with engine handling. The trolley mechanism allows for smooth transportation, reducing the likelihood of accidents during movement. The materials and construction of the Electric Engine Stand with Trolley withstand the rigors of daily use, with a lifespan exceeding industry standards of a Highly Efficient in the level of efficiency. Additionally, its multifunc-tional design accommodates a variety of engine sizes and configura-tions, making it versatile for different automotive tasks. The Electric Engine Stand with Trolley offers notable improvements in efficiency, safety, durability, and functionality, positioning it as an essential tool for modern automotive workshops.