Safety Of Medical Care Research Articles

Reconsideration: ″Psychological safety″ and quality and safety of medical care

Reconsideration: ″Psychological safety″ and quality and safety of medical care

Новые требования к медицинским организациям по проведению внутреннего контроля качества и безопасности медицинской деятельности: содержание, цели, перспективы

In order to form common approaches for organization and conduction internal control of the quality and safety of medical care, and to assuring mechanisms for continuous improvement of medical processes in medical organizations of the Russian Federation, the Ministry of Health of Russia, together with Roszdravnadzor, developed an Order of June 7, 2019 No. 381n “On Approval of Requirements for organization and conduction internal control of the quality and safety of medical care in hospitals”.

Система управления качеством и безопасностью в медицинской организации. Современное состояние

The article presents main approaches to provision of quality and safety of medical organization’s activities. The main attention is focused on the issues of implementation of the Suggestions (recommended practice) of Roszdravnadzor on organization of the internal quality and safety control of medical activities, as well as particular points of the Order of June 7, 2019 No. 381n “On Approval of Requirements for organization and conduction internal control of the quality and safety of medical care in hospitals”.

Arquitectura de procesos con indicadores estratégicos en los servicios médicos de consulta externa en hospitales de alta especialidad.

The importance of granting high specialty outpatient services calls for a diagnosis through process architecture in order to measure outpatient services deferral with key performance indicators and to evaluate the opportunity of scheduling appointments at high specialty hospitals. To apply the process architecture model and key performance indicators in high specialty hospitals, in order to analyze outpatient appointment scheduling activities and to improve the quality of medical care and patient safety. Quantitative, sequential and deductive reasoning study, with correlational scope, to assess the degree of association between variables, and to establish and define key performance indicators, according to the importance of activities in medical services. A convenience sample in time and by accessibility to two high specialty hospitals in Mexico city was used. Deferral in outpatient services was measured with an emphasis on the analysis of 19 indicators for a proposal of strategies. The model of priority indicators of the architecture of medical processes is presented through the analysis of activities, which comprehensively visualizes medical care and allows improving the quality of the medical services provided to the patient.

Opioid Stewardship in Urology: Quality Improvement Summit 2018.

We summarize the 2018 AUA (American Urological Association) Quality Improvement Summit, Opioid Stewardship in Urology, highlighting appropriate urological opioid use as well as reviewing programs that have been successful in reducing opioid prescribing. The AUA brought together nearly 100 attendees from across the United States, including clinicians who specialize in urology and other specialties, as well as researchers, government officials and others. The 2018 AUA Quality Improvement Summit was a 1-day meeting held at AUA headquarters in Linthicum, Maryland. Talks and panels highlighted opioid stewardship programs and emphasized research on the nature and management of postoperative pain. The impact of the opioid epidemic is profound and the contribution of postoperative prescribing is noteworthy (eg 6% of opioid naïve patients demonstrate new persistent use habits after surgery and up to 70% of opioid pills prescribed after surgery go unused). Speakers raised awareness of these facts and detailed opportunities to improve, including prudent prescribing, opioid reclamation, use of nonopioid alternatives, and outreach and education. The 2018 AUA Quality Improvement Summit provided a platform for urologists to discuss the opioid epidemic and to learn strategies for combatting this issue from multidisciplinary experts. Physician led opioid stewardship and research, facilitated by this Summit, may enhance the quality and safety of medical care and improve the lives of patients, their families and their communities.

Assessment of Modern Health Care Opportunities in Management of Medical Care Safety

Assessment of Modern Health Care Opportunities in Management of Medical Care Safety

American Urological Association, American College of Emergency Physicians and American College of Radiology Quality Improvement Summit 2017: Challenges and Opportunities for Stewardship of Urological Imaging.

Since 2014 the AUA (American Urological Association) has convened several Quality Improvement Summits to provide education and promote dialogue around issues of quality improvement and patient safety. The 2017 Summit, Challenges and Opportunities for Stewardship of Urological Imaging, organized in partnership with the American College of Radiology and the American College of Emergency Physicians, highlighted opportunities for collaborative improvement in the value, safety and quality of imaging for patients with urological conditions. The Summit was held at AUA headquarters in Linthicum, Maryland on October 21, 2017. Each talk, panel and working group held during the summit highlighted gaps in care being addressed by physician led stewardship initiatives in imaging, in general, as well as multiple specific examples related to prostate cancer and urinary stone disease. Presentations facilitated information exchange on quality efforts between clinicians across disciplines and care settings and served to educate urology practitioners, primary care physicians, and specialists about existing patient centered quality improvement programs. This exchange serves to accelerate adoption of evidence-based practices and brings together stakeholder organizations to form partnerships that facilitate the further development of research and policy agendas to advance physician led stewardship of advanced imaging across emergency medicine, radiology and urology. In parallel, this meeting established a consortium to develop and disseminate tools for facilitating organizational improvement activities needed to enhance the quality and safety of medical care.

Classification Scheme for Incident Reports of Medication Errors.

This study aimed to develop a classification scheme for retrieving information from incident reports of medication errors. This 15-category classification scheme captures minimal medication-incident related information from incident reports and thus serves as an information model for automatic information retrieval solution. The automatic solution uses recent advances in artificial intelligence methods to learn from incident report resources and is promising to the prevention of adverse drug events and promotion of safety in medical care.

Burnout in Anesthesiology and Resuscitation

Background . The term “burnout” was originally developed by the psychologist Herbert Freudenberg (Germany, USA) in the seventies of the last century. Then another psychologist, Christina Maslach was a co-author of the Maslach Burnout Inventory, which was adapted to different professions and translated into different languages. According to Russian scientist professor Victor V Boyko “the emotional burnout is a form of professional distortion of an individual ...”. Anesthesiology and resuscitation are certainly among the most stressful medical disciplines, daily exposing doctors to high responsibility associated with life-threatening scenarios of patients. Therefore, burnout detection is important because it is related to the safety and quality of medical care, as well as to the life and health of intensive care specialists. Aim of study Anonymous, blind observational study of the frequency and dynamics of burnout, depression, situational and personal anxiety of anesthesiologists and resuscitation doctors and nurses of anesthesiology and intensive care departments. Material and methods. The study included 64 specialists of anesthesiology and intensive care departments (41 doctors and 23 nurses). Maslach Burnout Inventory (MBI) for Medical Personnel, Purpose in life test (Crumbaugh & Maholick, 1964), “Burnout” questionnaire of V. V. Boyko, Toronto Alexithymia Scale (TAS), Spielberger State-Trait Anxiety Inventory (STAI) in the adaptation by Y L. Khanin, Assessment of depression (HADS), and a series of general questions (gender, age, profession, working experience, marital status, number of working hours per week, how much do I love my job, how much I would like to love my job, somatic complaints, etc.). Results. According to MBI, 65.9% of examined doctors and 43.5% of nurses have high rates of certain burnout, which confirms the relevance of the studied problem. Of these, 12.19% of doctors and 8.7% of nurses have high rates of all three sub-scales of burnout syndrome. Depression, personal and situational anxiety have a positive correlation with burnout. Conclusion. According to the literature, burnout leads to a steady decrease in work productivity, destructive behavior, emergence of a variety of psychosomatic disorders, and a sense of meaninglessness of existence, despair, suicidal thoughts and committed suicides at the final stage of burnout. It is necessary to conduct regular testing of intensive care specialists to detect burnout, depression and anxiety. When the burnout is identified, it is necessary to perform psychological interventions.

Nontechnical Skills in Neurosurgery: A Systematic Review of the Literature

Undesirable events in the neurosurgery operating theater have less often been the result of a technical error than of a dysfunction linked to nontechnical skills (NTSs). The essential aim of our study was to perform a systematic review of the reported data on NTS in neurosurgery. Our secondary objective was to identify the NTSs more specific to neurosurgery to define the training needs of neurosurgery trainees. The MEDLINE and Cochrane Database of Systematic Reviews were searched according to the PRISMA (preferred reporting items for systematic reviews and meta-analysis) guidelines. The search initially identified 2132 reports, of which 21 were eligible for systematic study. Data were extracted from the report regarding study design, sample size, NTSs assessed, and assessment tools, and the key results were collected. Interpersonal skills (communication, teamwork), cognitive skills (decision making, situational awareness), and personal resource factors (coping with stress or fatigue) were specifically identified. No study had used assessment tools such as NOTECHS (nontechnical skills), NOTSS (nontechnical skills for surgeons), or OTAS (observational teamwork assessment for surgery). They were performed in a real environment in 11 cases, in a simulated environment in 9, and during theoretical teaching in 1 case. Very few studies have been performed concerning neurosurgical NTSs, despite the increasing the number of studies during the past few years on NTSs in other domains of surgery. Society has been concentrating more and more on the quality and safety of medical care. The development and application of NTS assessment tools is, therefore, essential to provide assistance in the training of future neurosurgeons.

Changes in the upper airway following induction of anaesthesia: a prospective observational study protocol to determine the use of ultrasound in the assessment of a difficult airway in China

IntroductionDifficult airway management is closely related to the safety and quality of medical care. However, the low incidence of correct prediction of difficult airway in clinical screening tests presents physicians...

ФАКТОРЫ РИСКА РАЗВИТИЯ ГЕПАТИТА B У ПАЦИЕНТОВ НА ГЕМОДИАЛИЗЕ ПО ДАННЫМ СИСТЕМАТИЧЕСКОГО ОБЗОРА

Aim. To perform a systematic review of hepatitis В risk factors in patients receiving hemodialysis. Materials and Methods . We screened English-and Russian-language databases for relevant obser- vational cohort studies. Screening of publications and extraction of primary data were carried out in accordance with the Cochrane recommendations. The significance of hepatitis В risk factors was given in odds ratios with 95% confidence intervals. Results. All included primary studies demonstrated that patients on hemodialysis are at high risk of acquiring blood-borne diseases due to the combination of various risk factors. For example, duration of hemodialysis > 2 years significantly increased hepatitis В risk (OR = 2.24, 1QR 1.052.08). Conclusion. A critical attitude to modifiable and non-modifiable risk factors increases the effectiveness of epidemiological surveillance and infection control and ensures quality and safety of medical care for the patients receiving hemodialysis.

Health Care Safety Management in Modern Health Care

The article is a systematic review of the research devoted to the study of epidemiology, mechanisms of adverse events associated with the provision of medical care, as well as the principles of patient safety management. The meta-analysis allowed to establish that cases of harm in the provision of medical care (adverse events) are recorded in 10.6% of patients. At the heart of the development of adverse events are systemic causes – latent threats, the management of which is the basis of the modern strategy of ensuring the safety of medical care.

Socio-economic aspects of medical errors and their consequences in medical organizations

Medical errors and adverse events are a global problem of strategic importance, accompanied by economic costs that impose a burden on the health care system, the country's economy and society as a whole. The article presents the results of a review of world experience in developing approaches to assessing the safety of medical care in medical organizations, systematization and analysis of factors affecting the patient safety.Purpose: the purpose of the article is to study and assess the risks associated with medical errors and adverse events in the activities of medical organizations that affect the patient safety in order to reduce the loss of public health, improve the system of identification and monitoring of risk indicators that affect the safety of medical care.Methods: the method of rapid assessment and content analysis of published evidence, including who experience in safety of medical care, was used to highlight the issue. The methodology of functional benchmarking, which included the collection and analysis of the necessary information, the choice of individual functions, processes, methods of work of medical organizations working in similar conditions, was used in the study.Results: the approaches allowing to predict occurrence and development of risks in ensuring safety of medical care, reduction of losses of public health and social and economic costs of the state are considered and offered.Conclusions and Relevance: the materials presented in the article show that safety is a fundamental principle of providing medical services to patients and a critical component of the quality management system of medical care. To reduce the loss of public health, direct and indirect socio-economic costs of the state, comprehensive efforts are needed to reduce the risks that threaten the patient safety and improve the activities of medical organizations.

Качество и безопасность медицинской помощи больным торакального профиля

Качество и безопасность медицинской помощи больным торакального профиля

Correlation between attitude towards patients for patient safety and health literacy among patients with coronary artery bypass graft

Objective To explore the attitude towards patients for patient safety and health literacy among patients with coronary artery bypass graft (CABG) and to analyze the correlation between them. Methods From September 2017 to May 2018, a total of 210 CABG patients were investigated with the general information questionnaire, Patients for Patient Safety Questionnaire and Health Literacy Management Scale (HeLMS) by convenience sampling to evaluate the attitude towards patient participation as well as patient safety and health literacy. Pearson correlation analysis was used to explore the correlation between them. Results A total of 209 valid questionaires were collected. Among 209 CABG patients, the average item scores of attitude towards patients for patient safety and health literacy were (3.68±0.20) and (4.14±0.23) respectively. Pearson correlation analysis showed that attitude towards patients for patient safety had a positive correlation with health literacy (r=0.422, P<0.01) . Conclusions CABG patients are with the low level of attitude towards patients for patient safety and good level of health literacy. Corresponding measures should be taken in clinical work to improve the level of health literacy, attitude towards patients for patient safety safety and the safety of medical care. Key words: Questionnaires; Coronary artery bypass graft; Health literacy; Patients for patient safety; Correlation analysis

Challenges of helicopter mountain rescue missions by human external cargo: need for physicians onsite and comprehensive training

BackgroundHuman external cargo (HEC) extrication during helicopter rescue missions is commonly used in mountain emergency medical services. Furthermore, longline or winch operations offer the opportunity to deliver professional medical care onsite. As the safety and quality of emergency medical care depends on training and experience, we aimed to investigate characteristics of mountain rescue missions with HEC.MethodsWe retrospectively reviewed all rescue missions conducted by Air Zermatt (a commercial rescue service in the high-alpine region of Switzerland) from January 2010 to September 2016.ResultsOut of 11,078 rescue missions 1137 (10%) required a HEC rescue. In 3% (n = 29) rapid sequence induction and endotracheal intubation, in 2% (n = 14) cardiopulmonary resuscitation, and in 0.4% (n = 3) a chest tube insertion had to be performed onsite prior to HEC extraction. The most common medical intervention onsite is analgesia or analgosedation, in 17% (n = 142) fentanyl or ketamine was used in doses of ≥ 0.2 mg or ≥ 50 mg, respectively.ConclusionsAs these interventions have to be performed in challenging terrain, with reduced personnel resources, and limited monitoring, our results point out the need for physicians onsite who are clinically experienced in these procedures and specially and intensively trained for the specific characteristics and challenges of HEC rescue missions.

Healthcare-Associated Infections: Modern Doctrine of Prophylaxis. Part II. Basic Concept

The Doctrine for the prevention of health с are-associated Infections (HAIs) is a declaration of the state policy in the field of epidemiological safety of medical care. This is a system of views and provisions that establishes the direction of prevention of HAIs, the ways and forms of their implementation. The presence of a deeply developed doctrine makes it possible to have a basis for decision-making. According to the conclusion of experts from the World Health Organization, no type of healthcare settings in any country can claim to be free from the risk of HAIs. Four key provisions underpin the risk-based approach: 1. The risk of HAIs in a healthcare settings always exists; 2. The risk of HAIs is determined by the degree of aggression and invasion, the epidemiological safety of the medical technologies used, the properties of pathogens and the conditions of the hospital environment; 3. The need to move from assessing and managing the epidemiological situation by morbidity to assessing the potential risk, risk management and risk-oriented prevention technologies; 4. Epidemiological safety is an integral part of ensuring the quality and safety of medical care.

Social Security of Aging: Problem Statement

The article raises the question of the need to consider aging in the context of social security. The author the author shows the main stages of the humanitarization of social security, the trend of development of theoretical ideas in the direction of «human security», which develops within the framework of «enhanced security». The main object of social security of the elderly people is the safety of physical and psychological health. The object of security is comprised of three components: safety of medical care, drug provision and food security. The relevance of these issues to Russian practice is substantiated on the basis of research materials. Some shortcomings of the state social protection of elderly people are shown.

Open access system of life quality management on the basis of spatial modelling of pollution in the coastal areas

The quality of human life consists of many parameters: physical, psychological, level of independence, social life and the environment. The latter, in turn, includes safety, ecology, security, availability and quality of medical care, information, training opportunities, and life. The system of life quality evaluation, combining an objective component (indicators of water and air quality, morbidity) and subjective (the degree of satisfaction of residents with water quality) was developed. “Crowd survey” data block realizes the function of “Open access”. The system of life comfort includes information on people morbidity and the main consumed water and air parameters that affect the satisfaction with natural resources and health. Such system units as «Input Interface» and «Interaction Interface» have been developed as a mobile application. In addition, system includes geographic information system that allows visualizing, analyzing and predicting the state of the object. Thematic maps of spatial pollution of the Taganrog Bay at control points were simulated. The main features of the system are shown and recommendations for its application are offered.