Minor Harm Research Articles

An Estimate of Preventable Harms Associated With Screening Colonoscopy Overuse in the U.S.

IntroductionScreening colonoscopy is often performed on patients who are younger or older than the ages specified in national guidelines, or at shorter intervals than recommended. The annual incidence of harms associated with overuse of screening colonoscopy in the United States is not known. This study estimated the incidence of low value screening colonoscopies annually in the United States and the number of preventable harms associated with them. MethodsThe 2018 National Health Interview Survey (NHIS) was used to estimate the number of annual screening colonoscopies. Rates of colonoscopy overuse and serious (bleeding and bowel perforation) and minor harms were drawn from three recent systematic reviews. ResultsApproximately 12.4 million screening colonoscopies were completed in the United States in 2018. Given the credible range of overuse rates of screening colonoscopy, between 2.1 and 3.2 million low value colonoscopies occur per year. Applying the credible ranges identified for serious and minor harms secondary to screening colonoscopy resulted in an estimated annual incidence of serious harm from unnecessary colonoscopies ranging from 9,055 to 11,874. The estimate for minor harms ranged from 359,5790 to 1,566,846. ConclusionsIn the United States, screening colonoscopies are often completed at intervals and in populations that are inconsistent with national recommendations, resulting in unnecessary serious and minor harm. While individual risk is relatively low, the large number of non-indicated screening colonoscopies results in large numbers of adverse events that are preventable with better adherence to recommendations.

On the conflict of norms on criminal liability of special subjects for encroachment on life and health of a newborn or unborn child

From the standpoint of Russian criminal law, the life and health of an unborn child are not independent objects of criminal and legal protection. This article shows that the government can use more opportunities to guarantee the life and health of not only a pregnant woman, but also an unborn child, as well as a newborn child. The article pays special attention to the problem of conflict of norms on the responsibility of special subjects of illegal artificial termination of pregnancy. With the actual complicity of subjects of different types in the illegal termination of pregnancy: 1) a pregnant woman; 2) a person who is not a medical professional; and (or) 3) a medical worker – the qualification of the deed must be carried out in accordance with the principle of individual responsibility, by choosing one of the related elements of crimes with the corresponding sign of a special subject. However, at present, the legal question of the basis of a woman’s responsibility for illegal termination of pregnancy has not been resolved, and it is not clear by what criteria the legislation differentiates the administrative and criminal liability of medical workers and other persons for the same acts (Article 6.32 of the Administrative Code of the Russian Federation and Article 123 of the Criminal Code of the Russian Federation). In recent years, scientific studies have appeared justifying the expediency of criminalizing a number of socially dangerous acts committed by pregnant women and women in labor (maternity hospitals). The position of the authors of this article is only partially consistent with the proposals made. The authors of the article do not question the right of a woman to make an independent decision on the birth of a child, but recognize as justified the criminal law prohibition on artificial termination of pregnancy when there are no circumstances of a medical or social nature that exclude or significantly reduce the public danger of this act. The article argues that the range of new types of acts committed by maternity hospitals proposed in the doctrine for the purpose of criminalization is unreasonably expanded, in particular, there are no grounds for criminalizing the murder of a terminally ill newborn child by a mother on the grounds of compassion;intentional infliction by a mother of minor harm to the health of a newborn child, as well as causing death by negligence to a newborn child by a mother who is in a state of intoxication.

Implementation of a Standardized Tool for Root Cause Analysis Selection.

This study sought to determine if a standardized root cause analysis (RCA2) selection algorithm, developed by the Veterans Affairs, would select high-risk events for RCA. Physician-entered incident reports for all surgical service admissions and perioperative visits were queried over 12 months in the DATIX Clinical Incident Management System. Independent reviewers assigned potential harm and event frequency scores using an institutional scoring system and then calculated and rounded average scores. These were classified using RCA2 terminology (catastrophic, major, moderate, minor for harm; frequent, occasional, uncommon, remote for frequency). The scores were then evaluated with the standardized Safety Assessment Code Matrix (SAC) algorithm from the National Patient Safety Foundation's RCA2 guidelines to determine Potential Harm Scores. The SAC combines severity and probability to determine the necessity of conducting an RCA. Catastrophic and major high-frequency events (matrix score = 3) were classified as "RCA recommended." The study then compared cases selected for RCAs using the updated RCA2 algorithm against cases selected using a current, institutional-specific RCA selection process. One hundred four cases were reviewed, comprising 20 catastrophic, 48 major harm, 26 moderate harm, and 10 minor harm events. After removing 9 high-variance cases, our institution's current selection process selected 18 cases for RCAs, including 6/20 catastrophic, 8/39 major harm, and 4/36 moderate/minor harm events. Only 17.3% of cases had an RCA completed, while the standardized RCA2 algorithm recommended investigation for 56.7% of patient safety events, based on SAC Matrix scoring. Current RCA selection processes rendered 4 RCAs on low potential harm or low-frequency events, while 45 potential high-frequency, high potential harm events did not complete RCAs. Standardizing the selection of patient safety incidents for RCA using the RCA2 algorithm improves case identification based on the event frequency and potential harm score. Thus, this algorithm has the potential to advance patient safety.

Some objective factors influencing delinquent behavior of regional youth in the 2000s

Delinquent behavior and objective factors influencing it have been considered. It should be noted that crime is a complex phenomenon, which is influenced by many factors. Modern scientists combine these factors into two large groups such as subjective (or socio-cultural) and objective (or socio-economic). In order to study the latter and establish the existence of a relationship between them and youth crime, we have selected the most common criminal acts committed in the youth environment such as theft and robbery, as well as the most numerous crimes committed by young people against life and health such as infliction of minor and moderate harm to health. Among objective factors, we have chosen the indicators that can have the strongest impact on youth crime as a whole and on its individual categories such as ­average monthly accrued wages in the region, cash income per capita, and average per capita consumer spending. According to the conducted simple statistical analysis results, an inverse correlation between the number of criminals committing property crimes and the selected socio-economic factors has been revealed. Due to the use of a simple research method, it was not possible to establish any dependence of the number of young people committing crimes against property on the selected objective (socio-economic) factors.

Evaluation of the Implementation of Low-Low Hospital Beds With Respect to Fall Frequency and Patient Harms: ARetrospective Analysis.

To identify whether the introduction of low-low hospital beds resulted in changes in the incidence, associated patient harms and event characteristics of bed-related falls where implemented. This retrospective quality improvement study covered 36 months: 18 months pre-intervention and 18 months post-intervention. Our analysis incorporated patient fall data from a hospital in upstate New York. Pre-/post-intervention data covered 18 months on either side of introduction at the units of implementation. Data were sourced from contemporaneously recorded incident reports and the organisation's business intelligence records. Analysis addressed the incidence rate, frequency, patient harm classification and recurrence of bed-related falls, as well as Morse Fall Scale risk classification, patient age, gender and other individualised risk factors. Lastly, we reviewed the presence of individualised interventions, staff assistance during the event, patient census and staffing ratios. Chi-square goodness of fit tests were employed to compare the distribution, and Brunner-Munzel tests the stochastic equality, of the pre- and post-implementation categorical and continuous data. There were no significant differences in the incidence rate of bed-related falls, patient harms or in the need for medical intervention following implementation of the low-low hospital beds. Neither were there any significant differences in the proportion of events resulting in detectable harm or the need for medical intervention post-implementation. The total number of bed-involved falls substantively increased following implementation of the low-low beds, as did the number of events resulting in detectable harms and medical intervention. Among these, substantive increases were noted among events resulting in minor temporary harm and patients referred for diagnostic imaging. The number of events involved patients experiencing recurrent falls of any kind increased significantly post-implementation. We found that the introduction of low-low hospital beds preceded no change in the incidence of bed-related falls, associated patient harms or the need for post-event medical intervention where implemented. While data limitations precluded definitive determination with respect to certain event characteristics, several post-implementation changes, including substantive increases in the number of falls occurring during ingress and egress, may suggest a potential for relationship worthy of future study. Low-low hospital beds are purported to help reduce the occurrence and severity of bed-related falls, both serious problems in inpatient settings. This study describes null outcomes following an implementation of such beds, with implications for adoption in similar settings. We adhered to the relevant Enhancing the Quality and Transparency of Health Research guidelines, specifically following the Standards for Quality Improvement Reporting Excellence standards. No patient or public involvement in the design or conduct of the study. Nurses and medical staff were involved in intervention implementation, data collection and the conception, design and conduct of the study.

Maxillo-orbital gunshot trauma in a pediatric patient

Gunshot injuries to the maxillofacial region vary in severity from minor harm to critical situations necessitating urgent medical intervention. Effective handling of facial gunshot wounds mandates a multidisciplinary approach to deliver thorough care to the individual.We present a pediatric patient presenting to the Emergency Department following an accidental machine gun injury.

Minority of a deed provided for by the criminal law: praxis legis, guae debet esse

Objective: to develop scientifically substantiated provisions on the insignificance of a deed provided for by the criminal law and to propose measures to improve legislation and law enforcement in this area. Methods: dialectical approach to cognition of social phenomena, allowing to analyze them in development and functioning, which contributed to the use of the following research methods: a) general scientific (logical, systemic, analysis and synthesis, induction and deduction), b) special (documentary, practical, comparative-legal, formal-legal). Results: the work substantiates the conclusion that the recognition by an inquirer, investigator, prosecutor, judge of the insignificance of a deed provided for by the criminal law should be based on the following information: about the occurrence of all elements and signs of corpus delicti in the deed; about the infliction of small (minor) harm to law-protected interests in conjunction with the intent of the perpetrator aimed at causing such, including the lack of desire to cause harm, which excludes the existence of a reasonable amount of criminal-law harm. It is proposed to supplement Part 1 of Article 24 of the Russian Criminal Procedure Code with a new ground for refusal to initiate criminal proceedings (termination of criminal proceedings), namely, the insignificance of the deed, and to consider it as a circumstance excluding criminal prosecution of a suspect (accused). Scientific novelty: the following means to distinguish a minor act from a crime were substantiated: a) the introduction of the “reasonable amount of criminal-legal harm” category in the investigative and judicial practice, b) the need for law enforcement to establish objective and subjective conditions of minor significance of the deed, c) the proposal on modernizing the criminal-procedural legislation. Practical significance: the main provisions and conclusions stated in the article can be used in scientific, pedagogical, law-making, investigative and judicial activity when considering the issues of application and improvement of the norm on the insignificance of a deed provided for by the criminal law, on the delimitation of such deed from a crime.

DIRECTIONS FOR IMPROVING THE LEGISLATIVE REGULATION OF BEATINGS IN THE LIGHT OF COUNTERING DOMESTIC VIOLENCE

The analysis of changes in the Russian criminal legislation establishing responsibility for the commission of beatings is carried out in terms of their impact on the prevention and counteraction of domestic violence. The inconsistency of the legislator in adopting these changes has been revealed, which is a consequence of the lack of consistency in the legislative regulation of countering domestic violence, insufficient use of the potential of criminological science in the legislative process. The analysis of statistical data for 2016-2022 allowed us to conclude that the latency of family and domestic crime has increased due to the decriminalization of single beatings against loved ones, as well as the artificial latency of torture (Part 1 of Article 117 of the Criminal Code of the Russian Federation). Based on the results of the analysis of the empirical base, the authors concluded that the commission of serious domestic violence is preceded by the infliction of beatings and minor harm to the victims and convicts. The suppression and prevention of beatings as a crime with double prevention is a prerequisite for an effective fight against the grave consequences of domestic violence. It is proposed to return the criminalization of single beatings against close people, expanding this concept by including other close people in addition to relatives and relatives.

Assessing current handover practices in surgery: A survey of non-consultant hospital doctors in Ireland

BackgroundHandovers of care are potentially hazardous moments in the patient journey and can lead to harm if conducted poorly. Through a national survey of surgical doctors in Ireland, this paper assesses contemporary surgical handover practices and evaluates barriers and facilitators of effective handover. MethodsAfter ethical approval and pre-testing with a representative sample, a cross-sectional, online survey was distributed to non-consultant hospital doctors (NCHDs) working in the Republic of Ireland. A mixed-methods approach was used, combining data using triangulation design. Main findingsA total of 201 responses were received (18.5%). Most participants were senior house officers or senior registrars (49.7% and 37.3%). Most people (85.1%) reported that information received during handover was missing or incorrect at least some of the time. One-third of respondents reported that a near-miss had occurred as a result of handover within the past three months, and handover-related errors resulted in minor (16.9%), moderate (4.9%), or major (1.5%) harm. Only 11.4% had received any formal training. Reported barriers to handover included negative attitudes, a lack of institutional support, and competing clinical activities. Facilitators included process standardisation, improved access to resources, and staff engagement. ConclusionsSurgical NCHDs working in Irish hospitals reported poor compliance with international best practice for handover and identified potential harms. Process standardisation, appropriate staff training, and the provision of necessary handover-related resources is required at a national level to address this significant patient safety concern.

Medication errors by caregivers in the homes of children discharged from a pediatric department in Ghana.

Medication errors (MEs) by caregivers at home are a cause of morbidity and mortality, shortly after discharge from the hospital. The objective of this study was to determine the rate and types of MEs at the homes of children discharged from a hospital in Ghana and to explore the factors associated with these errors. This was a cross-sectional study of infants and children discharged from the hospital to review medication administration practices. Caregivers of children discharged from the hospital after at least 24 hours of admission were interviewed at their homes about medication administration practices. The study assessed potential harm associated with MEs made by caregivers using the Harm Associated with Medication Error Classification tool. The Least Absolute Shrinkage and Selection Operator regression were used to identify the variables associated with MEs. A total of 95 children (mean age: 28.6 months, 52.6% female) and their caregivers were included. Overall, 65 (68.4%) children experienced one or more MEs. Out of a total of 232 medications reviewed, 102 (44.0%) (95% CI: 37.6-50.4) were associated with a ME. The top two errors, wrong time errors and errors in the frequency of dosing were, 45.1% and 21.6%, respectively. Understanding the information on the disease condition being treated and the medicines dispensed was associated with committing fewer MEs. The number of medicines prescribed was associated with a higher likelihood of MEs. Out of 102 MEs, 48 (47.1%) were assessed as posing potentially no harm, 26 (25.5%) minor harm, 15 (14.7%) moderate harm, and 13 (12.8%) serious harm to the patients. Importantly, none of the MEs were assessed as posing potentially severe or life-threatening harm to the patients. MEs in children following discharge are high, and systems should be developed to prevent these errors.

Self Harm and Suicide in Adolescents

Self harm is also called Non-Suicidal Self-Injury (NSSI). NSSI is defined as intentional self-injurious behavior to cause minor bodily harm without suicidal intent. Self-harm is strongly associated with suicidal thoughts and approximately 27-30% of adolescents with NSSI have reported suicide attempts. Based on the explanation above, the author is interested in discussing self-harm and suicide to explore the definition and management of self-harm and suicidal behavior in adolescents. In writing this literature review, we used a literature study method from various references and focused on discussions about self-harm and suicide. The search engines used were PubMed, ProQuest, and Google Scholar with the keywords "Self harm and suicide", "Epidemiology", "Diagnosis", and "Management". Overall, there were 30 articles used as references for preparing the literature review. The results of the investigation showed that self-harm and suicide are mental problems that often occur in teenagers and therefore require appropriate management using non-pharmacological and pharmacological medical approaches.

Exercise intervention for patients with chronic low back pain: a systematic review and network meta-analysis.

Chronic low back pain (CLBP) is an aging and public health issue that is a leading cause of disability worldwide and has a significant economic impact on a global scale. Treatments for CLBP are varied, and there is currently no study with high-quality evidence to show which treatment works best. Exercise therapy has the characteristics of minor harm, low cost, and convenient implementation. It has become a mainstream treatment method in clinics for chronic low back pain. However, there is insufficient evidence on which specific exercise regimen is more effective for chronic non-specific low back pain. This network meta-analysis aimed to evaluate the effects of different exercise therapies on chronic low back pain and provide a reference for exercise regimens in CLBP patients. We searched PubMed, EMBASE, Cochrane Library, and Web of Science from inception to 10 May 2022. Inclusion and exclusion criteria were used for selection. We collected information from studies to compare the effects of 20 exercise interventions on patients with chronic low back pain. This study included 75 randomized controlled trials (RCTs) with 5,254 participants. Network meta-analysis results showed that tai chi [standardized mean difference (SMD), -2.11; 95% CI, -3.62 to -0.61], yoga (SMD, -1.76; 95% CI -2.72 to -0.81), Pilates exercise (SMD, -1.52; 95% CI, -2.68, to -0.36), and sling exercise (SMD, -1.19; 95% CI, -2.07 to -0.30) showed a better pain improvement than conventional rehabilitation. Tai chi (SMD, -2.42; 95% CI, -3.81 to -1.03) and yoga (SMD, -2.07; 95% CI, -2.80 to -1.34) showed a better pain improvement than no intervention provided. Yoga (SMD, -1.72; 95% CI, -2.91 to -0.53) and core or stabilization exercises (SMD, -1.04; 95% CI, -1.80 to -0.28) showed a better physical function improvement than conventional rehabilitation. Yoga (SMD, -1.81; 95% CI, -2.78 to -0.83) and core or stabilization exercises (SMD, -1.13; 95% CI, -1.66 to -0.59) showed a better physical function improvement than no intervention provided. Compared with conventional rehabilitation and no intervention provided, tai chi, toga, Pilates exercise, sling exercise, motor control exercise, and core or stabilization exercises significantly improved CLBP in patients. Compared with conventional rehabilitation and no intervention provided, yoga and core or stabilization exercises were statistically significant in improving physical function in patients with CLBP. Due to the limitations of the quality and quantity of the included studies, it is difficult to make a definitive recommendation before more large-scale and high-quality RCTs are conducted.

Crime severity, relational distance, and bystander reporting

ObjectivesThis study examined the effects of crime severity and relational distance on bystanders' willingness to report crime and provide a statement to police. MethodsA sample of 1438 adults in the U.S. completed a factorial vignette survey. Participants read three crime scenarios and indicated their willingness to report and provide a statement to police. Crime severity (major harm or minor harm), bystander relationship to the perpetrator (family member, friend, or stranger), and bystander relationship to the victim (family member, friend, or stranger) were manipulated across scenarios. Multilevel models were estimated. ResultsCrime severity increased the willingness to report, whereas a close relationship with the perpetrator decreased it. However, a close relationship with the victim attenuated the effect of relational distance to the perpetrator on the willingness to report. Crime severity and relational distance did not influence the willingness to provide a statement, with one exception. ConclusionsCrime severity and relational distance influence bystanders' willingness to report, but do not appear to influence the willingness to provide a statement. The willingness to report and provide a statement are related, but may be distinct dimensions of the willingness to cooperate.

The risk of harm whilst waiting for varicose veins procedure.

Varicose veins (VV) negatively impact quality of life (QoL) and have risks of major complications including bleeding, ulceration and phlebitis. During the COVID-19 pandemic, the VSGBI (Vascular Society of Great Britain and Ireland) and GIRFT (Get It Right First Time) classified VVs as lowest priority for intervention. This study aims to determine harm caused and the impact on the QoL on patients waiting for their VVs procedures for more than 1 year. This was a prospective study conducted at the Norfolk and Norwich University Hospital (NNUH). Patients with VVs awaiting intervention for >1 year were included in the study. Patients with CEAP C6 disease were considered to be too high risk to be invited for treatment during the Covid-19 pandemic. Patients were sent QoL questionnaires and underwent a telephone consultation to assess harm. Both generic (EQ-VAS and EQ-5D) and disease-specific (AVVQ and CIVIQ-14) instruments were utilised. There were no control groups available for comparison. 275 patients were identified (37.1% male) with median time on waiting list of 60 weeks (IQR 56-65). 19 patients (6.9%) came to major harm, including phlebitis (3.6%), bleeding (1.8%) and ulceration (1.8%). Fifty-two patients (18.9%) had minor harm, including worsening pain (12.7%) and swelling (6.2%). 6.9% reported psychological harm. Rising CEAP stage was also associated with worsening level of harm in patients with C5-6 disease (p < 0.0001). Only 8.7% stated they would decline surgery during the pandemic. 104 QoL questionnaires were returned. Median EQ-VAS and EQ-5D was 75 (IQR: 60-85) and 0.685 (0.566-0.761), respectively. Median AVVQ score was 23.2 (14.9-31.0) and CIVIQ-14 score was 33 (21-44).ConclusionsThis study highlights the impact of delaying VVs surgery during a pandemic. A significant rate of both major and minor as well as psychological harm was reported. In addition, VVs had a significant detriment to quality of life.

Practice-Based Learning and Improvement: Improving Morbidity and Mortality Review Using Natural Language Processing

IntroductionPractice-Based Learning and Improvement, a core competency identified by the Accreditation Council for Graduate Medical Education, carries importance throughout a physician's career. Practice-Based Learning and Improvement is cultivated by a critical review of complications, yet methods to accurately identify complications are inadequate. Machine-learning algorithms show promise in improving identification of complications. We compare a manual-supplemented natural language processing (ms-NLP) methodology against a validated electronic morbidity and mortality (MM) database, the Morbidity and Mortality Adverse Event Reporting System (MARS) to understand the utility of NLP in MM review. MethodsThe number and severity of complications were compared between MARS and ms-NLP of surgical hospitalization discharge summaries among three academic medical centers. Clavien-Dindo (CD) scores were assigned to cases with identified complications and classified into minor (CD I-II) or major (CD III-IV) harm. ResultsOf 7774 admissions, 987 cases were identified to have 1659 complications by MARS and 1296 by ms-NLP. MARS identified 611 (62%) cases, whereas ms-NLP identified 670 (68%) cases. Less than one-third of cases (299, 30.3%) were detected by both methods. MARS identified a greater number of complications with major harm (457, 46.30%) than did ms-NLP (P < 0.0001). ConclusionsBoth a prospectively maintained MM database and ms-NLP review of discharge summaries fail to identify a significant proportion of postoperative complications and overlap 1/3 of the time. ms-NLP more frequently identifies cases with minor complications, whereas prospective voluntary reporting more frequently identifies major complications. The educational benefit of reporting and analysis of complication data may be supplemented by ms-NLP but not replaced by it at this time.

Patient handoffs among general surgery residents in Saudi Arabia: a cross-sectional study

BackgroundCommunication failure is a common cause of adverse events. An essential element of communication among health care providers is patient handoff. Patient handoff is defined as a practice whereby a health care provider transfers a patient’s care information to another health care provider to ensure the patient’s safety and continuity of care. To explore this practice, we assessed patient handoffs among general surgery residents in Saudi Arabia.MethodsA cross-sectional survey was conducted with individuals in accredited general surgery residency programs in Saudi Arabia between 2020 and 2021.ResultsParticipants comprised 118 general surgery residents: 66 (57.3%) were female; 67 (72.8%) did not receive any formal training on patient handoff; and 35 (38.8%) reported that they were sometimes interrupted during the patient handoff process. The most common reason for such interruptions was medical personnel paging. Furthermore, 60 (68.1%) general surgery residents stated that these interruptions led to a decreased quality of effective communication, 39 (44.3%) believed it led to decreased quality of patient care, 63 (71.5%) believed it led to the loss of some information related to patient handoff, and 16 (18.1%) believed it led to patient harm. Finally, 31 (34.4%) general surgery residents believed that the existing handoff system at their institutions neither adequately protected the patients’ safety nor allowed for continuity of care, and 51 (68%) reported that their institution did not have a standardized protocol for the verbal patient handoff process. There was a higher proportion of patients with minor harm among residents who did not, rarely or sometimes received verbal or written hand off instructions compare to those who did so always or most of the time (67% vs. 49%, respectively).ConclusionThe patient handoff process among general surgery residents in Saudi Arabia is subjective and is not standardized, and if not addressed, may lead to patient harm. Standardizing this process is paramount to improve patient safety.

A retrospective cohort study of factors associated with severity of falls in hospital patients

Severity of falls in hospital patients are threat to patient safety which can result in a financial burden on the patient’s family and health care services. Both patient specific and environmental and organisational factors are associated with severity of falls in hospital. It is important to continuously analyse the factors associated with severity of fall which can inform the implementation of any fall preventive strategies. This study aims to identify factors associated with the severity of falls in hospitalised adult patients in Western Australia. This study involved a retrospective cohort analysis of inpatient falls records extracted from the hospital’s Clinical Incident Database from May 2014 to April 2019. Severity of falls were classified as three Severity Assessment Code (SAC): SAC 1 was “high” causing serious harm or death; SAC 2 was “medium” causing moderate or minor harm; and SAC 3 was “low” indicating no harm. Univariable and multivariable generalised ordinal logistic regression models were used to quantify the magnitude of effects of the potential risk factors on severity of falls at 5% level of significance and reported the crude odds and adjusted odds ratio of falling at a higher severity level. There were 3705 complete reported cases of falls with the average age of the patients was 68.5 ± 17.0 years, with 40.2% identified as female. The risk of falling at a higher level of severity increased by patient age over 50 years. Females were 15.1% more likely to fall at higher severity level compared to females. Fall incidents occurred during toileting and showering activities and incidents in a communal area were 14.5% and 26% more likely to occur at a higher severity respectively. Similarly, depression (167%), influence of alcohol or illicit drugs (more than 300%), use of medications (86%) and fragile skin (75%) significantly increased the odds of falling at higher level of severity. Identification of underlying risk factors associated with fall severity provides information which can guide nurses and clinicians to design and implement effective interventional strategies that mitigate the risk of serious fall injuries. The results suggest that fall prevention strategies should target patients with these risk factors to avoid severity of falls.

Evaluation of Physicians' Perception of Patient Safety Incidents Including Disclosure Utilizing Hypothetical Clinical Vignettes

Purpose:We investigated physicians' responses to a series of clinical vignettes consisting of patient safety incidents, with and without disclosure of patient safety incidents (DPSI).Methods: An anonymous survey was conducted to investigate physicians’ responses to the DPSI via online communities of physicians, and additional participants were recruited using a snowballing sampling method. We evaluated physicians’ responses to the DPSI using eight hypothetical scenarios (HS) from the following perspectives: thoughts regarding medical errors, revisiting the physician, recommendation, lawsuit, criminal prosecution, trust score, and compensation amounts. We used the chi-square test to evaluate the overall differences in response rates among the scenarios. Statistical analyses were performed using the Student's t-test to compare the trust scores and compensation amounts.Results: A total of 910 physicians participated in this survey. An overall comparison of trust scores among HS showed that HS 1 (unclear medical errors, minor harm, and DPSI) had the highest trust score. In contrast, in the opposite scenario, HS 8 (clear medical errors, major harm, and DPSI not conducted) received the lowest scores. Cases with minor harm to patients (HS 1, 2, 5, and 6) showed lower compensation amounts than the others (HS 3, 4, 7, and 8). Physicians were more likely to think of situations with DPSI as not having medical errors (53.1% vs. 55.2%). In addition, the scenarios with DPSI were evaluated favorably in terms of intention to revisit, recommend, suit, and engage in criminal proceedings. Physicians showed higher trust scores (6.2 vs 5.4) and gave lower compensation amounts ($27.7 million vs $28.1 million), although there was no significant difference in terms of compensation amounts to the physician conducting DPSI.Conclusion: Our study showed overall positive perceptions regarding DPSI among Korean physicians.

Accidental Tracheostomy Decannulations in Children-A Prospective Cohort Study of Inpatients.

To determine the incidence of tracheostomy accidental decannulations (AD) among pediatric inpatients and identify risks for these events. Prospective cohort. All tracheostomy patients (≤18 years) admitted at a tertiary children's hospital between August 2018 and April 2021 were included. AD were recorded and patient harm was classified as no harm/minor, moderate, or severe. Monthly AD incidence was described as events per 1000 tracheostomy-days. One-hundred seventeen AD occurred among 67 children with 33% (22/67) experiencing multiple events (median: 2.5 events, range: 2-10). Mean age at AD was 4.7 years (SD: 4.4). AD resulted from patient movement (32%, 37/117), performing tracheostomy care (27%, 31/117), repositioning or transporting (15%, 17/117), or unclear reasons (27%, 32/117). A parent or guardian was involved in 28% (33/117) of events. Nearly all AD resulted in no more than minor harm (84%, 98/117) but moderate (12%, 14/117) and severe (4%, 5/117) events did occur. There were no deaths. Tracheostomy care or repositioning were frequently responsible in acute versus subacute events (48% vs. 26%, p=0.04). Mean monthly AD incidence was 4.7 events per 1000 tracheostomy-days (95% CI: 3.7-5.8) and after implementation of safety initiatives, the mean rate decreased from 5.9 events (95% CI: 4.2-7.7) to 3.7 events (95% CI: 2.5-5.0) per 1000 tracheostomy-days (p=0.04). AD in children occur at nearly 5 events per 1000 tracheostomy-days and often result in minimal harm. Quality initiatives targeting patient movement, provider education, and tracheostomy care might reduce the frequency of these complications. 3 Laryngoscope, 133:963-969, 2023.

Patient falls in the operating room setting: An analysis of reported safety events.

Patient falls are a preventable public health problem, and they are among the most reported safety incidents in the hospital. We used a hospital safety reporting system to examine the nature of reported falls in the perioperative setting at an academic tertiary center. In this retrospective study, reports of perioperative safety events listed as "Falls" between 2014 and 2020 were analyzed for severity level and specific event type. Out of 8337 safety reports from 2014 to 2020, 86 were "fall" related (1%). The most common "fall" event type was "ambulating with assistance and the severity level reported was mainly level 1 (no harm, did reach patient, 63%) followed by level 2 (temporary or minor harm, 28%). One of the most frequently reported types of perioperative falls was from a bed or stretcher (15% of falls)". Our safety data reporting system identified falls as a safety event that causes patient harm in the perioperative setting that could be preventable with a multifaceted interdisciplinary approach. Risk managers can use these data to implement strategies to reduce falls such as creating screening protocols to identify high-risk patients, educating and training healthcare personnel, and optimizing operating room, hospital, and equipment design.