Patient Safety Measures Research Articles

Associations between pharmaceutical industry interactions and prescribing practices in chronic non-malignant pain management: A protocol for a systematic review

Introduction Chronic non-malignant pain (CNMP) represents a major global health issue and is a primary reason for disability worldwide. Managing CNMP often involves prescribing analgesics which carry risks such as dependency and adverse outcomes. Interactions between healthcare professionals (HCPs) and the pharmaceutical industry, including financial incentives, gifts, and sponsored education, may influence analgesic prescribing practices. Understanding these dynamics is essential for promoting ethical, evidence-based prescribing and ensuring patient safety. Therefore, the aim is to assess how pharmaceutical industry interactions with HCPs affect the prescribing of analgesics, specifically in the context of CNMP management. Methods This is a protocol for a systematic review, which is also prospectively registered on PROSPERO (Registration Number: CRD42024627184) and is reported according to PRISMA-P guidelines. A systematic search will be performed across MEDLINE, EMBASE, CINAHL, PsycINFO, and Web of Science. Observational studies (e.g., cross-sectional, cohort) evaluating the association between pharmaceutical industry interactions and HCPs’ prescribing patterns for CNMP management will be included. Primary outcomes include analgesic prescribing patterns, such as rate, volume, and cost. Secondary outcomes involve patient safety measures and HCP attitudes towards prescribing. Titles, abstracts, and full texts will be screened according to the inclusion criteria. Data extraction will utilize a standardized form, and the methodological quality will be evaluated using the ROBINS-I tool. Screening, data extraction and quality appraisal will be conducted by two reviewers, independently, resolving any discrepancies with the help of a third reviewer. Should there be sufficient homogeneity in the results data, a meta-analysis will be conducted; if not, the findings will be presented in a narrative synthesis. The strength of evidence will be assessed using the GRADE approach. Discussion The findings could inform strategies to enhance unbiased and evidence-based prescribing in CNMP management, promoting better patient care.

Physician inpatient handoffs-Patient and physician outcomes: A systematic review.

Prior reviews have shown that interventions to improve inpatient handoffs are inconsistently associated with improvement in patient outcomes. This systematic review examines the effectiveness of inpatient handoff interventions on outcomes affecting patients and physicians, including objective measures when reported (PROSPERO ID: CRD42022309326). Pubmed, Embase, and Cochrane Central Register of Controlled Trials were searched on January 13th, 2022. We included experimental or quasi-experimental studies that examined handoff communication between inpatient physicians and reported patient clinical, patient experiential, physician experiential, or cost and utilization outcomes. Studies were excluded if they examined handoffs between facilities or levels of care, or only reported subjective measures of patient safety or physician experience. Risk of bias was assessed using the ROBINS-1 and RoB-2 tools. Of the 42 included studies, six were randomized controlled trials. Most studies were conducted at academic centers (67%) and involved only residents (64%). An educational intervention was used in 52% of studies and a structural intervention was used in 43%, with 9% using both. Adverse events were significantly improved in three of 16 studies, medical errors in three of seven studies, and length of stay in three of seven studies. Four studies examined mortality, and none reported a significant improvement. Studies that used both structural and educational components reported significant improvements more frequently. The literature is mixed on the impact of efforts to improve handoffs, though there are few randomized trials. Few studies reported patient experiential or cost/utilization outcomes, or involved hospitalist physicians, which represent potential areas for future research.

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.

Healthcare professionals’ perception of the World Health Organization Surgical Safety Checklist and psychological safety: a cross-sectional survey

BackgroundThe Surgical Safety Checklist (SSC) is a cornerstone of ensuring the safety and accuracy of communication among interdisciplinary teams in the operating room. Central to the successful implementation of such...

The Impact of a New Case-Based Payment System on Quality of Care: A Difference-in-Differences Analysis in China.

China has developed and widely piloted a new case-based payment, ie, the "Diagnosis-Intervention Packet" (DIP) payment, which has a granular classification system. We evaluated the impact of DIP payment on the quality of care in a large pilot city in China and explored potential mechanisms of quality change. The city started to implement DIP payment with a hospital-level cap on July 1, 2019. Using a 5% random sample of discharge records from July 2017 to June 2021, we employed a difference-in-differences approach to compare two mortality measures (in-hospital mortality, mortality of surgical patients), two readmission measures (all-cause readmission within 30 days, readmission with the same principal diagnosis within 30 days) and a patient safety measure (operation associated complications or adverse event) in 13 pilot hospitals and 27 non-pilot hospitals before and after DIP payment reform. Of 122,637 discharge records included, 43,023 (35.1%) were from pilot hospitals. After DIP payment, the readmission rate within 30 days and readmission rate with the same principal diagnosis in pilot hospitals decreased significantly by 3.2 percentage points (P <0.001) and 1.8 percentage points (P <0.001), respectively. The in-hospital mortality rate, the mortality rate of surgical patients, and the rate of operation-associated complications or adverse events did not have significant changes. The decrease in quality measures was primarily driven by tertiary hospitals, was more obvious over time after the policy adoption, and was more pronounced in groups with higher intensity of care. This study indicated that DIP payment with a cap in the study city was associated with improved quality of care among patients in pilot hospitals. The provider's behavior of increasing the intensity of care, especially for more severe patients, may partially contribute to the results.

From an Informatics Lens: Dashboards for Hospital Nurse Managers Influencing Unit Patient Outcomes.

Dashboards display hospital quality and patient safety measures aimed to improve patient outcomes. Although literature establishes dashboards aid quality and performance improvement initiatives, research is limited from the frontline nurse manager's perspective. This study characterizes factors influencing hospital nurse managers' use of dashboards for unit-level quality and performance improvement with suggestions for dashboard design. Using a descriptive qualitative design, semistructured interviews were conducted with 11 hospital nurse managers from a health system in the Midwestern United States. Thematic analysis was used to describe four perceived factors influencing dashboard use: external, data, technology features, and personal. External factors included regulatory standards, professional standards of care, organizational expectations, and organizational resources. Data factors included dashboard data quality and usefulness. Technology features included preference for simple, interactive, and customizable visual displays. Personal factors included inherent nurse manager qualities and knowledge. Guidelines for dashboard design involve display of required relevant quality measures that are accurate, timely, useful, and usable. Future research should involve hospital nurse managers in user-centered design to ensure dashboards are favorable for use. Further, opportunities exist for nurse manager informatics training and education on dashboard use in preparation for their role and responsibilities in unit-level quality and performance improvement.

Assessment of Practice of Radiation Protection Devices in Fluoroscopy in SKIMS SOURA Hospital Srinagar J&amp;K

This study evaluated radiation protection practices in fluoroscopy at Sher-i-Kashmir Institute of Medical Sciences (SKIMS) in Soura, Jammu and Kashmir. A descriptive cross-sectional design involved observing 47 patients and medical professionals during radiological procedures in the gastroenterology and radiology departments. Data were collected using a chart table, focusing on the use of radiation protection apparel and devices. Results showed that 50% of patients were aged 26-35, with an equal gender ratio. Thyroid shields were used by 56.7% and gonad shields by 36.7% of patients. Among radiation technologists, 75% were aged 30-40 and all used lead aprons and thyroid shields. Radiologists were evenly split by age and gender, with all using lead gloves, thyroid shields, collimators, and filters. The findings indicate that SKIMS staff exhibit strong knowledge and adherence to radiation protection guidelines, providing adequate safety measures for patients and themselves.

Tapentadol: navigating the complexities of abuse, patient safety & regulatory measures

Aim To evaluate tapentadol abuse cases by analyzing real-world data and identifying under-reporting countries from Southeast Asian Region (SEAR) to enhance vigilance. Method A retrospective, observational study from 2013 to March 2024 using VigiBase was conducted. Result Tapentadol-related abuse falls within the System Organ Class (SOC) categories of psychiatric disorder, nervous system disorder and injury, poisoning, and procedural complications. These are further categorized into Preferred Terms (PT) such as anxiety, delirium, Central Nervous System toxicity, depressive disorder, drug abuse, dependence/withdrawal syndrome, and overdose using the Medical Dictionary for Regulatory Activities (MedDRA) system. Among the 11 countries in the SEAR, India is the only country to report cases of tapentadol-related abuse, no Individual Case Safety Reports (ICSRs) related to tapentadol abuse have been submitted from other SEAR nations. Out of 127 ICSRs concerning tapentadol-related adverse events reported in India, 20 cases involved abuse. Focusing on the ICSRs submitted in India, the reported adverse reactions included anger(n = 1,10%), anxiety (n = 2, 10%), delirium (n = 1, 5%), drug abuse (n = 4, 20%), drug dependence/withdrawal syndrome (n = 7, 35%), intentional overdose (n = 2, 10%), depressive disorder (n = 1, 5%), euphoric mood (n = 1, 5%), and product misuse (n = 1, 5%) indicating a concerning pattern of substance abuse. Conclusion Stringent regulatory actions are needed to curb this practice in India, such as rescheduling tapentadol from Schedule H (Prescription drugs) to Schedule X(Narcotic drugs) in India could offer more regulatory oversight and measures to reduce risks related to abuse, addiction, and dependence while enhancing patient safety in pain management practices. Additionally, tapentadol should be closely monitored in other SEAR countries due to its potential for dependence. This study also emphasizes the importance of encouraging SEAR countries to report more Adverse Drug Reactions (ADRs), which would facilitate the implementation of more rigorous regulatory measures.

Nurse Burnout and Patient Safety, Satisfaction, and Quality of Care

Occupational burnout syndrome is characterized by emotional exhaustion, depersonalization, and a diminished sense of personal accomplishment and is prevalent among nurses. Although previous meta-analyses have explored the correlates of nurse burnout, none have estimated their association with health care quality and safety and patient morbidity and mortality. To evaluate the magnitude and moderators of the association between nurse burnout and patient safety, patient satisfaction, and quality of care. The Web of Science, Scopus, MEDLINE, Embase, PsycINFO, CINAHL, and ProQuest databases were searched from January 1, 1994, to February 29, 2024. Two reviewers independently identified studies that reported a quantifiable association between nurse burnout and any of the outcomes of patient safety, patient satisfaction, or quality of health care. The PRISMA 2020 guideline was followed. Two reviewers independently extracted the standardized mean difference (SMD) (Cohen d) estimates for a random-effects meta-analysis. Subgroup analyses and meta-regressions were conducted using prespecified variables. Any measure of patient safety, patient satisfaction, or quality of health care previously associated with nurse burnout. A total of 85 studies (81 cross-sectional and 4 longitudinal) involving 288 581 nurses from 32 countries (mean [SD] age, 33.9 (2.1) years; 82.7% female; mean [SD] burnout prevalence rate with study-specific ascertainments, 30.7% [9.7%]) were included. Nurse burnout was associated with a lower safety climate or culture (SMD, -0.68; 95% CI, -0.83 to -0.54), lower safety grade (SMD, -0.53; 95% CI, -0.72 to -0.34), and more frequent nosocomial infections (SMD, -0.20; 95% CI, -0.36 to -0.04), patient falls (SMD, -0.12; 95% CI, -0.22 to -0.03), medication errors (SMD, -0.30; 95% CI, -0.48 to -0.11), adverse events or patient safety incidents (SMD, -0.42; 95% CI, -0.76 to -0.07), and missed care or care left undone (SMD, -0.58; 95% CI, -0.91 to -0.26) but not with the frequency of pressure ulcers. Nurse burnout was also associated with lower patient satisfaction ratings (SMD, -0.51; 95% CI, -0.86 to -0.17) but not with the frequencies of patient complaints or patient abuse. Finally, nurse burnout was associated with lower nurse-assessed quality of care (SMD, -0.44; 95% CI, -0.57 to -0.30) but not with standardized mortality rate. The associations were consistent across nurses' age, sex, work experience, and geography and persistent over time. For patient safety outcomes, the association was smaller for the low personal accomplishment subcomponent of burnout than for emotional exhaustion or depersonalization, as well as for nurses with a college education. In this systematic review and meta-analysis, nurse burnout was found to be associated with lower health care quality and safety and lower patient satisfaction. This association was consistent across nurse and study characteristics.

Moving the Needle on Measurement of Patient Safety: The Evolving Role of the Agency for Healthcare Research and Quality (AHRQ) Patient Safety Indicators

Moving the Needle on Measurement of Patient Safety: The Evolving Role of the Agency for Healthcare Research and Quality (AHRQ) Patient Safety Indicators

Revised Hospital Survey on Patient Safety Culture (HSOPSC 2.0): cultural adaptation, validity and reliability of the Malay version

BackgroundSurveys on Patient Safety Culture™ Hospital Survey (HSOPSC) developed by the U.S. Agency for Healthcare Research and Quality (AHRQ) has been adopted worldwide. The Hospital Survey on Patient Safety Culture (HSOPSC) version 2.0 was released in 2019, but there have been no publications to date of its translation and validation for use in Malaysia. This study aimed to translate and cross-culturally adapt the revised HSOPSC 2.0 into the Malay language and determine its psychometric properties including the content, face, and construct validity, and reliability analyses.MethodsThis study was conducted from April – June 2023 and divided into three stages: translation and cultural adaptation; content and face validation; and construct validation using confirmatory factor analysis and reliability testing among 319 healthcare personnel from a public university hospital in Malaysia.ResultsThe translated instrument demonstrated excellent content validity (I-CVI = 0.80 ~ 1.0, SCVI-average = 0.96) and face validity (I-FVI = 0.80 ~ 1.0, SFVI-average = 0.98). Reliability testing was acceptable (Cronbach’s α = 0.60 ~ 0.80) but indicated that reverse-coded items were poorly perceived. Confirmatory factor analysis showed a satisfactory model fit for the translated instrument (RMSEA = 0.08, GFI = 0.80, CFI = 0.80, and χ2/df = 2.96). Six items had very low factor loadings (< 0.40), with two constructs “Staffing and Work Pace” and “Response to Error” having AVE < 0.4, but acceptable CR ≥ 0.6. No items were removed from the questionnaire despite low factor loadings following a consensus from an expert panel.ConclusionThe Malay version of the HSOPSC 2.0 containing ten domains and 32 items demonstrated satisfactory psychometric properties following expert consensus, with acceptable reliability and construct validity for measuring patient safety culture. Given factor loadings smaller than 0.40 in six items, broader validation is suggested to support the use of the translated instrument in the Malaysian healthcare setting.

Instruments for Patient Safety Assessment: A Scoping Review.

Patient safety is an important component of healthcare service quality, and there are numerous instruments in the literature that measure patient safety. This scoping reviewaims to map the instruments/scales for assessing patient safety in healthcare services. This scoping review follows the JBI methodology. The protocol was registered on the Open Science Framework. Eligibility criteria were defined based on studies that include instruments or scales for assessing patient safety in healthcare services, in any language, and without temporal restrictions. It adhered to all scoping review checklist items [PRISMA-ScR], with searches in the Embase, Lilacs, MedLine, and Scopus databases, as well as the repository of the Brazilian Digital Library of Theses and Dissertations. Two independent reviewers performed selection and data extraction in July 2023. Of the 4019 potential titles, 63 studies reported on a total of 47 instruments/scales and 71 dimensions for patient safety assessment. The most-described dimensions were teamwork, professional satisfaction, safety climate, communication, and working conditions. The diversity of instruments and dimensions for patient safety assessment characterizes the multidimensionality and scope of patient safety. However, it hinders benchmarking between institutions and healthcare units.

The Use of a Single Risk Assessment Tool for Mortality and Numerous Hospital-Acquired Conditions.

Quality assessment organizations leverage numerous patient safety measures to evaluate hospital performance, resulting in significant financial, administrative, and operational burdens on health systems. Low-intensity approaches that allow for reliable risk stratification of patients can reduce the required investment. The Braden score is a routinely performed bedside nursing evaluation validated to assess risk for hospital-acquired pressure injury. We hypothesized that the tool can be used to evaluate risk for other hospital-related adverse outcomes, including mortality, catheter-associated urinary tract infection (CAUTI), and central line-associated bloodstream infection (CLABSI). We found that abnormal Braden scores have significant association with numerous adverse outcome measures, including mortality, CLABSI, CAUTI, and iatrogenic hypoglycemia. Because of its frequency of reevaluation, we have found preliminary evidence that leveraging this tool can reduce harm by quickly identifying the most at-risk patients for various types of iatrogenic harm. We conclude that in the face of increasing automation and technical applications, for example, artificial intelligence-driven tools, highly reliable clinician bedside physical examination and evaluation can still have significant, low-cost, and high-value impact in improving patient safety.

Structuring and restructuring COVID-19 Intensive Care Units: a systematic review

Background and Objectives: the COVID-19 pandemic imposed restructuring and reorganization in healthcare services, particularly in Intensive Care Units (ICUs), due to the increased demand for hospital care for the thousands of severe cases of the disease. Thus, understanding this ICU reorganization process is useful for healthcare system planning and, consequently, for preventing system collapse in the face of impending pandemics. The objective was to identify elements related to the restructuring and organization of human resources, materials, and organization/structure processes in ICUs during the COVID-19 pandemic. Methods: this is a qualitative systematic review. Searches were conducted in the MEDLINE, PubMed, Scopus, Web of Science, and Embase databases. The results were exported to the Rayyan software for subsequent screening and blind selection by two independent researchers as well as for assessing the risk of bias and individual methodological quality of selected studies. Results: a total of 171 articles were found across the five databases, with five articles selected to be included in this review. The identified elements concerning the restructuring and organization of ICUs were the use and availability of personal protective equipment, oxygen, and oxygen therapy equipment, medications, psychological support for healthcare professionals, patient safety measures, and space maintenance. Conclusion: this review allowed for the compilation and synthesis of necessary elements for the restructuring and organization of ICUs during the pandemic, considering the need for managers to respond swiftly to the high demand brought on by COVID-19.

Evaluation of Patient Safety Measures in the ICCU at Pune: A Comparative Study Against ISCCM Guidelines

Introduction: This cross-sectional descriptive study evaluated patient safety measures in the Intensive Coronary Care Unit (ICCU) of a tertiary care hospital in Pune, India, over 90 days. Methodology: A validated checklist from the Indian Society of Critical Care Medicine (ISCCM) was used to assess compliance with established guidelines. Result: The ICCU demonstrated high adherence to infrastructure standards and environmental controls. However, gaps were identified, including the absence of a portable CT scanner and inadequate counselling room size, emphasizing the need for further improvements to align with global best practices. Recommendations include investing in a portable CT scanner and expanding the counselling room. This study underscores the importance of adhering to standardized safety protocols in critical care settings to enhance patient outcomes and reduce adverse events.

Safety of Fibrinogen Concentrate for Correcting Perioperative Bleeding-Associated Hypofibrinogenemia in Adults: A Single-Center Experience.

Background: Surgery often leads to bleeding associated with hypofibrinogenemia. Supplementation with fibrinogen concentrate appears to be effective and safe, although findings from studies are inconsistent. The primary aim of this study was to assess the safety of fibrinogen concentrate during the perioperative period. Methods: This single-centre, prospective, observational study included adult patients undergoing scheduled or emergency surgery related to bleeding coagulopathy and the administration of fibrinogen concentrate. Patients were followed until their discharge from the institution. Comprehensive data were collected, including age, sex, type of surgery, associated comorbidities, anticoagulant and/or anti-aggregating therapy, and the number of blood transfusions. Laboratory data on plasma fibrinogen concentration, haemoglobin, and platelet count before and after surgery were also collected. The primary outcomes were the mortality rate at discharge and any reported thrombotic or thromboembolic events, including deep vein thrombosis, pulmonary embolism, and myocardial infarction. Results: The study included 91 adult patients who had undergone surgery, with 29 surgeries (32%) conducted in an emergency setting. The mean age was 59.2 years, and 53.8% were male. Major bleeding occurred in 29 cases, mainly in older males and those on anticoagulant therapy. The pre-operative fibrinogen level averaged 161 mg/dL, and the average dosage of fibrinogen concentrate administered was 2.7 g. Eight patients died (8.8%), mostly due to septic or cardiogenic shock, with deaths being more frequent in emergency settings. Thromboembolic events occurred in eight patients, none of whom died. No additional adverse events directly related to the administration of fibrinogen concentrate were reported. Conclusions: Our findings suggest a favourable safety profile for fibrinogen concentrate in surgical patients, as evidenced by a low incidence of deaths and thromboembolic events, which were primarily attributed to other factors. Future research should strive to increase statistical robustness to further illuminate clinically significant patient safety measures.

Crying wolf, alarm safety and management in paediatrics: A scoping review.

To provide a contemporaneous evidentiary overview of neonatal and paediatric studies investigating alarm-related patient safety and alarm system management. Furthermore, to describe how clinical alarm burden is captured and reported, to identify clinical devices that contribute to alarm burden, to explore alarm-related and patient safety measures and terminologies and to review alarm management initiatives. Scoping review. A systematic search of PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature, Scopus and EBSCOhost was conducted from 2013 to 2023 using predetermined search terms, index terms, medical subject headings and truncation. Observational and qualitative studies with neonatal and paediatric populations reporting monitoring and alarm practices; and interventional studies reporting the success of alarm safety interventions were included. The quality of the included studies was assessed using the mixed methods appraisal tool. The search yielded 37 studies of acceptable quality. The majority explored alarm burden associated with physiological monitoring (n = 35; 95%). Alarm definitions were reported in 46% (n = 17) of studies, and commonly included what constituted actionable and non-actionable alarms. While 32% (n = 12) of studies considered alarms in relation to clinical outcomes surrounding patient safety, clinician response to alarms was only reported in 19% (n = 7) of studies. Alarm and monitoring interventions were assessed in 51% (n = 19) of included studies, with categorization into six domains: changing alarm parameters, clinician education, communication and planning, technology, alarm ordering and standardization or guidelines. This review has demonstrated the enormity of alarms in clinical settings, heterogeneity of alarm definitions and outlined interventions associated with alarm burden and patient safety. Strategies to ensure appropriate alarm limits are set and clinicians are empowered through education to recognize and respond appropriately to alarms can maximize patient safety. This review adheres to the preferred reporting items for systematic reviews and meta-analysis protocols extension for scoping reviews. No patient or public contribution.

Medication errors and mitigation strategies in obstetric anesthesia.

Medication administration errors represent a significant yet preventable cause of patient harm in the peripartum period. Implementation of best practices contained in this manuscript can significantly reduce medication errors and associated patient harm. Cases of medication errors involving unintended intrathecal administration of tranexamic acid highlight the need to improve medication safety in peripartum patients and obstetric anesthesia. In obstetric anesthesia, medication errors can include wrong medication, dose, route, time, patient, or infusion setting. These errors are often underreported, have the potential to be catastrophic, and most can be prevented. Implementation of various types of best practice cost effective mitigation strategies include recommendations to improve drug labeling, optimize storage, determine correct medication prior to administration, use non-Luer epidural and intravenous connection ports, follow patient monitoring guidelines, use smart pumps and protocols for all infusions, disseminate medication safety educational material, and optimize staffing models. Vigilance in patient care and implementation of improved patient safety measures are urgently needed to decrease harm to mothers and newborns worldwide.

Electronic Health Record Nudges and Health Care Quality and Outcomes in Primary Care

Nudges have been increasingly studied as a tool for facilitating behavior change and may represent a novel way to modify the electronic health record (EHR) to encourage evidence-based care. To evaluate the association between EHR nudges and health care outcomes in primary care settings and describe implementation facilitators and barriers. On June 9, 2023, an electronic search was performed in PubMed, Embase, PsycINFO, CINAHL, and Web of Science for all articles about clinician-facing EHR nudges. After reviewing titles, abstracts, and full texts, the present review was restricted to articles that used a randomized clinical trial (RCT) design, focused on primary care settings, and evaluated the association between EHR nudges and health care quality and patient outcome measures. Two reviewers abstracted the following elements: country, targeted clinician types, medical conditions studied, length of evaluation period, study design, sample size, intervention conditions, nudge mechanisms, implementation facilitators and barriers encountered, and major findings. The findings were qualitatively reported by type of health care quality and patient outcome and type of primary care condition targeted. The Risk of Bias 2.0 tool was adapted to evaluate the studies based on RCT design (cluster, parallel, crossover). Studies were scored from 0 to 5 points, with higher scores indicating lower risk of bias. Fifty-four studies met the inclusion criteria. Overall, most studies (79.6%) were assessed to have a moderate risk of bias. Most or all descriptive (eg, documentation patterns) (30 of 38) or patient-centeredness measures (4 of 4) had positive associations with EHR nudges. As for other measures of health care quality and patient outcomes, few had positive associations between EHR nudges and patient safety (4 of 12), effectiveness (19 of 48), efficiency (0 of 4), patient-reported outcomes (0 of 3), patient adherence (1 of 2), or clinical outcome measures (1 of 7). This systematic review found low- and moderate-quality evidence that suggested that EHR nudges were associated with improved descriptive measures (eg, documentation patterns). Meanwhile, it was unclear whether EHR nudges were associated with improvements in other areas of health care quality, such as effectiveness and patient safety outcomes. Future research is needed using longer evaluation periods, a broader range of primary care conditions, and in deimplementation contexts.

Patient involvement in patient safety measures: the impact of demographic and socioeconomic factors – a scoping review

Patient involvement in patient safety measures: the impact of demographic and socioeconomic factors – a scoping review