Patient Safety Performance Research Articles

Patient Safety Activity Under the Social Insurance Medical Fee Schedule in Japan: An Overview of the 2010 Nationwide Survey.

Little is known about patient safety performance under the social insurance medical fee schedule in Japan. The Health Ministry in Japan introduced the preferential patient safety countermeasure fee (PPSCF) to promote patient safety in 2006 and revised the PPSCF system in 2010. This study aims to address the patient safety performance status at hospitals implementing the PPSCF. A nationwide questionnaire survey targeting 2674 hospitals with the PPSCF was performed in 2010 to 2011. The 627 participant hospitals were divided into the following three groups: 178 hospitals implementing PPSCF 1 with 400 beds or more (group A), 286 hospitals implementing PPSCF 1 with 399 beds or fewer (group B), and 163 hospitals implementing PPSCF 2 (group C). The mean numbers (standard errors) of patient safety managers were 1.45 (0.07) in group A, 1.12 (0.04) in group B, and 0.37 (0.12) in group C (P < 0.001). The participation number and rates of all staff for the patient safety seminar were 1721 (167) and 1.64 (0.10) in group A, 580 (26) and 1.94 (0.09) in group B, and 349 (31) and 1.98 (0.17) in group C (P < 0.001, P = 0.105).These results can be explained because hospitals with PPSCF 1 (groups A and B) must assign at least one full-time patient safety manager, whereas hospitals with PPSCF 2 (group C) are not required to do so. Patient safety performance at hospitals with PPSCF 1 was more active than that at hospitals with PPSCF 2. However, when the values were converted to per capita or per 100 beds, there were no differences across the three groups. The PPSCF encourages hospitals to perform actions for patient safety by providing incentives under the social insurance medical fee schedule in Japan.

Patient Safety Culture, Evidence-Based Practice and Performance in Nursing

Evidence-based practice is a problem-solving approach in which the best available and useful evidence is used by integrating research evidence, clinical expertise, and patient values and preferences to improve health outcomes, service quality, patient safety and clinical effectiveness, and employee performance. This study aimed to identify the effects of nurses’ patient safety culture perceptions and their evidence-based nursing attitudes on the hospital’s patient safety level and employee performance. A cross-sectional design was employed in this study. Participants included nurses working in a state hospital in Burdur, Turkey, and 218 nurses responded to the research instrument (participation rate: 55.7%). Data were collected through face to face interviews that were conducted from February 20–May 20, 2016. The results of the analyses revealed that evidence-based nursing attitudes and hospital safety culture dimensions explained 29.2% of the total variance in the hospital patient safety level, while evidence-based nursing attitudes and hospital safety culture dimensions explained 15.5% of the total variance in nurse performance. The “evidence-based nursing related beliefs and expectations” aspect of the evidence-based nursing attitude dimension, and the “management support for patient safety” aspect of the patient safety culture dimension were significant predictors of nurses’ performance. The present findings add to the increasing interest in improving evidence-based practice and service quality in order to achieve better patient outcomes.

간호대학생의 환자안전관리 지식, 태도, 수행자신감 및 안전관리 행위

This study is a descriptive research to survey nursing students’ knowledge(KPS), attitude(APS), confidence in performance(CPS) and behavior of patient safety(BPS). The subjects were enrolled in 391 the 4th grade nursing college students. The percent of correct answer in KPS was 70.7%, APS, CPS and BPS were 3.79, 3.99 and 4.24 points out of 5. KPS was significantly different according to negligence and oblivion. APS was different according to gender, grade point, satisfaction with nursing major, practice satisfaction, negligence and safety education. CPS was different according to gender, satisfaction with major, practice satisfaction and negligence. BPS wad different according to satisfaction with major, practice satisfaction, negligence, oblivion and safety education. Significant positive correlations were showed among KPS, APS, CPS and BPS, except between KPS and BPS. It is necessary to develop the patient safety guideline and the education plan for increasing patient safety behaviors of nursing students.

Optimizing Crisis Resource Management to Improve Patient Safety and Team Performance - A handbook for acute care health professionals

Optimizing Crisis Resource Management to Improve Patient Safety and Team Performance - A handbook for acute care health professionals

Doing well by doing good: Evaluating the influence of patient safety performance on hospital financial outcomes.

As financial pressures on hospitals increase because of changing reimbursement structures and heightened focus on quality and value, the association between patient safety performance and financial outcomes remains unclear. The purpose of this study is to investigate if hospitals with higher patient safety performance are associated with higher levels of profitability than those with lower safety performance. Using multinomial logistic regression, we analyzed data from the spring 2014 Leapfrog Hospital Safety Score and the 2014 American Hospital Association to determine the association between Leapfrog Hospital Safety Score performance and three dimensions of organizational profitability: operating margin, net patient revenue, and operating income. Our findings suggest that improved hospital safety scores are associated with a relative risk of being in the top versus bottom quartile of financial performance: 5.41 times greater (p < .001) for operating margin, 10.98 times greater (p < .001) for net patient revenue, and 4.03 times greater (p < .001) for operating income. Our findings suggest that improved patient safety performance, as evaluated within the Leapfrog Hospital Safety Score, is associated with improved financial performance at the hospital level. Targeted focus on patient safety may allow hospitals to improve financial performance, maximize scarce resources, and generate additional capital to continue to positively evolve care.

A Family-Centered Rounds Checklist, Family Engagement, and Patient Safety: A Randomized Trial.

Family-centered rounds (FCRs) have become standard of care, despite the limited evaluation of FCRs' benefits or interventions to support high-quality FCR delivery. This work examines the impact of the FCR checklist intervention, a checklist and associated provider training, on performance of FCR elements, family engagement, and patient safety. This cluster randomized trial involved 298 families. Two hospital services were randomized to use the checklist; 2 others delivered usual care. We evaluated the performance of 8 FCR checklist elements and family engagement from 673 pre- and postintervention FCR videos and assessed the safety climate with the Children's Hospital Safety Climate Questionnaire. Random effects regression models were used to assess intervention impact. The intervention significantly increased the number of FCR checklist elements performed (β = 1.2, P < .001). Intervention rounds were significantly more likely to include asking the family (odds ratio [OR] = 2.43, P < .05) or health care team (OR = 4.28, P = .002) for questions and reading back orders (OR = 12.43, P < .001). Intervention families' engagement and reports of safety climate were no different from usual care. However, performance of specific checklist elements was associated with changes in these outcomes. For example, order read-back was associated with significantly more family engagement. Asking families for questions was associated with significantly better ratings of staff's communication openness and safety of handoffs and transitions. The performance of FCR checklist elements was enhanced by checklist implementation and associated with changes in family engagement and more positive perceptions of safety climate. Implementing the checklist improves delivery of FCRs, impacting quality and safety of care.

Engaging Learners in Health System Quality Improvement Efforts.

In 1999, an Institute of Medicine report spurred health care organizations to implement systems-based quality improve ment efforts and tackle patient safety. Simultaneously, the Accreditation Council for Graduate Medical Education asked residency programs to address Practice-Based Learning and Systems-Based Practice competencies. Medical educators now advocate incorporation of these competencies in undergraduate medical education.The authors examine the success of these efforts both from the health care delivery and systems perspective as well as from the perspective of educators as they aspire to engage medical students and residents in these domains. The authors argue that the missing element that prevents health care systems from the full realization of the promise of quality improvement is bidirectional alignment. Included are examples from the literature to demonstrate how medical educators are moving toward alignment of learners with health system quality improvement and safety needs. Finally, the authors explore business and information technology governance literature in support of the hypothesis that bidirectional alignment should be the next step in moving from reactive to proactive systems of care.

Improving service operations: linking safety culture to hospital performance

PurposeThe purpose of this paper is to examine the relationship between patient safety culture and hospital performance using objective performance measures and secondary data on patient safety culture.Design/methodology/approachPatient safety culture is measured using data from the Agency for Healthcare Research and Quality’s Hospital Survey on Patient Safety Culture. Hospital performance is measured using objective patient safety and operational performance metrics collected by the Centers for Medicare and Medicaid Services (CMS). Control variables were obtained from the CMS Provider of Service database. The merged data included 154 US hospitals, with an average of 848 respondents per hospital providing culture data. Hierarchical linear regression analysis is used to test the proposed relationships.FindingsThe findings indicate that patient safety culture is positively associated with patient safety, process quality and patient satisfaction.Practical implicationsHospital managers should focus on building a stronger patient safety culture due to its positive relationship with hospital performance.Originality/valueThis is the first study to test these relationships using several objective performance measures and a comprehensive patient safety culture data set that includes a substantial number of respondents per hospital. The study contributes to the literature by explicitly mapping high-reliability organization (HRO) theory to patient safety culture, thereby illustrating how HRO theory can be applied to safety culture in the hospital operations context.

Correlates of Patient Safety Performance among Nurses from Hospitals with Less than 200 Beds

Purpose: Although the patient safety is the first priority in hospitals, the safety strategies and supportive programs for nurses in medium and small-sized hospitals are still insufficient. The purpose of this study was to identify the correlates of patient safety performance related to characterist...

Progress at the Intersection of Patient Safety and Medical Liability: Insights from the AHRQ Patient Safety and Medical Liability Demonstration Program.

To identify lessons learned from the experience of the Agency for Healthcare Research and Quality (AHRQ) Patient Safety and Medical Liability (PSML) Demonstration Program. On September 9, 2009, President Obama directed the Secretary of Health and Human Services to authorize demonstration projects that put "patient safety first" with the intent of reducing preventable adverse outcomes and stemming liability costs. Seven demonstration projects received 3years of funding from AHRQ in the summer of 2010, and the program formally came to a close in June 2015. The seven grantees implemented complex, broad-ranging innovations addressing both patient safety and medical liability in "real-world" contexts. Some projects featured novel approaches, while others implemented adaptations of existing models. Each project was funded by AHRQ to collect data on the impact of its interventions. In addition, AHRQ funded a cross-cutting qualitative evaluation focused on lessons learned in implementing PSML interventions. Site visits and follow-up interviews supplemented with material abstracted from formal project reports to AHRQ. The PSML demonstration projects focused on three broad approaches: (1) improving communication around adverse events through disclosure and resolution programs; (2) preventing harm through implementation of clinical "best practices"; and (3) exploring alternative methods of settling claims. Although the demonstration contributed to accumulating evidence that these kinds of interventions can positively affect outcomes, there is also evidence to suggest that these interventions can be difficult to scale. In addition to producing at least preliminary positive outcomes, the demonstration also lends credence to the idea that targeted interventions that improve some aspect of patient safety or malpractice performance may also contribute more broadly to institutional culture and the alignment of all parties around reducing risk and preventing harm. However, more empirical work needs to be carried out to quantify the effect of such interventions.

Understanding patient safety performance and educational needs using the ‘Safety-II’ approach for complex systems

Participation in projects to improve patient safety is a key component of general practice (GP) specialty training, appraisal and revalidation. Patient safety training priorities for GPs at all career stages are described in the Royal College of General Practitioners’ curriculum. Current methods that are taught and employed to improve safety often use a ‘find-and-fix’ approach to identify components of a system (including humans) where performance could be improved. However, the complex interactions and inter-dependence between components in healthcare systems mean that cause and effect are not always linked in a predictable manner. The Safety-II approach has been proposed as a new way to understand how safety is achieved in complex systems that may improve quality and safety initiatives and enhance GP and trainee curriculum coverage. Safety-II aims to maximise the number of events with a successful outcome by exploring everyday work. Work-as-done often differs from work-as-imagined in protocols and guidelines and various ways to achieve success, dependent on work conditions, may be possible. Traditional approaches to improve the quality and safety of care often aim to constrain variability but understanding and managing variability may be a more beneficial approach. The application of a Safety-II approach to incident investigation, quality improvement projects, prospective analysis of risk in systems and performance indicators may offer improved insight into system performance leading to more effective change. The way forward may be to combine the Safety-II approach with ‘traditional’ methods to enhance patient safety training, outcomes and curriculum coverage.

Abstract PR599

Background & Objectives: Induction of anesthesia is a time of increased risk for surgical patients, especially in resource poor settings. Some of this risk may be due to errors in preparation, and the use of checklists is an effective strategy for risk reduction. We hypothesized that performance of a Pre-anesthetic Induction Patient Safety (PIPS) checklist would reduce errors in preparation as well as problems such as cardiopulmonary instability. Materials & Methods: A pre-checklist group was established by observing 72 non-consecutive anesthesia inductions in a single operating theater in a large referral hospital in Rwanda. The anesthesia providers were blinded to the data gathering. A baseline of errors in preparation and problems encountered during induction of anesthesia was established by assessing both preparation of critical materials at the time of induction and by observing physiologic instability such as hypoxemia, hypotension, cardiac arrest and death. A nine-point PIPS checklist was created using the frequency and types of deficiencies identified from the baseline risk data. Introduction and implementation of the PIPS checklist into the daily operating theater use included classroom training sessions followed by two weeks of training in the operating rooms. A post-checklist group was established by observing 48 non-consecutive cases during a follow-up period. Results: Baseline group and Intervention group demographics demonstrated no statistically significant differences. There was a significant reduction in problems encountered: hypoxemia, (29.2% vs.4.2%, p = 0.001); hypotension, (13.9% vs. 0%, p = 0.006); key personnel leaving the room during induction, (11.1 vs. 0%, p = 0.021); and overall cases with at least one error in preparation,(94.0% vs. 22.9%, p < 0.001). Major complications, defined as death, cardiac arrest, hypotension, or hypoxia were reduced (25% vs. 4.2%; odds ratio 0.08; 95% CI (0.01; 0.37); p<0.001). Multivariate adjustment did not significantly change these results. Conclusion: Proper performance of a PIPS checklist significantly decreases cardiopulmonary instability during induction and the rate of errors in preparation in a low resource setting.To our knowledge, this is the first study to show that performance of a PIPS checklist can reduce the rate of cardiopulmonary instability as well as reduce errors in preparation in the peri-induction period. This is an important step in establishing evidence to support routine use of a PIPS checklist for patients undergoing surgery.

Association Between Hospital Performance on Patient Safety and 30-Day Mortality and Unplanned Readmission for Medicare Fee-for-Service Patients With Acute Myocardial Infarction.

BackgroundLittle is known regarding the relationship between hospital performance on adverse event rates and hospital performance on 30‐day mortality and unplanned readmission rates for Medicare fee‐for‐service patients hospitalized for acute myocardial infarction (AMI).Methods and ResultsUsing 2009–2013 medical record‐abstracted patient safety data from the Agency for Healthcare Research and Quality's Medicare Patient Safety Monitoring System and hospital mortality and readmission data from the Centers for Medicare & Medicaid Services, we fitted a mixed‐effects model, adjusting for hospital characteristics, to evaluate whether hospital performance on patient safety, as measured by the hospital‐specific risk‐standardized occurrence rate of 21 common adverse event measures for which patients were at risk, is associated with hospital‐specific 30‐day all‐cause risk‐standardized mortality and unplanned readmission rates for Medicare patients with AMI. The unit of analysis was at the hospital level. The final sample included 793 acute care hospitals that treated 30 or more Medicare patients hospitalized for AMI and had 40 or more adverse events for which patients were at risk. The occurrence rate of adverse events for which patients were at risk was 3.8%. A 1% point change in the risk‐standardized occurrence rate of adverse events was associated with average changes in the same direction of 4.86% points (95% CI, 0.79–8.94) and 3.44% points (95% CI, 0.19–6.68) for the risk‐standardized mortality and unplanned readmission rates, respectively.ConclusionsFor Medicare fee‐for‐service patients discharged with AMI, hospitals with poorer patient safety performance were also more likely to have poorer performance on 30‐day all‐cause mortality and on unplanned readmissions.

재활전문병원 간호사의 환자안전문화에 대한 인식과 안전간호활동 수행의 관계

재활전문병원 간호사의 환자안전문화에 대한 인식과 안전간호활동 수행의 관계

요양병원 간호사의 환자안전인식도와 업무수행도 비교

본 연구는 요양병원 인증 조사기준을 근거로 요양병원 간호사의 환자안전 인식도와 환자안전 업무수행도 파악을 목적으로 하는 서술적 조사연구이다. 연구도구는 의료기관 평가인증원이 개발한 요양병원 인증 조사기준 항목 205개 중 환자안전과 관련된 39개 항목을 설문으로 사용하였다. 자료는 2015년 1월 5일부터 30일까지 수집되었으며, SPSS 21.0 통계프로그램을 이용하여 서술통계, t-test, ANOVA, Pearson’s correlation coefficient 으로 분석하였다. 간호사의 환자안전 인식도와 업무수행도의 평균은 각각 5점 만점에 4.36과 4.24였으며 두 변수간 차이는 통계적으로 유의하였다. 두 변수는 간호사의 높은 연령, 기혼자, 상급지위자, 많은 경력과 인증제를 알고 있는 간호사의 경우에 유의하게 높은 것으로 나타났다. 3개의 하부 영역내 인식도와 업무수행도 간에는 모두 유의한 정적인 상관관계가 있었으며, 환자진료체계내에서의 두 변수간 상관관계가 가장 높은 것으로 나타났다(r=.894, p<.001). 인증기준 항목 중 화재관련 기준들에 가장 낮은 인식도와 업무수행도를 보였다. 전반적으로 간호사들의 인식도는 업무수행도 보다 높은 것으로 나타났다. 따라서, 업무수행도를 인식도 수준까지 높힐 수 있는 가능한 환경과 프로그램을 개발하는 것이 필요하다.

Examining pathways to safety and financial performance in hospitals: A study of lean in professional service operations

Healthcare operates in a complex professional service environment that faces challenges in delivering high quality and affordable care – a set of goals that some healthcare professionals believe are incongruous. To consider opportunities to achieve these important outcomes, this study examines the relationships among comprehensive lean orientation, internal integration, patient safety, and financial performance. This study draws on the professional services operations (PSOs) literature stream to explain and offer a means of addressing the complexity of healthcare delivery. Grounded in dynamic capabilities, this study develops a model for improving financial performance and patient safety in hospitals. Using structural equation modeling, the model is tested with survey data from 211 acute care hospitals in the USA that are matched with data from two other sources – objective patient safety data from the Centers for Medicare and Medicaid Services and objective net income data from the American Hospital Directory. Results indicate that although a comprehensive lean orientation has a direct and positive impact on patient safety, it impacts financial performance indirectly through internal integration. The results have major implications for enhancing patient safety and financial performance in healthcare service organizations, and improving operations in PSOs more broadly.

Causes and Issues of High-risk Intravenous Medication Safety among Nurses

This survey study systematically investigated issues associated with medication-related procedures and elucidated the issues regarding high-risk intravenous medication safety among nurses. The results indicated that for nurses, high-risk intravenous medication safety issues included a lack of knowledge about administered medicines, patient confirmation negligence, inappropriate medicine management, inappropriate storage, lack of awareness about high-risk medicines, frequent verbal prescriptions, and confusion regarding packages and containers. This study therefore will contribute to improvements in nurses’ work satisfaction, patient safety, and medication-related knowledge and performance in terms of the safety of high-risk medicines requiring caution.

Treatment of breast fibroadenoma with high intensity focused ultrasound (HIFU): a feasibility study

Fibroadenomas are common, benign lesions of the breast. A minority of fibroadenomas will disappear without treatment, but most increase in size or remain unchanged. Current management of patients with fibroadenomas in the United States varies on a case by case basis and includes observation or surgical excision. Many patients find their fibroadenoma bothersome, and opt for surgical excision. The objectives of this study are to evaluate the safety and feasibility of Ultrasound guided High Intensity Focused Ultrasound (USgHIFU) delivered by the Echopulse device (Theraclion, Paris) for treatment of breast fibroadenomas. General patient safety, cosmetic outcome, tumor response, patient experience, physician/operator experience, and device performance will be assessed.

Transfusion Reduction in Gynecologic Surgery

INTRODUCTION: Data from the American College of Surgeons National Surgical Quality Improvement Project (NSQIP) showed that our center was an outlier in the area of blood transfusion at approximately 12%. Given the potential risks of unnecessary blood transfusions affecting patient safety, a performance improvement project was implemented to focus on preoperative and postoperative interventions to decrease transfusions in gynecologic surgery. Our goal was to be at the national NSQIP average of 6% by 6 months after starting this project. METHODS: We implemented a patient safety performance improvement project in 2012 that focused on obtaining an early blood count at the time of surgical consult, improving preoperative anemia with supplements and hormones, and educating surgeons about restrictive criteria for transfusions postoperatively. We then performed a retrospective chart review of all patients undergoing elective, non-cancer hysterectomy and myomectomy procedures from January 2013 through December 2014. We recorded the date of surgical consult and surgery and hemoglobin and hematocrit levels. All operative reports and discharge summaries were reviewed for blood transfusions. RESULTS: A total of 718 cases were reviewed for the performance improvement project. The transfusion rate was 6.9% in the first quarter and was 3.6% by the second quarter. A transfusion rate of less than 4% was maintained through December 2014. CONCLUSIONS: We described a performance improvement project with the focus on patient safety by addressing the preoperative and postoperative areas and educational sessions with surgeons regarding restrictive transfusion criteria. The project met the goal within the first six months and has sustained a successful reduction in blood transfusion for two years.

Linkages among organisational culture, knowledge management, and patient safety performance: evidence from a state hospital in a developing country

The present study aims to reveal the effects of organisational culture and knowledge management applications on patient safety performance. The sample of the study consists of nurses working in a state hospital with a 502-bed capacity in Turkey. The data were collected through a questionnaire. The analyses conducted revealed that there is a negative correlation between various aspects of organisational culture and patient safety performance. In this correlation, it was found that the strongest effect comes from developmental culture and the weakest effect comes from rational culture. A positive strong and significant correlation was found between applications of knowledge management techniques and patient safety performance. This correlation is most affected by knowledge dissemination and it is followed by knowledge acquisition and responsiveness of knowledge. Moreover, we found a significant correlation between knowledge management and organisational culture. Finally, the implications for practice and literature were discussed and suggestions were made for further research.