Reporting Patient Safety Events Research Articles

Exploring the safety reporting culture among healthcare practitioners in Saudi hospitals: a comprehensive 2022 national study

BackgroundWith the rise in medical errors, establishing a strong safety culture and an effective incident reporting system is crucial. As part of the Saudi National Health Transformation Vision of 2030, multiple projects have been initiated to periodically assess healthcare quality measures and ensure a commitment to continuous improvement. Among these is the Hospital Survey on Patient Safety Culture National Project (HSPSC), conducted regularly by the Saudi Patient Safety Center (SPSC). However, comprehensive tools for assessing reporting culture are lacking. Addressing this gap can enhance reporting, efficiency, and health safety.ObjectiveThis paper aims to investigate the reporting practices among healthcare professionals (HCPs) in Saudi Arabian hospitals and examine the relationship between reporting culture domains and other variables such as hospital bed capabilities and HCPs’ work positions.MethodsThe study focuses on measuring the reporting culture-related items measures and employs secondary data analysis using information from the Hospital Survey on Patient Safety Culture conducted by the Saudi Center for Patient Safety in 2022, encompassing hospitals throughout Saudi Arabia. Data incorporated seven items in total: four items related to the Response to Error Domain, two related to the Reporting Patient Safety Events Domain, and one associated with the number of events reported in the past 12 months.ResultsThe sample for the analyzed data included 145,657 HCPs from 392 hospitals. The results showed that the average positive response rates for reporting culture-related items were between 50% and 70%. In addition, the research indicated that favorable response rates were relatively higher among managerial and quality/patient safety/risk management staff. In contrast, almost half had not reported any events in the preceding year, and a quarter reported only 1 or 2 events. Pearson correlation analysis demonstrates a strong negative correlation between bed capacity and reporting safety events, response to error, and number of events reported (r = -0.935, -0.920, and − 0.911, respectively; p < 0.05), while a strong positive correlation is observed between reporting safety events and response to error (r = 0.980; p < 0.01).ConclusionsAlmost 75% of the HCPs reported fewer safety events over the last 12 months, indicating an unexpectedly minimal recorded occurrence variance ranging from 0 to 2 incidents.

Developing patient safety scale for hospitals.

The study aimed to contribute to the literature with a reliable and valid scale for hospitals to be used in determining the current patient safety culture and following up on its development. The study was conducted with the participation of 1137 healthcare professionals selected using the convenience sampling method in 3 secondary-care state hospitals and three research and training hospitals, one of which was affiliated with a medical faculty, and two were affiliated with the Health Sciences University. To begin with, to discover the latent structure of the items on the scale, an Exploratory Factor Analysis (EFA) was performed. Additionally, to determine the factor structure of the scale, the Confirmatory Factor Analysis (CFA) method was used. The Cronbach's alpha coefficient was calculated to check the reliability of the responses. According to Kaiser-Meyer-Olkin (KMO = 0.924) coefficient and the result of Bartlett's test of sphericity (χ 2 = 9748.777, df = 770), it was determined that the data structure was suitable for factor analysis. The Cronbach's alpha coefficient of the total scale was found to be 0.921. According to the EFA results, the scale was determined to have seven subscales, which were 1. Organizational Learning, Development, and Communication, 2. Management Support and Leadership, 3. Reporting Patient Safety Events, 4. Number of Personnel and Working Hours, 5. Response to Error, 6. Teamwork, and 7. Working Environment. The goodness-of-fit index results of the scale showed a good model fit (χ 2 / df = 3.04, RMSEA = 0.06, CFI = 0.97, NFI = 0.95, IFI = 0.97, SRMR = 0.06). The Cronbach's alpha coefficients of the subscales varied between 0.66 and 0.91. The results showed that the Patient Safety Scale for Hospitals is a valid and reliable measurement instrument for healthcare professionals.

Analysis of patient safety event report categories at one large academic hospital.

Given the persistent safety incidents in operating rooms (ORs) nationwide (approx. 4,000 preventable harmful surgical errors per year), there is a need to better analyze and understand reported patient safety events. This study describes the results of applying the Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) supported by the Teamwork Evaluation of Non-Technical Skills (TENTS) instrument to analyze patient safety event reports at one large academic medical center. Results suggest that suboptimal behaviors stemming from poor communication, lack of situation monitoring, and inappropriate task prioritization and execution were implicated in most reported events. Our proposed methodology offers an effective way of programmatically sorting and prioritizing patient safety improvement efforts.

The prevalence of incivility in hospitals and the effects of incivility on patient safety culture and outcomes: A systematic review and meta-analysis.

Workplace incivility is a barrier to safe and high-quality patient care in nursing workplaces and more broadly in tertiary hospitals. The present study aims to systematically review the existing evidence to provide a comprehensive understanding of the prevalence of co-worker incivility experienced and witnessed by nurses and other healthcare professionals, the effects of incivility on patient safety culture (PSC) and patient outcomes, and the factors which mediate the relationship between incivility and patient safety. A systematic review with narrative synthesis and meta-analysis was undertaken to synthesize the data from 41 studies. Databases searched included MEDLINE, PubMed, SCOPUS, CINAHL, PsycInfo, ProQuest, Emcare and Embase. Searches were conducted on 17 August 2021 and repeated on 15 March 2023. The pooled prevalence of experienced incivility was 25.0%. The pooled prevalence of witnessed incivility was 30.1%. Workplace incivility was negatively associated with the PSC domains of teamwork, reporting patient safety events, organization learning/improvement, management support for safety, leadership, communication openness and communication about error. The composite pooled effect size of incivility on these domains of PSC was OR = 0.590, 95% CI [0.515, 0.676]. Workplace incivility was associated with a range of patient safety outcomes (PSOs) including near misses, adverse events, reduced procedural and diagnostic performance, medical error and mortality. State depletion, profession, psychological responses to incivility, information sharing, help seeking, workload and satisfaction with organizational communication were found to mediate the relationship between incivility and patient safety. Experienced and witnessed incivility is prevalent in tertiary hospitals and has a deleterious effect on PSC and PSOs. A better understanding of the mechanisms of this relationship will support the development of interventions aimed at reducing both incivility and patient harm. This study quantifies the effect of incivility on PSC and outcomes. It provides support that interventions focusing on incivility are a valuable mechanism for improving patient care. It guides intervention design by highlighting which domains of PSC are most associated with incivility. It explores the profession-specific experiences of workplace incivility. This report adheres to PRISMA reporting guidelines. No patient or public contribution. The focus of this study is the nursing and healthcare workforce, therefore, patient or public involvement not required.

The impact of nuance DAX ambient listening AI documentation: a cohort study.

To assess the impact of the use of an ambient listening/digital scribing solution (Nuance Dragon Ambient eXperience (DAX)) on caregiver engagement, time spent on Electronic Health Record (EHR) including time after hours, productivity, attributed panel size for value-based care providers, documentation timeliness, and Current Procedural Terminology (CPT) submissions. We performed a peer-matched controlled cohort study from March to September 2022 to evaluate the impact of DAX in outpatient clinics in an integrated healthcare system. Primary outcome measurements included provider engagement survey results, reported patient safety events related to DAX use, patients' Likelihood to Recommend score, number of patients opting out of ambient listening, change in work relative values units, attributed value-based primary care panel size, documentation completion and CPT code submission deficiency rates, and note turnaround time. A total of 99 providers representing 12 specialties enrolled in the study; 76 matched control group providers were included for analysis. Median utilization of DAX was 47% among active participants. We found positive trends in provider engagement, while non-participants saw worsening engagement and no practical change in productivity. There was a statistically significant worsening of after-hours EHR. There was no quantifiable effect on patient safety. Nuance DAX use showed positive trends in provider engagement at no risk to patient safety, experience, or clinical documentation. There were no significant benefits to patient experience, documentation, or measures of provider productivity. Our results highlight the potential of ambient dictation as a tool for improving the provider experience. Head-to-head comparisons of EHR documentation efficiency training are needed.

Psychometric Analysis of the Indian Version of the Patient Safety Culture Tool (I-HSOPSC 2.0) Validation

Patient safety, which is both an overarching principle and a key factor in determining the quality of healthcare, continues to be a priority in healthcare systems on a global scale. A cross-sectional study in accredited Indian hospitals aimed to evaluate the HSOPSC V-2 (Hospital Survey on Patient Safety Culture). 1,603 healthcare professionals participated, assessing psychometric features using confirmatory factor analysis in SMART PLS 4. The average composite positive response rate was 64.8%. High positive responses (79%) were seen in ‘teamwork’, ‘communication about error’, and ‘hospital management support for patient safety’. However, ‘staffing and work pace’ (30%), ‘response to error’ (50%), ‘communication openness’, and ‘reporting patient safety events’ (both 59%) had lower positive responses, indicating room for improvement. Findings suggest I-HOSPSC 2.0’s content validity, reliability, and construct validity in measuring patient safety culture in Indian hospitals. It can aid administrators in assessing safety culture and improving patient safety and treatment efficacy. Notably, this is the inaugural HSOPSC V-2 validation research in the Indian healthcare context. Future research should explore the tool’s psychometric properties based on care setting levels due to substantial differences between public and private healthcare setups in India.

What Do We Know About Patient Safety Culture in Saudi Arabia? A Descriptive Study.

Patient safety is described as the prevention and mitigation of medical errors that can result in harm while a patient is receiving care. One important way to improve safety is through improving the patient safety culture in healthcare. The purposes of this study are to evaluate the patient safety culture trend in Saudi Arabia and assess the improvement over time. This study is a descriptive study that used a retrospective analysis of a national data set for 3 cycles from 2019 to 2022. To generate a baseline and allow comparison of the hospital's survey results with the aggregated findings from the database, the 10th, 25th, 50th, 75th, and 90th percentiles were calculated to set the percentage of values. Our results found that one of the barriers to developing a strong patient safety culture in Saudi Arabia is management support of patient safety, which caused a blame culture. This could explain the absence of improvement in the average percentage of reporting patient safety events for all 3 cycles. On the other hand, a decrease was observed in organizational learning/continuous improvement as well as a reduction in the positive percentage of patient safety ratings in the last cycle. Moreover, areas of strength in all 3 cycles did not reach the 75th percentile, whereas staffing and response to error domains remained the lowest-scoring composites in all cycles. Our results have determined the percentile of the positive rate that could guide hospitals to improve their culture survey results. More investigations can focus on change over the years in both patient safety culture and the effectiveness of implementing interventions to measure the impact on quality of care.

Implementation and Maturity of Clinical Learning Environment Components Across Pediatric Residency Programs.

Pediatric residency programs prioritize clinical learning environment components depending on resource availability, institutional constraints and culture, and accreditation requirements. However, there is limited literature on the landscape of implementation and maturity of clinical learning environment components across programs nationally. We used Nordquist's clinical learning environment conceptual framework to craft a survey around the implementation and maturity of learning environment components. We performed a cross-sectional survey of all pediatric program directors enrolled in the Pediatric Resident Burnout-Resiliency Study Consortium. Components with the highest implementation rates were resident retreats, in-person social events, and career development, while components least likely to be implemented were scribes, onsite childcare, and hidden curriculum topics. The most mature components were resident retreats, anonymous systems for reporting patient safety events, and faculty-resident mentoring programs, while the least mature components were use of scribes and formalized mentorship for trainees underrepresented in medicine. Learning environment components included in the Accreditation Council of Graduate Medical Education Program Requirements were significantly more likely to be implemented and mature than nonrequired components. To our knowledge, this is the first study to use an iterative and expert process to provide extensive and granular data about learning environment components for pediatric residencies.

Patient safety culture among healthcare professionals in Bhutan

Introduction: There is dearth of information regarding the status of patient safety culture in Bhutanese healthcare system. The aim of the study was to assess the baseline patient safety culture among the healthcare professionals working in different levels of hospitals in Bhutan. Methods: A cross-sectional study was conducted using the Hospital Survey on Patient Safety, version 2 (HSOPS2) questionnaire in 2021 in six District Hospitals (DHs), two Regional Referral Hospitals (RRHs), and one National Referral Hospital (NRH) in Bhutan. A total of 782 healthcare professionals were recruited into the study. EpiData version 3.0 and Statistical Package for Social Science (SPSS) version 28.0 were used to process data and conduct the statistical analysis on survey data including descriptive statistics and validity and reliability of survey. The internal consistency reliability of each composite measure was assessed by calculating Cronbach’s alpha score. Results: The overall level of patient safety culture was 61.28% (95% CI: 113.26, 115.27) and the percentage scores for the ten patient safety dimensions ranged from 45.13% to 82.65%. The dimension, “Teamwork within the hospital units” had the highest positive score while the dimensions, “Staffing and work pace” and “Reporting patient safety events” had the lowest positive scores. Conclusions: The healthcare professionals working in hospitals in Bhutan had average patient safety culture. To improve patient safety culture, more emphasis should be given on human resource management, patient safety event reporting system, hospital management support for patient safety and quality improvement initiatives and creating an environment that promote just and learning culture.

Assessing patient safety culture among healthcare professionals in Ibadan South-west region of Oyo State, Nigeria

Objectives Patient safety culture is essential to improve care, prevent adverse events, and deliver quality healthcare service. The levels of patient safety culture and adverse events in Nigerian healthcare institutions are still widely underreported. The main objective of this study was to assess patient safety culture among healthcare professionals in primary and secondary healthcare facilities in Ibadan South-west local government area of Oyo State, Nigeria. Methods In this cross-sectional study, investigators collected data with the English version of the Hospital Survey on Patient Safety Culture version 2.0 questionnaire. They analyzed data using the Statistical Package for the Social Sciences (SPSS) software with descriptive statistics, Pearson Correlation Analysis, and one-way analysis of variance. Results A total of 271 healthcare professionals participated in the study. Study findings showed the overall perception of patient safety culture to be 72.1%. Among patient safety dimensions, Teamwork (88.5%) and Reporting Patient Safety Events (47.4%) were the highest and lowest percentage of positive responses, respectively. Conclusions Patient safety culture is an emerging concept in Nigeria. The assessed dimensions showed the need to improve the safety culture among healthcare professionals. Therefore, stakeholders, policymakers, and managers should employ policies, strategies, and programs to enhance safety culture across all healthcare institutions.

The impact of an educational program on knowledge and perception of patient safety culture among nurses in the two medical colleges of Manipur: A quasi-experimental study.

Nurses' leaders are protracted as high-leverage players who would be instrumental in initiating or bettering the culture of safety in the hospital, with no previous intervention done for the same in Manipur. The aim of this study was to assess the effectiveness of an educational intervention program on patient safety culture among nurses in Manipur. A quasi-experimental study was conducted from July 2019 to December 2021 among the 32 nurses of two tertiary-level hospitals in Manipur. A structured questionnaire and Hospital Survey on Patient Safety Culture version 2 were used (Hospital Survey on Patient Safety Culture (HSOPSC) version 2.O (AHRQ, Rockyville, Maryland, USA)). A 2-day intervention based on the WHO's Multi-Professional Patient Safety Curriculum Guide was used. Data were collected before, immediately, and 3 months after the intervention. Data were summarized using descriptive using IBM SPSS 26. Paired t-test, Chi-square test, and t-test were employed to check for differences within and between the groups, and P < 0.05 was taken as statistically significant. The mean knowledge scores were comparable between the groups at baseline (7.13 ± 3.3, 8.44 ± 3.74; P = 0.142) but differed significantly at posttest and follow-up tests (P < 0.0001). The dimensions of "staffing and work pace" and "reporting patient safety events" had the lowest positive responses from both the groups at baseline. There is a significant increase in the total safety score from baseline to posttest and follow-up in the intervention group (P < 0.001). The study asseverated the effectiveness of an educational intervention in increasing the knowledge and perception of patient safety culture, but the results highlighted the need for training at regular intervals.

Cross-cultural adaptation and validation of the Chinese version of the revised surveys on patient safety culture™ (SOPS®) hospital survey 2.0

BackgroundSurveys on Patient Safety Culture™ (SOPS®) Hospital Survey (HSOPS 1.0), developed by the U.S. Agency for Healthcare Research and Quality in 2004, has been widely adopted in the United States and internationally. An updated version, the SOPS Hospital Survey 2.0 (HSOPS 2.0), released in 2019, has not yet been applied in China. The aim of the present study was to translate HSOPS 2.0 into Chinese version with cross-cultural adaptations and test its psychometric properties.MethodsA convenience sample was used. Hospital nurses (N = 1013) and a sub-set (n = 200) was invited for the re-test. A three-stage study was conducted. Firstly, the HSOPS 2.0 was translated by a panel. Secondly, the content validity was tested using the two-round Delphi method and cognitive interview. Next, the construct validity was tested by the confirmatory factor analysis and further demonstrated by the convergent validity, discriminant validity, and correlations with the outcome of patient safety. Thirdly, the reliability was tested by internal consistency reliability and re-test reliability.ResultsThe “float or PRN” and “manager” words were deleted as considered unfitted for the Chinese health care system. The content validity index provided evidence of strong content validity (I-CVI = 0.84 ~ 1.00, S-CVI = 0.98). Confirmatory factor analysis revealed a good model fit (χ2/df = 4.05, RMSEA = 0.06, CFI = 0.94) and acceptable factor loadings (0.41 ~ 0.97). Convergent validity, and discriminant validity supported the factorial structure of the Chinese version of HSOPS 2.0. Further evidence for the construct validity was derived from correlations with the outcome of patient safety (r = 0.10 ~ 0.41). A good internal consistency (Cronbach’s α = 0.68 ~ 0.93, McDonald’s omega = 0.84 ~ 0.96) and test-retest reliability (ICC = 0.78 ~ 0.95) showed acceptable reliability. Additionally, Chinese nurses reported markedly lower scores for three dimensions, including “Response to Error”, “Communication Openness”, and “Reporting Patient Safety Events”, when comparing the findings of this study with those from U.S. research utilizing the HSOPS 2.0.ConclusionThe Chinese version of HSOPS 2.0 demonstrated good validity and reliability in a Chinese sample of hospital nurses, which suggests that it can be used to measure nurse-perceived patient safety culture in future research and practice. Psychometric properties of the Chinese version of HSOPS 2.0 among other Chinese healthcare professionals remain to be confirmed.

The Effect of a System-Level Tiered Huddle System on Reporting Patient Safety Events: An Interrupted Time Series Analysis.

The objective of this research was to evaluate the effect of implementing a system-level tiered huddle system (THS) on the reporting of patient safety events into the official event reporting system. A quasi-experimental study using interrupted time series was conducted to assess the impact and changes to trends in the reporting of patient safety events pre- (February-July 2020; six months) and post- (September 2020-February 2021; six months) THS implementation within one health care system (238 clinics and 4 hospitals). The severity of harm was analyzed in July 2021 using a modified Agency for Healthcare Research and Quality (AHRQ) harm score classification. The primary outcome measure was the number of patient safety events reported per month. Secondary outcomes included the number of patient safety events reported per month by each AHRQ harm score classification. The system-level THS implementation led to a significant and immediate increase in the total number of patient safety events reported per month (777.73, 95% confidence interval [CI] 310.78-1,244.68, p = 0.004). Similar significant increases were seen for reported numbers of unsafe conditions, near misses, no-harm events that reached patients, and temporary harm (p < 0.05 for each). Reporting of events with permanent harm and deaths also increased but was not statistically significant, likely due to the small number of reported events involving actual harm. These findings suggest that system-level THS implementation may increase reporting of patient safety events in the official event reporting system.

Perceived Patient Safety Culture among Healthcare Providers in Southern Jordanian Hospitals during COVID-19 Pandemic

Background: The first step towards creating safe circumstances for patient care is to conduct thorough and ongoing assessments of the safety culture in the healthcare sector. Purpose: The purpose of this study was to assess healthcare professionals’ perceived culture of patient safety during the 2019 corona virus disease (COVID-19) outbreak in southern Jordanian hospitals. Methods: A descriptive, cross-sectional research of healthcare professionals (physicians, nurses and their administrators) was carried out. An Arabic translation of the Hospital Survey of Patient Safety Culture (HSPSC) questionnaire was used to collect information from 531 healthcare providers between July and November 2021 in four hospitals in Southern Jordan. Results: Nurses perceived ‘staffing’ as the highest dimension of the twelve dimensions of safety culture. However, they perceived ‘reporting patient safety events’ as the lowest dimension. The results show that healthcare providers perceived the twelve dimensions of patient safety culture as weakness areas that need improvement. The number of patient safety events reported by respondents in public hospitals was significantly (p&lt;0.05) higher than the number of those reported by respondents in private ones (2.4±0.71 vs. 2.8±0.98, respectively). Conclusions: Hospitals in southern Jordan need to improve their patient safety culture procedures as well as patient safety aspects, such as personnel, handoffs and reporting-related components. Implications for Nursing: Hospital policies need to be adopted in a way that enhances a blame-free culture and an organized safety education program for all healthcare providers, especially new staff. Healthcare providers should be motivated to work as a team through a more reasonable allocation of authority and commission of work. Keywords: Patient safety, Safety culture, Southern Jordan, COVID-19 pandemic

Team Work, Openness of Communication and Working Period for Reporting Patient Safety Events at the Regional General Hospital dr. ISKAK Tulungagung

Background: In 2021 RSUD Dr. Iskak Tulungagung again adopted a patient safety culture measure that was implemented for all hospital staff from several sources as the first step in a good patient safety program. Nurses are a component of human resources (HR) in the hospital health care system, who work directly on the front lines and have more time to deal with patients. Purpose: The purpose of this study is to analyze the influence of team work, communication openness and tenure on patient safety incident reporting at dr. ISK Tulungagung. Methods: The type of research conducted in this activity is an observational study with a cross-sectional design and using logistic regression statistical tests. The sample in this study were 406 respondents. Results: Based on the characteristics of the respondents, it showed that there were 304 female nurses and 102 male nurses. The longest working period was 6-10 years, namely 196 people. The results of the descriptive analysis show that the value of team work is 85%, the value of open communication is 83% and the cultural value of reporting patient safety incidents is 94%. Meanwhile, based on the statistical test results, the p-value is 0.001 &lt;0.05; p-value 0.001 &lt;0.05; and a p-value of 0.000 &lt;0.05. Conclusion: Thus showing that there isThe Influence of Team Work, Open Communication and Working Period on Reporting of Patient Safety Incidents at the Regional General Hospital dr. ISK Tulungagung.

Review of Reported Adverse Events Occurring Among the Homeless Veteran Population in the Veterans Health Administration.

United States veterans face an even greater risk of homelessness and associated medical conditions, mental health conditions, and fatal and nonfatal overdose as compared with nonveterans. Beginning 2009, the Department of Veterans Affairs developed a strategy and allocated considerable resources to address veteran homelessness and the medical conditions commonly associated with this condition. This study aimed to examine the Veterans Health Administration National Center for Patient Safety database for patient safety events in the homeless veteran population to mitigate future risk and inform policy. This was a retrospective, descriptive quality improvement study of reported patient safety events of homeless veterans enrolled in Veterans Health Administration care between January 2012 and August 2020. A validated codebook was used to capture individual patient characteristics, location and type of event, homeless status, and root causes of the events and proposed actions for prevention. Suicide attempt or death, elopement, delay in care, and unintentional opioid overdose were the most common adverse events reported for this population. Root causes include issues with policies, procedures, and care processes for managing and evaluating homeless patients for the risk of suicidal or overdose behaviors and discharge, poor interdisciplinary communication, and coordination of patient care. Actions included standardization of procedures for discharge, overdose and suicide risk, staff education, and purchasing new equipment. Suicide and opioid overdose are the most serious reported health care-related adverse events in the unsheltered homeless veteran population. Failures to recognize homelessness status, communicate status, and coordinate available services are root causes of these events.

Results of survey on perception of patient safety culture among emergency nurses in Jordan: Influence of burnout, job satisfaction, turnover intention, and workload

BackgroundPatient safety culture is an essential factor in the decreasing of medical errors and development of the institutions. This study was conducted to determine to what extent the selected variables, including age, weekly working hours, years of experience, burnout, turnover intention, workload, and job satisfaction, predict perceived patient safety culture among emergency nurses in Jordanian hospitals. MethodsA cross-sectional design with convenience sampling approach was used. A total of 157 emergency nurses from governmental and public hospitals were participated in the study and completed the study's survey: Hospital Survey on Patient Safety Culture (PSC), Copenhagen Burnout Inventory–Student Survey (CBI–SS), NASA Task Load Index (NASA-TLX), Nursing Workplace Satisfaction Questionnaire (NWSQ) and turnover intention scale (TIS). ResultsThe results showed that there was a negative relationship found between nurses’ age and PSC perception (r=−.166, P=.039), personal burnout and PSC (r=−.160, P=.048), and there was also a negative relationship between turnover intentions and perceived PSC (r=−.334, P=.000). The results from the regression model indicated that turnover intentions, reporting patient safety events, and the number of events reported predicted PSC. The results showed that R2=.29, adjusted R2=.287, F(6,141)=9.45, P<0.01. ConclusionOur results suggests that nurses’ managers may pay attention to decreasing burnout and analyze turnover intention among nurses in order to improve the culture of patient safety.

A prospective parallel cohort study comparing a novel multi-priority emergency surgery waitlist management system to a paper-based system at a Canadian hospital

BackgroundApproximately 20% of all surgery performed in Canada is scheduled by allocation into emergency operating room time. There is currently no national standard for managing how this mixture of emergent, urgent, and semi urgent surgical cases should progress to the operating room. MethodsWe introduced a novel dynamic multi priority emergency surgery waitlist management system to a medium-sized Canadian acute care hospital from December 1, 2018 to February 28, 2019. Our hospitals critical incident reporting system was monitored before and during the study for any evidence of related adverse patient safety events. Internet-based user acceptance surveys were collected from users at 28 days and 89 days into the study. Results703 operations were scheduled for 684 patients. The electronic system was reliable and had no outages or shutdowns over 89 days. There was no detectable change in the incidence of adverse patient safety events during the study. Overall, there were 54 system users enrolled in the study. The user acceptance survey results were not statistically significant but did show a preference for the new scheduling system in the surgeon user group, all other users preferred the original system. DiscussionWhile there are evident efficiencies from the use of information systems in other industries the safe introduction of a such a system in the emergency surgery setting has never been fully realized. The authors relate the development of the novel multi-priority emergency surgery waitlist management system that was introduced in this study. The challenges of implementing this system and the limitations of the study are discussed. ConclusionThe introduction of a novel emergency surgery waitlist management system into this active operating room setting for 89 days was not associated with a change in reported patient safety events. The tested system was reliable and was preferred by some surgeon users.

A resident-led initiative to improve patient safety event reporting in an internal medicine residency program

ABSTRACT Background Despite the Clinical Learning Environment Review’s recommendations of their use, patient safety event reporting systems are underutilized by residents. Objective We aimed to identify perceived barriers to event reporting amongst internal medicine residents and implement a targeted quality improvement initiative to address the identified barriers and increase overall resident event report rates. Methods A total of 94 Internal Medicine (IM) residents participated in the educational intervention in 2018. We measured residents’ perception of barriers to event reporting and employed the results of the questionnaire to create a skill-based educational workshop. We conducted the plan-do-study-act model to test a structured educational intervention and its effectiveness on pre-post IM residents’ event report rates and compared it to report rates of Non-Internal Medicine (Non-IM) residents. Additionally, we assessed pre-post intervention knowledge, skills, and attitudes in event reporting. Results 94/94 (100%) of IM residents had a significantly higher median percent of patient safety event reporting when compared to pre-intervention (23.6% compared to 5.88%, p-value = 0.0030) and when compared to Non-IM residents (23.6% compared to 5.31%, p-value = 0.0002). Residents performed better on the post-test compared to the pre-test (90% compared to 30%, p-value = 0.0001) for knowledge. 100% of the critical action items were completed and 90% of participants reported their perception of the event reporting process improved. Conclusions By elucidating common reasons why residents are not reporting patient safety events, a specific intervention can be created to target the identified impediments and improve resident event reporting. Abbreviations IM: Internal Medicine IM; Non-IM: Non-Internal Medicine; IOM: Institute of Medicine I; ACGME CLER: Accreditation Council for Graduate Medical Education Clinical Learning Environment Review; GME: Graduate Medical Education; IRB: Institutional Review Board; PDSA: Plan, Do, Study, Act

Impact of a Preoperative Safety Checklist on Perioperative Quality Outcomes and Operative Efficiency.

Additional preoperative safety checklist requirements at Penn State Health were recently implemented on the morning of surgery. We evaluate whether this added safety policy impacted reported adverse patient safety events and institutional operating room performance indicators. Key operating room performance indicators from fiscal years 2016 through 2019 quarter 2 were reviewed. Additional attestation requirements by the attending surgeon were implemented at start of fiscal year 2018 (July 1, 2017). All reported perioperative patient safety events during this time were reviewed with events classified into one of 8 select categories. Total operative case volume was 49,894 cases in fiscal years 2016 and 2017, and 36,533 in fiscal years 2018 and 2019 through quarter 2 (p <0.10). Mean operating room use was 81% in both groups (p <0.46). First case on time start rates decreased from 79.5% to 58%, respectively (p <0.0001). Mean turnover time between cases also increased from 35 minutes to 40 minutes, respectively (p <0.0001). There were 252 patient events (0.51%) in fiscal years 2016 and 2017 compared to 94 (0.26%) events in fiscal years 2018 and 2019 through quarter 2 following implementation of the surgical safety checklist (p <0.0001). The number of incomplete preoperative checklists (39 vs 14, p=0.008) and missing/incomplete patient identification bands (15 vs 2, p=0.004) were also decreased between fiscal years 2016 and 2017, and fiscal years 2018 and 2019 through quarter 2, respectively. A day-of-surgery safety checklist decreased the number of reported patient safety events but with a negative impact on standard metrics of operating room productivity for 18 months following implementation. Further study is necessary to determine if these effects persist over time.