Patient Safety Risks Research Articles

Microbial Load of Hand Sanitizer Dispensers—A University Hospital Study

Hospital-acquired infections are a significant concern in healthcare settings, leading to patient safety risks, increased morbidity and mortality, and financial burdens. Hand hygiene is crucial in preventing the spread of bacteria in hospitals and communities. Manual hand sanitizer dispensers can harbor presumptive pathogenic bacteria and act as fomites for bacterial transmission. This study aimed to assess the microbial contamination of manual hand sanitizer dispensers in a hospital setting and to study their antibiotic resistance profiles. Samples were collected using sterile cotton swabs and then inoculated into brain heart infusion broth. Subsequent subcultures were performed on both blood and MacConkey agar. The isolates were then identified using the Bruker MALDI Biotyper (Bruker Daltonik, Bremen, Germany) to the species level. Sampling was conducted in various wards and in the hospital and the University areas on dispenser levers and nozzle areas. The results showed that all samples yielded one or more bacterial species. Bacterial isolates identified belonged to species commonly found on the skin microflora and some Gram-negative enteric bacilli. Higher colonization was observed on the dispenser lever. Among Gram+ microorganisms, most bacterial species were shown to be sensitive to β-lactams, with the exception of Staphylococcus spp., resistant to AMP (Ampicillin) and Penicillin. However, no Methicillin resistant isolates were detected. Gram− microorganisms such as Pseudomonas luteola were shown to be sensitive to all tested antibiotics, while Pantoea agglomerans was shown to be resistant to AMC (amoxicillin–clavulanic acid). Rifampicin tested only against Bacilli showed resistance. Based on the findings, it is recommended to implement systematic cleaning and proper maintenance of manual dispenser areas or to use automated dispensers to reduce hand contact and minimize microbial contamination. Monitoring the presence of microorganisms in hand sanitizing gels and dispensers is an essential infection control strategy.

Measuring transitional patient safety: Adaptation and validation of the German version of the Care Transitions Measure

IntroductionThe transition between different care contexts, especially during discharge from inpatient treatment to home, is associated with risks for patient safety. Internationally established, the Care Transitions Measure (CTM) is used to assess the quality and safety of this transition from the patients’ perspective. A systematic and standardized assessment of quality and safety in the discharge process from the patients’ perspective has not been possible in German-speaking countries due to the lack of a German adaptation and validation of the CTM. This study aims to translate, adapt, and validate the CTM for use in German-speaking countries MethodsThe German version of the CTM was developed based on internationally accepted recommendations for translating and adapting questionnaires. Patients of all departments (except pediatric departments) of a German university hospital who were discharged home after at least three days of inpatient treatment received the questionnaire by mail between May and August 2022. A total of 806 patients participated in the survey. The validity of the CTM was tested by factor analyses. For this purpose, different factor models were compared. In addition, the measurement invariance of the instrument was examined. ResultsThe construct validity of the long version of the CTM (15items) with a two-factorial model structure was confirmed with good model fit indices. The two subscales had excellent internal consistency. In addition, the one short version with four items achieved excellent model fit indices and high internal consistency. For the long version of the CTM, measurement invariance was confirmed for all sociodemographic, care-related, and survey response characteristics examined. The measurement invariance of the short version was only partially confirmed. DiscussionThe validity and reliability of the German version of the CTM were confirmed. In its long version, the instrument is measurement invariant across various characteristics and thus allows valid interpretation of group differences. The short version is partially measurement invariant and is suitable as a screening instrument for assessing the quality and safety of discharge processes due to its high validity and reliability. ConclusionsWith a validated and standardized German version of the CTM, an instrument is now available to assess the quality and safety of the discharge process from the patients’ perspective. Thus, this study provides an essential tool for systematically investigating and optimizing patient safety in the discharge process.

Tata Kelola Rekam Medis Berbasis Elektronik Pada Kunjungan Harian Pasien Rawat Jalan Menggunakan Metode RAD

Problems faced in the governance of electronic-based medical records in outpatient daily visits include the lack of governance standards, inconsistencies in data collection, and low interoperability between existing systems. These problems can lead to errors in diagnosis, less efficient treatment, and increased patient safety risks. In order to solve these problems, the RAD (Rapid Application Development) method was proposed as a solution. This method involves a needs analysis phase conducted by listening to stakeholders, identifying existing problems, and designing a suitable solution. The use of the RAD method can provide significant results. After the implementation of the RAD method, the results showed significant improvement. Clear and measurable governance standards have been implemented to ensure consistency and accuracy in data collection. In addition, faster system development is also possible through the implementation of the RAD method, thus overcoming the technical challenges associated with electronic medical records. Overall, the results of applying the RAD method in the governance of electronic-based medical records on daily outpatient visits have successfully addressed the existing problems. This method can be widely applied in clinical practice to improve efficiency, quality of care and patient safety.

Development and validation of a theory-based questionnaire examining barriers and facilitators to discontinuing long-term benzodiazepine receptor agonist use

BackgroundLong-term use of benzodiazepine receptor agonists (BZRAs) is a persistent healthcare challenge and poses patient safety risks. Interventions underpinned by behaviour change theory are needed to support discontinuation of long-term BZRA use. The aim of this study was to develop and validate a questionnaire based on the Theoretical Domains Framework (TDF) to examine mediators of behaviour change relating to the discontinuation of long-term BZRA use. MethodsAn initial 52 item questionnaire was developed using the 14 domains of TDF version 2 and iteratively refined over two rounds. The questionnaire was disseminated online via online support groups that focused on BZRAs to community-based adults with either current or previous experience of taking BZRAs on a long-term basis (≥3 months). Confirmatory factor analysis was undertaken to assess the questionnaire's reliability, discriminant validity and goodness of fit. The Standardized Root Mean Square Residual (SRMR), Root Mean Square Error of Approximation (RMSEA) and Comparative Fit Index (CFI) were calculated. ResultsFollowing an iterative process of adjustment, the results obtained from confirmatory factor analysis resulted in the final questionnaire consisting of 29 items across nine theoretical domains. The internal consistency reliability values across these domains ranged from 0.62 to 0.85. For the final model, the SRMR was 0.23, the RMSEA was 0.11 and the CFI was 0.6. ConclusionsThe questionnaire offers a potential tool that could be used to identify domains that need to be targeted as part of a behaviour change intervention at an individual patient level. Further research is needed to assess the questionnaire's acceptability and usability, and to develop a scoring system so that domains can be prioritised and subsequently targeted as part of an intervention.

Sky-High Safety? A Qualitative Study of Physicians' Experiences of Patient Safety in Norwegian Helicopter Emergency Services.

Patients treated and transported by Helicopter Emergency Medical Services (HEMS) are prone to both flight and medical hazards, but incident reporting differs substantially between flight organizations and health care, and the extent of patient safety incidents is still unclear. A qualitative descriptive study based on in-depth interviews with 8 experienced Norwegian HEMS physicians from 4 different bases from February to July 2020 using inductive qualitative content analysis. The study objectives were to explore the physicians' experience with incident reporting and their perceived areas of risk in HEMS. The HEMS physicians stated that the limited number of formal incident reports was due to the "nature of the HEMS missions" and because reports were mainly relevant when deviating from procedures, which are sparse in HEMS. The physicians preferred informal rather than formal incident reporting systems and reporting to a colleague rather than a superior. The reasons were ease of use, better feedback, and less fear of consequences. Their perceived areas of risk were related to all the phases of a HEMS mission: the physician as the team leader, medication errors, the handover process, and the helicopter as a work platform. The sparse, informal, and fragmented incident reporting provides a poor overview of patient safety risks in HEMS. Focusing on organizational factors and system responsibility and research on environmental and contextual factors are needed to further improve patient safety in HEMS.

Consultants’ and referrers’ perceived barriers to closing the cross-institutional referral loop, and perceived impact on clinical care

BackgroundCross-institutional (external) referrals are prone to communication breakdowns, increasing patient safety risks, clinician burnout, and healthcare costs. To close these external referral loops, referring primary care physicians (PCPs) need to receive patient information from consultants at different healthcare institutions. Although existing studies investigated the early phases of external referral loops, we lack sufficient knowledge about the closing phases of these loops. This knowledge could allow health care institutions to improve care coordination and rates of closed referral loops by implementing socio-technical interventions for patient information exchange throughout a referral loop. Human factors engineering (HFE) provides a systematic approach to advance our understanding of barriers perceived by physicians. Using HFE, our objective was to characterize referring and consulting physicians’ barriers to closing referral loops and implications for care. MethodsThis qualitative cross-sectional study included semi-structured interviews with referrers and external consultants. We used the Systems Engineering Initiative for Patient Safety 2.0 framework to conduct rapid qualitative analyses, determining perceived barriers and related implications. Main measures were consultants’ and referrers’ perceptions of, and experiences with, barriers to external referrals. ResultsSix referring PCPs and 12 consultants participated from two healthcare systems and four medical specialties. Physicians perceived three main barriers in external referrals: receipt of excessive and unnecessary faxed documents, missing or delayed documentation, and organizational policies regarding information privacy interfering with closing the loop. Compared to internal referrals, physicians reported increased staff burden, patient frustration, and delays in diagnosis with external referrals. Consultants reported the ability to provide the same level of care to patients with internal or external referrals. However, consultants described communication breakdowns that prohibited confirmation of follow-up plan retrieval, initiation, or effectiveness. ConclusionPhysicians reported technological and organizational barriers to closing cross-institutional referral loops. Promises of HIE technology for external referrals have not fully materialized. Among physicians and patients, retrieval and exchange of medical information increases perceived workload, burden, and frustration. These increases are not accurately captured by traditional organizational metrics. This study provides evidence that informs future human factors engineering research to address perceived barriers and guide future HIE design or implementation.

Risk management in a medical organization

The introduction of ISO 9001:2015 standards into widespread clinical practice is one of the priorities for managing the quality of medical care. The risk-oriented approach is an essential component of standardization under the ISO system. The article proposes an algorithm for managing patient safety risks in a medical organization and general rules for developing a corrective risk program.

The delivery of safe and effective test result communication, management and follow-up.

This paper reports on a program of research funded by a National Health and Medical Research Council (NHRMC) partnership grant (2015-2021) entitled "Delivering safe and effective test result communication, management and follow-up". The project's objectives were to: 1) improve the effectiveness and safety of test-result management through the establishment of clear governance processes of communication, responsibility, and accountability; 2) harness health information technology to inform and monitor test-result management; and 3) enhance consumer contribution to the establishment of safe and effective test-result management systems. Type of program: The partnership project addressed its key objectives through: i) the development of a consumer-driven approach; ii) using diagnostic stewardship and digital health to enhance safety and quality; iii) identifying clinical workflows that can lead to timely and meaningful communication; and iv) contributing to the Royal College of Pathologists of Australasia and Australasian Association for Clinical Biochemistry and Laboratory Medicine's work on nationally harmonised alert thresholds for critical laboratory results. The project employed a convergent mixed-methods approach using multistage studies across hospitals in South Eastern Sydney and Illawarra and Shoalhaven Local Health Districts. A consumer-centred approach, including patient reference groups and community forums, was used to identify mechanisms to enhance consumers' role in test-management governance processes and inform the direction of the research and interpretation of findings. Results and lessons learnt: The body of evidence generated by the project highlights the multilayered and interconnected components required to achieve safe and effective test results management. Addressing the significant patient safety risk associated with the failure to follow-up test results must include consideration of diagnostic clinical work tasks (involving multiple people across numerous clinical settings) and embrace patient-centred and digital health strategies for shared information and timely and meaningful communication.

Mapping Processes in the Emergency Department Using the Functional Resonance Analysis Method.

Emergency departments (EDs) are dynamic, complex, and demanding environments. Introducing changes that lead to improvements in EDs can be challenging owing to the high staff turnover and mix, high patient volume with different needs, and being the front door to the hospital for the sickest patients. Quality improvement is a methodology applied routinely in EDs to instigate change to improve several outcomes such as waiting times, time to definitive treatment, and patient safety. Introducing the changes needed to transform the system in this way is seldom straightforward with the risk of "not seeing the forest for the trees" when attempting to change the system. In this article, we demonstrate how the functional resonance analysis method can be used to capture the experiences and perceptions of frontline staff to identify the key functions in the system (the trees), to understand the interactions and dependencies between them to make up the ED ecosystem ("the forest") and to support quality improvement planning, identifying priorities and patient safety risks.

Healthcare resilience: a meta-narrative systematic review and synthesis of reviews

ObjectivesThe COVID-19 pandemic has tested global healthcare resilience. Many countries previously considered ‘resilient’ have performed poorly. Available organisational and system frameworks tend to be context-dependent and focus heavily on physical...

374 Cognitive Biases and Heuristics in Surgical Settings: A Systematic Review

Abstract Aim Cognitive biases and heuristics represent mental shortcuts that can lead to errors in judgement. Both are noted in surgical settings and risk patient safety. Yet, up till now, the extent of biases in surgical settings has not been systematically reviewed. Method This PROSPERO registered (CRD42022334828) review was conducted in accordance with PRISMA guidelines. MEDLINE and four other major databases were searched from their inception to 28th August 2022 using “surg*” with “cognitive bia*” and “heuristics” terms. Original primary research studies in English were included, with blinded full text screening. Relevant risk of bias (RoB) tools were employed for each study. Results The search identified 26,640 papers. Following de-duplication and screening, 16 final papers were included. 34 biases were identified including three prospective experiments, three retrospective analyses, and 10 questionnaire studies. Confirmation and anchoring biases were the most represented. RoB analysis found broad heterogeneity, with four studies being deemed of high risk. All identified cognitive biases were found to influence relevant surgical outcomes and seven studies cited a negative impact on patient care. Conclusions Cognitive biases will continue to contribute to surgical errors and never events unless they are described and recognised with greater precision and de-biasing strategies are implemented. Of note, mindfulness-based training and deliberate reflection tested by two studies demonstrated reduced rates of surgical error. Nevertheless, our review demonstrates a lack of experimental studies which are crucial to understanding why and how biases contribute to negative outcomes and we suggest avenues for further research and systems change.

Risk-Adjusted Cumulative Sum for Early Detection of Hospitals With Excess Perioperative Mortality

National surgical quality improvement programs lack tools for early detection of quality or safety concerns, which risks patient safety because of delayed recognition of poor performance. To compare the risk-adjusted cumulative sum (CUSUM) with episodic evaluation for early detection of hospitals with excess perioperative mortality. National, observational, hospital-level, comparative effectiveness study of 697 566 patients. Identification of hospitals with excess, risk-adjusted, quarterly 30-day mortality using observed to expected ratios (ie, current criterion standard in the Veterans Affairs Surgical Quality Improvement Program) was compared with the risk-adjusted CUSUM. Patients included in the study underwent a noncardiac operation at a Veterans Affairs hospital, had a record in the Veterans Affairs Surgical Quality Improvement Program (January 1, 2011, through December 31, 2016), and were aged 18 years or older. Number of hospitals identified as having excess risk-adjusted 30-day mortality. The cohort included 697 566 patients treated at 104 hospitals across 24 quarters. The mean (SD) age was 60.9 (13.2) years, 91.4% were male, and 8.6% were female. For each hospital, the median number of quarters detected with observed to expected ratios, at least 1 CUSUM signal, and more than 1 CUSUM signal was 2 quarters (IQR, 1-4 quarters), 8 quarters (IQR, 4-11 quarters), and 3 quarters (IQR, 1-4 quarters), respectively. During 2496 total quarters of data, outlier hospitals were identified 33.3% of the time (830 quarters) with at least 1 CUSUM signal within a quarter, 12.5% (311 quarters) with more than 1 CUSUM signal, and 11.0% (274 quarters) with observed to expected ratios at the end of the quarter. The CUSUM detection occurred a median of 49 days (IQR, 25-63 days) before observed to expected ratio reporting (1 signal, 35 days [IQR, 17-54 days]; 2 signals, 49 days [IQR, 26-61 days]; 3 signals, 58 days [IQR, 44-69 days]; ≥4 signals, 49 days [IQR, 42-69 days]; trend test, P < .001). Of 274 hospital quarters detected with observed to expected ratios, 72.6% (199) were concurrently detected by at least 1 CUSUM signal vs 42.7% (117) by more than 1 CUSUM signal. There was a dose-response relationship between the number of CUSUM signals in a quarter and the median observed to expected ratio (0 signals, 0.63; 1 signal, 1.28; 2 signals, 1.58; 3 signals, 2.08; ≥4 signals, 2.49; trend test, P < .001). This study found that with CUSUM, hospitals with excess perioperative mortality can be identified well in advance of standard end-of-quarter reporting, which suggests episodic evaluation strategies fail to detect out-of-control processes and place patients at risk. Continuous performance evaluation tools should be adopted in national quality improvement programs to prevent avoidable patient harm.

SP7.6 Do we need Routine Histopathological Examination of Gall Bladder Specimens after Cholecystectomy?

Abstract Aims Gall bladder diseases usually manifest as gall stones, inflammation of gall bladder and gall bladder cancer. There had been a constant debate over the years regarding selective vs. routine histopathological assessment of all gall bladder specimens. This study was aimed to assess the safety of adopting the policy of selective histopathological examination of those gall bladder specimens with pre-operative and/or intra-operative suspicion of malignancy without risking patient safety. Methodology A descriptive, cross-sectional study was conducted. All 1285 cases of gall bladder biopsies done after elective cholecystectomies, during a period of 2 years from 1st January, 2018 to 31st December 2019, were reviewed retrospectively. Results During the study period, a total of 1285 gall bladder specimens were submitted for histopathological analysis. Chronic cholecystitis was found in 1020 (79.3%) patients, acute cholecystitis in 198 (15.4%), gangrenous gall bladder in 19 (1.47%) patients and gall bladder carcinoma (GBC) in 26 (2.02%) patients. Pre-operative or intraoperative diagnosis of GBC was made in 22/26 patients. The remaining 4 patients had either stage Tis or T1 stage carcinoma and did not require revision surgery. Conclusion In areas with low incidence of gall bladder carcinoma, a selective approach of histopathological examination of gall bladder specimens may be considered safe. Such selective approach is more economical and reduces the work burden of pathologists without risking patient safety.

Unintended consequences of the electronic health record and cognitive load in emergency department nurses

AimThe study aimed to explore the relationship between the unintended consequences of the electronic health record and cognitive load in emergency department nurses. MethodsThe study utilized a correlational quantitative design with a survey method approach. This study had a 30.4 % response rate for a total of 304 ED nurse participants who were members of a national ED nursing organization. Data analysis included descriptive and correlational measurements of two instruments. ResultsIn this study, there was a statistically significant, weak negative relationship between CL and UC-EHR in ED nurses, rs (264) = −0.154, p 0.002. Although a significant weak relationship was identified in this study, the study variables, subscales, and demographic data groupings presented moderate-to-strong positive, statistically significant correlations. Descriptive frequency data unveiled EHR stimulated patient safety threats occurring once a week to monthly. ConclusionsThe novelty of this research study provided profound implications for the future of nursing practice, policy, and nursing science. EHR optimization to minimize patient safety risks is recommended with the inclusion of end-users from this study's identified subgroups. The researchers propose a reduction of EHR burden in nursing practice.

Cancer Patients’ Experience of a Patient-Safe Pathway Is Associated with Health Literacy and Support from Relatives: A Cross-Sectional Survey

Introduction. The aim was to assess the impact of cancer patients’ health literacy (HL) on their experience of patient safety. Furthermore, we investigated whether support from relatives affected cancer patients’ experiences of patient safety. Methods. A cross-sectional study was conducted using questionnaire data from the Danish National Cancer Patient Survey 2017 among Danish cancer patients (n = 5,389) and sociodemographic characteristic data from national registries. Results. A low level of HL is associated with increased patient safety errors among cancer patients regarding patient-reported adverse events and an experience of inadequate information. Results also showed increased odds of patient safety risks among patients with no support from relatives. Conclusion. Having a low level of HL or no support from relatives has a negative impact on patient safety. Focusing on improvements related to cancer patients’ HL and supportive network may increase patients experiencing a high quality and safe health care system and reduce inequalities and inequity in the cancer pathway.

Home practice for robotic surgery: a randomized controlled trial of a low-cost simulation model

Pre-operative simulated practice allows trainees to learn robotic surgery outside the operating room without risking patient safety. While simulation practice has shown efficacy, simulators are expensive and frequently inaccessible. Cruff (J Surg Educ 78(2): 379–381, 2021) described a low-cost simulation model to learn hand movements for robotic surgery. Our study evaluates whether practice with low-cost home simulation models can improve trainee performance on robotic surgery simulators. Home simulation kits were adapted from those described by Cruff (J Surg Educ 78(2): 379–381, 2021). Hand controllers were modified to mimic the master tool manipulators (MTMs) on the da Vinci Skills Simulator (dVSS). Medical students completed two da Vinci exercises: Sea Spikes 1 (SS1) and Big Dipper Needle Driving (BDND). They were subsequently assigned to either receive a home simulation kit or not. Students returned two weeks later and repeated SS1 and BDND. Overall score, economy of motion, time to completion, and penalty subtotal were collected, and analyses of covariance were performed. Semi-structured interviews assessed student perceptions of the robotic simulation experience. Thirty-three medical students entered the study. Twenty-nine completed both sessions. The difference in score improvement between the experimental and control groups was not significant. In interviews, students provided suggestions to increase fidelity and usefulness of low-cost robotic home simulation. Low-cost home simulation models did not improve student performance on dVSS after two weeks of at-home practice. Interview data highlighted areas to focus future simulation efforts. Ongoing work is necessary to develop low-cost solutions to facilitate practice for robotic surgery and foster more inclusive and accessible surgical education.

Deployment of an Automated Method Verification-Graphical User Interface (MV-GUI) Software

Clinical laboratories frequently conduct method verification studies to ensure that the process meets quality standards for its intended use, such as patient testing. They play a pivotal role in healthcare, but issues such as accurate statistical assessment and reporting of verification data often make these studies challenging. Missteps can lead to false conclusions about method performance, risking patient safety or leading to incorrect diagnoses. Despite a requirement for accredited labs to document method performance, existing solutions are often expensive and complex. Addressing these issues, we present Method Verification-Graphical User Interface (MV-GUI), a software package designed for ease of use. It is platform-independent, capable of statistical analysis, and generates accreditation-ready reports swiftly and efficiently. Users can input patient data from one or more .CSV files, and MV-GUI will produce comprehensive reports, including statistical comparison tables, regression plots, and Bland–Altman plots. While method validation, which establishes the performance of new diagnostic tools, remains a crucial concern for manufacturers, MV-GUI primarily streamlines the method verification process. The software aids both medical practitioners and researchers and is designed to be user-friendly, even for non-experienced users. Requiring no internet connection, MV-GUI can operate in restricted IT environments, making method verification widely accessible and efficient.

The effect of clinical risk management training on patient safety competency and related aspects in nursing students

Background Students’ exposure to clinical risk management during their studentships can improve their safety competency, comfort speaking up about patient safety, and attitudes toward patient safety education. This study aimed to determine the effect of clinical risk management training on nursing students’ patient safety competency, attitudes toward broader aspects of patient safety in professional education, and comfort in speaking up about patient safety. Methods This experimental study used stratified sampling to assign 56 nursing students to intervention and control groups (28 students in each group). The intervention group received clinical risk management training in three three-hour sessions. The Health Professional Education in Patient Safety Survey was used to collect data from both groups before and one month after the intervention. Results The study found no statistically significant difference in patient safety competency and its subscales between the intervention and control groups in the pretest stage, but these competencies increased significantly in the intervention group in the post-test stage compared to the control group. The mean scores of attitudes toward broader aspects of patient safety in professional education and comfort speaking up about patient safety did not differ significantly between the intervention and control groups in the pre-test stage, but they increased significantly in the intervention group in the post-test stage compared with the control group. Conclusion It is recommended that clinical risk management and patient safety training be applied to the nursing curriculum so that nursing students become competent to provide safe care in clinical settings.

Evaluation of Replies to Voice Queries in Gynecologic Oncology by Virtual Assistants Siri, Alexa, Google, and Cortana

Women that receive news that they have a malignancy of gynecologic origin can have questions about their diagnosis. These questions might be posed as voice queries to the virtual assistants Siri, Alexa, Google, and Cortana. Because our world has increasingly adopted smart phones and standalone voice query devices, this study focused on the accuracy of audible replies by the virtual assistants (VAs) Siri, Alexa, Google, and Cortana to voice queries related to gynecologic oncology. Twenty-one evaluators analyzed VA audible answers to select voice queries related to gynecologic oncology. Questions were posed in three different ways for each voice query in order to maximize the likelihood of acceptability to the VAs in a 24-question panel. For general queries that were not related to gynecologic oncology, Google provided the most correct audible replies (83.3% correct), followed by Alexa (66.7% correct), Siri (45.8% correct), and Cortana (20.8% correct). For gynecologic oncology-related queries, the accuracy of the VAs was considerably lower: Google provided the most correct audible replies (18.1%), followed by Alexa (6.5%), Siri (5.5%), and Cortana (2.3%). There was a considerable drop in the accuracy of audible replies to oral queries on topics in gynecologic oncology relative to general queries that were not related to gynecologic oncology. There is considerable room for improvement in VA performance, so that caution is advised when using VAs for medical queries in gynecologic oncology. Our specific findings related to gynecologic oncology extend the work of others with regard to the low usability of general medical information obtained from VAs, so that reliance on conversational assistants for actionable medical information represents a safety risk for patients and consumers.

Quality Management of the Pre-Analytical Phase Errors: Monitoring and Way Forward

Inadequate quality management during laboratory analysis can increase errors, specimen rejection, and economic resources wastages. A laboratory quality management system (QMS) helps to streamline and coordinate all the processes and operations within the lab, ensuring that each step is well planned, controlled, and correctly performed. Quality management ensures that results are accurate, reliable, and obtained under a traceable process that can easily detect errors. The study aimed to investigate quality practice among laboratory workers during pre-analytical phase activities. Unexpected deviation from quality procedures consequently compromise laboratory test results, leading to patient mismanagement and patient safety risks. Analysis of results showed that 97.1% (340 respondents) were knowledgeable on quality management of pre-analytical phase, and 2.9% (10 respondents) were not. 99.1% (347respondents) agreed to availability of quality management materials and 0.9% (3 respondents) had no resources. 4.6% (16 respondents) do not practice quality management system at pre-analytical phase and 94.5% (334 respondents) practiced quality improvements. 3.4% (12 respondents) agreed that quality improvement is the responsibility of phlebotomist and field staff. 96.6% (338 respondents) agreed that quality management is the responsibility of everyone at the facility. There was maximum knowledge of quality management at the facility. Availability of quality management resources at the facility was standard. The practice of quality management was below standard. Facility requires training in quality management. It is recommended that quality management system be integrated into the curriculum of school of health technology to guide graduates at work. Keywords: Quality, Improvement, Patient, Management, System.