Browsing by Subject "Hospitals"

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  • Palojoki, Sari; Saranto, Kaija; Reponen, Elina; Skants, Noora; Vakkuri, Anne; Vuokko, Riikka (2021)
    Background: It is assumed that the implementation of health information technology introduces new vulnerabilities within a complex sociotechnical health care system, but no international consensus exists on a standardized format for enhancing the collection, analysis, and interpretation of technology-induced errors. Objective: This study aims to develop a classification for patient safety incident reporting associated with the use of mature electronic health records (EHRs). It also aims to validate the classification by using a data set of incidents during a 6-month period immediately after the implementation of a new EHR system. Methods: The starting point of the classification development was the Finnish Technology-Induced Error Risk Assessment Scale tool, based on research on commonly recognized error types. A multiprofessional research team used iterative tests on consensus building to develop a classification system. The final classification, with preliminary descriptions of classes, was validated by applying it to analyze EHR-related error incidents (n=428) during the implementation phase of a new EHR system and also to evaluate this classification’s characteristics and applicability for reporting incidents. Interrater agreement was applied. Results: The number of EHR-related patient safety incidents during the implementation period (n=501) was five-fold when compared with the preimplementation period (n=82). The literature identified new error types that were added to the emerging classification. Error types were adapted iteratively after several test rounds to develop a classification for reporting patient safety incidents in the clinical use of a high-maturity EHR system. Of the 427 classified patient safety incidents, interface problems accounted for 96 (22.5%) incident reports, usability problems for 73 (17.1%), documentation problems for 60 (14.1%), and clinical workflow problems for 33 (7.7%). Altogether, 20.8% (89/427) of reports were related to medication section problems, and downtime problems were rare (n=8). During the classification work, 14.8% (74/501) of reports of the original sample were rejected because of insufficient information, even though the reports were deemed to be related to EHRs. The interrater agreement during the blinded review was 97.7%. Conclusions: This study presents a new classification for EHR-related patient safety incidents applicable to mature EHRs. The number of EHR-related patient safety incidents during the implementation period may reflect patient safety challenges during the implementation of a new type of high-maturity EHR system. The results indicate that the types of errors previously identified in the literature change with the EHR development cycle.
  • Kaipio, Johanna; Karisalmi, N.; Hiekkanen, K.; Stenhammar, H.; Lahdenne, P. (IOS PRESS, 2019)
    Studies in Health Technology and Informatics
    Patient experience (PX) is an important evaluation criterion for quality in healthcare. Compared to patient satisfaction, however less research has focused on the development of instruments to measure experiences of patients and their families. In the article, we describe the process of developing a PX questionnaire for the parents of pediatric patients in the context of children's hospital and illustrate the questionnaire items for measuring PX. The phases of the development process included retrospective interviews, description of the themes influencing PX and the metrics for measuring PX, as well as iterative development of three versions of questionnaires including data gathering and factor analysis. The final versions of the surveys suggested for implementation at the hospitals include eight PX statements for the outpatient clinic and five statements for the ward. Compared to satisfaction surveys, the developed surveys emphasize the aspects of parent's attitude towards the illness, support for families, and daily arrangements with a child patient. © 2019 American Psychological Association Inc. All rights reserved.
  • Makkonen, Marja; Hurskainen, Ritva; Salinto, Sirpa; Helminen, Mika; Nord-Saari, Merja; Savolainen, Kalle (2017)
    Lähtökohdat Tutkimuksen tavoitteena oli verrata hysteroskooppisesta endometriumpolyypin poistosta aiheutuvia ¬kustannuksia ja lisäkäyntien tarvetta polikliinisesti ja päiväkirurgisesti suoritetuissa toimenpiteissä. Menetelmät Hyvinkään sairaalassa tehtiin 702 polyypinpoistoa joko polikliinisesti tai päiväkirurgisesti vuosina 2006–12, ja niistä v. 2007–09 tehdyt 269 toimenpidettä analysoitiin kolmen vuoden seuranta-ajan jälkeen. Tulokset Polikliinisen toimenpiteen kokonaiskustannukset/potilas olivat kolmessa vuodessa 846 € ja päiväkirurgisen toimenpiteen 2 814 €. Hoitovaihtoehto ei vaikuttanut sairaalakontaktien tai uusintatoimenpiteiden kokonais¬määrään seurannassa. Päätelmät Polyypin poisto polikliinisesti on edullisempi, nopeampi ja yhtä tehokas vaihtoehto kuin poisto päiväkirurgisesti.
  • Rauhala, Auvo; Ylihärsilä, Heli; Aaltonen, Leena-Maija; Roine, Risto P.; Kinnunen, Marina (2018)
    Sairaalassa tapahtuneiden kuolemien systemaattinen selvittely on Suomessa jäänyt liian vähälle huomiolle. Terveydenhuollon vakavimmasta haittatapahtumasta voidaan – ja pitää – ottaa opiksi.
  • Linden-Lahti, Carita; Holmstrom, Anna-Riia; Pennanen, Pirjo; Airaksinen, Marja (2019)
    Background: The study was carried out as part of the European Network for Patient Safety (EUNetPas) project in 2008-2010. Objective: To investigate facilitators and barriers in implementation process of selected medication safety practices across hospitals within European Union countries. Methods: This was an implementation study of seven selected medication safety practices in 55 volunteering hospitals of 11 European Union (EU) member states. The selected practices were: two different versions of medicine bed dispensation; safety vest; discharge medication list for patients; medication reconciliation at patient discharge; medication reconciliation at patient admission and patient discharge, and sleep card. The participating hospitals submitted an evaluation report describing the implementation process of a chosen practice in their organisation. The reports were analysed with inductive content analysis to identify general and practice-specific facilitators and barriers to the practice implementation. Results: Altogether 75 evaluation reports were submitted from 55 hospitals in 11 EU member states. Implementation of the medication safety practices was challenging and more time consuming than expected. The major reported challenge was to change the work process because of the new practice. General facilitators for successful implementation were: existence of safety culture, national guidelines and projects, expert support, sufficient resources, electronic patient records, interdisciplinary cooperation and clinical pharmacy services supporting the practice implementation. Conclusions: The key for the successful implementation of a medication safety practice is to select the right practice for the right problem, in the right setting and with sufficient resources in an organization with a safety culture.
  • Peltonen, Laura-Maria; Junttila, Kristiina; Salanterä, Sanna (IOS PRESS, 2018)
    Studies in Health Technology and Informatics
    Day-to-day operations management in hospital units is difficult due to continuously varying situations, several actors involved and a vast number of information systems in use. The aim of this study was to describe front-line physicians' satisfaction with existing information systems needed to support the day-to-day operations management in hospitals. A cross-sectional survey was used and data chosen with stratified random sampling were collected in nine hospitals. Data were analyzed with descriptive and inferential statistical methods. The response rate was 65 % (n = 111). The physicians reported that information systems support their decision making to some extent, but they do not improve access to information nor are they tailored for physicians. The respondents also reported that they need to use several information systems to support decision making and that they would prefer one information system to access important information. Improved information access would better support physicians' decision making and has the potential to improve the quality of decisions and speed up the decision making process.
  • Syyrilä, Tiina; Vehviläinen-Julkunen, Katri; Härkänen, Marja (2021)
    Background Communication challenges contribute to medication incidents in hospitals, but it is unclear how communication can be improved. The aims of this study were threefold: firstly, to describe the most common communication challenges related to medication incidents as perceived by healthcare professionals across specialized hospitals for adult patients; secondly, to consider suggestions from healthcare professionals with regard to improving medication communication; and thirdly, to explore how text mining compares to manual analysis when analyzing the free-text content of survey data. Methods This was a cross-sectional, descriptive study. A digital survey was sent to professionals in two university hospital districts in Finland from November 1, 2019, to January 31, 2020. In total, 223 professionals answered the open-ended questions; respondents were primarily registered nurses (77.7 %), physicians (8.6 %), and pharmacists (7.3 %). Text mining and manual inductive content analysis were employed for qualitative data analysis. Results The communication challenges were: (1) inconsistent documentation of prescribed and administered medication; (2) failure to document orally given prescriptions; (3) nurses' unawareness of prescriptions (given outside of ward rounds) due to a lack of oral communication from the prescribers; (4) breaks in communication during care transitions to non-communicable software; (5) incomplete home medication reconciliation at admission and discharge; (6) medication lists not being updated during the inpatient period due to a lack of clarity regarding the responsible professional; and (7) work/environmental factors during medication dispensation and the receipt of verbal prescriptions. Suggestions for communication enhancements included: (1) structured digital prescriptions; (2) guidelines and training on how to use documentation systems; (3) timely documentation of verbal prescriptions and digital documentation of administered medication; (4) communicable software within and between organizations; (5) standardized responsibilities for updating inpatients' medication lists; (6) nomination of a responsible person for home medication reconciliation at admission and discharge; and (7) distraction-free work environment for medication communication. Text mining and manual analysis extracted similar primary results. Conclusions Non-communicable software, non-standardized medication communication processes, lack of training on standardized documentation, and unclear responsibilities compromise medication safety in hospitals. Clarification is needed regarding interdisciplinary medication communication processes, techniques, and responsibilities. Text mining shows promise for free-text analysis.
  • Pitkäpaasi, Marjaana; Kanerva, Mari; Lehtinen, Jaana-Marija (2018)
    LÄHTÖKOHDAT Helsingin ja Uudenmaan sairaanhoitopiirin alueen terveyskeskussairaaloissa selvitettiin syksyllä 2015 vallitsevuus- eli prevalenssitutkimuksella hoitoon liittyvien infektioiden määrä sekä menetelmän soveltuvuus uuden tartuntatautilain mukaiseen infektioiden seurantaan. MENETELMÄT Sairaaloiden infektiontorjuntatiimit keräsivät tiedot yhdessä osastojen henkilökunnan kanssa. Hoitoon liittyvien infektioiden lisäksi kerättiin tiedot eristysten tarpeesta sekä katetrien ja mikrobilääkkeiden käytöstä. TULOKSET Tutkimukseen osallistui 22 sairaalaa 16 kunnasta. Potilaista 11 %:lla (95 %:n LV 10–13 %) oli ¬vähintään yksi hoitoon liittyvä infektio. Tutkimushetkellä 29 %:lla (95 %:n LV 26–33 %) potilaista oli käytössä vähintään yksi mikrobilääke. Potilaista 14 %:lla oli virtsatiekatetri. PÄÄTELMÄT Prevalenssitutkimus sopii hyvin hoitoon liittyvien infektioiden seurantaan, varsinkin kun se toistetaan määrävälein.
  • Halmesmäki, Esa; Pasternack, Iris; Roine, Risto Paavo Antero (2016)
    Background: This study examines, as a part of the European Union funded Adopting Hospital Based Health Technology Assessment (AdHopHTA) project, the results and barriers of collaboration between Finnish hospitals and the national health technology assessment (HTA) agency, Finohta. A joint collaborative HTA program has existed since 2006 between the Finnish hospitals and the national agency. Methods: A case study method was used. Information about the collaboration between Finnish hospitals and Finohta was retrieved from interviews and publications, and categorised per theme. Hypotheses and indicators of successful collaboration were determined beforehand and reflected on the observations from the interviews and literature. Results: Overall, 48 collaborative HTA reports have been performed during 7 years of collaboration. However, there were no clear indications that the use of HTA information or the transparency of decision-making regarding new technologies would have increased in hospitals. The managerial commitment to incorporate HTAs into the decision-making processes in hospitals was still low. The quality of the collaborative HTA reports was considered good, but their applicability in the hospital setting limited. There were differing expectations about the timing and relevance of the content. Signs of role conflict and mistrust were observed. Conclusions: Despite collaborative efforts to produce HTAs for hospitals, the impact of HTA information on hospital decision-making appears to remain low. The difficulties identified in this case study, such as lack of managerial commitment in hospitals, can hopefully be better addressed in the future with the guidance and tools having been developed in the AdHopHTA project. Collaboration between hospitals and national HTA agencies remains important for the efficient sharing of skills and resources.
  • Takala, Annika; Kohvakka, Ulla; Kirves, Hetti; Harve-Rytsälä, Heini (2022)
    Lisähappea tarvitsevan potilaan hapenantolaitteen yhdistäminen ilmavirtausmittariin on estettävissä oleva vaaratapahtuma. Kuvatussa tapauksessa tilanne toistui suuressa erikoissairaanhoidon organisaatiossa laskennallisesti yli kolme kertaa kuukaudessa.
  • Kaila, Minna; Haapiainen, Reijo; Keistinen, Timo; Salomaa, Eva (2019)
    Erikoissairaanhoidon keskittämisen kipukohtien taustalla on ¬henkilöstön saatavuuteen, koulutukseen ja päivystysvalmiuteen sekä aluepolitiikkaan liittyviä argumentteja, todetaan erikois¬sairaanhoidon keskittämisen ja päivystyksen tilaa käsittelevässä tuoreessa raportissa
  • Heinäaho, Emil (2019)
  • Halmesmäki, Karoliina; Paajanen, Juuso; Bianchi, Simone; Mason, Anna; Sinkkonen, Saku T.; Tallgren, Minna; Hirvensalo, Eero (2020)
    HUS:n koronapotilaat päätettiin keskittää Kirurgisen sairaalan tiloihin. Kiinteistö soveltui erinomaisesti erilliseksi infektiopotilaiden hoitoyksiköksi – jollaiseksi se pitkälti oli suunniteltukin sairaalan aloittamisvuonna 1882. Näin toiminta rakennettiin.
  • Kinnunen, Marina; Mönttinen, Helena; Aaltonen, Leena-Maija; Roine, Risto P. (2017)
    Terveydenhuollon toimintayksiköiden lääkkeet on tarkoitettu vain potilaille. Sairaaloiden lääkekaapeista on usein valitettavan helppoa ottaa lääkkeitä myös omaan käyttöön. Ratkaisevaa on, kuinka organisaatio suhtautuu tähän.
  • Kvarnström, Kirsi; Linden-Lahti, Carita (2020)
    Helsingin yliopistollisessa sairaalassa pilotoidussa kliinisessä kaksoistarkistuksessa farmaseutti esitti muutosta lääkitykseen 5 %:iin lääkemääräyksistä.Niistä 85 % toteutettiin.
  • Peltonen, Laura-Maria; Junttila, Kristiina; Salantera, Sanna (IOS PRESS, 2018)
    Studies in Health Technology and Informatics
    Information usage in the day-to-day operations management of hospital units is complex due to numerous information systems in use. The aim of this study was to describe and compare nurse leaders' satisfaction with information systems used in the day-to-day operations management in hospital units. The design was a cross-sectional survey with five questions rated from one (disagree) to five (fully agree). The response rate was 65 % (n = 453). Respondents reported fair satisfaction with how information systems support decision-making (median 4, IQR 3-4) and improve ease of access to information (median 4, IQR 3-4). However, respondents were less satisfied with how systems improve speed of access to information (median 3, IQR 3-4). Nor did respondents think that systems were developed for them (median 3, IQR 2-4). Respondents further reported needing numerous systems daily to support decision-making (median 4, IQR 3-5). A clear need for one system, which would gather important information for display was stated (median 5, IQR 4-5). Work experience, gender and time when overseeing the unit were associated with some aspects related to satisfaction. In conclusion, information system improvements are needed to better support the day-to-day operations management in hospital units.
  • Molander, Pauliina; Udd, Marianne (2018)
    PEG eli perkutaaninen endoskooppinen gastrostomia on laajasti hyväksytty menetelmä enteraalisen ravitsemuksen ylläpitämiseksi. Toimenpiteen aiheet ja siihen liittyvät komplikaatiot tunnetaan ohjeistuksista huolimatta huonosti. PEG-letkun asennusta harkittaessa tulee huomioida potilaan henkilökohtaiset toiveet, diagnoosi jaelinajan ennuste. Potilaan ja usein myös omaisen asianmukainen ohjaus on onnistuneen hoidon keskeinen osa.
  • Kauppinen, Niina (2022)
    Koronaepidemian aikana viestinnässä on koettu monia onnistumisia, mutta myös sudenkuoppia on tarjolla. Kestävyyskuntoa tarvitaan myös viestinnässä epidemian pitkittyessä.