Browsing by Subject "Patient safety"

Sort by: Order: Results:

Now showing items 1-9 of 9
  • Torlen, Klara; Kurland, Lisa; Castren, Maaret; Olanders, Knut; Bohm, Katarina (2017)
    Background: Emergency medical dispatching should be as accurate as possible in order to ensure patient safety and optimize the use of ambulance resources. This study aimed to compare the accuracy, measured as priority level, between two Swedish dispatch protocols - the three-graded priority protocol Medical Index and a newly developed prototype, the four-graded priority protocol, RETTS-A. Methods: A simulation study was carried out at the Emergency Medical Communication Centre (EMCC) in Stockholm, Sweden, between October and March 2016. Fifty-three voluntary telecommunicators working at SOS Alarm were recruited nationally. Each telecommunicator handled 26 emergency medical calls, simulated by experienced standard patients. Manuscripts for the scenarios were based on recorded real-life calls, representing the six most common complaints. A cross-over design with 13 + 13 calls was used. Priority level and medical condition for each scenario was set through expert consensus and used as gold standard in the study. Results: A total of 1293 calls were included in the analysis. For priority level, n = 349 (54.0%) of the calls were assessed correctly with Medical Index and n = 309 (48.0%) with RETTS-A (p = 0.012). Sensitivity for the highest priority level was 82.6% (95% confidence interval: 76.6-87.3%) in the Medical Index and 54.0% (44.3-63.4%) in RETTS-A. Overtriage was 37.9% (34.2-41.7%) in the Medical Index and 28.6% (25.2-32.2%) in RETTS-A. The corresponding proportion of undertriage was 6.3% (4.7-8.5%) and 23.4% (20.3-26.9%) respectively. Conclusion: In this simulation study we demonstrate that Medical Index had a higher accuracy for priority level and less undertriage than the new prototype RETTS-A. The overall accuracy of both protocols is to be considered as low. Overtriage challenges resource utilization while undertriage threatens patient safety. The results suggest that in order to improve patient safety both protocols need revisions in order to guarantee safe emergency medical dispatching.
  • 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.
  • Kurttila, Minna S K; Saano, Susanna; Laaksonen, Raisa (2021)
    Background:Fluid therapy is a common intervention in critically ill patients. Fluid therapy errors may cause harm to patients. Thus, understanding of reported fluid therapy incidents is required in order to learn from them and develop protective measures, including utilizing expertise of pharmacists and technology to improve patient safety at the national level. Objectives:To describe fluid therapy incidents voluntarily reported in intensive care and high dependency units (ICUs) to a national incident reporting system, by investigating the error types,fluid products, consequences to patients and actions taken to alleviate them, and to identify at which phase of the medication process the incidents had occurred and had been detected. Methods:Medication related voluntarily reported incident (n= 7623) reports were obtained from all ICUs in2007–2017. Incidents concerning fluid therapy (n= 2201) were selected. The retrospective analysis utilized categorized data and narrative descriptions of the incidents. The results were expressed as frequencies and percentages. Results:Most voluntarily reported incidents had occurred during the dispensing/preparing phase(n= 1306, 59%) of the medication process: a point of risk. Most incidents (n= 1975, 90%) had reached the patient and passed through many phases in the medication process and nursing shift change checks before detection. One third of the errors (n=596,30%) were reported to have caused consequences to patients. One quarter (n= 492, 25%) of the errors were reported to have required an additional procedure to alleviate or monitor the consequences. Conclusions:Utilizing national incident report data enabled identifying systemic points of risk in the medication process and learning to improve patient safety. To prevent similar incidents, initial interventions should focus on the dispensing/preparing phase before implementing active medication identification procedures at each phase of the medication process and nursing shift changes. Strengthening clinical pharmacy services, utilizing technology, co-ordinated by IV Fluid Coordinators and Medication Safety Officers, could improve patient safety in the ICUs.
  • Venesoja, Anu; Lindström, Veronica; Aronen, Pasi; Castrén, Maaret; Tella, Susanna (2021)
    Background: Emergency Medical Services (EMS) is, by its nature, a challenging context that may create risks for both patients and employees. It is also known that an organisation’s safety culture has an influence on both patient and employee safety. Finnish EMS organisations lack knowledge of how their safety culture is perceived by their employees. Aim: This study aims to test the psychometric properties of the Emergency Medical Services Safety Attitudes Questionnaire (EMS-SAQ) in a Finnish EMS setting. We also explore the connections between individual- and organisation-based characteristics and safety attitudes in the Finnish EMS. Methods: A cross-sectional survey study design was used. The EMS-SAQ was used to collect data via social media. The instrument measures six domains of workplace safety culture: safety climate, teamwork climate, perceptions of management, job satisfaction, working conditions and stress recognition. The 5-point Likert scale was converted to a 100-point scale and mean ≥ 75 was dichotomized as a positive. Confirmatory factor analysis (CFA) was carried out to validate the EMS-SAQ in a Finnish setting. Other results were analysed by using non-parametric tests. Results: 327 responses were included in the analysis. CFA showed that the total EMS-SAQ model had acceptable goodness-of-fit values in the Finnish EMS setting. Total mean scores for each safety culture domain were identified non-positively (mean score < 75); safety climate 60.12, teamwork climate 60.92, perceptions of management 56.31, stress recognition 64.55, working conditions 53.43 and job satisfaction 70.36. Higher education was connected to lower job satisfaction and the teamwork climate within the individual characteristics. All organisation-based characteristics caused at least one significant variation in the safety culture domain scores. Working area significantly affected (p < 0.05) five out of the six safety culture domain scores. Conclusions: The EMS-SAQ is a valid tool to evaluate safety culture among the Finnish EMS organisations; it offers a novel method to evaluate safety and patient safety within the Finnish EMS organisations. According to the findings, the organisation-based characteristics more likely had an impact on safety attitudes than did the individual-based characteristics. Therefore, it is suggested that the Finnish EMS organisations undertake safety culture development at the organisational level.
  • Howard, Ian; Cameron, Peter; Wallis, Lee; Castrén, Maaret; Lindström, Veronica (2019)
    Introduction Historically, performance within the Prehospital Emergency Care (PEC) setting has been assessed primarily based on response times. While easy to measure and valued by the public, overall, response time targets are a poor predictor of quality of care and clinical outcomes. Over the last two decades however, significant progress has been made towards improving the assessment of PEC performance, largely in the form of the development of PEC-specific quality indicators (QIs). Despite this progress, there has been little to no development of similar systems within the low- to middle-income country setting. As a result, the aim of this study was to identify a set of QIs appropriate for use in the South African PEC setting. Methods A three-round modified online Delphi study design was conducted to identify, refine and review a list of QIs for potential use in the South African PEC setting. Operational definitions, data components and criteria for use were developed for 210 QIs for inclusion into the study. Results In total, 104 QIs reached consensus agreement including, 90 clinical QIs, across 15 subcategories, and 14 non-clinical QIs across two subcategories. Amongst the clinical category, airway management (n = 13 QIs; 14%); out-of-hospital cardiac arrest (n = 13 QIs; 14%); and acute coronary syndromes (n = 11 QIs; 12%) made up the majority. Within the non-clinical category, adverse events made up the significant majority with nine QIs (64%). Conclusion Within the South Africa setting, there are a multitude of QIs that are relevant and appropriate for use in PEC. This was evident in the number, variety and type of QIs reaching consensus agreement in our study. Furthermore, both the methodology employed, and findings of this study may be used to inform the development of PEC specific QIs within other LMIC settings.
  • O'Connor, Niall; Sugrue, Michael; Melly, Conor; McGeehan, Gearoid; Bucholc, Magda; Crawford, Aileen; O'Connor, Paul; Abu-Zidan, Fikri; Wani, Imtiaz; Balogh, Zsolt J.; Shelat, Vishal G.; Tebala, Giovanni D.; De Simone, Belinda; Eid, Hani O.; Chirica, Mircea; Fraga, Gustavo P.; Di Saverio, Salomone; Picetti, Edoardo; Bonavina, Luigi; Ceresoli, Marco; Fette, Andreas; Sakakushe, Boris; Pikoulis, Emmanouil; Coimbra, Raul; Ten Broek, Richard; Hecker, Andreas; Leppäniemi, Ari; Litvin, Andrey; Stahel, Philip; Tan, Edward; Koike, Kaoru; Catena, Fausto; Pisano, Michele; Coccolini, Federico; Johnston, Alison (2022)
    Background Despite the call to enhance accuracy and value of operation records few international recommended minimal standards for operative notes documentation have been described. This study undertook a systematic review of existing operative reporting systems for laparoscopic cholecystectomy (LC) to fashion a comprehensive, synoptic operative reporting template for the future. Methods A search for all relevant articles was conducted using PubMed version of Medline, Scopus and Web of Science databases in June 2021, for publications from January 1st 2011 to October 25th 2021, using the keywords: laparoscopic cholecystectomy AND operation notes OR operative notes OR proforma OR documentation OR report OR narrative OR audio-visual OR synoptic OR digital. Two reviewers (NOC, GMC) independently assessed each published study using a MINORS score of >= 16 for comparative and >= 10 for non-comparative for inclusion. This systematic review followed PRISMA guidelines and was registered with PROSPERO. Synoptic operative templates from published data were assimilated into one "ideal" laparoscopic operative report template following international input from the World Society of Emergency Surgery board. Results A total of 3567 articles were reviewed. Following MINORS grading 25 studies were selected spanning 14 countries and 4 continents. Twenty-two studies were prospective. A holistic overview of the operative procedure documentation was reported in 6/25 studies and a further 19 papers dealt with selective surgical aspects of LC. A unique synoptic LC operative reporting template was developed and translated into Chinese/Mandarin, French and Arabic. Conclusion This systematic review identified a paucity of publications dealing with operative reporting of LC. The proposed new template may be integrated digitally with hospitals' medical systems and include additional narrative text and audio-visual data. The template may help define new OR (operating room) recording standards and impact on care for patients undergoing LC.
  • Suuronen, Marianne; Autti, Taina; Lehtonen, Lasse (2023)
    Objectives Our study aimed to reveal the frequency of patient safety incidents (PSI) in dentomaxillofacial radiology (DMFR), including their mitigating and contributing factors, to help recognize and thus better prevent these adverse events (AE) in the future. Methods Hospital District Helsinki and Uusimaa (HUS) and the City of Helsinki (HKI) use HaiPro, an anonymous web-based tool, for healthcare professionals to report PSI. Dentistry-related PSIs were evaluated individually to find any DMFR-related reports. Additionally, we searched the HaiPro-data using multiple dentistry- and DMFR-related keywords. We compartmentalized all DMFR-related PSI by their type and assessed their contributing factors, as well as their risk classification, severity, outcome, and possible corrective actions. Results In HUS and HKI, 43 of the 195,589 HaiPro-reports filed during 2012-2017 were DMFR-related. The most prevalent event type of DMFR-related PSIs was laboratory-, medical imaging-, or other patient examination-related events (33%). The second most common event type was defined as being related to flow or control of information (26%). For both of these event types, the most common contributing factors were shortcomings of communication and flow of information. Risk classification showed only one AE to be of moderate risk, and all others were perceived as irrelevant or minor. Conclusions PSI in DMFR are only rarely reported, and mostly, they are perceived of causing little or no harm. We detected a great difference in reporting activity between primary and secondary healthcare workers, but the underlaying causes remain unclear.
  • Reponen, Elina; Tuominen, Hanna; Korja, Miikka (2019)
    BACKGROUND: Multiple nationwide outcome registries are utilized for quality benchmarking between institutions and individual surgeons. OBJECTIVE: To evaluate whether nationwide quality of care programs in the United Kingdom and United States can measure differences in neurosurgical quality. METHODS: This prospective observational study comprised 418 consecutive adult patients undergoing elective craniotomy at Helsinki University Hospital between December 7, 2011 and December 31, 2012.We recorded outcome event rates and categorized them according to British Neurosurgical National Audit Programme (NNAP), American National Surgical Quality Improvement Program (NSQIP), and American National Neurosurgery Quality and Outcomes Database (N(2)QOD) to assess the applicability of these programs for quality benchmarking and estimated sample sizes required for reliable quality comparisons. RESULTS: The rate of in-hospital major and minor morbidity was 18.7% and 38.0%, respectively, and 30-d mortality rate was 2.4%. The NSQIP criteria identified 96.2% of major but only 38.4% of minor complications. N(2)QOD performed better, but almost one-fourth (23.2%) of all patients with adverse outcomes, mostly minor, went unnoticed. For NNAP, a sample size of over 4200 patients per surgeon is required to detect a 50.0% increase in mortality rates between surgeons. The sample size required for reliable comparisons between the rates of complications exceeds 600 patients per center per year. CONCLUSION: The implemented benchmarking programs in the United Kingdom and United States fail to identify a considerable number of complications in a high-volume center. Health care policy makers should be cautious as outcome comparisons between most centers and individual surgeons are questionable if based on the programs.
  • Jakonen, Antti; Mänty, Minna; Nordquist, Hilla (2022)
    Background: Emergency response driving (ERD) is a major occupational risk factor in emergency medical services (EMS). Inadequate communication has been acknowledged as a significant contributing cause for major incidents during ERD. Previous evidence shows that structured communication can promote safety in high-risk procedures, but knowledge in ERD context is lacking. The aim of this study was to examine what are the safety-critical points in ERD that should be secured using structured communication. Method: The nominal group technique (NGT) was used for gathering interview material from ERD experts’ (n = 11) workshop. In addition, semi-structured thematic interviews were conducted with other ERD experts (n = 15) from five different EMS areas in Finland. The interview material was analyzed using inductive content analysis. Results: Using NGT, 13 safety-critical points in ERD requiring the use of structured communication were identified. As a result of the interviews, two main categories were found: 1) Factors affecting the adaptation of the appropriate speed for the current situation and 2) Factors affecting orientation in a driving event. Conclusion: ERD comprises multiple safety-critical points that should be secured using structured communication between ambulance crew members. Pilot and implementation studies exploring the use of structured communication in ERD are needed in the future.