Patient Safety Outcomes under Flexible and Standard Resident Duty-Hour Rules

ObjectivesTo produce a narrative synthesis of published academic and grey literature focusing on patient safety outcomes for people with learning disabilities in an acute hospital setting.DesignScoping review with narrative synthesis.MethodsThe review followed the six stages of the Arksey and O’Malley framework. We searched four research databases from January 2000 to March 2021, in addition to handsearching and backwards searching using terms relating to our eligibility criteria—patient safety and adverse events, learning disability and hospital setting. Following stakeholder input, we searched grey literature databases and specific websites of known organisations until March 2020. Potentially relevant articles and grey literature materials were screened against the eligibility criteria. Findings were extracted and collated in data charting forms.Results45 academic articles and 33 grey literature materials were included, and we organised the findings around six concepts: (1) adverse events, patient safety and quality of care; (2) maternal and infant outcomes; (3) postoperative outcomes; (4) role of family and carers; (5) understanding needs in hospital and (6) supporting initiatives, recommendations and good practice examples. The findings suggest inequalities and inequities for a range of specific patient safety outcomes including adverse events, quality of care, maternal and infant outcomes and postoperative outcomes, in addition to potential protective factors, such as the roles of family and carers and the extent to which health professionals are able to understand the needs of people with learning disabilities.ConclusionPeople with learning disabilities appear to experience poorer patient safety outcomes in hospital. The involvement of family and carers, and understanding and effectively meeting the needs of people with learning disabilities may play a protective role. Promising interventions and examples of good practice exist, however many of these have not been implemented consistently and warrant further robust evaluation.

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Delinking resident duty hours from patient safety

BMC Medical Education ◽

10.1186/1472-6920-14-s1-s2 ◽

2014 ◽

Vol 14 (S1) ◽

Cited By ~ 10

Author(s):

Roisin Osborne ◽

Christopher S Parshuram

Keyword(s):

Patient Safety ◽

Duty Hours ◽

Resident Duty

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INTERPROFESSIONAL COLLABORATION AS A MEDIATOR IN THE RELATIONSHIP BETWEEN NURSE WORK ENVIRONMENT, PATIENT SAFETY OUTCOMES AND JOB SATISFACTION AMONG NURSES

Journal of Nursing Management ◽

10.1111/jonm.13491 ◽

2021 ◽

Author(s):

Leodoro J. Labrague ◽

Sulaiman Al Sabei ◽

Omar Al Rawajfah ◽

Raeda AbuAlRub ◽

Ikram Burney

Keyword(s):

Job Satisfaction ◽

Patient Safety ◽

Work Environment ◽

Interprofessional Collaboration ◽

Safety Outcomes ◽

Nurse Work Environment ◽

The Relationship

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Recognizing and Responding to the “Toxic” Work Environment: Worker Safety, Patient Safety, and Abuse/Neglect in Nursing Homes

Qualitative Health Research ◽

10.1177/1049732317723889 ◽

2017 ◽

Vol 27 (12) ◽

pp. 1870-1881 ◽

Cited By ~ 10

Author(s):

Carolyn E. Z. Pickering ◽

Katie Nurenberg ◽

Lawrence Schiamberg

Keyword(s):

Patient Safety ◽

Nursing Homes ◽

Work Environment ◽

Worker Safety ◽

Nursing Assistant ◽

Telephone Interviews ◽

Certified Nursing Assistant ◽

Safety Outcomes ◽

Multistep Model ◽

Constant Comparative Analysis

This grounded theory study examined how the certified nursing assistant (CNA) understands and responds to bullying in the workplace. Constant comparative analysis was used to analyze data from in-depth telephone interviews with CNAs ( N = 22) who experienced bullying while employed in a nursing home. The result of the analysis is a multistep model describing CNA perceptions of how, over time, they recognized and responded to the “toxic” work environment. The strategies used in responding to the “toxic” environment affected their care provision and were attributed to the development of several resident and worker safety outcomes. The data suggest that the etiology of abuse and neglect in nursing homes may be better explained by institutional cultures rather than individual traits of CNAs. Findings highlight the relationship between worker and patient safety, and suggest worker safety outcomes may be an indicator of quality in nursing homes.

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Development of the individualised Comparative Effectiveness of Models Optimizing Patient Safety and Resident Education (iCOMPARE) trial: a protocol summary of a national cluster-randomised trial of resident duty hour policies in internal medicine

BMJ Open ◽

10.1136/bmjopen-2018-021711 ◽

2018 ◽

Vol 8 (9) ◽

pp. e021711 ◽

Cited By ~ 3

Author(s):

Judy A Shea ◽

Jeffrey H Silber ◽

Sanjay V Desai ◽

David F Dinges ◽

Lisa M Bellini ◽

...

Keyword(s):

Internal Medicine ◽

Patient Safety ◽

Randomised Trial ◽

Cluster Randomised Trial ◽

Medicare Beneficiaries ◽

Internal Medicine Training ◽

Duty Hours ◽

Time Motion ◽

Wrist Actigraphy ◽

Resident Duty

IntroductionMedical trainees’ duty hours have received attention globally; restrictions in Europe, New Zealand and some Canadian provinces are much lower than the 80 hours per week enforced in USA. In USA, resident duty hours have been implemented without evidence simultaneously reflecting competing concerns about patient safety and physician education. The objective is to prospectively evaluate the implications of alternative resident duty hour rules for patient safety, trainee education and intern sleep and alertness.Methods and analysis63 US internal medicine training programmes were randomly assigned 1:1 to the 2011 Accreditation Council for Graduate Medical Education resident duty hour rules or to rules more flexible in intern shift length and number of hours off between shifts for academic year 2015–2016. The primary outcome is calculated for each programme as the difference in 30-day mortality rate among Medicare beneficiaries with any of several prespecified principal diagnoses in the intervention year minus 30-day mortality in the preintervention year among Medicare beneficiaries with any of several prespecified principal diagnoses. Additional safety outcomes include readmission rates, prolonged length of stay and costs. Measures derived from trainees’ and faculty responses to surveys and from time-motion studies of interns compare the educational experiences of residents. Measures derived from wrist actigraphy, subjective ratings and psychomotor vigilance testing compare the sleep and alertness of interns. Differences between duty hour groups in outcomes will be assessed by intention-to-treat analyses.Ethics and disseminationThe University of Pennsylvania Institutional Review Board (IRB) approved the protocol and served as the IRB of record for 40 programmes that agreed to sign an Institutional Affiliation Agreement. Twenty-three programmes opted for a local review process.Trial registration numberNCT02274818; Pre-results.

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Patient safety initiatives in obstetrics: a rapid review

BMJ Open ◽

10.1136/bmjopen-2017-020170 ◽

2018 ◽

Vol 8 (7) ◽

pp. e020170 ◽

Cited By ~ 5

Author(s):

Jesmin Antony ◽

Wasifa Zarin ◽

Ba’ Pham ◽

Vera Nincic ◽

Roberta Cardoso ◽

...

Keyword(s):

Patient Safety ◽

Healthcare Providers ◽

Audit And Feedback ◽

Rapid Review ◽

Secondary Outcome ◽

Provider Education ◽

Eligibility Criteria ◽

Clinician Education ◽

Study Selection ◽

Safety Outcomes

ObjectivesThis review was commissioned by WHO, South Africa-Country office because of an exponential increase in medical litigation claims related to patient safety in obstetrical care in the country. A rapid review was conducted to examine the effectiveness of quality improvement (QI) strategies on maternal and newborn patient safety outcomes, risk of litigation and burden of associated costs.DesignA rapid review of the literature was conducted to provide decision-makers with timely evidence. Medical and legal databases (eg, MEDLINE, Embase, LexisNexis Academic, etc) and reference lists of relevant studies were searched. Two reviewers independently performed study selection, abstracted data and appraised risk of bias. Results were summarised narratively.InterventionsWe included randomised clinical trials (RCTs) of QI strategies targeting health systems (eg, team changes) and healthcare providers (eg, clinician education) to improve the safety of women and their newborns. Eligible studies were limited to trials published in English between 2004 and 2015.Primary and secondary outcome measuresRCTs reporting on patient safety outcomes (eg, stillbirths, mortality and caesarean sections), litigation claims and associated costs were included.ResultsThe search yielded 4793 citations, of which 10 RCTs met our eligibility criteria and provided information on over 500 000 participants. The results are presented by QI strategy, which varied from one study to another. Studies including provider education alone (one RCT), provider education in combination with audit and feedback (two RCTs) or clinician reminders (one RCT), as well as provider education with patient education and audit and feedback (one RCT), reported some improvements to patient safety outcomes. None of the studies reported on litigation claims or the associated costs.ConclusionsOur results suggest that provider education and other QI strategy combinations targeting healthcare providers may improve the safety of women and their newborns during childbirth.

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