Research Methods, Statistics, Patient Safety, and Quality Improvement

2020 ◽  
pp. 521-530
Author(s):  
Carlos Lerner
Keyword(s):  
Patient Safety ◽  
Quality Improvement ◽  
Adverse Events ◽  
Research Methods ◽  
Confidence Intervals ◽  
Medical Errors ◽  
Likelihood Ratios ◽  
Predictive Values ◽  
Analysis Of Variation ◽  
Answer Format

The chapter on research methods, statistics, patient safety, and quality improvement (QI) uses a question-and-answer format to make concepts in these areas relevant and accessible to general pediatricians. Research topics covered include study design and study types, validity, sources of bias, types of errors, sensitivity and specificity, positive and negative predictive values, likelihood ratios, incidence and prevalence, p values and confidence intervals. The patient safety questions focus on medical errors and adverse events, including their categorization, detection, prevention, and disclosure. Finally, the QI questions address key QI principles and methods, including tools to understand systems (e.g. fishbone diagrams and Pareto charts), analysis of variation, and the Langley Model for Improvement.

Recognizing the Ordinary as Extraordinary: Insight Into the “Way We Work” to Improve Patient Safety Outcomes

2017 ◽  
Vol 26 (4) ◽  
pp. 272-277 ◽  
Author(s):  
Elizabeth A. Henneman
Keyword(s):  
Patient Safety ◽  
Adverse Events ◽  
Eye Tracking ◽  
Medical Errors ◽  
Improve Patient Safety ◽  
Safety Net ◽  
Near Miss ◽  
The Impact ◽  
Risk Processes ◽  
Insight Into

The Institute of Medicine (now National Academy of Medicine) reports “To Err is Human” and “Crossing the Chasm” made explicit 3 previously unappreciated realities: (1) Medical errors are common and result in serious, preventable adverse events; (2) The majority of medical errors are the result of system versus human failures; and (3) It would be impossible for any system to prevent all errors. With these realities, the role of the nurse in the “near miss” process and as the final safety net for the patient is of paramount importance. The nurse’s role in patient safety is described from both a systems perspective and a human factors perspective. Critical care nurses use specific strategies to identify, interrupt, and correct medical errors. Strategies to identify errors include knowing the patient, knowing the plan of care, double-checking, and surveillance. Nursing strategies to interrupt errors include offering assistance, clarifying, and verbally interrupting. Nurses correct errors by persevering, being physically present, reviewing/confirming the plan of care, or involving another nurse or physician. Each of these strategies has implications for education, practice, and research. Surveillance is a key nursing strategy for identifying medical errors and reducing adverse events. Eye-tracking technology is a novel approach for evaluating the surveillance process during common, high-risk processes such as blood transfusion and medication administration. Eye tracking has also been used to examine the impact of interruptions to care caused by bedside alarms as well as by other health care personnel. Findings from this safety-related eye-tracking research provide new insight into effective bedside surveillance and interruption management strategies.

Validation of new ICD-10-based patient safety indicators for identification of in-hospital complications in surgical patients: a study of diagnostic accuracy

2019 ◽  
Vol 29 (3) ◽  
pp. 209-216 ◽  
Author(s):  
Daniel I McIsaac ◽  
Gavin M Hamilton ◽  
Karim Abdulla ◽  
Luke T Lavallée ◽  
Husien Moloo ◽  
...  
Keyword(s):  
Patient Safety ◽  
Secondary Analysis ◽  
Data Systems ◽  
Reference Standard ◽  
Likelihood Ratios ◽  
Primary Analysis ◽  
Predictive Values ◽  
Individual Level ◽  
Patient Safety Indicators ◽  
Icd 10

ObjectiveAdministrative data systems are used to identify hospital-based patient safety events; few studies evaluate their accuracy. We assessed the accuracy of a new set of patient safety indicators (PSIs; designed to identify in hospital complications).Study designProspectively defined analysis of registry data (1 April 2010–29 February 2016) in a Canadian hospital network. Assignment of complications was by two methods independently. The National Surgical Quality Improvement Programme (NSQIP) database was the clinical reference standard (primary outcome=any in-hospital NSQIP complication); PSI clusters were assigned using International Classification of Disease (ICD-10) codes in the discharge abstract. Our primary analysis assessed the accuracy of any PSI condition compared with any complication in the NSQIP; secondary analysis evaluated accuracy of complication-specific PSIs.PatientsAll inpatient surgical cases captured in NSQIP data.AnalysisWe assessed the accuracy of PSIs (with NSQIP as reference standard) using positive and negative predictive values (PPV/NPV), as well as positive and negative likelihood ratios (±LR).ResultsWe identified 12 898 linked episodes of care. Complications were identified by PSIs and NSQIP in 2415 (18.7%) and 2885 (22.4%) episodes, respectively. The presence of any PSI code had a PPV of 0.55 (95% CI 0.53 to 0.57) and NPV of 0.93 (95% CI 0.92 to 0.93); +LR 6.41 (95% CI 6.01 to 6.84) and −LR 0.40 (95% CI 0.37 to 0.42). Subgroup analyses (by surgery type and urgency) showed similar performance. Complication-specific PSIs had high NPVs (95% CI 0.92 to 0.99), but low to moderate PPVs (0.13–0.61).ConclusionValidation of the ICD-10 PSI system suggests applicability as a first screening step, integrated with data from other sources, to produce an adverse event detection pathway that informs learning healthcare systems. However, accuracy was insufficient to directly identify or rule out individual-level complications.

scholarly journals Patient Safety in Cross-border Care

2015 ◽  
Vol 8 (1) ◽  
pp. 77-83
Author(s):  
Eva Turk ◽  
Stephen Leyshon ◽  
Morten Pytte
Keyword(s):  
European Union ◽  
Quality Assurance ◽  
Patient Safety ◽  
Adverse Events ◽  
Health Systems ◽  
Medical Errors ◽  
The State ◽  
The European Union ◽  
Cross Border

Patient safety is a right and it raises particular issues in the context of cross-border care. Patients should be able to have trust and confidence in the healthcare structure as a whole; they must be protected from the harm caused by poorly functioning health systems, medical errors and adverse events. This paper addresses the state of cross-border healthcare in the European Union, the state of patient safety, the question of quality assurance and the role of accreditation as a risk based approach.

Factors contributing to patient safety culture: the staff perspective

2021 ◽  
Vol 27 (12) ◽  
pp. 1-6
Author(s):  
Ahmed Yahya Ayoub ◽  
Nezar Ahmed Salim ◽  
Belal Mohammad Hdaib ◽  
Nidal F Eshah
Keyword(s):  
Patient Safety ◽  
Adverse Events ◽  
Safety Culture ◽  
Medical Errors ◽  
Relevant Literature ◽  
Healthcare Providers ◽  
Patient Safety Culture ◽  
Open Communication ◽  
Staffing Levels ◽  
Large Numbers

Background/Aims Unsafe medical practices lead to large numbers of injuries, disabilities and deaths each year worldwide. An understanding of safety culture in healthcare organisations is vital to improve practice and prevent adverse events from medical errors. This integrated literature review aimed to evaluate healthcare staff's perceptions of factors contributing to patient safety culture in their organisations. Methods A comprehensive in-depth review was conducted of studies associated with patient safety culture. Multiple electronic databases, such as PubMed, Wolters Kluwer Health, Karger, SAGE journal and Biomedical Central, were searched for relevant literature published between 2015 and 2020. The keywords ‘patient safety culture’, ‘patient safety’, ‘healthcare providers’, ‘adverse event’, ‘attitude’ and ‘perception’ were searched for. Results Overall, 18 articles met the inclusion criteria. Across all studies, staff highlighted several factors that need improvement to facilitate an effective patient safety culture, with most dimensions of patient safety culture lacking. In particular, staffing levels, open communication, feedback following an error and reporting of adverse events were perceived as lacking across the studies. Conclusion Many issues regarding patient safety culture were present across geographical locations and staff roles. It is crucial that healthcare managers and policymakers work towards an environment that focuses on organisational learning, rather than punishment, in regards to medical errors and adverse incidents. Teamwork between units, particularly during handovers, also requires improvement.

scholarly journals Quality and Safety in Healthcare for Medical Students: Challenges and the Road Ahead

Healthcare ◽  
2020 ◽  
Vol 8 (4) ◽  
pp. 540
Author(s):  
Luz Berenice López-Hernández ◽  
Benjamín Gómez Díaz ◽  
Edgar Oswaldo Zamora González ◽  
Karen Itzel Montes-Hernández ◽  
Stephanie Simone Tlali Díaz ◽  
...  
Keyword(s):  
Patient Safety ◽  
Quality Improvement ◽  
Medical Students ◽  
Medical Errors ◽  
Just Culture ◽  
The Road ◽  
Reporting Systems ◽  
Safety Interventions ◽  
Fourth Year Medical Students ◽  
Essential Knowledge

Background: The development of skills, behaviors and attitudes regarding patient safety is of utmost importance for promoting safety culture for the next generation of health professionals. This study describes our experience of implementing a course on patient safety and quality improvement for fourth year medical students in Mexico during the COVID-19 outbreak. The course comprised essential knowledge based on the patient safety curriculum provided by the WHO. We also explored perceptions and attitudes of students regarding patient safety. Methods: Fourth year medical students completed a questionnaire regarding knowledge, skills, and attitudes on patient safety and quality improvement in medical care. The questionnaire was voluntarily answered online prior to and after the course. Results: In total, 213 students completed the questionnaires. Most students were able to understand medical error, recognize failure and the nature of causation, perform root-cause analysis, and appreciate the role of patient safety interventions. Conversely, a disapproving perspective prevailed among students concerning the preventability of medical errors, utility of reporting systems, just culture and infrastructure (p < 0.05). Conclusion: We found students had a positive perspective concerning learning quality in healthcare and patient safety during our course; nevertheless, their perception of the usefulness of reporting systems to prevent future adverse events and prevent medical errors is uncomplimentary. Medical education should promote error reporting and just culture to change the current perception of medical students.

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