Association of patient safety indicator 03 and clinical outcome in a surgery hospital

2020 ◽  
Vol 33 (6) ◽  
pp. 403-412
Author(s):  
Mahi Mahmoud Al-Tehewy ◽  
Sara Ebraheem Abd Al-Razak ◽  
Tamer Shahat Hikal ◽  
Maha Magdy Wahdan
Keyword(s):  
Patient Safety ◽  
Clinical Outcomes ◽  
Patient Outcomes ◽  
Improve Patient Safety ◽  
Cardiothoracic Surgery ◽  
Hospital Data ◽  
Content Type ◽  
Patient Safety Indicators ◽  
Risk Of Death

PurposePatient safety indicators (PSIs) were developed as a tool for hospitals to identify potentially preventable complications and improve patient safety performance. The study aimed at measuring the incidence of the Agency for Healthcare Research and Quality (AHRQ) PSI03 (pressure ulcer [PU] rate) and to identify the association between PSI03 and clinical outcomes including death, readmission within 30 days and length of stay (LOS) at the cardiothoracic surgery hospital at Ain Shams University, Cairo, Egypt.Design/methodology/approachAn exploratory prospective cohort study was conducted to follow up patients, who fulfilled the inclusion criteria, from admission until one month after discharge at the cardiothoracic surgery hospital. Data were collected through basic information and follow-up sheets. The total number of included participants in the study was 330.FindingsPSI03 incidence rate was 67.7 per 1,000 discharges. Patients aged 60 years and above had the highest risk among all age groups. In patients who developed PSI03, the risk ratio (RR) of death was 8.8 [95% CI (3.79–20.24)], RR of staying more than 30 days at the hospital was 1.5 [95% CI (1.249–1.872)] and of readmission within 30 days in patients who developed PSI03 was 1.5 [95% CI (0.38–6.15)]. In the study’s hospital, the patients who developed PSI03 were at higher risk of death and stayed longer at the hospital than patients without PSI03. This study demonstrated a clear association between PSI03 and patient outcomes such as LOS and mortality. Early detection, prevention and proper management of PSI03 are recommended to decrease unfavorable clinical outcomes.Originality/valueThe importance of PSIs lies in the fact that they facilitate the recognition of the adverse events and complications which occurred during hospitalization and give the hospitals a chance to improve the possible clinical outcomes. Therefore, the current study aimed at measuring the association between AHRQ PSI03 ( PU rate) and the clinical outcomes including death, readmission within 30 days and the LOS at the cardiothoracic surgery hospital at Ain Shams University. This study will provide the hospital management with baseline data for this type of adverse event and guide them to develop a system for identifying the high-risk group of patients and to upgrade relevant hospital policies and guidelines that lead to improved patient outcomes.

Incidence and Association of Patient Safety Indicator 9 (Perioperative hemorrhage or hematoma) and clinical outcomes in Cardio-thoracic surgery hospital, Ain Shams University, Egypt

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Mahi M Al-Tehewy ◽  
Sara E. M Abd AlRazak ◽  
Maha M Wahdan ◽  
Tamer S. F Hikal
Keyword(s):  
Patient Safety ◽  
Incidence Rate ◽  
Clinical Outcomes ◽  
Improve Patient Safety ◽  
Cardiothoracic Surgery ◽  
Patient Safety Indicators ◽  
Risk Of Death ◽  
Safety Indicator ◽  
Perioperative Hemorrhage

Abstract Background Patient Safety Indicators (PSIs) were developed as a tool for hospitals to identify potentially preventable complications and improve patient safety performance. Aim the study aimed to measure the association between the AHRQ patient safety indicator PSI9 (Perioperative hemorrhage or hematoma) and the clinical outcome including death, readmission within 30 days and length of stay at the cardiothoracic surgery hospital Ain Shams University. Methods exploratory prospective cohort study was conducted to follow up patients from admission till 1 month after discharge at the cardiothoracic surgery hospital who fulfills the inclusion criteria. Data were collected for 330 patients through basic information sheet and follow-up sheet. Results the incidence rate of PSI9 was 49.54 per 1000 discharges. Demographic data was not significantly associated with increased incidence of PSI9. The risk of development of PSI9 was significantly higher in patients admitted directly to ICU [relative risk (RR) =5.6]. The risk of death and readmission was higher in cases developed PSI9 than the cases without PSI9 [RR = 2.40 (0.60-9.55) and 2.43 (0.636 - 9.48) respectively]. Conclusion high incidence rate of PSI9 and the incidence is higher in male gender and 60 years old and more patients. Those patients developed PSI9 were at high risk for readmission and death. Recommendations the hospital administration should consider strategies and policies to decrease the rate of PSI9 and subsequent unfavorable clinical outcomes.

Broadening the concept of patient safety culture through value-based healthcare

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Viktor Dombrádi ◽  
Klára Bíró ◽  
Guenther Jonitz ◽  
Muir Gray ◽  
Anant Jani
Keyword(s):  
Patient Safety ◽  
Patient Experience ◽  
Safety Culture ◽  
Improve Patient Safety ◽  
Cost Benefit ◽  
Population Level ◽  
Patient Safety Culture ◽  
Content Type ◽  
Experience Of Care ◽  
Improve Patient

PurposeDecision-makers are looking for innovative approaches to improve patient experience and outcomes with the finite resources available in healthcare. The concept of value-based healthcare has been proposed as one such approach. Since unsafe care hinders patient experience and contributes to waste, the purpose of this paper is to investigate how the value-based approach can help broaden the existing concept of patient safety culture and thus, improve patient safety and healthcare value.Design/methodology/approachIn the arguments, the authors use the triple value model which consists of personal, technical and allocative value. These three aspects together promote healthcare in which the experience of care is improved through the involvement of patients, while also considering the optimal utilisation and allocation of finite healthcare resources.FindingsWhile the idea that patient involvement should be integrated into patient safety culture has already been suggested, there is a lack of emphasis that economic considerations can play an important role as well. Patient safety should be perceived as an investment, thus, relevant questions need to be addressed such as how much resources should be invested into patient safety, how the finite resources should be allocated to maximise health benefits at a population level and how resources should be utilised to get the best cost-benefit ratio.Originality/valueThus far, both the importance of patient safety culture and value-based healthcare have been advocated; this paper emphasizes the need to consider these two approaches together.

scholarly journals Clinical Predictors of Mortality in Prehospital Distress Calls by Emergency Medical Service Subscribers

2021 ◽  
Vol 10 (22) ◽  
pp. 5355
Author(s):  
Gabby Elbaz-Greener ◽  
Shemy Carasso ◽  
Elad Maor ◽  
Lior Gallimidi ◽  
Merav Yarkoni ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Population Based ◽  
Hospital Data ◽  
Clinical Predictors ◽  
Emergency Calls ◽  
Emergency Medical ◽  
Risk Patients ◽  
Early Decision ◽  
Risk Predictors

(1) Introduction: Most studies rely on in-hospital data to predict cardiovascular risk and do not include prehospital information that is substantially important for early decision making. The aim of the study was to define clinical parameters in the prehospital setting, which may affect clinical outcomes. (2) Methods: In this population-based study, we performed a retrospective analysis of emergency calls that were made by patients to the largest private emergency medical services (EMS) in Israel, SHL Telemedicine Ltd., who were treated on-site by the EMS team. Demographics, clinical characteristics, and clinical outcomes were analyzed. Mortality was evaluated at three time points: 1, 3, and 12 months’ follow-up. The first EMS prehospital measurements of the systolic blood pressure (SBP) were recorded and analyzed. Logistic regression analyses were performed. (3) Results: A total of 64,320 emergency calls were included with a follow-up of 12 months post index EMS call. Fifty-five percent of patients were men and the mean age was 70.2 ± 13.1 years. During follow-up of 12 months, 7.6% of patients died. Age above 80 years (OR 3.34; 95% CI 3.03–3.69, p < 0.005), first EMS SBP ≤ 130 mm Hg (OR 2.61; 95% CI 2.36–2.88, p < 0.005), dyspnea at presentation (OR 2.55; 95% CI 2.29–2.83, p < 0001), and chest pain with ischemic ECG changes (OR 1.95; 95% CI 1.71–2.23, p < 0.001) were the highest predictors of 1 month mortality and remained so for mortality at 3 and 12 months. In contrast, history of hypertension and first EMS prehospital SBP ≥ 160 mm Hg were significantly associated with decreased mortality at 1, 3 and 12 months. (4) Conclusions: We identified risk predictors for all-cause mortality in a large cohort of patients during prehospital EMS calls. Age over 80 years, first EMS-documented prehospital SBP < 130 mm Hg, and dyspnea at presentation were the most profound risk predictors for short- and long-term mortality. The current study demonstrates that in prehospital EMS call settings, several parameters can be used to improve prioritization and management of high-risk patients.

Application of Bow-tie methodology to improve patient safety

2016 ◽  
Vol 29 (4) ◽  
pp. 425-440 ◽  
Author(s):  
Zhaleh Abdi ◽  
Hamid Ravaghi ◽  
Mohsen Abbasi ◽  
Bahram Delgoshaei ◽  
Somayeh Esfandiari
Keyword(s):  
Patient Safety ◽  
Adverse Events ◽  
Blood Stream Infection ◽  
Improve Patient Safety ◽  
Blood Stream ◽  
Clinical Settings ◽  
Content Type ◽  
Clinical Risks ◽  
Improve Patient ◽  
Bow Tie

Purpose – The purpose of this paper is to apply Bow-tie methodology, a proactive risk assessment technique based on systemic approach, for prospective analysis of the risks threatening patient safety in intensive care unit (ICU). Design/methodology/approach – Bow-tie methodology was used to manage clinical risks threatening patient safety by a multidisciplinary team in the ICU. The Bow-tie analysis was conducted on incidents related to high-alert medications, ventilator associated pneumonia, catheter-related blood stream infection, urinary tract infection, and unwanted extubation. Findings – In total, 48 potential adverse events were analysed. The causal factors were identified and classified into relevant categories. The number and effectiveness of existing preventive and protective barriers were examined for each potential adverse event. The adverse events were evaluated according to the risk criteria and a set of interventions were proposed with the aim of improving the existing barriers or implementing new barriers. A number of recommendations were implemented in the ICU, while considering their feasibility. Originality/value – The application of Bow-tie methodology led to practical recommendations to eliminate or control the hazards identified. It also contributed to better understanding of hazard prevention and protection required for safe operations in clinical settings.

scholarly journals Surgical learning and guidance on operative risks and potential errors

2017 ◽  
Vol 29 (5) ◽  
pp. 326-342 ◽  
Author(s):  
Minna Ruoranen ◽  
Teuvo Antikainen ◽  
Anneli Eteläpelto
Keyword(s):  
Patient Safety ◽  
Improve Patient Safety ◽  
Hospital Environment ◽  
Surgical Operation ◽  
Learning From Errors ◽  
Content Type ◽  
Surgical Residents ◽  
Context Of Learning ◽  
Surgical Learning ◽  
Surgical Operations

Purpose Within the framework of learning from errors, this study focused on how operative risks and potential errors are addressed in guidance to surgical residents during authentic surgical operations. The purpose of this paper is to improve patient safety and to diminish medical complications resulting from possible operating errors. Further in the process of the optimal contexts for instruction aimed at preventing risks and errors in the practical hospital environment was evaluated. Design/methodology/approach The five authentic surgical operations were analyzed, all of which were organized as training sessions for surgical residents. The data (collected via video-recoding) were analyzed by a consultant surgeon and an education expert working together. Findings The results showed that the risks and potential errors in the surgical operations were rarely addressed in guidance during operations. The guidance provided mostly concerned technical issues, such as instrument handling, and exploration of critical anatomical structures. There was little guidance focusing on situation-based risks and potential errors, such as unexpected procedural challenges, teamwork and practical decision-making. The findings showed that optimal context of learning about risks and potential errors of surgical operation are not always the authentic operation context. Originality/value The study was conducted in an authentic surgical operation-cum-training context. The originality of the study derives from its focus on guidance related to risk and error prevention in surgical workplace learning. The findings can be used to create a meaningful learning environment – including powerful guidance – for practice-based surgical learning, maximally addressing patient safety, but giving possibilities also for other training options.

Comparing the coding of complications in Queensland and Victorian admitted patient data

2011 ◽  
Vol 35 (3) ◽  
pp. 245 ◽  
Author(s):  
Jude L. Michel ◽  
Diana Cheng ◽  
Terri J. Jackson
Keyword(s):  
Patient Safety ◽  
Data Quality ◽  
Secondary Analysis ◽  
Routine Data ◽  
Complication Rates ◽  
Hospital Data ◽  
Patient Safety Indicators ◽  
Hospital Acquired Conditions ◽  
Hospital Acquired

Objective. To examine differences between Queensland and Victorian coding of hospital-acquired conditions and suggest ways to improve the usefulness of these data in the monitoring of patient safety events. Design. Secondary analysis of admitted patient episode data collected in Queensland and Victoria. Methods. Comparison of depth of coding, and patterns in the coding of ten commonly coded complications of five elective procedures. Results. Comparison of the mean complication codes assigned per episode revealed Victoria assigns more valid codes than Queensland for all procedures, with the difference between the states being significantly different in all cases. The proportion of the codes flagged as complications was consistently lower for Queensland when comparing 10 common complications for each of the five selected elective procedures. The estimated complication rates for the five procedures showed Victoria to have an apparently higher complication rate than Queensland for 35 of the 50 complications examined. Conclusion. Our findings demonstrate that the coding of complications is more comprehensive in Victoria than in Queensland. It is known that inconsistencies exist between states in routine hospital data quality. Comparative use of patient safety indicators should be viewed with caution until standards are improved across Australia. More exploration of data quality issues is needed to identify areas for improvement. What is known about the topic? Routine data are low cost, accessible and timely but the quality is often questioned. This deters researchers and clinicians from using the data to monitor aspects of quality improvement. Previous studies have reported on the quality of diagnosis coding in Australia but not specifically on the quality of use of the condition-onset flag denoting hospital-acquired conditions. What does this paper add? Few studies have tested the consistency of the data between Australian states. No previous studies have evaluated the comprehensiveness of the coding of hospital-acquired conditions using routine data. This paper compares two states to highlight the differences in the coding of complications, with the aim of improving routine data to support patient safety. What are the implications for practitioners? The results imply more work needs to be done to improve the coding and flagging of complications so the data are valid and comprehensive. Further research should identify problem areas responsible for differences in the data so that training and audit strategies can be developed to improve the collection of this information. Practitioners may then be more confident in using routine coded inpatient data as part of the process of monitoring patient safety.

Faculty Clinical Quality Goals Drive Improvement in University HealthSystem Consortium Outcome Measures

2012 ◽  
Vol 78 (7) ◽  
pp. 749-754 ◽  
Author(s):  
Kevin E. Behrns ◽  
Darwin Ang ◽  
Huazi Liu ◽  
Steven J. Hughes ◽  
Holly Creel ◽  
...  
Keyword(s):  
Patient Safety ◽  
Improve Patient Safety ◽  
Clinical Score ◽  
Outcome Data ◽  
Faculty Members ◽  
Clinical Quality ◽  
Patient Safety Indicators ◽  
Before And After ◽  
The University ◽  
Hospital Acquired

Mortality, length of stay (LOS), patient safety indicators (PSIs), and hospital-acquired conditions (HACs) are routinely reported by the University HealthSystem Consortium (UHC) to measure quality at academic health centers. We hypothesized that a clinical quality measurable goal assigned to individual faculty members would decrease UHC measures of mortality, LOS, PSIs, and HACs. For academic year (AY) 2010–2011, faculty members received a clinical quality goal related to mortality, LOS, PSIs, and HACs. The quality metric constituted 25 per cent of each faculty member's annual evaluation clinical score, which is tied to compensation. The outcomes were compared before and after goal assignment. Outcome data on 6212 patients from AY 2009–2010 were compared with 6094 patients from AY 2010–2011. The mortality index (0.89 vs 0.93; P = 0.73) was not markedly different. However, the LOS index decreased from 1.01 to 0.97 ( P = 0.011), and department-wide PSIs decreased significantly from 285 to 162 ( P = 0.011). Likewise, HACs decreased from 54 to 18 ( P = 0.0013). Seven (17.9%) of 39 faculty had quality grades that were average or below. Quality goals assigned to individual faculty members are associated with decreased average LOS index, PSIs, and HACs. Focused, relevant quality assignments that are tied to compensation improve patient safety and outcomes.

Adverse obstetric outcomes in two Brazilian maternity hospitals

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Alessa Leila Andrade ◽  
Zenewton André da Silva Gama ◽  
Marise Reis de Freitas ◽  
Wilton Rodrigues Medeiros ◽  
Kelienny de Meneses Sousa ◽  
...  
Keyword(s):  
Patient Safety ◽  
High Risk ◽  
Adverse Outcome ◽  
Obstetric Care ◽  
Care Quality ◽  
Adverse Outcomes ◽  
Content Type ◽  
Maternity Hospitals ◽  
One Year

PurposeObstetric adverse outcomes (AOs) are an important topic and the use of composite measures may favor the understanding of their impact on patient safety. The aim of the present study was to estimate AO frequency and obstetric care quality in low and high-risk maternity hospitals.Design/methodology/approachA one-year longitudinal follow-up study in two public Brazilian maternity hospitals. The frequency of AOs was measured in 2,880 randomly selected subjects, 1,440 in each institution, consisting of women and their newborn babies. The frequency of 14 AOs was estimated every two weeks for one year, as well as three obstetric care quality indices based on their frequency and severity as follows: the Adverse Outcome Index (AOI), the Weighted Adverse Outcome Score and the Severity Index.FindingsA significant number of mothers and newborns exhibited AOs. The most prevalent maternal AOs were admission to the ICU and postpartum hysterectomy. Regarding newborns, hospitalization for > seven days and neonatal infection were the most common complications. Adverse outcomes were more frequent at the high-risk maternity, however, they were more severe at the low-risk facility. The AOI was stable at the high-risk center but declined after interventions during the follow-up year.Originality/valueHigh AO frequency was identified in both mothers and newborns. The results demonstrate the need for public patient safety policies for low-risk maternity hospitals, where AOs were less frequent but more severe.

Patient safety culture in Hungarian hospitals

2019 ◽  
Vol 32 (2) ◽  
pp. 412-424 ◽  
Author(s):  
Nina Granel ◽  
Josep Maria Manresa-Domínguez ◽  
Anita Barth ◽  
Katalin Papp ◽  
Maria Dolors Bernabeu-Tamayo
Keyword(s):  
Patient Safety ◽  
Safety Culture ◽  
Improve Patient Safety ◽  
Patient Safety Culture ◽  
Healthcare Staff ◽  
Content Type ◽  
Work Area ◽  
Exploratory Factor Analyses ◽  
The Usa ◽  
Blame Culture

Purpose The Hospital Survey on Patient Safety Culture (HSOPSC) is a rigorously designed tool for measuring inpatient safety culture. The purpose of this paper is to develop a cross-cultural HSOPSC for Hungary and determine its strengths and weaknesses. Design/methodology/approach The original US version was translated and adapted using existing guidelines. Healthcare workers (n=371) including nurses, physicians and other healthcare staff from six Hungarian hospitals participated. Answers were analyzed using exploratory factor analyses and reliability tests. Findings Positive responses in all dimensions were lower in Hungary than in the USA. Half the participants considered their work area “acceptable” regarding patient safety. Healthcare staff worked in “crisis mode,” trying to accomplish too much and too quickly. The authors note that a “blame culture” does not facilitate patient safety improvements in Hungary. Practical implications The results provide valuable information for promoting a more positive patient safety culture in Hungary and for evaluating future strategies to improve patient safety. Originality/value Introducing a validated scale to measure patient safety culture in Hungary improves healthcare quality.

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