scholarly journals Delivering safe and effective test-result communication, management and follow-up: a mixed-methods study protocol

BMJ Open ◽  
2018 ◽  
Vol 8 (2) ◽  
pp. e020235 ◽  
Author(s):  
Maria R Dahm ◽  
Andrew Georgiou ◽  
Johanna I Westbrook ◽  
David Greenfield ◽  
Andrea R Horvath ◽  
...  
Keyword(s):  
Patient Safety ◽  
Mixed Methods ◽  
Local Health ◽  
Safety Risks ◽  
Semistructured Interviews ◽  
Result Management ◽  
Governance Processes ◽  
The Impact ◽  
Test Result

IntroductionThe failure to follow-up pathology and medical imaging test results poses patient-safety risks which threaten the effectiveness, quality and safety of patient care. The objective of this project is to: (1) improve the effectiveness and safety of test-result management through the establishment of clear governance processes of communication, responsibility and accountability; (2) harness health information technology (IT) to inform and monitor test-result management; (3) enhance the contribution of consumers to the establishment of safe and effective test-result management systems.Methods and analysisThis convergent mixed-methods project triangulates three multistage studies at seven adult hospitals and one paediatric hospital in Australia.Study 1 adopts qualitative research approaches including semistructured interviews, focus groups and ethnographic observations to gain a better understanding of test-result communication and management practices in hospitals, and to identify patient-safety risks which require quality-improvement interventions.Study 2 analyses linked sets of routinely collected healthcare data to examine critical test-result thresholds and test-result notification processes. A controlled before-and-after study across three emergency departments will measure the impact of interventions (including the use of IT) developed to improve the safety and quality of test-result communication and management processes.Study 3 adopts a consumer-driven approach, including semistructured interviews, and the convening of consumer-reference groups and community forums. The qualitative data will identify mechanisms to enhance the role of consumers in test-management governance processes, and inform the direction of the research and the interpretation of findings.Ethics and disseminationEthical approval has been granted by the South Eastern Sydney Local Health District Human Research Ethics Committee and Macquarie University. Findings will be disseminated in academic, industry and consumer journals, newsletters and conferences.

Patient groups, clinicians and healthcare professionals agree – all test results need to be seen, understood and followed up

Diagnosis ◽  
2018 ◽  
Vol 5 (4) ◽  
pp. 215-222 ◽  
Author(s):  
Maria R. Dahm ◽  
Andrew Georgiou ◽  
Robert Herkes ◽  
Anthony Brown ◽  
Julie Li ◽  
...  
Keyword(s):  
Patient Safety ◽  
Systems Approach ◽  
Digital Health ◽  
Diagnostic Testing ◽  
Care Process ◽  
Test Results ◽  
Levels Of Care ◽  
Result Management ◽  
Test Result

AbstractBackgroundDiagnostic testing provides integral information for the prevention, diagnosis, treatment and management of disease. Inadequate test result reporting and follow-up is a major risk to patient safety. Factors contributing to failure to follow-up test results include unclear delineation of responsibility about who is meant to act on a test result; poor coordination across different levels of care; and the absence of integrated health information systems for the efficient information communication.MethodsA 2016 Australian Stakeholder Forum brought together over 30 representatives from 14 different consumer, clinical and management stakeholder organisations to discuss safe and effective test result communication, management and follow-up. Thematic analysis was conducted drawing on multimodal data collected in the form of observational fieldnotes and document artefacts produced by participants.ResultsThe forum identified major challenges which pose immediate risks to patient safety. Participants recommended priorities for addressing issues relating to: (i) the governance of test result management processes; (ii) integration of health care processes through the utilisation of effective digital health solutions; and (iii) involving patients as key partners in the decision-making and care process.ConclusionsStakeholder groups diverged slightly in their priorities. Consumers highlighted the lack of patient involvement in the test result management process but were less concerned about standardisation of reports and critical result thresholds than pathologists. The forum foregrounded the need for a systems approach, capable of identifying and addressing interconnections and multiple factors that contribute to poor test result follow-up, with a strong emphasis on enhancing the contribution of patients.

scholarly journals Variation in electronic test results management and its implications for patient safety: A multisite investigation

2020 ◽  
Vol 27 (8) ◽  
pp. 1214-1224
Author(s):  
Judith Thomas ◽  
Maria R Dahm ◽  
Julie Li ◽  
Peter Smith ◽  
Jacqui Irvine ◽  
...  
Keyword(s):  
Information Technology ◽  
Patient Safety ◽  
Health Information Technology ◽  
Health Information ◽  
Diagnostic Test ◽  
Test Results ◽  
Results Management ◽  
Result Management ◽  
Test Result

Abstract Objective The management and follow-up of diagnostic test results is a major patient safety concern. The aim of this qualitative study was to explore how clinicians manage test results on an everyday basis (work-as-done) in a health information technology–enabled emergency department setting. The objectives were to identify (1) variations in work-as-done in test results management and (2) the strategies clinicians use to ensure optimal management of diagnostic test results. Materials and Methods Qualitative interviews (n = 26) and field observations were conducted across 3 Australian emergency departments. Interview data coded for results management (ie, tracking, acknowledgment, and follow-up), and artifacts, were reviewed to identify variations in descriptions of work-as-done. Thematic analysis was performed to identify common themes. Results Despite using the same test result management application, there were variations in how the system was used. We identified 5 themes relating to electronic test results management: (1) tracking test results, (2) use and understanding of system functionality, (3) visibility of result actions and acknowledgment, (4) results inbox use, and (5) challenges associated with the absence of an inbox for results notifications for advanced practice nurses. Discussion Our findings highlight that variations in work-as-done can function to overcome perceived impediments to managing test results in a HIT-enabled environment and thus identify potential risks in the process. By illuminating work-as-done, we identified strategies clinicians use to enhance test result management including paper-based manual processes, cognitive reminders, and adaptive use of electronic medical record functionality. Conclusions Test results tracking and follow-up is a priority area in need of health information technology development and training to improve team-based collaboration/communication of results follow-up and diagnostic safety.

scholarly journals Acute care nurses’ perceptions of leadership, teamwork, turnover intention and patient safety – a mixed methods study

BMC Nursing ◽  
2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Shahram Zaheer ◽  
Liane Ginsburg ◽  
Hannah J. Wong ◽  
Kelly Thomson ◽  
Lorna Bain ◽  
...  
Keyword(s):  
Patient Safety ◽  
Mixed Methods ◽  
Turnover Intention ◽  
Interactive Effect ◽  
Mixed Methods Study ◽  
Senior Leadership ◽  
Healthcare Organizations ◽  
Staff Perceptions ◽  
Leadership Support ◽  
The Impact

Abstract Background This study contributes to a small but growing body of literature on how context influences perceptions of patient safety in healthcare settings. We examine the impact of senior leadership support for safety, supervisory leadership support for safety, teamwork, and turnover intention on overall patient safety grade. Interaction effects of predictors on perceptions of patient safety are also examined. Methods In this mixed methods study, cross-sectional survey data (N = 185) were collected from nurses and non-physician healthcare professionals. Semi-structured interview data (N = 15) were collected from nurses. The study participants worked in intensive care, general medicine, mental health, or the emergency department of a large community hospital in Southern Ontario. Results Hierarchical regression analyses showed that staff perceptions of senior leadership (p < 0.001), teamwork (p < 0.01), and turnover intention (p < 0.01) were significantly associated with overall patient safety grade. The interactive effect of teamwork and turnover intention on overall patient safety grade was also found to be significant (p < 0.05). The qualitative findings corroborated the survey results but also helped expand the characteristics of the study’s key concepts (e.g., teamwork within and across professional boundaries) and why certain statistical relationships were found to be non-significant (e.g., nurse interviewees perceived the safety specific responsibilities of frontline supervisors much more broadly compared to the narrower conceptualization of the construct in the survey). Conclusions The results of the current study suggest that senior leadership, teamwork, and turnover intention significantly impact nursing staff perceptions of patient safety. Leadership is a modifiable contextual factor and resources should be dedicated to strengthen relational competencies of healthcare leaders. Healthcare organizations must also proactively foster inter and intra-professional collaboration by providing teamwork educational workshops or other on-site learning opportunities (e.g., simulation training). Healthcare organizations would benefit by considering the interactive effect of contextual factors as another lever for patient safety improvement, e.g., lowering staff turnover intentions would maximize the positive impact of teamwork improvement initiatives on patient safety.

Effect of In Situ High-Fidelity Simulation Training on the Emergency management of Pneumonia (INSTEP): a mixed-methods study

2018 ◽  
Vol 4 (4) ◽  
pp. 190-195 ◽  
Author(s):  
Owain Michael Leng ◽  
Charlotte Rothwell ◽  
Annamarie Buckton ◽  
Catherine Elmer ◽  
Jan Illing ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Patient Outcomes ◽  
High Fidelity ◽  
High Fidelity Simulation ◽  
Simulation Education ◽  
Audit Data ◽  
Semistructured Interviews ◽  
The Impact

BackgroundThe patient safety agenda has propelled the rise of simulation education, but relatively few evaluations of simulation-based educational interventions have focused on patient outcomes.ObjectiveTo evaluate the impact of an in situ, high-fidelity simulation teaching intervention on the management of community-acquired pneumonia in the ambulatory care unit of a district general hospital.MethodsThis study used a mixed-methods approach to evaluate the impact of a programme of 10 in situ high-fidelity simulation education sessions delivered to a total of 10 junior doctors, nine nurses and seven healthcare assistants. Participants were tasked with managing a manikin simulating a patient with pneumonia in real time in a working clinical area. Subsequent structured debrief emphasised key themes from the national guidelines on pneumonia management. The intervention was evaluated through an immediate feedback form, follow-up semistructured interviews by independent qualitative researchers that underwent content analysis and triangulation with audit data on compliance with national pneumonia guidelines before and after the simulation intervention.ResultsThe in situ simulation intervention was valued by participants both in immediate written feedback and in follow-up semistructured interviews. In these interviews, 17 of 18 participants were able to identify a self-reported change in practice following the simulation intervention. Furthermore, most participants reported observing a change in the clinical practice of their colleagues following the training. Collected audit data did not show a statistically significant change in compliance with the guidelines for the management of pneumonia.ConclusionThis study found evidence of a change in both self-reported and observed clinical practice following a simulation intervention, supporting expert opinion that simulation education can impact clinician behaviours and patient outcomes in complex clinical scenarios. Furthermore, this feasibility study provides a transferrable method to evaluate the real-world impact of simulation education that merits further investigation through an appropriately powered study.

Opt-out screening for HIV, hepatitis B and hepatitis C: observational study of screening acceptance, yield and treatment outcomes

2019 ◽  
Vol 37 (2) ◽  
pp. 102-105 ◽  
Author(s):  
Conor Grant ◽  
Sarah O'Connell ◽  
Darren Lillis ◽  
Anne Moriarty ◽  
Ian Fitzgerald ◽  
...  
Keyword(s):  
Hepatitis C ◽  
Hepatitis B ◽  
Screening Programme ◽  
Linkage To Care ◽  
Opt Out ◽  
B Virus ◽  
Lost To Follow Up ◽  
The Impact ◽  
Test Result

BackgroundWe initiated an emergency department (ED) opt-out screening programme for HIV, hepatitis B virus (HBV) and hepatitis C virus (HCV) at our hospital in Dublin, Ireland. The objective of this study was to determine screening acceptance, yield and the impact on follow-up care.MethodsFrom July 2015 through June 2018, ED patients who underwent phlebotomy and could consent to testing were tested for HIV, HBV and HCV using an opt-out approach. We examined acceptance of screening, linkage to care, treatment and viral suppression using screening programme data and electronic health records. The duration of follow-up ranged from 1 to 36 months.ResultsOver the 36-month study period, there were 140 550 ED patient visits, of whom 88 854 (63.2%, 95% CI 63.0% to 63.5%) underwent phlebotomy and 54 817 (61.7%, 95% CI 61.4% to 62.0%) accepted screening for HIV, HBV and HCV, representing 41 535 individual patients. 2202 of these patients had a positive test result. Of these, 267 (12.1%, 95% CI 10.8% to 13.6%) were newly diagnosed with an infection and 1762 (80.0%, 95% CI 78.3% to 81.7%) had known diagnoses. There were 38 new HIV, 47 new HBV and 182 new HCV diagnoses. 81.5% (95% CI 74.9% to 87.0%) of known patients who were not linked were relinked to care after screening. Of the new diagnoses, 86.2% (95% CI 80.4 to 90.8%) were linked to care.ConclusionAlthough high proportions of patients had known diagnoses, our programme was able to identify many new infected patients and link them to care, as well as relink patients with known diagnoses who had been lost to follow-up.

scholarly journals The impact of the Safer Anaesthesia from Education (SAFE) Obstetric Anaesthesia training course in Ethiopia: A mixed methods longitudinal cohort study

2020 ◽  
Vol 48 (4) ◽  
pp. 297-305
Author(s):  
Jolene N Moore ◽  
Wayne W Morriss ◽  
Gebrehiwot Asfaw ◽  
Gosa Tesfaye ◽  
Aaliya R Ahmed ◽  
...  
Keyword(s):  
Cohort Study ◽  
Mixed Methods ◽  
Maternal Mortality ◽  
Longitudinal Cohort Study ◽  
Structured Interviews ◽  
Middle Income ◽  
Longitudinal Cohort ◽  
Obstetric Anaesthesia ◽  
The Impact

Summary Reducing maternal mortality remains a global priority, particularly in low- and middle-income countries (LMICs). The Safer Anaesthesia from Education (SAFE) Obstetric Anaesthesia (OB) course is a three-day refresher course for trained anaesthesia providers addressing common causes of maternal mortality in LMICs. This aim of this study was to investigate the impact of SAFE training for a cohort of anaesthesia providers in Ethiopia. We conducted a mixed methods longitudinal cohort study incorporating a behavioural questionnaire, multiple-choice questionnaires (MCQs), structured observational skills tests and structured interviews for anaesthesia providers who attended one of four SAFE-OB courses conducted in two regions of Ethiopia from October 2017 to May 2018. Some 149 participants from 60 facilities attended training. Behavioural questionnaires were completed at baseline ( n = 101, 69% response rate). Pre- and post-course MCQs ( n = 121, n = 123 respectively) and pre- and post-course skills tests ( n = 123, n = 105 respectively) were completed, with repeat MCQ and skills tests, and semi-structured interviews completed at follow-up ( n = 88, n = 76, n = 49 respectively). The mean MCQ scores for all participants improved from 80.3% prior to training to 85.4% following training ( P < 0.0001) and skills test scores improved from 56.5% to 83.2% ( P < 0.0001). Improvements in MCQs and skills were maintained at follow-up 3–11 months post-training compared to baseline ( P = 0.0006, < 0.0001 respectively). Participants reported improved confidence, teamwork and communication at follow-up. This study suggests that the SAFE-OB course can have a sustained impact on knowledge and skills and can improve the confidence of anaesthesia providers and communication within surgical teams.

scholarly journals A mixed-methods evaluation of transformational change in NHS North East

2014 ◽  
Vol 2 (47) ◽  
pp. 1-186 ◽  
Author(s):  
David J Hunter ◽  
Jonathan Erskine ◽  
Chris Hicks ◽  
Tom McGovern ◽  
Adrian Small ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Focus Groups ◽  
Leadership Style ◽  
Large Scale ◽  
Research Programme ◽  
Transformational Change ◽  
North East ◽  
The North ◽  
Semistructured Interviews ◽  
The Impact

BackgroundThe North East Transformation System (NETS) was conceived as an experiment in adopting large-scale transformational change across a NHS region in England. Although the NHS in the North East performs well, the health of the population ranks among the poorest in the country. The NETS was viewed as a means of addressing this conundrum. It comprised three components: Vision, Compact and Method.ObjectivesThe evaluation study comprised six elements: a literature review; an evaluation of the evolution and impact of the NETS; an identification of the factors facilitating, and/or acting as barriers to, successful change; an assessment of the role of the NETS project team; establishing how far the changes introduced through the NETS became embedded and sustained; and an evaluation of the impact of the NETS on end users.DesignThe research comprised a longitudinal mixed-methods study conducted over 3.5 years. Research methods included 68 semistructured interviews, observation, two focus groups, documentary analysis and interrupted time series (ITS) analysis. The ITS component comprised analysis of five rapid process improvement workshops in two of the sites.SettingThe research setting was the NHS North East region until its abolition in April 2013 following the UK government’s NHS changes. Fourteen sites were selected for the study, comprising primary care trusts as commissioners, and provider trusts including mental health, community, acute care and ambulance services.ParticipantsThe study respondents were members of staff in the 14 sites drawn from different levels of their organisations.InterventionsThe NETS comprised a complex set of interventions aimed at improving the efficiency and effectiveness of care pathways for staff and patients.Main outcome measuresThe ‘receptive contexts for change’ framework was used to evaluate the transformational change process and its outcomes.Data sourcesQualitative parts of the study drew on semistructured interviews, focus groups, observation and documents. Quantitative parts of the study used routinely collected NHS data.ResultsTransformational change in a complex system takes time and demands consistency, constancy of purpose and organisational stability. The NETS was seriously disrupted by the NHS changes announced in July 2010. Progress was sustained at four of the study sites, but slowed or ceased at the other sites. Leadership style was found to be critical to the success of transformational change.ConclusionsThe NETS was a bold and ambitious initiative which succeeded in bringing about real and lasting change in some parts of the North East. However, it was unable to fully realise its vision and purpose partly because of the widespread reorganisation of the NHS by the new coalition government.Future workThere is a need to develop new methods to understand how change occurs, or fails, in complex settings like the NHS. There is a need for more in-depth studies in those sites that were able to implement and sustain change. This would inform future policy and practice. The results of the quantitative analyses were less conclusive than those obtained by qualitative methods. Further development of mixed-methods approaches would provide additional support for evidence-based decision-making.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

scholarly journals Improving practice in safeguarding at the interface between hospital services and children’s social care: a mixed-methods case study

2015 ◽  
Vol 3 (4) ◽  
pp. 1-164 ◽  
Author(s):  
Susan White ◽  
David Wastell ◽  
Suzanne Smith ◽  
Christopher Hall ◽  
Emilie Whitaker ◽  
...  
Keyword(s):  
Patient Safety ◽  
Mixed Methods ◽  
Child Protection ◽  
Social Care ◽  
Research Programme ◽  
Unintended Consequences ◽  
Primary Site ◽  
Hospital Environment ◽  
Future Research ◽  
The Impact

BackgroundHospital settings have an important impact on children harmed by parents and carers. Concern arises from the capacity of these settings to respond effectively to individual needs despite increased NHS policy awareness and actions on safeguarding. Patient safety initiatives have rarely modelled in detail the social and cultural dynamics of child health settings and children’s safeguarding. This study is focused on supporting and evaluating clinician-led service design in an acute trust. A suite of initiatives and artefacts has been designed, based on sociotechnical principles, on the premise that only a thorough understanding of human, social and organisational challenges will afford effective solutions.ObjectivesThe study addresses the following primary question: ‘Can a safeguarding culture be designed within the hospital environment that will provide the conditions for the detection of children at risk of abuse and support protective actions before discharge, including collaboration with external agencies?’ Objectives include the development of a sociologically rich understanding of why diagnostic failures and communication breakdowns occur; the design of a suite of integrated interventions for promoting a positive safety culture, following a user-centred approach; and the evaluation of the effectiveness of this package, including its generalisability across sites.DesignThe study took place in two sites: the primary site where the initiatives were developed and a further site with the original intention of transferring developments. The investigation follows a broaddesign scienceapproach. The evaluation of a design intervention relies on a rigorous understanding of the realities of everyday practice, and the study thus draws on mixed methods to examine the impact of service redesign on cultures and practices.FindingsThe data suggest that safeguarding children can become mainstream patient safety business. Board support is vital. In our primary site, there has been a steady integration of learning from serious case reviews and other child protection-related processes with ‘patient safety’-related incidents, with growing recognition that similar systemic issues impact on both domains. Making use of a familiar vocabulary to redescribesafeguardingas asafetyissue, and thus as something fundamental to the functions of an acute hospital, has been part of the success. The data suggest that persistence, resilience and vigilance from the safeguarding leadership and executive teams are crucial. Current policy includes the development of the Child Protection Information Sharing project, which is intended to improve information flow between the NHS, particularly hospitals and children’s social care. The findings from this study suggest the importance of good design, piloting, incrementalism and a thorough empirical engagement with everyday practices during implementation of this and any future information systems based reform.ConclusionsSafeguarding takes place in a complex system and even minor changes within any part of that system can impact on the rest in unpredictable ways. It is important that managers adopt a ‘design attitude’ and seek to mitigate unintended consequences through careful experimentation. The findings suggest the need for the design of systems to enhance communication and not simply to ‘share information’. Technological solutions impact on everyday decision-making and can have unintended consequences. Attention to forces of change and stasis in health settings, the factors affecting technology transfer and the impact of the configuration of local authority services are suggested as a key priorities for future research.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

scholarly journals Language barriers and patient safety risks in hospital care. A mixed methods study

2016 ◽  
Vol 54 ◽  
pp. 45-53 ◽  
Author(s):  
Floor van Rosse ◽  
Martine de Bruijne ◽  
Jeanine Suurmond ◽  
Marie-Louise Essink-Bot ◽  
Cordula Wagner
Keyword(s):  
Patient Safety ◽  
Mixed Methods ◽  
Hospital Care ◽  
Language Barriers ◽  
Mixed Methods Study ◽  
Safety Risks

Longevity, legacy, and lament: Learning from longstanding educators in an innovative curriculum

2021 ◽  
Vol 2021 (April) ◽  
pp. 1-20
Author(s):  
Gillian Maudsley
Keyword(s):  
Student Outcomes ◽  
Medical Curriculum ◽  
Research Question ◽  
System Integrity ◽  
Semistructured Interviews ◽  
Innovative Curriculum ◽  
The Impact ◽  
Long Term Experience

Research about problem-based learning (PBL) tutoring in medicine has prioritized quantifying relationships between tutor characteristics or learning environment and tutoring behaviour or student outcomes. Longitudinal studies and qualitative research about how such tutors conceptualize their long-term experience are rare. The research question was thus: What educator outlooks do inaugural PBL tutors develop after substantial experience in a problem-based medical curriculum? At16 year-follow-up of interviews with an inaugural cohort of PBL tutors, semistructured interviews with the remaining ten explored their outlooks as educators now versus then. Two years later, an open-ended e-questionnaire (E-interview) reviewed their outlooks, particularly about the curriculum being replaced. Tutors viewed their role now through a more discerning, reflective, and constructivist ‘good educator’ lens. They articulated principles for facilitating active learning. When that curriculum was replaced, tutors were positive about its legacy but also lamented flawed educational governance for maintaining and renewing whole-system integrity. Educator development should prompt critical reflection about ‘the good educator’ identity, the related enthusiasms, discomforts, and uncertainties, and the impact of curriculum shifts.

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