Impact of the communication and patient hand-off tool SBAR on patient safety: a systematic review

ObjectivesCommunication breakdown is one of the main causes of adverse events in clinical routine, particularly in handover situations. The communication tool SBAR (situation, background, assessment and recommendation) was developed to increase handover quality and is widely assumed to increase patient safety. The objective of this review is to summarise the impact of the implementation of SBAR on patient safety.DesignA systematic review of articles published on SBAR was performed in PUBMED, EMBASE, CINAHL, Cochrane Library and PsycINFO in January 2017. All original research articles on SBAR fulfilling the following eligibility criteria were included: (1) SBAR was implemented into clinical routine, (2) the investigation of SBAR was the primary objective and (3) at least one patient outcome was reported.SettingA wide range of settings within primary and secondary care and nursing homes.ParticipantsA variety of heath professionals including nurses and physicians.Primary and secondary outcome measuresAspects of patient safety (patient outcomes) defined as the occurrence or incidence of adverse events.ResultsEight studies with a before–after design and three controlled clinical trials performed in different clinical settings met the inclusion criteria. The objectives of the studies were to improve team communication, patient hand-offs and communication in telephone calls from nurses to physicians. The studies were heterogeneous with regard to study characteristics, especially patient outcomes. In total, 26 different patient outcomes were measured, of which eight were reported to be significantly improved. Eleven were described as improved but no further statistical tests were reported, and six outcomes did not change significantly. Only one study reported a descriptive reduction in patient outcomes.ConclusionsThis review found moderate evidence for improved patient safety through SBAR implementation, especially when used to structure communication over the phone. However, there is a lack of high-quality research on this widely used communication tool.Trial registrationnone

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Effect of dose administration aids on adherence to self-administered medications: a systematic review protocol

BMJ Open ◽

10.1136/bmjopen-2019-030536 ◽

2019 ◽

Vol 9 (10) ◽

pp. e030536

Author(s):

Kanika Chaudhri ◽

Madeleine Kearney ◽

Richard O Day ◽

Anthony Rodgers ◽

Emily Atkins

Keyword(s):

Systematic Review ◽

Health Outcomes ◽

Meta Analysis ◽

Study Participant ◽

Risk Of Bias ◽

Cochrane Library ◽

Secondary Outcome ◽

Dose Administration ◽

Common Solution ◽

The Impact

IntroductionForgetting to take a medication is the most common reason for non-adherence to self-administered medication. Dose administration aids (DAAs) are a simple and common solution to improve unintentional non-adherence for oral tablets. DAAs can be in the form of compartmentalised pill boxes, automated medication dispensing devices, blister packs and sachets packets. This protocol aims to outline the methods that will be used in a systematic review of the current literature to assess the impact of DAAs on adherence to medications and health outcomes.Methods and analysisRandomised controlled trials will be identified through electronic searches in databases including EMBASE, MEDLINE, CINAHL and the Cochrane Library, from the beginning of each database until January 2020. Two reviewers will independently screen studies and extract data using the standardised forms. Data extracted will include general study information, characteristics of the study, participant characteristics, intervention characteristics and outcomes. Primary outcome is to assess the effects of DAAs on medication adherence. Secondary outcome is to evaluate the changes in health outcomes. The risk of bias will be ascertained by two reviewers in parallel using The Cochrane Risk of Bias Tool. A meta-analysis will be performed if data are homogenous.Ethics and disseminationEthics approval will not be required for this study. The results of the review described within this protocol will be disseminated through publication in a peer-reviewed journal and relevant conference presentations.PROSPERO registration numberCRD42018096087

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Patient prioritisation methods to shorten waiting times for elective surgery: a systematic review of how to improve access to surgery

10.1101/2021.02.18.21252033 ◽

2021 ◽

Author(s):

Dimuthu Rathnayake ◽

Mike Clarke ◽

Viraj Jayasinghe

Keyword(s):

Systematic Review ◽

Web Of Science ◽

Elective Surgery ◽

Waiting Times ◽

Healthcare Management ◽

Waiting List ◽

Cochrane Library ◽

Wide Range ◽

The Impact ◽

Patient Prioritisation

ABSTRACTBackgroundConcern about long waiting times for elective surgeries is not a recent phenomenon, but it has been heightened by the impact of the COVID-19 pandemic and its associated measures. One way to alleviate the problem might be to use prioritisation methods for patients on the waiting list and a wide range of research is available on such methods. However, significant variations and inconsistencies have been reported in prioritisation protocols from various specialties, institutions, and health systems. To bridge the evidence gap in existing literature, this comprehensive systematic review will synthesise global evidence on policy strategies with a unique insight to patient prioritisation methods to reduce waiting times for elective surgeries. This will provide evidence that might help with the tremendous burden of surgical disease that is now apparent in many countries because of operations that were delayed or cancelled due to the COVID-19 pandemic and inform policy for sustainable healthcare management systems.MethodsWe searched PubMed, EMBASE, SCOPUS, Web of Science, and the Cochrane Library, with our most recent searches in January 2020. Articles published after 2013 on major elective surgery lists of adult patients were eligible, but cancer and cancer-related surgeries were excluded. Both randomised and non-randomised studies were eligible and the quality of studies was assessed with ROBINS-I and CASP tools. We registered the review in PROSPERO (CRD42019158455) and reported it in accordance with the PRISMA statement.ResultsThe electronic search in five bibliographic databases yielded 7543 records (PubMed, EMBASE, SCOPUS, Web of Science, and Cochrane) and 17 eligible articles were identified in the screening. There were four quasi-experimental studies, 11 observational studies and two systematic reviews. These demonstrated moderate to low risk of bias in their research methods. Three studies tested generic approaches using common prioritisation systems for all elective surgeries in common. The other studies assessed specific prioritisation approaches for re-ordering the waiting list for a particular surgical specialty.ConclusionsExplicit prioritisation tools with a standardised scoring system based on clear evidence-based criteria are likely to reduce waiting times and improve equitable access to health care. Multiple attributes need to be considered in defining a fair prioritisation system to overcome limitations with local variations and discriminations. Collating evidence from a diverse body of research provides a single framework to improve the quality and efficiency of elective surgical care provision in a variety of health settings. Universal prioritisation tools with vertical and horizontal equity would help with re-ordering patients on waiting lists for elective surgery and reduce waiting times.

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Patient prioritisation methods to shorten waiting times for elective surgery: A systematic review of how to improve access to surgery

PLoS ONE ◽

10.1371/journal.pone.0256578 ◽

2021 ◽

Vol 16 (8) ◽

pp. e0256578

Author(s):

Dimuthu Rathnayake ◽

Mike Clarke ◽

Viraj Jayasinghe

Keyword(s):

Systematic Review ◽

Web Of Science ◽

Elective Surgery ◽

Waiting Times ◽

Healthcare Management ◽

Waiting List ◽

Cochrane Library ◽

Wide Range ◽

The Impact ◽

Patient Prioritisation

Background Concern about long waiting times for elective surgeries is not a recent phenomenon, but it has been heightened by the impact of the COVID-19 pandemic and its associated measures. One way to alleviate the problem might be to use prioritisation methods for patients on the waiting list and a wide range of research is available on such methods. However, significant variations and inconsistencies have been reported in prioritisation protocols from various specialties, institutions, and health systems. To bridge the evidence gap in existing literature, this comprehensive systematic review will synthesise global evidence on policy strategies with a unique insight to patient prioritisation methods to reduce waiting times for elective surgeries. This will provide evidence that might help with the tremendous burden of surgical disease that is now apparent in many countries because of operations that were delayed or cancelled due to the COVID-19 pandemic and inform policy for sustainable healthcare management systems. Methods We searched PubMed, EMBASE, SCOPUS, Web of Science, and the Cochrane Library, with our most recent searches in January 2020. Articles published after 2013 on major elective surgery lists of adult patients were eligible, but cancer and cancer-related surgeries were excluded. Both randomised and non-randomised studies were eligible and the quality of studies was assessed with ROBINS-I and CASP tools. We registered the review in PROSPERO (CRD42019158455) and reported it in accordance with the PRISMA statement. Results The electronic search in five bibliographic databases yielded 7543 records (PubMed, EMBASE, SCOPUS, Web of Science, and Cochrane) and 17 eligible articles were identified in the screening. There were four quasi-experimental studies, 11 observational studies and two systematic reviews. These demonstrated moderate to low risk of bias in their research methods. Three studies tested generic approaches using common prioritisation systems for all elective surgeries in common. The other studies assessed specific prioritisation approaches for re-ordering the waiting list for a particular surgical specialty. Conclusions Explicit prioritisation tools with a standardised scoring system based on clear evidence-based criteria are likely to reduce waiting times and improve equitable access to health care. Multiple attributes need to be considered in defining a fair prioritisation system to overcome limitations with local variations and discriminations. Collating evidence from a diverse body of research provides a single framework to improve the quality and efficiency of elective surgical care provision in a variety of health settings. Universal prioritisation tools with vertical and horizontal equity would help with re-ordering patients on waiting lists for elective surgery and reduce waiting times.

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P92 Power dynamics in healthcare teams – a barrier to team effectiveness and patient safety: A systematic review

BJS Open ◽

10.1093/bjsopen/zrab032.091 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

Author(s):

Emma Kearns ◽

Zuneera Khurshid ◽

Sabrina Anjara ◽

Aoife De Brún ◽

Brendan Rowan ◽

...

Keyword(s):

Systematic Review ◽

Patient Safety ◽

Team Effectiveness ◽

Negative Impact ◽

Cochrane Library ◽

Power Dynamics ◽

Team Communication ◽

Speaking Up ◽

Healthcare Teams ◽

The Impact

Abstract Introduction Hierarchies in healthcare teams are pervasive and widely acknowledged as impacting on working cultures. This review explores the impact of power dynamics in multidisciplinary healthcare teams on patient safety and team effectiveness. Methods A systematic review was conducted using five academic databases (PubMed, CINAHL, PsycInfo, Cochrane Library, Embase) between January 2010-2020. Potentially relevant articles were selected based on title and abstract review, followed by full text review, data extraction and data appraisal. Consistent with PRISMA guidelines, two researchers independently carried out all stages, from data screening to quality appraisal. A narrative synthesis was conducted. Results The databases searches yielded a total of 869 studies. 28 studies met the eligibility criteria and were included in the synthesis. Of these, 20 articles associated power dynamics with team effectiveness and 19 linked power dynamics to patient safety outcomes. Hierarchical power dynamics inhibit team communication and speaking up behaviours, which impacts team effectiveness and patient safety. Barriers to speaking up include workplace policies; respect for seniors’ experience; time pressures; feelings of intimidation and powerlessness; fears of reprisal and repercussions; perceived poor self-efficacy; lack of confidence and role clarity. Conclusion Hierarchies and power dynamics have a profoundly negative effect on patient safety and team effectiveness through their negative impact on communication and speaking up behaviours. Whilst hierarchies cannot be abolished, to improve team communication and collaboration, healthcare organisations and training programmes should consider initiatives that break down silos and promote an inclusive approach to patient care. Initiatives that target the practice of collective leadership and an open and supportive work environment have been shown to improve communication and team effectiveness. Theme: Cross-disciplinary research

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Association between organisational and workplace cultures, and patient outcomes: systematic review

BMJ Open ◽

10.1136/bmjopen-2017-017708 ◽

2017 ◽

Vol 7 (11) ◽

pp. e017708 ◽

Cited By ~ 77

Author(s):

Jeffrey Braithwaite ◽

Jessica Herkes ◽

Kristiana Ludlow ◽

Luke Testa ◽

Gina Lamprell

Keyword(s):

Systematic Review ◽

Patient Outcomes ◽

Science Studies ◽

Positive Association ◽

Final Analysis ◽

Aged Care ◽

Secondary Outcome ◽

Cross Sectional ◽

Wide Range ◽

Workplace Cultures

Design and objectivesEvery organisation has a unique culture. There is a widely held view that a positive organisational culture is related to positive patient outcomes. Following the Preferred Reporting Items for Systematic Review and Meta-Analyses statement, we systematically reviewed and synthesised the evidence on the extent to which organisational and workplace cultures are associated with patient outcomes.SettingA variety of healthcare facilities, including hospitals, general practices, pharmacies, military hospitals, aged care facilities, mental health and other healthcare contexts.ParticipantsThe articles included were heterogeneous in terms of participants. This was expected as we allowed scope for wide-ranging health contexts to be included in the review.Primary and secondary outcome measuresPatient outcomes, inclusive of specific outcomes such as pain level, as well as broader outcomes such as patient experience.ResultsThe search strategy identified 2049 relevant articles. A review of abstracts using the inclusion criteria yielded 204 articles eligible for full-text review. Sixty-two articles were included in the final analysis. We assessed studies for risk of bias and quality of evidence. The majority of studies (84%) were from North America or Europe, and conducted in hospital settings (89%). They were largely quantitative (94%) and cross-sectional (81%). The review identified four interventional studies, and no randomised controlled trials, but many good quality social science studies. We found that overall, positive organisational and workplace cultures were consistently associated with a wide range of patient outcomes such as reduced mortality rates, falls, hospital acquired infections and increased patient satisfaction.ConclusionsSynthesised, although there was no level 1 evidence, our review found a consistently positive association held between culture and outcomes across multiple studies, settings and countries. This supports the argument in favour of activities that promote positive cultures in order to enhance outcomes in healthcare organisations.

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Prevalence of harmful diagnostic errors in hospitalised adults: a systematic review and meta-analysis

BMJ Quality & Safety ◽

10.1136/bmjqs-2019-010822 ◽

2020 ◽

Vol 29 (12) ◽

pp. 1008-1018 ◽

Cited By ~ 4

Author(s):

Craig G Gunderson ◽

Victor P Bilan ◽

Jurgen L Holleck ◽

Phillip Nickerson ◽

Benjamin M Cherry ◽

...

Keyword(s):

Systematic Review ◽

Adverse Events ◽

Meta Analysis ◽

Diagnostic Errors ◽

Diagnostic Error ◽

Error Rates ◽

Cochrane Library ◽

Physician Review ◽

Hospitalised Patients ◽

Wide Range

BackgroundDiagnostic error is commonly defined as a missed, delayed or wrong diagnosis and has been described as among the most important patient safety hazards. Diagnostic errors also account for the largest category of medical malpractice high severity claims and total payouts. Despite a large literature on the incidence of inpatient adverse events, no systematic review has attempted to estimate the prevalence and nature of harmful diagnostic errors in hospitalised patients.MethodsA systematic literature search was conducted using Medline, Embase, Web of Science and the Cochrane library from database inception through 9 July 2019. We included all studies of hospitalised adult patients that used physician review of case series of admissions and reported the frequency of diagnostic adverse events. Two reviewers independently screened studies for inclusion, extracted study characteristics and assessed risk of bias. Harmful diagnostic error rates were pooled using random-effects meta-analysis.ResultsTwenty-two studies including 80 026 patients and 760 harmful diagnostic errors from consecutive or randomly selected cohorts were pooled. The pooled rate was 0.7% (95% CI 0.5% to 1.1%). Of the 136 diagnostic errors that were described in detail, a wide range of diseases were missed, the most common being malignancy (n=15, 11%) and pulmonary embolism (n=13, 9.6%). In the USA, these estimates correspond to approximately 249 900 harmful diagnostic errors yearly.ConclusionBased on physician review, at least 0.7% of adult admissions involve a harmful diagnostic error. A wide range of diseases are missed, including many common diseases. Fourteen diagnoses account for more than half of all diagnostic errors. The finding that a wide range of common diagnoses are missed implies that efforts to improve diagnosis must target the basic processes of diagnosis, including both cognitive and system-related factors.PROSPERO registration numberCRD42018115186.

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β-(1→3,1→6)-D-glucans in disease prevention and health promotion - a systematic review of randomized controlled trials

Proceedings of The Nutrition Society ◽

10.1017/s0029665120004772 ◽

2020 ◽

Vol 79 (OCE2) ◽

Author(s):

Marigoula Vlassopoulou ◽

Adamantini Kyriacou ◽

Vasiliki Pletsa ◽

George Zervakis ◽

Mary Yiannakoulia

Keyword(s):

Systematic Review ◽

Randomized Controlled Trials ◽

Abdominal Circumference ◽

Cochrane Library ◽

Controlled Trials ◽

Beneficial Effects ◽

Randomized Controlled ◽

Wide Range ◽

Tract Infections ◽

The Impact

AbstractIntroductionβ-Glucans comprise a heterogeneous group of polysaccharides exhibiting a wide range of biological properties. They are categorized as dietary fibers due to their ability to reach the large intestine undigested and undergo fermentation by gut microbiota, with potential beneficial effects for the host. Aim of this systematic review is to assess the effects of consumption of β-(1→3,1→6)-D-glucans, naturally found in the cell walls of fungi, on health outcomes.MethodsA comprehensive literature search was performed on PubMed, Cochrane Library and Web of Science in order to retrieve studies that investigated the impact of exclusively oral administration of β-(1→3,1→6)-D-glucans to healthy individuals and/or patients in any form, at any dosage. Only randomized controlled trials (RCTs) were considered.ResultsTwenty-five RCTs, of the 48 clinical studies retrieved in total, met the eligibility criteria and are included in the present review. The sources of β-(1→3,1→6)-D-glucans were Saccharomyces cerevisiae, Aureobasidium pullulans, Pleurotus ostreatus and Lentinula edodes and the dosage of supplementation ranged from 2.5 to 3000 mg daily for up to 6 months. The main physiological outcome for the majority of the interventions was immunomodulation, which resulted in a) strengthened immune defence that reduces the incidence and symptoms of cold, flu and upper respiratory tract infections in general and b) alleviation of allergic symptoms. However, findings on the induction of immune response alterations were inconsistent at a cellular and molecular level. Another aspect is psychological wellbeing, as the cohorts that received the polysaccharides of interest reported improvement of mood state as well as amelioration of the wellbeing overall, while co-administration with chemotherapeutic drugs enhanced cancer patients’ quality of life and prolonged their survival. Furthermore, supplements containing β-(1→3,1→6)-D-glucan induced beneficial changes in body fat mass and abdominal circumference in overweight adults. Notably, no adverse event causally related to the glucans was recorded in any of the trials.ConclusionsSupplementation with β-(1→3,1→6)-D-glucans is well-tolerated and health-promoting properties are manifested primarily through the potentiation of the immune system. More studies are required in order to confirm additional beneficial effects, establish the optimal dose and reveal the underlying molecular mechanisms.

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Stress, anxiety, depression and burnout in frontline health care workers during COVID-19 pandemic: a brief systematic review and new data from Russia

10.31234/osf.io/je3ch ◽

2021 ◽

Author(s):

Ekaterina Mosolova ◽

Dmitry Sosin ◽

Sergey Mosolov

Keyword(s):

Risk Factors ◽

Systematic Review ◽

Female Gender ◽

Assessment Tools ◽

Care Workers ◽

Younger Age ◽

Wide Range ◽

Associated Risk Factors ◽

Anxiety Depression ◽

The Impact

During the COVID-19 pandemic, healthcare workers (HCWs) have been subject to increased workload while also exposed to many psychosocial stressors. In a systematic review we analyze the impact that the pandemic has had on HCWs mental state and associated risk factors. Most studies reported high levels of depression and anxiety among HCWs worldwide, however, due to a wide range of assessment tools, cut-off scores, and number of frontline participants in the studies, results were difficult to compare. Our study is based on two online surveys of 2195 HCWs from different regions of Russia during spring and autumn epidemic outbreaks revealed the rates of anxiety, stress, depression, emotional exhaustion and depersonalization and perceived stress as 32.3%, 31.1%, 45.5%, 74.2%, 37.7% ,67.8%, respectively. Moreover, 2.4% of HCWs reported suicidal thoughts. The most common risk factors include: female gender, nurse as an occupation, younger age, working for over 6 months, chronic diseases, smoking, high working demands, lack of personal protective equipment, low salary, lack of social support, isolation from families, the fear of relatives getting infected. These results demonstrate the need for urgent supportive programs for HCWs fighting COVID-19 that fall into higher risk factors groups.

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The impact of nurse staffing methodologies on nurse and patient outcomes: A systematic review

Journal of Advanced Nursing ◽

10.1111/jan.14909 ◽

2021 ◽

Author(s):

Diane E. Twigg ◽

Lisa Whitehead ◽

Gemma Doleman ◽

Sonia El‐Zaemey

Keyword(s):

Systematic Review ◽

Patient Outcomes ◽

Nurse Staffing ◽

The Impact

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The effects of clinical decision support system for prescribing medication on patient outcomes and physician practice performance: a systematic review and meta-analysis

BMC Medical Informatics and Decision Making ◽

10.1186/s12911-020-01376-8 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Sharare Taheri Moghadam ◽

Farahnaz Sadoughi ◽

Farnia Velayati ◽

Seyed Jafar Ehsanzadeh ◽

Shayan Poursharif

Keyword(s):

Systematic Review ◽

Decision Support ◽

Patient Outcomes ◽

Clinical Decision Support ◽

Meta Analysis ◽

Clinical Decision ◽

Cochrane Library ◽

Physician Practice ◽

Positive Effects ◽

Practice Performance

Abstract Background Clinical Decision Support Systems (CDSSs) for Prescribing are one of the innovations designed to improve physician practice performance and patient outcomes by reducing prescription errors. This study was therefore conducted to examine the effects of various CDSSs on physician practice performance and patient outcomes. Methods This systematic review was carried out by searching PubMed, Embase, Web of Science, Scopus, and Cochrane Library from 2005 to 2019. The studies were independently reviewed by two researchers. Any discrepancies in the eligibility of the studies between the two researchers were then resolved by consulting the third researcher. In the next step, we performed a meta-analysis based on medication subgroups, CDSS-type subgroups, and outcome categories. Also, we provided the narrative style of the findings. In the meantime, we used a random-effects model to estimate the effects of CDSS on patient outcomes and physician practice performance with a 95% confidence interval. Q statistics and I2 were then used to calculate heterogeneity. Results On the basis of the inclusion criteria, 45 studies were qualified for analysis in this study. CDSS for prescription drugs/COPE has been used for various diseases such as cardiovascular diseases, hypertension, diabetes, gastrointestinal and respiratory diseases, AIDS, appendicitis, kidney disease, malaria, high blood potassium, and mental diseases. In the meantime, other cases such as concurrent prescribing of multiple medications for patients and their effects on the above-mentioned results have been analyzed. The study shows that in some cases the use of CDSS has beneficial effects on patient outcomes and physician practice performance (std diff in means = 0.084, 95% CI 0.067 to 0.102). It was also statistically significant for outcome categories such as those demonstrating better results for physician practice performance and patient outcomes or both. However, there was no significant difference between some other cases and traditional approaches. We assume that this may be due to the disease type, the quantity, and the type of CDSS criteria that affected the comparison. Overall, the results of this study show positive effects on performance for all forms of CDSSs. Conclusions Our results indicate that the positive effects of the CDSS can be due to factors such as user-friendliness, compliance with clinical guidelines, patient and physician cooperation, integration of electronic health records, CDSS, and pharmaceutical systems, consideration of the views of physicians in assessing the importance of CDSS alerts, and the real-time alerts in the prescription.

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