scholarly journals Suicide as an incident of severe patient harm: a retrospective cohort study of investigations after suicide in Swedish healthcare in a 13-year perspective

BMJ Open ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. e044068
Author(s):  
Elin Fröding ◽  
Boel Andersson Gäre ◽  
Åsa Westrin ◽  
Axel Ros
Keyword(s):  
Patient Safety ◽  
Information Transfer ◽  
Demographic Data ◽  
Healthcare Providers ◽  
Healthcare Services ◽  
Mandatory Reporting ◽  
Secondary Outcome ◽  
Patient Harm ◽  
Incident Type ◽  
Supervisory Authority

ObjectivesTo explore how mandatory reporting to the supervisory authority of suicides among recipients of healthcare services has influenced associated investigations conducted by the healthcare services, the lessons obtained and whether any suicide-prevention-related improvements in terms of patient safety had followed.Design and settingsRetrospective study of reports from Swedish primary and secondary healthcare to the supervisory authority after suicide.ParticipantsCohort 1: the cases reported to the supervisory authority in 2006, from the time the reporting of suicides became mandatory, to 2007 (n=279). Cohort 2: the cases reported in 2015, a period of well-established reporting (n=436). Cohort 3: the cases reported from September 2017, which was the time the law regarding reporting was removed, to November 2019 (n=316).Primary and secondary outcome measuresDemographic data and received treatment in the months preceding suicide were registered. Reported deficiencies in healthcare and actions were categorised by using a coding scheme, analysed per individual and aggregated per cohort. Separate notes were made when a deficiency or action was related to a healthcare-service routine.ResultsThe investigations largely adopted a microsystem perspective, focusing on final patient contact, throughout the overall study period. Updating existing or developing new routines as well as educational actions were increasingly proposed over time, while sharing conclusions across departments rarely was recommended.ConclusionsThe mandatory reporting of suicides as potential cases of patient harm was shown to be restricted to information transfer between healthcare providers and the supervisory authority, rather than fostering participative improvement of patient safety for suicidal patients.The similarity in outcomes across the cohorts, regardless of changes in legislation, suggests that the investigations were adapted to suit the structure of the authority’s reports rather than the specific incident type, and that no new service improvements or lessons are being identified.

scholarly journals Duration of second victim symptoms in the aftermath of a patient safety incident and association with the level of patient harm: a cross-sectional study in the Netherlands

BMJ Open ◽  
2019 ◽  
Vol 9 (7) ◽  
pp. e029923 ◽  
Author(s):  
Kris Vanhaecht ◽  
Deborah Seys ◽  
Loes Schouten ◽  
Luk Bruyneel ◽  
Ellen Coeckelberghs ◽  
...  
Keyword(s):  
Patient Safety ◽  
Healthcare Providers ◽  
Direct Patient Care ◽  
Secondary Outcome ◽  
Symptom Duration ◽  
Common Symptom ◽  
Patient Harm ◽  
Cross Sectional ◽  
Safety Incident ◽  
The Impact

ObjectivesTo describe healthcare providers’ symptoms evoked by patient safety incidents (PSIs), the duration of these symptoms and the association with the degree of patient harm caused by the incident.DesignCross-sectional survey.Setting32 Dutch hospitals that participate in the ‘Peer Support Collaborative’.Participants4369 healthcare providers (1619 doctors and 2750 nurses) involved in a PSI at any time during their career.InterventionsAll doctors and nurses working in direct patient care in the 32 participating hospitals were invited via email to participate in an online survey.Primary and secondary outcome measuresPrevalence of symptoms, symptom duration and its relationship with the degree of patient harm.ResultsIn total 4369 respondents were involved in a PSI and completely filled in the questionnaire. Of these, 462 reported having been involved in a PSI with permanent harm or death during the last 6 months. This had a personal, professional impact as well as impact on effective teamwork requirements. The impact of a PSI increased when the degree of patient harm was more severe. The most common symptom was hypervigilance (53.0%). The three most common symptoms related to teamwork were having doubts about knowledge and skill (27.0%), feeling unable to provide quality care (15.6%) and feeling uncomfortable within the team (15.5%). PSI with permanent harm or death was related to eightfold higher likelihood of provider-related symptoms lasting for more than 1 month and ninefold lasting longer than 6 months compared with symptoms reported when the PSI caused no harm.ConclusionThe impact of PSI remains an underestimated problem. The higher the degree of harm, the longer the symptoms last. Future studies should evaluate how these data can be integrated in evidence-based support systems.

scholarly journals Patient safety initiatives in obstetrics: a rapid review

BMJ Open ◽  
2018 ◽  
Vol 8 (7) ◽  
pp. e020170 ◽  
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.

scholarly journals The Personal Electronic Health Folder and the usefulness of electronic systems to improve health services

2020 ◽  
Vol 13 (4) ◽  
pp. 19-25
Author(s):  
Christina Girtsou ◽  
Pantelis Stergiannis ◽  
Theoharis Konstantinidis ◽  
Georgios Martinis
Keyword(s):  
Information Transfer ◽  
Clinical Status ◽  
Healthcare Providers ◽  
Control Process ◽  
Chronically Ill ◽  
The Elderly ◽  
Quality Of Healthcare ◽  
Healthcare Services ◽  
Electronic Health

Continuity in patient healthcare shows significant gaps and variations, due to reduced communication between healthcare services. The information transfer to all stages of health structures is often inadequate with many variations, especially at the critical stage after discharge from the hospital, in which patients are usually more vulnerable. The major problem of the lack of interconnection between healthcare services occurs mainly among the elderly, the chronically ill and those who take a lot medication. The main effects of this problem are medication side effects, treatment overlap, poor quality of healthcare and financial costs. Enhancing communication, through the electronic interface and the use of the Personal Electronic Health Folder (P.E.H.F.), which will include the individual details of each patient and information about his clinical status, is aiming at the use of best practices for patient recovery by healthcare providers. The thorough literature review, the strategic analysis PESTEL and the control process, pointed out the need to use the P.E.H.F., to achieve substantial improvements in the quality of patient healthcare. With the practical use of P.E.H.F., the healthcare of all patients will be unquestionably, safe, effective, patient-centered, immediate and fair.

scholarly journals Monitoring strategies on patient safety practices among healthcare providers at Nakuru county referral hospital, Kenya

2020 ◽  
Vol 7 (8) ◽  
pp. 2938
Author(s):  
Fancy J. Kipkech ◽  
Stanley M. Makindi ◽  
Joseph Juma
Keyword(s):  
Patient Safety ◽  
Clinical Care ◽  
Healthcare Delivery ◽  
Healthcare Providers ◽  
Healthcare Services ◽  
Referral Hospital ◽  
Healthcare Delivery System ◽  
Cross Sectional ◽  
Safety Practices ◽  
Monitoring Strategies

Background: Quality care is achieved through combined efforts which include integration of all the components within the healthcare delivery system. Patient safety is one of the dimensions of enhancing quality healthcare. It involves increasing the awareness about the errors made due to human factors in the process of delivering healthcare services that may lead to harm and other adverse effects.Methods: This study was on assessment of monitoring strategies on patient safety practices among healthcare providers at Nakuru County Referral Hospital, Kenya. The study was anchored on Donabedian model for assessment of quality of care. The study design was a descriptive cross-sectional study. The sampling technique was purposive, stratified random sampling and proportionate with a sample size of 310 healthcare providers drawn from various departments. Data collection tools were questionnaire, interview schedule and observational checklist. Quantitative data was analysed using descriptive statistics (mean, mode and standard deviation).Results: The results of the study indicated and concluded that there is adherence to standardized clinical care protocols and guidelines as well as continuous and constant surveillance with clear assessments and evaluation of patient safety practices, accurate collection, storage, analysis and sharing of information on patient safety issues.Conclusions: The paper recommends the need for policy reviews on healthcare so as to ensure that patient safety issues are reviewed so as to mitigate risks in handling patients. There is need to establish clear guidelines on monitoring and evaluation standards of patient safety practices.

Topical issues of medical malpractices

2014 ◽  
Vol 155 (38) ◽  
pp. 1510-1516
Author(s):  
Tamás Heiner ◽  
Tímea Barzó
Keyword(s):  
Medical Malpractice ◽  
Medical Service ◽  
Early Stage ◽  
Healthcare Providers ◽  
Healthcare Services ◽  
Practical Experience ◽  
Current Analysis ◽  
Breach Of Contract ◽  
Judicial Decisions ◽  
Contractual Relationship

The number of medical malpractice lawsuits filed each year in Hungary has considerably increased since 1990. The judicial decisions and practices on determining and awarding wrongful damages recoverable for medical malpractices in the Hungarian civil law have been developing for decades. In the meantime, a new Hungarian Civil Code (Act V of 2013) has entered into force, which among others, necessitates the revaluation of assessment of damages recoverable for medical malpractices. There are two main areas where fundamental changes have been introduced, which may significantly affect the outcome of medical malpractice lawsuits in the future. In the early stage of medical malpractices it was unclear whether the courts had to consider either the contractual relationship between patients and healthcare providers (contractual liability) or general codal articles on damages arising from non-contractual liability/torts (delictual liability) in their judgement delivered in the cases. Both the theoretical and practical experience of the last ten years shows that healthcare services agreements are concluded between healthcare providers and patients with the aim and intention to provide appropriate professional healthcare services to patients, which meet patients’ interests and wishes. The medical service is violated if it fails to meet patients’ interests and wishes as well as the objectives of the agreement. Since the new legislation implies a stricter liability for damages in the case of breach of contract and stricter rules for exempting the party in breach from compensation obligations, the opportunities to exempt healthcare providers from these obligations have become limited compared to previous regulations. This modification, which was aimed at further integrating the established judicial practices into legislation, stipulates the application of the rules for liability for damages resulting from medical malpractice in non-contractual situations. This paper analyses dogmatic and practical problems related to this topic. Another important area of current analysis is the institution of injury fees, which replaced the reimbursement of non-pecuniary damages. The mere fact of infringement allows setting injury fees. Taking into consideration the current resources in staff and equipment available in healthcare, this regulation may promote claims for injury fees impartial. Consequently, courts will have to apply other criteria when judgment in ‘trivial cases’, which might not require legal assessment, is delivered. Orv. Hetil., 2014, 155(38), 1510–1516.

Survey of Cloud Computing in Healthcare Sector

2017 ◽  
Vol 7 (7) ◽  
pp. 337
Author(s):  
S. Karthiga Devi ◽  
B. Arputhamary
Keyword(s):  
Cloud Computing ◽  
Healthcare Providers ◽  
High Volume ◽  
Healthcare Services ◽  
Healthcare Sector ◽  
Cloud Infrastructure ◽  
Healthcare Organizations ◽  
Privacy And Security ◽  
Healthcare Data ◽  
Number Of Patients

Today the volume of healthcare data generated increased rapidly because of the number of patients in each hospital increasing.  These data are most important for decision making and delivering the best care for patients. Healthcare providers are now faced with collecting, managing, storing and securing huge amounts of sensitive protected health information. As a result, an increasing number of healthcare organizations are turning to cloud based services. Cloud computing offers a viable, secure alternative to premise based healthcare solutions. The infrastructure of Cloud is characterized by a high volume storage and a high throughput. The privacy and security are the two most important concerns in cloud-based healthcare services. Healthcare organization should have electronic medical records in order to use the cloud infrastructure. This paper surveys the challenges of cloud in healthcare and benefits of cloud techniques in health care industries.

Clinical Cybersecurity Training Through Novel High Fidelity Simulations (Preprint)

2018 ◽  
Author(s):  
Christian Dameff ◽  
Jordan Selzer ◽  
Jonathan Fisher ◽  
James Killeen ◽  
Jeffrey Tully
Keyword(s):  
Patient Safety ◽  
Patient Care ◽  
Medical Devices ◽  
Healthcare Systems ◽  
High Fidelity ◽  
Protected Health Information ◽  
Patient Harm ◽  
Security Vulnerabilities ◽  
Clinical Simulations ◽  
Medical Infrastructure

BACKGROUND Cybersecurity risks in healthcare systems have traditionally been measured in data breaches of protected health information but compromised medical devices and critical medical infrastructure raises questions about the risks of disrupted patient care. The increasing prevalence of these connected medical devices and systems implies that these risks are growing. OBJECTIVE This paper details the development and execution of three novel high fidelity clinical simulations designed to teach clinicians to recognize, treat, and prevent patient harm from vulnerable medical devices. METHODS Clinical simulations were developed which incorporated patient care scenarios with hacked medical devices based on previously researched security vulnerabilities. RESULTS Clinician participants universally failed to recognize the etiology of their patient’s pathology as being the result of a compromised device. CONCLUSIONS Simulation can be a useful tool in educating clinicians in this new, critically important patient safety space.

scholarly journals Adopt, adapt, or abandon technology-supported person-centred care initiatives: healthcare providers’ beliefs matter

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Kari Dyb ◽  
Gro Rosvold Berntsen ◽  
Lisbeth Kvam
Keyword(s):  
Information Technologies ◽  
Scale Up ◽  
Healthcare Providers ◽  
Healthcare Services ◽  
Analytical Framework ◽  
Development Project ◽  
Technology Support ◽  
Care Needs ◽  
Term Care

Abstract Background Technology support and person-centred care are the new mantra for healthcare programmes in Western societies. While few argue with the overarching philosophy of person-centred care or the potential of information technologies, there is less agreement on how to make them a reality in everyday clinical practice. In this paper, we investigate how individual healthcare providers at four innovation arenas in Scandinavia experienced the implementation of technology-supported person-centred care for people with long-term care needs by using the new analytical framework nonadoption, abandonment, and challenges to the scale-up, spread, and sustainability (NASSS) of health and care technologies. We also discuss the usability and sensitivity of the NASSS framework for those seeking to plan, implement, and evaluate technology-supported healthcare programmes. This study is part of an interdisciplinary research and development project called Patients and Professionals in Partnership (2016–2020). It originates at one of ten work packages in this project. Method The main data consist of ethnographic field observations at the four innovation arenas and 29 interviews with involved healthcare providers. To ensure continuous updates and status on work in the four innovation arenas, we have also participated in a total of six annual network meetings arranged by the project. Results While the NASSS framework is very useful for identifying and communicating challenges with the adoption and spread of technology-supported person-centred care initiatives, we found it less sensitive towards capturing the dedication, enthusiasm, and passion for care transformation that we found among the healthcare providers in our study. When it comes to technology-supported person-centred care, the point of no return has passed for the involved healthcare providers. To them, it is already a definite part of the future of healthcare services. How to overcome barriers and obstacles is pragmatically approached. Conclusion Increased knowledge about healthcare providers and their visions as potential assets for care transformation might be critical for those seeking to plan, implement, and evaluate technology-supported healthcare programmes.

scholarly journals Qualitative investigation of trace-based communication: how are traces conceptualised in healthcare teamwork?

BMJ Open ◽  
2020 ◽  
Vol 10 (11) ◽  
pp. e038406
Author(s):  
Sayra Cristancho ◽  
Emily Field
Keyword(s):  
Internal Medicine ◽  
Healthcare Providers ◽  
Constructivist Grounded Theory ◽  
Teaching Hospitals ◽  
Secondary Outcome ◽  
Qualitative Investigation ◽  
Qualitative Nature ◽  
Saving Face ◽  
Critical Process ◽  
Biological Literature

ObjectivesThis interview-based qualitative study aims to explore how healthcare providers conceptualise trace-based communication and considers its implications for how teams work. In the biological literature, trace-based communication refers to the non-verbal communication that is achieved by leaving ‘traces’ in the environment and other members sensing them and using them to drive their own behaviour. Trace-based communication is a key component of swam intelligence and has been described as a critical process that enables superorganisms to coordinate work and collectively adapt. This paper brings awareness to its existence in the context of healthcare teamwork.DesignInterview-based study using Constructivist Grounded Theory methodology.SettingThis study was conducted in multiple team contexts at one of Canada’s largest acute-care teaching hospitals.Participants25 clinicians from across professions and disciplines. Specialties included surgery, anesthesiology, psychiatry, internal medicine, geriatrics, neonatology, paramedics, nursing, intensive care, neurology and emergency medicine.InterventionNot relevant due to the qualitative nature of the study.Primary and secondary outcomeNot relevant due to the qualitative nature of the study.ResultsThe dataset was analysed using the sensitising concept of ‘traces’ from Swarm Intelligence. This study brought to light novel and unique elements of trace-based communication in the context of healthcare teamwork including focused intentionality, successful versus failed traces and the contextually bounded nature of the responses to traces. While participants initially felt ambivalent about the idea of using traces in their daily teamwork, they provided a variety of examples. Through these examples, participants revealed the multifaceted nature of the purposes of trace-based communication, including promoting efficiency, preventing mistakes and saving face.ConclusionsThis study demonstrated that clinicians pervasively use trace-based communication despite differences in opinion as to its implications for teamwork and safety. Other disciplines have taken up traces to promote collective adaptation. This should serve as inspiration to at least start exploring this phenomenon in healthcare.

scholarly journals What was the impact of a participatory research project in Australian Indigenous primary healthcare services? Applying a comprehensive framework for assessing translational health research to Lessons for the Best

BMJ Open ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. e040749
Author(s):  
Shanthi Ann Ramanathan ◽  
Sarah Larkins ◽  
Karen Carlisle ◽  
Nalita Turner ◽  
Ross Stewart Bailie ◽  
...  
Keyword(s):  
Learning Community ◽  
Primary Healthcare ◽  
Health Research ◽  
Return On Investment ◽  
Health Centre ◽  
Healthcare Services ◽  
Secondary Outcome ◽  
Cost Consequence ◽  
Comprehensive Framework ◽  
The Impact

ObjectivesTo (1) apply the Framework to Assess the Impact from Translational health research (FAIT) to Lessons from the Best to Better the Rest (LFTB), (2) report on impacts from LFTB and (3) assess the feasibility and outcomes from a retrospective application of FAIT.SettingThree Indigenous primary healthcare (PHC) centres in the Northern Territory, Australia; project coordinating centre distributed between Townsville, Darwin and Cairns and the broader LFTB learning community across Australia.ParticipantsLFTB research team and one representative from each PHC centre.Primary and secondary outcome measuresImpact reported as (1) quantitative metrics within domains of benefit using a modified Payback Framework, (2) a cost-consequence analysis given a return on investment was not appropriate and (3) a narrative incorporating qualitative evidence of impact. Data were gathered through in-depth stakeholder interviews and a review of project documentation, outputs and relevant websites.ResultsLFTB contributed to knowledge advancement in Indigenous PHC service delivery; enhanced existing capacity of health centre staff, researchers and health service users; enhanced supportive networks for quality improvement; and used a strengths-based approach highly valued by health centres. LFTB also leveraged between $A1.4 and $A1.6 million for the subsequent Leveraging Effective Ambulatory Practice (LEAP) Project to apply LFTB learnings to resource development and creation of a learning community to empower striving PHC centres.ConclusionRetrospective application of FAIT to LFTB, although not ideal, was feasible. Prospective application would have allowed Indigenous community perspectives to be included. Greater appreciation of the full benefit of LFTB including a measure of return on investment will be possible when LEAP is complete. Future assessments of impact need to account for the limitations of fully capturing impact when intermediate/final impacts have not yet been realised and captured.

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