Speaking up about care concerns in the ICU: patient and family experiences, attitudes and perceived barriers

BackgroundLittle is known about patient/family comfort voicing care concerns in real time, especially in the intensive care unit (ICU) where stakes are high and time is compressed. Experts advocate patient and family engagement in safety, which will require that patients/families be able to voice concerns. Data on patient/family attitudes and experiences regarding speaking up are sparse, and mostly include reporting events retrospectively, rather than pre-emptively, to try to prevent harm. We aimed to (1) assess patient/family comfort speaking up about common ICU concerns; (2) identify patient/family-perceived barriers to speaking up; and (3) explore factors associated with patient/family comfort speaking up.MethodsIn collaboration with patients/families, we developed a survey to evaluate speaking up attitudes and behaviours. We surveyed current ICU families in person at an urban US academic medical centre, supplemented with a larger national internet sample of individuals with prior ICU experience.Results105/125 (84%) of current families and 1050 internet panel participants with ICU history completed the surveys. Among the current ICU families, 50%–70% expressed hesitancy to voice concerns about possible mistakes, mismatched care goals, confusing/conflicting information and inadequate hand hygiene. Results among prior ICU participants were similar. Half of all respondents reported at least one barrier to voicing concerns, most commonly not wanting to be a ‘troublemaker’, ‘team is too busy’ or ‘I don’t know how’. Older, female participants and those with personal or family employment in healthcare were more likely to report comfort speaking up.ConclusionSpeaking up may be challenging for ICU patients/families. Patient/family education about how to speak up and assurance that raising concerns will not create ‘trouble’ may help promote open discussions about care concerns and possible errors in the ICU.

Download Full-text

Speaking up about patient-perceived serious visit note errors: Patient and family experiences and recommendations

Journal of the American Medical Informatics Association ◽

10.1093/jamia/ocaa293 ◽

2020 ◽

Author(s):

Barbara D Lam ◽

Fabienne Bourgeois ◽

Zhiyong J Dong ◽

Sigall K Bell

Keyword(s):

Response Rate ◽

Free Text ◽

Patient Portal ◽

Quality Improvements ◽

Speaking Up ◽

Academic Medical ◽

Supportive Culture ◽

New Ideas ◽

Northeast Us ◽

Speak Up

Abstract Background Open notes invite patients and families to read ambulatory visit notes through the patient portal. Little is known about the extent to which they identify and speak up about perceived errors. Understanding the barriers to speaking up can inform quality improvements. Objective To describe patient and family attitudes, experiences, and barriers related to speaking up about perceived serious note errors. Methods Mixed method analysis of a 2016 electronic survey of patients and families at 2 northeast US academic medical centers. Participants had active patient portal accounts and at least 1 note available in the preceding 12 months. Results 6913 adult patients (response rate 28%) and 3672 pediatric families (response rate 17%) completed the survey. In total, 8724/9392 (93%) agreed that reporting mistakes improves patient safety. Among 8648 participants who read a note, 1434 (17%) perceived ≥1 mistake. 627/1434 (44%) reported the mistake was serious and 342/627 (56%) contacted their provider. Participants who self-identified as Black or African American, Asian, “other,” or “multiple” race(s) (OR 0.50; 95% CI (0.26,0.97)) or those who reported poorer health (OR 0.58; 95% CI (0.37,0.90)) were each less likely to speak up than white or healthier respondents, respectively. The most common barriers to speaking up were not knowing how to report a mistake (61%) and avoiding perception as a “troublemaker” (34%). Qualitative analysis of 476 free-text suggestions revealed practical recommendations and proposed innovations for partnering with patients and families. Conclusions About half of patients and families who perceived a serious mistake in their notes reported it. Identified barriers demonstrate modifiable issues such as establishing clear mechanisms for reporting and more challenging issues such as creating a supportive culture. Respondents offered new ideas for engaging patients and families in improving note accuracy.

Download Full-text

Impact of the COVID-19 pandemic on neuroimaging scan volumes at a teaching hospital

The Neuroradiology Journal ◽

10.1177/1971400920988664 ◽

2021 ◽

pp. 197140092098866

Author(s):

Daniel Thomas Ginat ◽

James Kenniff

Keyword(s):

Magnetic Resonance Imaging ◽

Computed Tomography ◽

Magnetic Resonance ◽

The United States ◽

Radiology Department ◽

Magnetic Resonance Imaging Scan ◽

Resonance Imaging ◽

Academic Medical Centre ◽

Academic Medical ◽

The Impact

Background The COVID-19 pandemic led to a widespread socioeconomic shutdown, including medical facilities in many parts of the world. The purpose of this study was to assess the impact on neuroimaging utilisation at an academic medical centre in the United States caused by this shutdown. Methods Exam volumes from 1 February 2020 to 11 August 2020 were calculated based on patient location, including outpatient, inpatient and emergency, as well as modality type, including computed tomography and magnetic resonance imaging. 13 March 2020 was designated as the beginning of the shutdown period for the radiology department and 1 May 2020 was designated as the reopening date. The scan volumes during the pre-shutdown, shutdown and post-shutdown periods were compared using t-tests. Results Overall, neuroimaging scan volumes declined significantly by 41% during the shutdown period and returned to 98% of the pre-shutdown period levels after the shutdown, with an estimated 3231 missed scans. Outpatient scan volumes were more greatly affected than inpatient scan volumes, while emergency scan volumes declined the least during the shutdown. In addition, the magnetic resonance imaging scan volumes declined to a greater degree than the computed tomography scan volumes during the shutdown. Conclusion The shutdown from the COVID-19 pandemic had a substantial but transient impact on neuroimaging utilisation overall, with variable magnitude depending on patient location and modality type.

Download Full-text