scholarly journals Shared leadership in tertiary care: design of a simulation for patient safety decision-making in healthcare management teams

2020 ◽  
pp. bmjstel-2020-000627
Author(s):  
Lisa Aufegger ◽  
Emma Soane ◽  
Ara Darzi ◽  
Colin Bicknell
Keyword(s):  
Decision Making ◽  
Patient Safety ◽  
Real World ◽  
Shared Leadership ◽  
Improve Patient Safety ◽  
Tertiary Care ◽  
Management Training ◽  
Healthcare Management ◽  
Self Report ◽  
Good Opportunity

IntroductionSimulation-based training (SBT) on shared leadership (SL) and group decision-making (GDM) can contribute to the safe and efficient functioning of a healthcare system, yet it is rarely incorporated into healthcare management training. The aim of this study was design, develop and validate a robust and evidence-based SBT to explore and train SL and GDM.MethodUsing a two-stage iterative simulation design approach, 103 clinical and non-clinical managerial students and healthcare professionals took part in an SBT that contained real-world problems and opportunities to improve patient safety set within a fictional context. Self-report data were gathered, and a focus group was conducted to address the simulation’s degree of realism, content, relevance, as well as areas for improvement.ResultsParticipants experienced the simulation scenario, the material and the role assignment as realistic and representative of real-world tasks and decision contexts, and as a good opportunity to identify and enact relevant tasks, behaviours and knowledge related to SL and GDM. Areas for improvement were highlighted with regard to involving an actor who challenges SL and GDM; more preparatory time to allow for an enhanced familiarisation of the content; and, video debriefs to reflect on relevant behaviours and team processes.ConclusionsOur simulation was perceived as an effective method to develop SL and GDM within the context of patient safety and healthcare management. Future studies could extend this scenario method to other areas of healthcare service and delivery, and to different sectors that require diverse groups to make complex decisions.

scholarly journals Time series evaluation of improvement interventions to reduce alarm notifications in a paediatric hospital

2020 ◽  
Vol 29 (9) ◽  
pp. 717-726 ◽  
Author(s):  
Colleen M Pater ◽  
Tina K Sosa ◽  
Jacquelyn Boyer ◽  
Rhonda Cable ◽  
Melinda Egan ◽  
...  
Keyword(s):  
Patient Safety ◽  
Improve Patient Safety ◽  
Tertiary Care ◽  
Secondary Outcome ◽  
Secondary Outcome Measure ◽  
Tertiary Care Centre ◽  
Patient Acuity ◽  
Nursing Satisfaction ◽  
Paediatric Hospital ◽  
Hospital Units

Background10The Joint Commission identified inpatient alarm reduction as an opportunity to improve patient safety; enhance patient, family and nursing satisfaction; and optimise workflow. We used quality improvement (QI) methods to safely decrease non-actionable alarm notifications to bedside providers.MethodsIn a paediatric tertiary care centre, we convened a multidisciplinary team to address alarm notifications in our acute care cardiology unit. Alarm notification was defined as any alert to bedside providers for each patient-triggered monitor alarm. Our aim was to decrease alarm notifications per monitored bed per day by 60%. Plan-Do-Study-Act testing cycles included updating notification technology, establishing alarm logic and modifying bedside workflow processes, including silencing the volume on all bedside monitors. Our secondary outcome measure was nursing satisfaction. Balancing safety measures included floor to intensive care unit transfers and patient acuity level.ResultsAt baseline, there was an average of 71 initial alarm notifications per monitored bed per day. Over a 3.5-year improvement period (2014–2017), the rate decreased by 68% to 22 initial alarm notifications per monitored bed per day. The proportion of initial to total alarm notifications remained stable, decreasing slightly from 51% to 40%. There was a significant improvement in subjective nursing satisfaction. At baseline, 32% of nurses agreed they were able to respond to alarms appropriately and quickly. Following interventions, agreement increased to 76% (p<0.001). We sustained these improvements over a year without a change in monitored balancing measures.ConclusionWe successfully reduced alarm notifications while preserving patient safety over a 4-year period in a complex paediatric patient population using technological advances and QI methodology. Continued efforts are needed to further optimise monitor use across paediatric hospital units.

scholarly journals Financial Incentives to Reduce Hospital-Acquired Infections Under Alternative Payment Arrangements

2018 ◽  
Vol 39 (5) ◽  
pp. 509-515 ◽  
Author(s):  
Catherine Crawford Cohen ◽  
Jianfang Liu ◽  
Bevin Cohen ◽  
Elaine L. Larson ◽  
Sherry Glied
Keyword(s):  
Patient Safety ◽  
Financial Incentives ◽  
Improve Patient Safety ◽  
Tertiary Care ◽  
Hospital Costs ◽  
Urban Hospital ◽  
Hospital System ◽  
Hospital Acquired Infections ◽  
Tract Infections ◽  
Hospital Acquired

OBJECTIVEThe financial incentives for hospitals to improve care may be weaker if higher insurer payments for adverse conditions offset a portion of hospital costs. The purpose of this study was to simulate incentives for reducing hospital-acquired infections under various payment configurations by Medicare, Medicaid, and private payers.DESIGNMatched case-control study.SETTINGA large, urban hospital system with 1 community hospital and 2 tertiary-care hospitals.PATIENTSAll patients discharged in 2013 and 2014.METHODSUsing electronic hospital records, we identified hospital-acquired bloodstream infections (BSIs) and urinary tract infections (UTIs) with a validated algorithm. We assessed excess hospital costs, length of stay, and payments due to infection, and we compared them to those of uninfected patients matched by propensity for infection.RESULTSIn most scenarios, hospitals recovered only a portion of excess HAI costs through increased payments. Patients with UTIs incurred incremental costs of $6,238 (P<.01), while payments increased $1,901 (P<.05) at public diagnosis-related group (DRG) rates. For BSIs, incremental costs were $15,367 (P<.01), while payments increased $7,895 (P<.01). If private payers reimbursed a 200% markup over Medicare DRG rates, hospitals recovered 55% of costs from BSI and UTI among private-pay patients and 54% for BSI and 33% for UTI, respectively, across all patients. Under per-diem payment for private patients with no markup, hospitals recovered 71% of excess costs of BSI and 88% for UTI. At 150% markup and per-diem payments, hospitals profited.CONCLUSIONSHospital incentives for investing in patient safety vary by payer and payment configuration. Higher payments provide resources to improve patient safety, but current payment structures may also reduce the willingness of hospitals to invest in patient safety.Infect Control Hosp Epidemiol 2018;39:509–515

Establishing a health economics and value unit at the Children’s Cancer Hospital–Egypt: Introducing a practical approach for evidence-based decision making.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e18859-e18859
Author(s):  
Ranin Soliman ◽  
Nourhan Tarek ◽  
Sandra Samir ◽  
Shimaa Okail ◽  
Wael Eweida ◽  
...  
Keyword(s):  
Decision Making ◽  
Health Economics ◽  
Childhood Cancer ◽  
Resource Use ◽  
Real World ◽  
Healthcare Management ◽  
Evidence Based ◽  
Real World Evidence ◽  
Oncology Center ◽  
Evidence Based Decision Making

e18859 Background: Health Economics is a multi-disciplinary practice that recently gained recognition in healthcare management systems. Value-based healthcare (VBHC) focuses on improving patient outcomes while using fewer healthcare resources. Integrating the principles of health economics and VBHC are essential to better inform decision-making based on evidence, especially in resource-limited settings, that need ultimate efficiency in managing resources. Egypt has the highest second estimated number of incident childhood cancer cases in the Eastern Mediterranean Region (EMR), based on GLOBOCAN 2020. Thus, childhood cancer in Egypt is an urging priority due to the large number of patients, limited resources, and poor outcomes. There is a need to optimize resource use and promote value in care delivery for childhood cancer care in Egypt, based on real-world evidence. Methods: This work aims to highlight the role of establishing a health economics and value (HEV) unit at the Children’s Cancer Hospital 57357 –Egypt (CCHE), to improve care and outcomes for children with cancer efficiently. CCHE is a not-for profit pediatric oncology center, treating around 50–60% of childhood cancers across Egypt free of charge. Results: The HEV unit was established in 2017 as a sub-function of the upper management at the hospital. The core mission of the unit is to translate health economics and VBHC concepts into practice to promote evidence-based decision-making, through applying the following functions and activities: monitoring trends in childhood cancer survival, resource use, and costs; applying health economic evaluation tools such as cost-effectiveness analysis (CEA) and multi-criteria decision analysis (MCDA); applying time-driven activity based costing (TDABC); implementing VBHC on a disease- and a hospital-level; monitoring costs and benchmarking. Some of these functions/activities reflect on operational processes such as integrating the CEA tools within the hospital procedures to maximize value of money spent; and restructuring hospital-wide cost centers for accurate costs reporting. Capacity building is also an important pillar in the unit’s framework, where the unit team conducts internal and external training sessions and workshops to spread the knowledge about health economics, VBHC, and evidence-based healthcare. Conclusions: The HEV unit at CCHE presents a unique model of applying health economics and value-based healthcare at a micro level in a pediatric oncology center in Egypt. This is a novel approach for healthcare management in Egypt and making informed decisions based on real-world evidence.

scholarly journals MP40: What are the factors contributing to medico-legal risk of procedural interventions performed by physicians practicing emergency medicine?

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S57-S57
Author(s):  
K. Lemay ◽  
P. Finestone ◽  
R. Liu ◽  
R. De Gorter ◽  
L. Calder
Keyword(s):  
Decision Making ◽  
Emergency Medicine ◽  
Patient Safety ◽  
Clinical Decision Making ◽  
Life Support ◽  
Improve Patient Safety ◽  
Clinical Decision ◽  
Wound Management ◽  
Contributing Factors ◽  
Orthopedic Injury

Introduction: Physicians who practice emergency medicine (EM) often perform procedural interventions, which can occasionally result in unintended patient harm. Our study's objective was to identify and describe the interventions and contributing factors associated with medico-legal (ML) cases involving emergency physicians performing procedural interventions. Methods: The Canadian Medical Protective Association (CMPA) is a not-for-profit, ML organization which represented over 99,000 physicians at the time of this study. We extracted five years (2014-2018) of CMPA data describing closed ML cases involving procedural interventions (e.g. suturing, reducing a dislocated joint) and excluding interventions related to pharmacotherapy (e.g. injection of local anesthetic), diagnosis (electrocardiograms) and physical assessments (e.g. ear exams), performed by physicians practicing EM. We then applied an internal contributing factor framework to identify themes. We analysed the data using descriptive statistics. Results: We identified 145 cases describing 145 patients who had 205 procedures performed in the course of their EM care. The three most common interventions were orthopedic injury management (47/145, 32.4%), wound management (43/145, 29.7%), and Advanced Cardiac Life Support (24/145, 16.6%). Out of 145 patients, 93.8% (136/145) experienced a patient safety event, and 55.9% (76/136) suffered an avoidable harmful incident. One quarter of patients suffered mild harm (34/76, 25.0%), 18.4% of patients died, 14.5% suffered severe harm, and 13.2% moderate harm. Peer experts were critical of 86/145 cases (59.3%) where the following provider contributing factors were found: a lack of situational awareness (20/68, 29.4%), and deficient physician clinical decision-making (54/68, 79.7%). Clinical decision-making issues included a lack of thoroughness of assessment (33/54, 61.1%), failure to perform tests or interventions (21/54, 38.9%), and a delay or failure to seek help from another physician (17/54, 31.2%). Peer experts were also critical of 48.8% of cases containing team factors (42/86) due to deficient medical record keeping (26/42, 61.9%), and communication breakdown with patients or other team members (25/42, 59.5%). Conclusion: Both provider and team factors contributed to ML cases involving EM physicians performing procedural interventions. Addressing these factors may improve patient safety and reduce ML risk for physicians.

scholarly journals Real-world experiences of the diagnosis process in Korean patients with ankylosing spondylitis based on a self-report questionnaire

2021 ◽  
Vol 49 (4) ◽  
pp. 030006052110042
Author(s):  
Jin-Wuk Hur ◽  
Kyung Min Ko ◽  
Kyung-Su Park ◽  
Seung-Jae Hong ◽  
Hyun-Sook Kim ◽  
...  
Keyword(s):  
Ankylosing Spondylitis ◽  
Real World ◽  
Disease Duration ◽  
Tertiary Care ◽  
Delayed Diagnosis ◽  
Self Report ◽  
The Real ◽  
Comorbid Diseases ◽  
Delayed Referral ◽  
Tertiary Care Hospitals

Objectives The diagnosis of ankylosing spondylitis (AS) is often delayed, which affects various clinical outcomes. This study examined the real-world situation of patients with AS during diagnosis and treatment. Methods Data were obtained from 26 tertiary care hospitals in Korea using a self-report questionnaire. The questionnaire assessed symptoms, pain, extra-articular manifestations, the initial pattern of pain before diagnosis, factors leading to delayed referral to rheumatology, time until receiving an AS diagnosis, comorbid diseases, treatment status, and disease education needs. Results Between September and October 2019, 1012 patients with AS completed the survey. Of these, 75.8% were men and 51.8% were in their 30s or 40s. Median disease duration was 76 months. The median time to diagnosis with AS was 12 months. When pain occurred, the medical departments most frequently visited first were orthopedic (61.5%) and rheumatology (18.7%) departments. The likelihood of the first visit being to the orthopedic department and the frequency of biologics use increased with the disease duration. The rates of uveitis, depressed mood, and comorbid diseases were higher in the group with delayed diagnosis. Conclusions Physicians should be aware of subtypes of AS that take longer to diagnose and comorbid diseases in the real-world clinical setting.

Attitude and Beliefs About Surgical Safety Checklist in a North Indian Tertiary Care Hospital a Decade Later of WHO Checklist

2020 ◽  
Author(s):  
Lovenish Bains ◽  
Anurag Mishra ◽  
Daljit Kaur ◽  
Pawan Lal ◽  
Lalit Gupta ◽  
...  
Keyword(s):  
Patient Safety ◽  
Improve Patient Safety ◽  
Tertiary Care ◽  
Health Care Facilities ◽  
Leadership Role ◽  
Junior Doctors ◽  
Care Hospital ◽  
Surgical Safety Checklist ◽  
Surgical Safety ◽  
Who Checklist

Abstract Avoidable surgical complications account for a large proportion of preventable medical injuries and deaths globally. Surgical Safety Checklist is evidence-based, internationally accepted valid instrument, which has been found to reduce postoperative morbidity and mortality; the benefits of which are most striking in low- and middle-income countries (LMICs) Despite implementation in many hospitals throughout the country, there is still lack of awareness and concern in many LMICS health care facilities towards SSCL and its use, even after a decade of WHO checklist. We conducted a survey to assess the knowledge, attitudes and beliefs about the WHO-surgical checklist in which 65.4% (138) surgeons, 25.1% (53) anaesthetists and 9.5% (20) nurses participated. Majority believed that use of SSCL improves the safety of procedures, improves communication amongst theatre staff and will result in a reduction in errors in theatre yet there was no commitment for use of SSCL. Although all theatre personnel support implementation and use of SSCL however hierarchical issues, lack of administrative support, lack of training, logistics and timing, high patient volume and overburdened residents, lack of co-ordinator or leadership role and shortage of man power can be impediment to effective use. Nurses and junior doctors play a crucial role. Commitment rather than compliance and teamwork will be the key, ably supported by education and training which should be mandatory for all OT stake holders. Therefore, any measure that can potentially improve patient safety should be embraced and benefits of SSCL be told to motivate them and enhance participation for patient safety. Committed leadership, knowledge sharing and periodic trainings, interdisciplinary communication, feedback and regular audits can define and determine effective implementation process.

scholarly journals Does classroom-based Crew Resource Management training improve patient safety culture? A systematic review

2014 ◽  
Vol 2 ◽  
pp. 205031211452956 ◽  
Author(s):  
Inge Verbeek-van Noord ◽  
Martine C de Bruijne ◽  
Nicolien C Zwijnenberg ◽  
Elise P Jansma ◽  
Cathy van Dyck ◽  
...  
Keyword(s):  
Systematic Review ◽  
Patient Safety ◽  
Resource Management ◽  
Safety Culture ◽  
Improve Patient Safety ◽  
Crew Resource Management ◽  
Management Training ◽  
Patient Safety Culture ◽  
Crew Resource Management Training ◽  
Improve Patient

Affective influences on clinical reasoning and diagnosis: insights from social psychology and new research opportunities

Diagnosis ◽  
2022 ◽  
Vol 0 (0) ◽  
Author(s):  
Guanyu Liu ◽  
Hannah Chimowitz ◽  
Linda M. Isbell
Keyword(s):  
Social Psychology ◽  
Decision Making ◽  
Patient Safety ◽  
Clinical Reasoning ◽  
Improve Patient Safety ◽  
Healthcare Providers ◽  
Diagnostic Errors ◽  
Psychological Research ◽  
Medical Decision ◽  
Great Promise

Abstract Psychological research consistently demonstrates that affect can play an important role in decision-making across a broad range of contexts. Despite this, the role of affect in clinical reasoning and medical decision-making has received relatively little attention. Integrating the affect, social cognition, and patient safety literatures can provide new insights that promise to advance our understanding of clinical reasoning and lay the foundation for novel interventions to reduce diagnostic errors and improve patient safety. In this paper, we briefly review the ways in which psychologists differentiate various types of affect. We then consider existing research examining the influence of both positive and negative affect on clinical reasoning and diagnosis. Finally, we introduce an empirically supported theoretical framework from social psychology that explains the cognitive processes by which these effects emerge and demonstrates that cognitive interventions can alter these processes. Such interventions, if adapted to a medical context, hold great promise for reducing errors that emerge from faulty thinking when healthcare providers experience different affective responses.

Using Standardized Insulin Orders to Improve Patient Safety in a Tertiary Care Centre

2014 ◽  
Vol 38 (2) ◽  
pp. 118-125 ◽  
Author(s):  
Mary-Anne Doyle ◽  
Sharon Brez ◽  
Silvana Sicoli ◽  
Filomena De Sousa ◽  
Erin Keely ◽  
...  
Keyword(s):  
Patient Safety ◽  
Improve Patient Safety ◽  
Tertiary Care ◽  
Care Centre ◽  
Tertiary Care Centre ◽  
Improve Patient

scholarly journals In Game as in Life? Linking Decision-making to Real-world Behavior

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Mikael Rubin ◽  
Michael Telch ◽  
Justin Dainer-Best
Keyword(s):  
Decision Making ◽  
Real World ◽  
Technology Use ◽  
Transition Probabilities ◽  
Self Report ◽  
Symptoms Of Depression ◽  
Unique Method ◽  
Decision Making Processes ◽  
The Stability ◽  
Post Hoc

Decision-making processes in everyday life are complex. Research on decision-making has focused on self-report or experimental paradigms to understand this process. Recent work has highlighted the potential for complex iterative decision-making frameworks. We developed a simulated decision-making paradigm to assess the relationship between in-game and real-world behaviors and symptoms of depression through exploratory and then pre-registered, confirmatory analyses. Our pre-registered and post-hoc confirmatory analyses highlighted the link between in-game technology use and real-world technology use. We also explored decision-making through transition probabilities to evaluate how specific decisions might unfold over time. The findings emphasized the stability of discrete decision-making in two independent samples. Taken together, these findings suggest that some behavioral patterns appear to be quite stable. Our novel “game” has the potential to provide important insights into decision-making processes and may provide a unique method for identifying and intervening on specific targeted behaviors.

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