scholarly journals The associations of information system’s support and nurses' documentation competence with the detection of documentation-related errors: Results from a nationwide survey

2021 ◽  
Vol 27 (4) ◽  
pp. 146045822110540
Author(s):  
Anu-Marja Kaihlanen ◽  
Kia Gluschkoff ◽  
Kaija Saranto ◽  
Ulla-Mari Kinnunen
Keyword(s):  
Information System ◽  
Adverse Event ◽  
Patient Safety ◽  
Significant Risk ◽  
Nationwide Survey ◽  
Health Record ◽  
Quality And Safety ◽  
Regression Analyses ◽  
Electronic Documentation

The use of information systems and electronic documentation has become a central part of a nurse’s work, and it is expected to increase the quality of documentation and patient safety. However, errors related to documentation have been identified as a significant risk for the quality and safety of care. This study examined whether information system’s support for documentation and nurses' documentation competence are associated with how frequently nurses detect documentation-related errors that have caused an adverse event. A nationwide survey was conducted in 2020, and a total of 3610 nurses participated. Results from linear regression analyses showed that high documentation support from the information system and high documentation competence were associated with fewer detected documentation-related errors. Nurses with low documentation support from the system and low documentation competence detected the most errors. The results highlight the need to develop electronic health record functions in a way that they better support accurate documentation. Furthermore, organisations should invest in ensuring the documentation skills of nurses and providing appropriate training.

Supporting and activating clinical governance development in Ireland: sharing our learning

2015 ◽  
Vol 29 (4) ◽  
pp. 455-481 ◽  
Author(s):  
Maureen A. Flynn ◽  
Thora Burgess ◽  
Philip Crowley
Keyword(s):  
Patient Safety ◽  
Clinical Care ◽  
Clinical Governance ◽  
Quality And Safety ◽  
Content Type ◽  
Governance Framework ◽  
Integrative Research ◽  
Action Project ◽  
Action Projects

Purpose – The purpose of this paper is to present a description of the Irish national clinical governance development initiative and an evaluation of the initiative with the purpose of sharing the learning and proposing actions to activate structures and processes for quality and safety. The Quality and Patient Safety Division of the Health Service Executive established the initiative to counterbalance a possible focus on finances during the economic crisis in Ireland and bring attention to the quality of clinical care. Design/methodology/approach – A clinical governance framework for quality in healthcare in Ireland was developed to clearly articulate the fundamentals of clinical governance. The project plan involved three overlapping phases. The first was designing resources for practice; the second testing the implementation of the national resources in practice; and the third phase focused on gathering feedback and learning. Findings – Staff responded positively to the clinical governance framework. At a time when there are a lot of demands (measurement and scrutiny) the health services leads and responds well to focused support as they improve the quality and safety of services. Promoting the use of the term “governance for quality and safety” assisted in gaining an understanding of the more traditional term “clinical governance”. The experience and outcome of the initiative informed the identification of 12 key learning points and a series of recommendations Research limitations/implications – The initial evaluation was conducted at 24 months so at this stage it is not possible to assess the broader impact of the clinical governance framework beyond the action project hospitals. Practical implications – The single most important obligation for any health system is patient safety and improving the quality of care. The easily accessible, practical resources assisted project teams to lead changes in structures and processes within their services. This paper describes the fundamentals of the clinical governance framework which might serve as a guide for more integrative research endeavours on governance for quality and safety. Originality/value – Experience was gained in both the development of national guidance and their practical use in targeted action projects activating structures and processes that are a prerequisite to delivering safe quality services.

Next level of board accountability in health care quality

2018 ◽  
Vol 32 (1) ◽  
pp. 2-8 ◽  
Author(s):  
Peter J. Pronovost ◽  
C. Michael Armstrong ◽  
Renee Demski ◽  
Ronald R. Peterson ◽  
Paul B. Rothman
Keyword(s):  
Patient Safety ◽  
Quality Of Care ◽  
Health System ◽  
Management System ◽  
Health Care Quality ◽  
High Reliability ◽  
Care Quality ◽  
Quality And Safety ◽  
Content Type

Purpose The purpose of this paper is to offer six principles that health system leaders can apply to establish a governance and management system for the quality of care and patient safety. Design/methodology/approach Leaders of a large academic health system set a goal of high reliability and formed a quality board committee in 2011 to oversee quality and patient safety everywhere care was delivered. Leaders of the health system and every entity, including inpatient hospitals, home care companies, and ambulatory services staff the committee. The committee works with the management for each entity to set and achieve quality goals. Through this work, the six principles emerged to address management structures and processes. Findings The principles are: ensure there is oversight for quality everywhere care is delivered under the health system; create a framework to organize and report the work; identify care areas where quality is ambiguous or underdeveloped (i.e. islands of quality) and work to ensure there is reporting and accountability for quality measures; create a consolidated quality statement similar to a financial statement; ensure the integrity of the data used to measure and report quality and safety performance; and transparently report performance and create an explicit accountability model. Originality/value This governance and management system for quality and safety functions similar to a finance system, with quality performance documented and reported, data integrity monitored, and accountability for performance from board to bedside. To the authors’ knowledge, this is the first description of how a board has taken this type of systematic approach to oversee the quality of care.

scholarly journals The next step in learning from sentinel events in healthcare

2020 ◽  
Vol 9 (1) ◽  
pp. e000739 ◽  
Author(s):  
Kelly Bos ◽  
Dave A Dongelmans ◽  
Sjoerd Greuters ◽  
Gert-Jan Kamps ◽  
Maarten J van der Laan
Keyword(s):  
Information System ◽  
Current Status ◽  
Successful Implementation ◽  
Quality And Safety ◽  
High Quality ◽  
Root Cause ◽  
Academic Hospitals ◽  
Sentinel Events ◽  
Selection Of

ObjectiveThe aim of this study was to evaluate the current status of handling and learning from sentinel events (SEs) in Dutch academic hospitals and to develop a basis for the first steps in a joint and transparent approach to improve learning from SEs.DesignSurvey by the Netherlands Federation of University Medical Centres (NFU) as part of the project ‘Quality-based Governance’.Participants and settingAll eight Dutch University Medical Centres (UMCs).ResultsThree methods are used to identify the root cause of SEs: the Systematic Incident Reconstruction and Evaluation, Prevention and Recovery Information System for Monitoring and Analysis or TRIPOD method. Experts with different backgrounds are involved in the analysis of SEs. UMCs have different policies regarding the selection of recommendations for implementation. Some UMCs implement all recommendations formulated by the analysis team and in some UMCs the head of the involved department selects recommendations for implementation. No predetermined criteria have been established for this selection. Most UMCs confirm that similar SEs reoccur, which might be due to the quality of the analysis of the SEs or the quality of the recommendations.ConclusionThere is a large variety in handling SEs in Dutch academic hospitals and standards for the selection of recommendations are lacking. A next step to decrease the number of (similar) SEs lies in a joint and transparent approach to objectively assess recommendations and further define strategies for successful implementation. Selecting high-quality recommendations for implementation has the potential to lead to a decrease in the number of (similar) SEs and increase in the quality and safety of Dutch healthcare.

scholarly journals A Identificação do paciente no alcance de práticas seguras: concepções e práticas

2019 ◽  
Vol 87 (25) ◽  
Author(s):  
Andréia Guerra
Keyword(s):  
Health Care ◽  
Patient Safety ◽  
Adverse Events ◽  
Safety Culture ◽  
Descriptive Study ◽  
Quality And Safety ◽  
Patient Identification ◽  
Nursing Team ◽  
Study Sites

Objetivo: Avaliar as dificuldades, ações e estratégias realizadas pela equipe de enfermagem para alcançar a meta de segurança de identificação dos pacientes em uma unidade de internação de um hospital filantrópico. Método: estudo descritivocom abordagem qualitativa. A coleta de dados foi realizada de junho a julho de 2016, por meio de entrevistas, com roteirosemiestruturado, com vinte profissionais da equipe de enfermagem. Resultados: foram construídas três categorias temáticas: Identificação do Paciente: concepções, ações e dificuldades vivenciadas; Identificação do Paciente: riscos existentes;Estratégias para desenvolver a cultura de segurança do paciente. Conclusão: evidenciou-se a falta de cultura de segurançado paciente nos locais de estudo. Surge a necessidade de criar estratégias educativas que possibilitem uma melhor capacitação, planejamento e organização das ações, assim como as notificações de eventos adversos garantindo qualidade esegurança aos pacientes.Palavras chave: Segurança do Paciente. Qualidade da Assistência à Saúde. Cultura Organizacional. ABSTRACTObjective: To evaluate the difficulties, actions and strategies carried out by the nursing team in order to achieve the goalof identifying patients in an inpatient unit of a philanthropic hospital. Method: descriptive study with qualitative approach.Data collection was carried out from June to July of 2016, through interviews, with semi-structured script, with twentyprofessionals of the nursing team. Results: three thematic categories were constructed: Patient Identification: conceptions,actions and difficulties experienced; Patient identification: existing risks; Strategies for developing a patient safety culture.Conclusion: the lack of safety culture of the patient in the study sites was evidenced. The need to create educationalstrategies that allow better training, planning and organization of actions, as well as the notifications of adverse events,guaranteeing quality and safety to the patients.Keywords: Patient Safety. Quality of Health Care. Organizational Culture

Prevalence of patient safety indicators and hospital-acquired conditions in those treated for unruptured cerebral aneurysms: establishing standard performance measures using the Nationwide Inpatient Sample database

2013 ◽  
Vol 119 (4) ◽  
pp. 966-973 ◽  
Author(s):  
Kyle M. Fargen ◽  
Maryam Rahman ◽  
Dan Neal ◽  
Brian L. Hoh
Keyword(s):  
Health Care ◽  
Adverse Event ◽  
Patient Safety ◽  
Nationwide Inpatient Sample ◽  
Cerebral Aneurysms ◽  
Patient Safety Indicators ◽  
Hospital Acquired Conditions ◽  
Unruptured Cerebral Aneurysms ◽  
Hospital Acquired

Object The Agency for Healthcare Research and Quality (AHRQ) patient safety indicators (PSIs) and the Centers for Medicare and Medicaid Services hospital-acquired conditions (HACs) are metrics used to gauge the quality of health care provided by health care institutions. The PSIs and HACs are publicly reported metrics and are directly linked to reimbursement for services. To better understand the prevalence of these adverse events in hospitalized patients treated for unruptured cerebral aneurysms, the authors determined the incidence rates of PSIs and HACs among patients with a diagnosis of unruptured aneurysm in the Nationwide Inpatient Sample (NIS) database. Methods The NIS, part of the AHRQ's Healthcare Cost and Utilization Project, was queried for all hospitalizations between 2002 and 2010 involving coiling or clipping of unruptured cerebral aneurysms. The incidence rate for each PSI and HAC was determined by searching the hospital records for ICD-9 codes. The SAS statistical software package was used to calculate incidences and perform multivariate analyses to determine the effects of patient variables on the probability of each indicator developing. Results There were 54,589 hospitalizations involving unruptured cerebral aneurysms in the NIS database for the years 2002–2010; 8314 patients (15.2%) underwent surgical clipping and 9916 (18.2%) were treated with endovascular coiling. One thousand four hundred ninety-two PSI and HAC events occurred among the 8314 patients treated with clipping; at least 1 PSI or HAC occurred in 14.6% of these patients. There were 1353 PSI and HAC events among the 9916 patients treated with coiling; at least 1 PSI or HAC occurred in 10.9% of these patients. Age, sex, and comorbidities had statistically significant associations with an adverse event. Compared with the patients having no adverse event, those having at least 1 PSI during their hospitalizations had significantly longer hospital stays (p < 0.0001), higher hospital costs (p < 0.0001), and higher mortality rates (p < 0.0001). Conclusions These results estimate baseline national rates of PSIs and HACs in patients with unruptured cerebral aneurysms. These data may be used to gauge individual institutional quality of care and patient safety metrics in comparison with national data.

The effects of hospital-physician financial integration on adverse incident rate: An agency theory perspective

2020 ◽  
pp. 095148482094864
Author(s):  
Soumya Upadhyay ◽  
Robert Weech-Maldonado ◽  
William Opoku-Agyeman
Keyword(s):  
Patient Safety ◽  
Quality Of Care ◽  
Financial Integration ◽  
Panel Study ◽  
Random Effects Model ◽  
Quality And Safety ◽  
Hospital Physician ◽  
Adverse Incident ◽  
Incident Rate

Background Patient safety is an important aspect of quality of care. Physicians’ alignment with hospitals by means of financial integration may possibly help hospitals achieve their quality goals. Most research examines the effects of financial integration on financial performance. There is a need to understand whether financial integration has an effect on quality and safety. Purpose The aim of this study is to examine the association between hospital physician financial integration (employment, joint ventures, and ownership) and Adverse Incident Rate. Methodology: A longitudinal panel study design was used. A random effects model with hospital, year, and state effects was used. Our sample contained 3,528 hospitals observations within U.S. from 2013–2015. Findings Contrary to our hypotheses, hospital physician financial integration does not influence AIR. Besides financial integration, hospitals need to have a high commitment towards quality and safety to influence a lower AIR.

Engineering Dependable Health Information Systems

2005 ◽  
pp. 91-109 ◽  
Author(s):  
Khin Than Win ◽  
Peter Croll
Keyword(s):  
Information System ◽  
Knowledge Management ◽  
Information Systems ◽  
Electronic Health Record ◽  
Health Information ◽  
Health Information System ◽  
Health Information Systems ◽  
Health Record ◽  
The Relationship

Effective and appropriate implementation of health information systems assists with an organization’s knowledge management. To enhance a user’s trustworthiness and full adoption, a health information system needs to be dependable. This chapter reviews the different development methodologies available for engineering dependable solutions and their application by citing two case studies as an example. Health information systems cover a diverse set of applications. The focus in this chapter is on the development of electronic health record systems, the importance of dependability, and the relationship between dependability and data quality of the health record systems.

scholarly journals Frozen-Section Checklist Implementation Improves Quality and Patient Safety

2019 ◽  
Vol 151 (6) ◽  
pp. 607-612 ◽  
Author(s):  
Yigu Chen ◽  
Kevin R Anderson ◽  
Jia Xu ◽  
Jeffrey D Goldsmith ◽  
Yael K Heher
Keyword(s):  
Patient Safety ◽  
Frozen Section ◽  
Turnaround Time ◽  
Surgical Pathology ◽  
Quality And Safety ◽  
Data Reporting ◽  
Quality And Patient Safety ◽  
Checklist Implementation

ABSTRACT Objectives An intraoperative consultation (IOC) checklist was developed and implemented aimed at standardizing slide labeling and monitoring metrics central to quality and safety in surgical pathology. Design Data were collected for all IOC cases over a 9-month period. Slide labeling defect rates and IOC turnaround time (TAT) were recorded and compared for the pre- and postimplementation periods. Results In total, 839 IOC cases were analyzed. Preintervention slide labeling showed that 85% of cases contained at least one defect (n = 565). Postintervention data revealed that 27% of cases contained at least one defect (n = 274). The improvement was statistically significant (P < .001). Mean TAT was 21.6 minutes preintervention vs 23.2 minutes postintervention, and the change was insignificant (P = .071). Conclusions The implementation of a standardized IOC reduced slide labeling error. This improvement did not affect mean TAT and may have the increased quality of IOC TAT data reporting. Other metrics affecting patient safety and quality were monitored and standardized.

scholarly journals Limited external reproducibility restricts the use of medical record review for benchmarking

2019 ◽  
Vol 8 (2) ◽  
pp. e000564
Author(s):  
Dorthe O Klein ◽  
Roger Rennenberg ◽  
Rijk Gans ◽  
Roelien Enting ◽  
Richard Koopmans ◽  
...  
Keyword(s):  
Adverse Event ◽  
Patient Safety ◽  
The Netherlands ◽  
Medical Record ◽  
Medical Records ◽  
Medical Record Review ◽  
Quality And Safety ◽  
Internal Review ◽  
Record Review ◽  
Kappa Agreement

BackgroundMedical record review (MRR) is used to assess the quality and safety in hospitals. It is increasingly used to compare institutions. Therefore, the external reproducibility should be high. In the current study, we evaluated this external reproducibility for the assessment of an adverse event (AE) in a sample of records from two university medical centres in the Netherlands, using the same review method.MethodsFrom both hospitals, 40 medical records were randomly chosen from patient files of deceased patients that had been evaluated in the preceding years by the internal review committees. After reviewing by the external committees, we assessed the overall and kappa agreement by comparing the results of both review rounds (once by the own internal committee and once by the external committee). This was calculated for the presence of an AE, preventability and contribution to death.ResultsKappa for the presence of AEs was moderate (k=0.47). For preventability, the agreement was fair (k=0.39) and poor for contribution to death (k=−0.109).ConclusionWe still believe that MRR is suitable for the detection of general issues concerning patient safety. However, based on the outcomes of this study, we would advise to be careful when using MRR for benchmarking.

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