From Fable to Reality at Parkland Hospital: The Impact of Evidence-Based Design Strategies on Patient Safety, Healing, and Satisfaction in an Adult Inpatient Environment

2020 ◽  
pp. 193758672097019
Author(s):  
Renae K. Rich ◽  
Francesqca E. Jimenez ◽  
Susan E. Puumala ◽  
Sheila DePaola ◽  
Kathy Harper ◽  
...  
Keyword(s):  
Patient Safety ◽  
Patient Satisfaction ◽  
Adverse Events ◽  
Noise Temperature ◽  
Evidence Based ◽  
Patient Acuity ◽  
Hospital Design ◽  
Inpatient Outcomes ◽  
Adult Inpatient ◽  
The Impact

Objective: This research aimed to evaluate the quantitative effects of new hospital design on adult inpatient outcomes. Background: Tenets of evidence-based healthcare design, notably single-patient acuity-adaptable and same-handed rooms, decentralized nursing stations, onstage offstage layout, and access to nature were expected to promote patient healing and increase patient satisfaction, while decreasing adverse events. Methods: Patient healing was operationalized through length of stay (LOS) and patient safety through three adverse events: falls, hospital-acquired infections (HAI), and medication-related events. Standard patient surveys captured patient satisfaction. Patient records from 2013 through 2017 allowed for equivalent time periods surrounding the move to the new hospital in August 2015. Stratified by hospital division where significant, pre/post comparisons utilized proportional hazards or logistic regression models as appropriate; interrupted time series analyses afforded longitudinal interpretations. Results: Observed higher postmove LOS was due to previously increasing trends, not increases after the move. In surgical and trauma units, a constant increase in falls was unaffected by the move. Medication events decreased consistently over time; medication events with harm dropped significantly after the move. No change in HAI was found. Significant improvement on most relevant patient satisfaction items occurred after the move. Call button response decreased immediately after the move but subsequently improved. Conclusion: Results did not clearly indicate a net change in adult inpatient outcomes of healing and safety due to the hospital design. There was evidence that the new hospital improved patient satisfaction outcomes related to the environment, including comfort, noise, temperature, and aesthetics.

Patient Safety in Microvascular Plastic Surgery

2019 ◽  
Vol 35 (09) ◽  
pp. 631-639
Author(s):  
Salih Colakoglu ◽  
Seth Tebockhorst ◽  
Tae W. Chong ◽  
David W. Mathes
Keyword(s):  
Risk Factors ◽  
Patient Safety ◽  
Adverse Events ◽  
Surgical Procedures ◽  
Evidence Based ◽  
Surgical Team ◽  
Related Risk ◽  
Prophylactic Measures ◽  
Patients At Risk ◽  
Preventable Harm

Patient safety is defined as freedom from accidental or preventable harm produced by medical care. The identification of patient- and procedure-related risk factors enables the surgical team to carry out prophylactic measures to reduce the rate of complications and adverse events.The purpose of this review is to identify the characteristics of patients, practitioners, and microvascular surgical procedures that place patients at risk for preventable harm, and to discuss evidence-based prevention practices that can potentially help to generate a culture of patient safety.

Eliminating Critical Incident Tracking Network Patient Safety Events at a Veterans Affairs Institution Through Crew Resource Management Training

2016 ◽  
Vol 32 (5) ◽  
pp. 480-484 ◽  
Author(s):  
SreyRam Kuy ◽  
Ramon A. L. Romero
Keyword(s):  
Patient Safety ◽  
Resource Management ◽  
Adverse Events ◽  
Critical Incident ◽  
Medical Center ◽  
Crew Resource Management ◽  
Management Training ◽  
Veterans Affairs ◽  
Crew Resource Management Training ◽  
The Impact

The objective of this study was to determine whether rates of Critical Incident Tracking Network (CITN) patient safety adverse events change after implementation of crew resource management (CRM) training at a Veterans Affairs (VA) hospital. CRM training was conducted for all surgical staff at a VA hospital. Compliance with briefing and debriefing checklists was assessed for all operating room procedures. Tracking of adverse patient safety events utilizing the VA CITN events was performed. There was 100% adherence to performance of briefings and debriefings after initiation of CRM training. There were 3 CITN events in the year prior to implementation of CRM training; following CRM training, there have been zero CITN events. Following CRM training, CITN events were eliminated, and this has been sustained for 2.5 years. This is the first study to demonstrate the impact of CRM training on CITN events, specifically, in a VA medical center.

Recognizing the Ordinary as Extraordinary: Insight Into the “Way We Work” to Improve Patient Safety Outcomes

2017 ◽  
Vol 26 (4) ◽  
pp. 272-277 ◽  
Author(s):  
Elizabeth A. Henneman
Keyword(s):  
Patient Safety ◽  
Adverse Events ◽  
Eye Tracking ◽  
Medical Errors ◽  
Improve Patient Safety ◽  
Safety Net ◽  
Near Miss ◽  
The Impact ◽  
Risk Processes ◽  
Insight Into

The Institute of Medicine (now National Academy of Medicine) reports “To Err is Human” and “Crossing the Chasm” made explicit 3 previously unappreciated realities: (1) Medical errors are common and result in serious, preventable adverse events; (2) The majority of medical errors are the result of system versus human failures; and (3) It would be impossible for any system to prevent all errors. With these realities, the role of the nurse in the “near miss” process and as the final safety net for the patient is of paramount importance. The nurse’s role in patient safety is described from both a systems perspective and a human factors perspective. Critical care nurses use specific strategies to identify, interrupt, and correct medical errors. Strategies to identify errors include knowing the patient, knowing the plan of care, double-checking, and surveillance. Nursing strategies to interrupt errors include offering assistance, clarifying, and verbally interrupting. Nurses correct errors by persevering, being physically present, reviewing/confirming the plan of care, or involving another nurse or physician. Each of these strategies has implications for education, practice, and research. Surveillance is a key nursing strategy for identifying medical errors and reducing adverse events. Eye-tracking technology is a novel approach for evaluating the surveillance process during common, high-risk processes such as blood transfusion and medication administration. Eye tracking has also been used to examine the impact of interruptions to care caused by bedside alarms as well as by other health care personnel. Findings from this safety-related eye-tracking research provide new insight into effective bedside surveillance and interruption management strategies.

Using Patient Safety Indicators to Estimate the Impact of Potential Adverse Events on Outcomes

2007 ◽  
Vol 65 (1) ◽  
pp. 67-87 ◽  
Author(s):  
Peter E. Rivard ◽  
Stephen L. Luther ◽  
Cindy L. Christiansen ◽  
Shibei Zhao ◽  
Susan Loveland ◽  
...  
Keyword(s):  
Patient Safety ◽  
Adverse Events ◽  
Patient Safety Indicators ◽  
The Impact

scholarly journals Formulation, implementation and evaluation of a distance course for accreditation in patient safety

2018 ◽  
Vol 16 (2) ◽  
Author(s):  
Poliana Nunes Wanderlei ◽  
Erik Montagna
Keyword(s):  
Patient Safety ◽  
Adverse Events ◽  
Learning Environment ◽  
Virtual Learning ◽  
Patient Safety Culture ◽  
Hospital Staff ◽  
Course Evaluation ◽  
Reporting Rate ◽  
Virtual Learning Environment ◽  
The Impact

ABSTRACT Objective To formulate and to implement a virtual learning environment course in patient safety, and to propose ways to estimate the impact of the course in patient safety outcomes. Methods The course was part of an accreditation process and involved all employees of a public hospital in Brazil. The whole hospital staff was enrolled in the course. The accreditation team defined the syllabus. The education guidelines were divided into 12 modules related to quality, patient safety and required organizational practices. The assessment was performed at the end of each module through multiple-choice tests. The results were estimated according to occurrence of adverse events. Data were collected after the course, and employees’ attitude was surveyed. Results More than 80% of participants reached up to 70% success on tests after the course; the event-reporting rate increased from 714 (16,264 patients) to 1,401 (10,180 patients). Conclusion Virtual learning environment was a successful tool data. Data on course evaluation is consistent with increase in identification and reporting of adverse events. Although the report increment is not positive per si, it indicates changes in patient safety culture.

scholarly journals Evaluating a major innovation in hospital design: workforce implications and impact on patient and staff experiences of all single room hospital accommodation

2015 ◽  
Vol 3 (3) ◽  
pp. 1-304 ◽  
Author(s):  
Jill Maben ◽  
Peter Griffiths ◽  
Clarissa Penfold ◽  
Michael Simon ◽  
Elena Pizzo ◽  
...  
Keyword(s):  
Patient Safety ◽  
Patient Experience ◽  
Clinical Care ◽  
Temporary Increase ◽  
Infection Rates ◽  
Hospital Design ◽  
Single Room ◽  
Working Practices ◽  
The Impact

BackgroundNew hospital design includes more single room accommodation but there is scant and ambiguous evidence relating to the impact on patient safety and staff and patient experiences.ObjectivesTo explore the impact of the move to a newly built acute hospital with all single rooms on care delivery, working practices, staff and patient experience, safety outcomes and costs.Design(1) Mixed-methods study to inform a pre-/post-‘move’ comparison within a single hospital, (2) quasi-experimental study in two control hospitals and (3) analysis of capital and operational costs associated with single rooms.SettingFour nested case study wards [postnatal, acute admissions unit (AAU), general surgery and older people’s] within a new hospital with all single rooms. Matched wards in two control hospitals formed the comparator group.Data sourcesTwenty-one stakeholder interviews; 250 hours of observation, 24 staff interviews, 32 patient interviews, staff survey (n = 55) and staff pedometer data (n = 56) in the four case study wards; routinely collected data at ward level in the control hospitals (e.g. infection rates) and costs associated with hospital design (e.g. cleaning and staffing) in the new hospital.Results(1) There was no significant change to the proportion of time spent by nursing staff on different activities. Staff perceived improvements (patient comfort and confidentiality), but thought the new accommodation worse for visibility and surveillance, teamwork, monitoring, safeguarding and remaining close to patients. Giving sufficient time and attention to each patient, locating other staff and discussing care with colleagues proved difficult. Two-thirds of patients expressed a clear preference for single rooms, with the benefits of comfort and control outweighing any disadvantages. Some patients experienced care as task-driven and functional, and interaction with other patients was absent, leading to a sense of isolation. Staff walking distances increased significantly after the move. (2) A temporary increase in falls and medication errors within the AAU was likely to be associated with the need to adjust work patterns rather than associated with single rooms, although staff perceived the loss of panoptic surveillance as the key to increases in falls. Because of the fall in infection rates nationally and the low incidence at our study site and comparator hospitals, it is difficult to conclude from our data that it is the ‘single room’ factor that prevents infection. (3) Building an all single room hospital can cost 5% more but the difference is marginal over time. Housekeeping and cleaning costs are higher.ConclusionsThe nature of tasks undertaken by nurses did not change, but staff needed to adapt their working practices significantly and felt ill prepared for the new ways of working, with potentially significant implications for the nature of teamwork in the longer term. Staff preference remained for a mix of single rooms and bays. Patients preferred single rooms. There was no strong evidence that single rooms had any impact on patient safety but housekeeping and cleaning costs are higher. In terms of future work, patient experience and preferences in hospitals with different proportions of single rooms/designs need to be explored with a larger patient sample. The long-term impact of single room working on the nature of teamwork and informal learning and on clinical/care outcomes should also be explored.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

Procedural characteristics and adverse events in diagnostic and interventional catheterisations in paediatric and adult CHD: initial report from the IMPACT Registry

2015 ◽  
Vol 26 (1) ◽  
pp. 70-78 ◽  
Author(s):  
Robert N. Vincent ◽  
John Moore ◽  
Robert H. Beekman ◽  
Lee Benson ◽  
Lisa Bergersen ◽  
...  
Keyword(s):  
Adverse Events ◽  
Interventional Procedures ◽  
Age Groups ◽  
Diagnostic Procedures ◽  
Time Frame ◽  
Patient Acuity ◽  
Initial Report ◽  
Adult Congenital ◽  
Data Elements ◽  
The Impact

AbstractObjectivesTo report procedural characteristics and adverse events on data collected in the registry.BackgroundThe IMPACT – IMproving Paediatric and Adult Congenital Treatment – Registry is a catheterisation registry of paediatric and adult patients with CHD undergoing diagnostic and interventional cardiac catheterisation. We are reporting the procedural characteristics and adverse events of patients undergoing diagnostic and interventional catheterisation procedures from January, 2011 to March, 2013.MethodsDemographic, clinical, procedural, and institutional data elements were collected at the participating centres and entered via either a web-based platform or software provided by American College of Cardiology-certified vendors, and were collected in a secure, centralised database. Centre participation was voluntary.ResultsDuring the time frame of data collection, 19,797 procedures were entered into the IMPACT Registry. Procedures were classified as diagnostic only (35.4%); one of six specific interventions (23.8%); other or multiple interventions (40.7%); and were further broken down into four age groups. Anaesthesia was used in 84.1% of diagnostic procedures and 87.8% of interventional ones. Adverse events occurred in 10.0% of diagnostic and 11.1% of interventional procedures.ConclusionsThe IMPACT Registry is gathering data to set national benchmarks for diagnostic and certain specific interventional procedures. We are seeing little differences in procedural characteristics or adverse events in diagnostic procedures compared with interventional procedures overall, but there is significant variation in adverse events amongst age categories. Risk stratification and patient acuity scores will be required for further analysis of these differences.

scholarly journals Acute Effects of Supervised Making Weight on Health Markers, Hormones and Body Composition in Muay Thai Fighters

Sports ◽  
2020 ◽  
Vol 8 (10) ◽  
pp. 137
Author(s):  
Roberto Cannataro ◽  
Erika Cione ◽  
Luca Gallelli ◽  
Natale Marzullo ◽  
Diego A. Bonilla
Keyword(s):  
Body Composition ◽  
Adverse Events ◽  
Repeated Measures ◽  
Thyroid Stimulating Hormone ◽  
Evidence Based ◽  
Rapid Weight Loss ◽  
Acute Effects ◽  
Normal Range ◽  
Rapid Weight Gain ◽  
The Impact

Making weight is a practice often used in combat sports. This consists of a rapid weight loss (RWL) and a subsequent rapid weight gain (RWG) in the days preceding competition. However, this practice is often carried out based on anecdotal information provided by ex-athletes or non-professionals, which has led to several adverse events. This study aimed to assess the acute effects of a supervised nutritional period of RWL/RWG on health markers, hormone concentrations, and body composition. We performed a single-arm repeated-measures (baseline, after RWL and after RWG) clinical trial with twenty-one (8F:16M) Italian Muay Thai fighters. Body mass was significantly lower after the RWL (−4.1%) while there was a significantly higher glucose availability after RWL and RWG. Blood urea nitrogen, lipid profile, and creatinine were within the normal range after RWL/RWG. Testosterone decrease significantly after RWL and RWG in the men group. Male fighters had a significant reduction in thyroid-stimulating hormone concentration after the RWL and RWG intervention, but no change was found in women at pre-competition. Bioelectrical parameters were almost fully restored after RWG. An evidence-based and individualized nutrition methodology reduces the adverse events after an RWL and RWG practice, although the impact on the hormonal profile is inevitable.

Risperidone long-acting injectable (RLAI) administration in deltoid muscle…. really is an improvement?

2011 ◽  
Vol 26 (S2) ◽  
pp. 1223-1223
Author(s):  
S. Arques ◽  
F. Arnau ◽  
T. Rubio ◽  
A. Pino ◽  
C. Iranzo
Keyword(s):  
Patient Satisfaction ◽  
Adverse Events ◽  
Psychotic Disorders ◽  
Deltoid Muscle ◽  
List Type ◽  
Global Satisfaction ◽  
Clinical Patient ◽  
Therapeutic Decisions ◽  
Long Acting ◽  
The Impact

IntroductionIn the treatment of psychotic disorders, any such instrument or way that could help to improve their prognosis should be valued and taken into account.ObjectivesTo determine the impact of the administration of RLAI in the deltoid, assessing patient satisfaction and acceptance, as well as efficacy and tolerability.Material and methodsProspective, naturalistic and descriptive, 20 patients with chronic psychosis treated with RLAI, performing a change in administration (gluteal to deltoid muscle).We realize 2 valuations:1Basal: demographic, clinical (PANSS, CGI, UKU, dose and duration RLAI).2Final (6 months): clinical, patient satisfaction (Questionnaire Medication Treatment Satisfaction, Visual Analogue Scale VAS).Analysis SPSS v15.0.ResultsIn subscales TSQM, punctuations very raised for deltoid: Efficiency 75, 55 %; adverse events 94, 38 %; Administration 75, 27 %; Global satisfaction 74, 64%. The VAS of satisfaction with deltoid was of 7′ 4 ± 1′ 3 (0–10).Opinion patientsless pain, adverse events and more normal (100%), more capacity decision (80%), less stigmatizing (85%).No differences in efficacy, but better tolerated.ConclusionsThe administration of the deltoid RLAI in can be a useful tool for the treatment of psychotic disorders because it can allow the patient to engage in certain therapeutic decisions (to be able to choose the way), promote adherence, may improve the perception of treatment to be associated deltoid administration to something less traumatic and stigmatizing, that is “more normal.”

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