scholarly journals Learning from diagnostic errors to improve patient safety when GPs work in or alongside emergency departments: incorporating realist methodology into patient safety incident report analysis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Alison Cooper ◽  
Andrew Carson-Stevens ◽  
Matthew Cooke ◽  
Peter Hibbert ◽  
Thomas Hughes ◽  
...  
Keyword(s):  
Patient Safety ◽  
Emergency Departments ◽  
Diagnostic Errors ◽  
Diagnostic Error ◽  
Priority Areas ◽  
Safety Incident ◽  
Patient Safety Incident ◽  
Gp Services ◽  
Realist Methodology

Abstract Background Increasing demand on emergency healthcare systems has prompted introduction of new healthcare service models including the provision of GP services in or alongside emergency departments. In England this led to a policy proposal and £100million (US$130million) of funding for all emergency departments to have co-located GP services. However, there is a lack of evidence for whether such service models are effective and safe. We examined diagnostic errors reported in patient safety incident reports to develop theories to explain how and why they occurred to inform potential priority areas for improvement and inform qualitative data collection at case study sites to further refine the theories. Methods We used a mixed-methods design using exploratory descriptive analysis to identify the most frequent and harmful sources of diagnostic error and thematic analysis, incorporating realist methodology to refine theories from an earlier rapid realist review, to describe how and why the events occurred and could be mitigated, to inform improvement recommendations. We used two UK data sources: Coroners’ reports to prevent future deaths (30.7.13–14.08.18) and National Reporting and Learning System (NRLS) patient safety incident reports (03.01.05–30.11.15). Results Nine Coroners’ reports (from 1347 community and hospital reports, 2013–2018) and 217 NRLS reports (from 13 million, 2005–2015) were identified describing diagnostic error related to GP services in or alongside emergency departments. Initial theories to describe potential priority areas for improvement included: difficulty identifying appropriate patients for the GP service; under-investigation and misinterpretation of diagnostic tests; and inadequate communication and referral pathways between the emergency and GP services. High-risk presentations included: musculoskeletal injury, chest pain, headache, calf pain and sick children. Conclusion Initial theories include the following topics as potential priority areas for improvement interventions and evaluation to minimise the risk of diagnostic errors when GPs work in or alongside emergency departments: a standardised initial assessment with streaming guidance based on local service provision; clinical decision support for high-risk conditions; and standardised computer systems, communication and referral pathways between emergency and GP services. These theories require refinement and testing with qualitative data collection from case study (hospital) sites.

scholarly journals Diagnostic error in the emergency department: learning from national patient safety incident report analysis

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Faris Hussain ◽  
Alison Cooper ◽  
Andrew Carson-Stevens ◽  
Liam Donaldson ◽  
Peter Hibbert ◽  
...  
Keyword(s):  
Emergency Department ◽  
Patient Safety ◽  
Diagnostic Error ◽  
Primary Data ◽  
National Database ◽  
Neck Of Femur ◽  
Cross Sectional ◽  
Contributory Factors ◽  
Safety Incident ◽  
Patient Safety Incident

Abstract Background Diagnostic error occurs more frequently in the emergency department than in regular in-patient hospital care. We sought to characterise the nature of reported diagnostic error in hospital emergency departments in England and Wales from 2013 to 2015 and to identify the priority areas for intervention to reduce their occurrence. Methods A cross-sectional mixed-methods design using an exploratory descriptive analysis and thematic analysis of patient safety incident reports. Primary data were extracted from a national database of patient safety incidents. Reports were filtered for emergency department settings, diagnostic error (as classified by the reporter), from 2013 to 2015. These were analysed for the chain of events, contributory factors and harm outcomes. Results There were 2288 cases of confirmed diagnostic error: 1973 (86%) delayed and 315 (14%) wrong diagnoses. One in seven incidents were reported to have severe harm or death. Fractures were the most common condition (44%), with cervical-spine and neck of femur the most frequent types. Other common conditions included myocardial infarctions (7%) and intracranial bleeds (6%). Incidents involving both delayed and wrong diagnoses were associated with insufficient assessment, misinterpretation of diagnostic investigations and failure to order investigations. Contributory factors were predominantly human factors, including staff mistakes, healthcare professionals’ inadequate skillset or knowledge and not following protocols. Conclusions Systems modifications are needed that provide clinicians with better support in performing patient assessment and investigation interpretation. Interventions to reduce diagnostic error need to be evaluated in the emergency department setting, and could include standardised checklists, structured reporting and technological investigation improvements.

scholarly journals Identifying safe care processes when GPs work in or alongside emergency departments: realist evaluation

2021 ◽  
pp. BJGP.2021.0090
Author(s):  
Alison Cooper ◽  
Andrew Carson-Stevens ◽  
Michelle Edwards ◽  
Freya Davies ◽  
Liam Donaldson ◽  
...  
Keyword(s):  
Patient Safety ◽  
Emergency Departments ◽  
Care Delivery ◽  
Care Processes ◽  
Safety Incident ◽  
Service Models ◽  
Patient Safety Incident ◽  
Incident Reports ◽  
Patient Safety Incidents ◽  
Safe Care

Background: Increasing pressure on emergency services has led to the development of different models of care delivery including GPs working in or alongside emergency departments (EDs), but with a lack of evidence for patient safety outcomes. Aim: We aimed to explore how care processes work and how patient safety incidents associated with GPs working in ED settings may be mitigated. Design and Setting: We used realist methodology with a purposive sample of 13 EDs with different GP service models. We sought to understand the relationship between contexts, mechanisms and outcomes to develop theories about how and why patient safety incidents may occur, and how safe care was perceived to be delivered. Method: We collected qualitative data (observations, semi-structured audio-recorded staff interviews and local patient safety incident reports). We coded data using ‘if, then, because’ statements to refine initial theories developed from an earlier rapid realist literature review and analysis of a sample of national patient safety incident reports. Results: We developed a programme theory to describe how safe patient care was perceived to be delivered in these service models including: an experienced streaming nurse using local guidance and early warning scores; support for GPs’ clinical decision-making with clear governance processes relevant to the intended role (traditional GP approach or emergency medicine approach); and strong clinical leadership to promote teamwork and improve communication between services. Conclusion: Our findings can be used as a focus for more in-depth human factors investigations to optimise work conditions in this complex care delivery setting.

scholarly journals Learning from patient safety incidents involving acutely sick adults in hospital assessment units in England and Wales: a mixed methods analysis for quality improvement

2021 ◽  
pp. 014107682110325
Author(s):  
Alexandra Urquhart ◽  
Sarah Yardley ◽  
Elin Thomas ◽  
Liam Donaldson ◽  
Andrew Carson-Stevens
Keyword(s):  
Patient Safety ◽  
Quality Improvement ◽  
Mixed Methods ◽  
Diagnostic Errors ◽  
Learning System ◽  
England And Wales ◽  
Safety Incident ◽  
Patient Safety Incident ◽  
Incident Reports ◽  
National Analysis

Objective Six per cent of hospital patients experience a patient safety incident, of which 12% result in severe/fatal outcomes. Acutely sick patients are at heightened risk. Our aim was to identify the most frequently reported incidents in acute medical units and their characteristics. Design Retrospective mixed methods methodology: (1) an a priori coding process, applying a multi-axial coding framework to incident reports; and, (2) a thematic interpretative analysis of reports. Setting Patient safety incident reports (10 years, 2005–2015) collected from the National Reporting and Learning System, which receives reports from hospitals and other care settings across England and Wales. Participants Reports describing severe harm/death in acute medical unit were identified. Main outcome measures Incident type, contributory factors, outcomes and level of harm were identified in the included reports. During thematic analysis, themes and metathemes were synthesised to inform priorities for quality improvement. Results A total of 377 reports of severe harm or death were confirmed. The most common incident types were diagnostic errors ( n = 79), medication-related errors ( n = 61), and failures monitoring patients ( n = 57). Incidents commonly stemmed from lack of active decision-making during patient admissions and communication failures between teams. Patients were at heightened risk of unsafe care during handovers and transfers of care. Metathemes included the necessity of patient self-advocacy and a lack of care coordination. Conclusion This 10-year national analysis of incident reports provides recommendations to improve patient safety including: introduction of electronic prescribing and monitoring systems; forcing checklists to reduce diagnostic errors; and increased senior presence overnight and at weekends.

Lessons in clinical reasoning – pitfalls, myths, and pearls: the contribution of faulty data gathering and synthesis to diagnostic error

Diagnosis ◽  
2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Martin A. Schaller-Paule ◽  
Helmuth Steinmetz ◽  
Friederike S. Vollmer ◽  
Melissa Plesac ◽  
Felix Wicke ◽  
...  
Keyword(s):  
Patient Safety ◽  
Clinical Reasoning ◽  
Data Gathering ◽  
Diagnostic Errors ◽  
Diagnostic Error ◽  
Care Physician ◽  
Diagnostic Process ◽  
Myasthenic Crisis ◽  
Hospital Organization ◽  
Substantial Impact

Abstract Objectives Errors in clinical reasoning are a major factor for delayed or flawed diagnoses and put patient safety at risk. The diagnostic process is highly dependent on dynamic team factors, local hospital organization structure and culture, and cognitive factors. In everyday decision-making, physicians engage that challenge partly by relying on heuristics – subconscious mental short-cuts that are based on intuition and experience. Without structural corrective mechanisms, clinical judgement under time pressure creates space for harms resulting from systems and cognitive errors. Based on a case-example, we outline different pitfalls and provide strategies aimed at reducing diagnostic errors in health care. Case presentation A 67-year-old male patient was referred to the neurology department by his primary-care physician with the diagnosis of exacerbation of known myasthenia gravis. He reported shortness of breath and generalized weakness, but no other symptoms. Diagnosis of respiratory distress due to a myasthenic crisis was made and immunosuppressive therapy and pyridostigmine were given and plasmapheresis was performed without clinical improvement. Two weeks into the hospital stay, the patient’s dyspnea worsened. A CT scan revealed extensive segmental and subsegmental pulmonary emboli. Conclusions Faulty data gathering and flawed data synthesis are major drivers of diagnostic errors. While there is limited evidence for individual debiasing strategies, improving team factors and structural conditions can have substantial impact on the extent of diagnostic errors. Healthcare organizations should provide the structural supports to address errors and promote a constructive culture of patient safety.

Long-Term Care Nurses' Experiences With Patient Safety Incident Management

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Nicole Serre ◽  
Sherry Espin ◽  
Alyssa Indar ◽  
Sue Bookey-Bassett ◽  
Karen LeGrow
Keyword(s):  
Patient Safety ◽  
Long Term Care ◽  
Incident Management ◽  
Term Care ◽  
Safety Incident ◽  
Patient Safety Incident

scholarly journals Can Patient Safety Incident Reports Be Used to Compare Hospital Safety? Results from a Quantitative Analysis of the English National Reporting and Learning System Data

PLoS ONE ◽  
2015 ◽  
Vol 10 (12) ◽  
pp. e0144107 ◽  
Author(s):  
Ann-Marie Howell ◽  
Elaine M. Burns ◽  
George Bouras ◽  
Liam J. Donaldson ◽  
Thanos Athanasiou ◽  
...  
Keyword(s):  
Patient Safety ◽  
Quantitative Analysis ◽  
Learning System ◽  
Hospital Safety ◽  
Safety Incident ◽  
Patient Safety Incident ◽  
System Data ◽  
Incident Reports

scholarly journals The Role of Transformational Leadership and Effective Communication on the Implementation of Patient Safety With Trust as Mediation at X Hospital Jakarta

2021 ◽  
Vol 10 (2) ◽  
pp. 90-102
Author(s):  
Vivi Silvia ◽  
Rokiah Kusumapradja ◽  
Idrus Jus'at
Keyword(s):  
Transformational Leadership ◽  
Patient Safety ◽  
Great Influence ◽  
Effective Communication ◽  
Primary Data ◽  
Global Issue ◽  
Safety Incident ◽  
Professional Nursing Practice ◽  
Patient Safety Incident

Patient safety has become a global issue in the field of health service including hospital. Implementation of patient safety in the hospital requires the involvement of leadership, effective communication and patient’s trust. At X Hospital Jakarta, the root case that frequently occurs on patient safety incident is communication matter. This has an impact on the reoccurrence of patient safety incident. This research aims to analyze the influence of transformational leadership and effective communication towards the implementation of patient safety by trust as mediation. The method of this research is causal associative with quantitative approach. There are 37 nurses as  samples counted with G-Power Statistics application. The technique of collecting data uses primary data questionnaires and is processed by path analysis. The result shows that there is a great influence on transformational leadership towards trust.  Therefore, in implementing patient safety in hospital, it needs program development on transformational leadership; controlling, and evaluating the implementation of effective communication; and improving nursing care as a form of professional nursing practice to create and to maintain patient’s trust towards nurse.

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