The Impact of CBAHI Accreditation on Efficiency Rate and Patient’ Safety: Makkah Experience, KSA

Abstract Introduction/Objective Since the start of the new millennium, optimization of Quality and Patient Safety (QPS) has taken a renewed focus in the healthcare industry. Consequently, the Accreditation Council for Graduate Medical Education has mandated that QPS be a part of residency training. We have previously presented our curriculum designed to meet the specific needs of Pathology training programs, and covering four content areas: Handoffs, Error Management, Laboratory Administration, and Process Improvement. We are now presenting implementation. Methods To implement this curriculum, we 1) created online modules for self-directed learning on basic topics (using courses developed by IHI and CAP, and assigned articles), and paired these with faculty-facilitated interactive learning activities on more complex topics, including proficiency testing, root cause analysis and test utilization, 2) assigned every resident to a QPS project that was aligned with departmental priorities, led by a faculty advisor, and ran over 8- 10 months, and 3) appointed a QPS Chief Resident to coordinate and support the residents’ QPS activities. We measured the impact of the curriculum by comparing RISE laboratory accreditation percentiles and QPS curriculum quiz scores before and after curriculum implementation. Results After its implementation, RISE percentiles increased by at least 25 for every PGY, and QPS quiz scores increased by at least 10% for 3 of 4 PGY. Every QPS project was presented at Grand Rounds, and 4 were presented externally, including 2 at national conferences. Conclusion Our curriculum was successful in improving residents’ knowledge and competence in QPS. Challenges included designing appropriate learning activities, tracking completion of activities, coordinating faculty schedules and maintaining resident buy-in to the curriculum. We believe that the basic structure of our curriculum offers a solid foundation to which revisions can be made as QPS priorities evolve, and which can be readily adapted to other programs and locations.

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Assessing the Impact of Multi-Morbidity and Related Constructs on Patient Reported Safety in Primary Care: Generalized Structural Equation Modelling of Observational Data

Journal of Clinical Medicine ◽

10.3390/jcm10081782 ◽

2021 ◽

Vol 10 (8) ◽

pp. 1782

Author(s):

Ignacio Ricci-Cabello ◽

Aina María Yañez-Juan ◽

Maria A. Fiol-deRoque ◽

Alfonso Leiva ◽

Joan Llobera Canaves ◽

...

Keyword(s):

Primary Care ◽

Patient Safety ◽

Structural Equation ◽

Structural Equation Models ◽

Cross Sectional ◽

Morbidity Burden ◽

Patient Reported ◽

Patient Complexity ◽

Complex Relationships ◽

The Impact

We aimed to examine the complex relationships between patient safety processes and outcomes and multimorbidity using a comprehensive set of constructs: multimorbidity, polypharmacy, discordant comorbidity (diseases not sharing either pathogenesis nor management), morbidity burden and patient complexity. We used cross-sectional data from 4782 patients in 69 primary care centres in Spain. We constructed generalized structural equation models to examine the associations between multimorbidity constructs and patient-reported patient safety (PREOS-PC questionnaire). These associations were modelled through direct and indirect (mediated by increased interactions with healthcare) pathways. For women, a consistent association between higher levels of the multimorbidity constructs and lower levels of patient safety was observed via either pathway. The findings for men replicated these observations for polypharmacy, morbidity burden and patient complexity via indirect pathways. However, direct pathways showed unexpected associations between higher levels of multimorbidity and better safety. The consistent association between multimorbidity constructs and worse patient safety among women makes it advisable to target this group for the development of interventions, with particular attention to the role of comorbidity discordance. Further research, particularly qualitative research, is needed for clarifying the complex associations among men.

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A Narrative Review of Clinical Decision Support for Inpatient Clinical Pharmacists

Applied Clinical Informatics ◽

10.1055/s-0041-1722916 ◽

2021 ◽

Vol 12 (02) ◽

pp. 199-207

Author(s):

Liang Yan ◽

Thomas Reese ◽

Scott D. Nelson

Keyword(s):

Patient Safety ◽

Quality Of Care ◽

Decision Support ◽

Clinical Decision Support ◽

Clinical Decision ◽

Controlled Trials ◽

Clinical Pharmacists ◽

Randomized Controlled ◽

The Impact

Abstract Objective Increasingly, pharmacists provide team-based care that impacts patient care; however, the extent of recent clinical decision support (CDS), targeted to support the evolving roles of pharmacists, is unknown. Our objective was to evaluate the literature to understand the impact of clinical pharmacists using CDS. Methods We searched MEDLINE, EMBASE, and Cochrane Central for randomized controlled trials, nonrandomized trials, and quasi-experimental studies which evaluated CDS tools that were developed for inpatient pharmacists as a target user. The primary outcome of our analysis was the impact of CDS on patient safety, quality use of medication, and quality of care. Outcomes were scored as positive, negative, or neutral. The secondary outcome was the proportion of CDS developed for tasks other than medication order verification. Study quality was assessed using the Newcastle–Ottawa Scale. Results Of 4,365 potentially relevant articles, 15 were included. Five studies were randomized controlled trials. All included studies were rated as good quality. Of the studies evaluating inpatient pharmacists using a CDS tool, four showed significantly improved quality use of medications, four showed significantly improved patient safety, and three showed significantly improved quality of care. Six studies (40%) supported expanded roles of clinical pharmacists. Conclusion These results suggest that CDS can support clinical inpatient pharmacists in preventing medication errors and optimizing pharmacotherapy. Moreover, an increasing number of CDS tools have been developed for pharmacists' roles outside of order verification, whereby further supporting and establishing pharmacists as leaders in safe and effective pharmacotherapy.

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The COVID‐19 outbreak in Saudi Arabia and the impact on patient safety incident reports: An empirical study among the medical facilities of Qassim health cluster

Journal of Healthcare Risk Management ◽

10.1002/jhrm.21464 ◽

2021 ◽

Author(s):

Sultan Al‐Shaya ◽

Ayed Al‐Reshidi ◽

Majeda Farajat ◽

Aliaa Elnefiely

Keyword(s):

Saudi Arabia ◽

Patient Safety ◽

Empirical Study ◽

Safety Incident ◽

Medical Facilities ◽

Patient Safety Incident ◽

Incident Reports ◽

The Impact

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Patient Safety/Quality Improvement Primer, Part III: The Role of Simulation

Otolaryngology ◽

10.1177/01945998211013314 ◽

2021 ◽

pp. 019459982110133

Author(s):

Ellen S. Deutsch ◽

Sonya Malekzadeh ◽

Cecelia E. Schmalbach

Keyword(s):

Patient Safety ◽

Quality Improvement ◽

Control Charts ◽

Neck Surgery ◽

Resident Training ◽

Statistical Process ◽

Ensure Patient Safety ◽

Statistical Process Control Charts ◽

The Individual ◽

The Impact

Simulation training has taken a prominent role in otolaryngology–head and neck surgery (OTO-HNS) as a means to ensure patient safety and quality improvement (PS/QI). While it is often equated to resident training, this tool has value in lifelong learning and extends beyond the individual otolaryngologists to include simulation-based learning for teams and health systems processes. Part III of this PS/QI primer provides an overview of simulation in medicine and specific applications within the field of OTO-HNS. The impact of simulation on PS/QI will be presented in an evidence-based fashion to include the use of run and statistical process control charts to assess the impact of simulation-guided initiatives. Last, steps in developing a simulation program focused on PS/QI will be outlined with future opportunities for OTO-HNS simulation.

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Acute care nurses’ perceptions of leadership, teamwork, turnover intention and patient safety – a mixed methods study

BMC Nursing ◽

10.1186/s12912-021-00652-w ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Shahram Zaheer ◽

Liane Ginsburg ◽

Hannah J. Wong ◽

Kelly Thomson ◽

Lorna Bain ◽

...

Keyword(s):

Patient Safety ◽

Mixed Methods ◽

Turnover Intention ◽

Interactive Effect ◽

Mixed Methods Study ◽

Senior Leadership ◽

Healthcare Organizations ◽

Staff Perceptions ◽

Leadership Support ◽

The Impact

Abstract Background This study contributes to a small but growing body of literature on how context influences perceptions of patient safety in healthcare settings. We examine the impact of senior leadership support for safety, supervisory leadership support for safety, teamwork, and turnover intention on overall patient safety grade. Interaction effects of predictors on perceptions of patient safety are also examined. Methods In this mixed methods study, cross-sectional survey data (N = 185) were collected from nurses and non-physician healthcare professionals. Semi-structured interview data (N = 15) were collected from nurses. The study participants worked in intensive care, general medicine, mental health, or the emergency department of a large community hospital in Southern Ontario. Results Hierarchical regression analyses showed that staff perceptions of senior leadership (p < 0.001), teamwork (p < 0.01), and turnover intention (p < 0.01) were significantly associated with overall patient safety grade. The interactive effect of teamwork and turnover intention on overall patient safety grade was also found to be significant (p < 0.05). The qualitative findings corroborated the survey results but also helped expand the characteristics of the study’s key concepts (e.g., teamwork within and across professional boundaries) and why certain statistical relationships were found to be non-significant (e.g., nurse interviewees perceived the safety specific responsibilities of frontline supervisors much more broadly compared to the narrower conceptualization of the construct in the survey). Conclusions The results of the current study suggest that senior leadership, teamwork, and turnover intention significantly impact nursing staff perceptions of patient safety. Leadership is a modifiable contextual factor and resources should be dedicated to strengthen relational competencies of healthcare leaders. Healthcare organizations must also proactively foster inter and intra-professional collaboration by providing teamwork educational workshops or other on-site learning opportunities (e.g., simulation training). Healthcare organizations would benefit by considering the interactive effect of contextual factors as another lever for patient safety improvement, e.g., lowering staff turnover intentions would maximize the positive impact of teamwork improvement initiatives on patient safety.

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Editorial

Acute Medicine Journal ◽

10.52964/amja.0532 ◽

2012 ◽

Vol 11 (1) ◽

Author(s):

Chris Roseveare ◽

Keyword(s):

Patient Safety ◽

Young Male ◽

Final Diagnosis ◽

Mass Casualty ◽

Major Incident ◽

Spare Capacity ◽

Acute Medical Unit ◽

Infected Urine ◽

Temporary Closure ◽

The Impact

The snow and freezing temperatures will hopefully have passed by the time this edition reaches you; the sight of daffodils may be asignal that the relief of spring is not far off. Winter frequently stretches AMU resources to the limit – in recent years we have had epidemics of seasonal and swine f lu, but this year Norovirus seems to have been the bigger challenge. Ward closures from diarrhoea outbreaks have traditionally been more of a ‘downstream’ problem (no pun intended), but the impact of closure of the AMU would be substantial.At the time of writing this has still, thankfully, been avoided in my own hospital; however it remains a circumstance for which we have to be prepared. This edition’s ‘Viewpoint’ article describes how temporary closure of the AMU was managed in a London hospital. The use of an empty ‘winter pressures ward’ eased the burden in this case, enabling the AMU service to be maintained. Even with the luxury of this spare capacity, there was clearly significant disruption, requiring close collaboration between a variety of departments, which is well described by the authors. Many hospitals have become highly dependent on a functioning AMU to provide timely, safe and effective care for medical emergencies. Major incident plans are in place to deal with mass casualty incidents; we need to consider similar contingencies to deal with AMU closure if patient safety is going to be maintained. This article is a timely reminder of the need for forward planning. Maintaining patient safety is a mantra which will be familiar to acute physicians, particularly those who attended any of the recent SAM meetings, where this theme has been well rehearsed. An acute medical unit can provide significant safety benefits by concentrating resources in a single area. However, for the 60% who cannot go directly home from the AMU, this model creates the need for care to be transferred at some point. It is well recognised that transfer is a time at which patient safety can become compromised; so if safety is our mantra, acute physicians and nurses have a responsibility to manage this process effectively. The article by David Hindmash and Liz Lees provides an important addition to the limited literature in this area. Structured checklists are becoming an increasing part of medical practice; this paper highlights how a checklist can be used to improve the quality of handover from AMU. The authors emphasise the need to keep the form simple, and the importance of regular reinforcement to ensure that it is used. What skills and attributes does an acute physician require? With interview season approaching it’s a question that many prospective trainees will be contemplating – remaining calm under pressure, communication skills and teamworking are some of the standard responses; but what about a good sense of smell? Most of us recognise the characteristic odour of melaena , or the whiff of infected urine. But the absence of body odour might be equally revealing. Luther and Yap noted their patient to be ‘remarkably clean’ – unusual, perhaps, for a young male patient on the AMU; along with his persistent demands to use the showering facilities, this was a clue to the final diagnosis of Cannabis Hyperemesis Syndrome.It’s a case worth reading and highlights the importance of lateral thinking, particularly when patients repeatedly attend – as well as having a ‘good nose’ to sniff out something unusual!

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The Impact of a Location-Sensing Electronic Health Record on Clinician Efficiency and Accuracy: A Pilot Simulation Study

Applied Clinical Informatics ◽

10.1055/s-0038-1675812 ◽

2018 ◽

Vol 09 (04) ◽

pp. 841-848

Author(s):

Kevin King ◽

John Quarles ◽

Vaishnavi Ravi ◽

Tanvir Chowdhury ◽

Donia Friday ◽

...

Keyword(s):

Patient Safety ◽

Pilot Study ◽

Human Computer Interaction ◽

Real Time ◽

Identification Accuracy ◽

Patient Identification ◽

Location Services ◽

Electronic Health ◽

The Impact ◽

Computer Interaction

Background Through the Health Information Technology for Economic and Clinical Health Act of 2009, the federal government invested $26 billion in electronic health records (EHRs) to improve physician performance and patient safety; however, these systems have not met expectations. One of the cited issues with EHRs is the human–computer interaction, as exhibited by the excessive number of interactions with the interface, which reduces clinician efficiency. In contrast, real-time location systems (RTLS)—technologies that can track the location of people and objects—have been shown to increase clinician efficiency. RTLS can improve patient flow in part through the optimization of patient verification activities. However, the data collected by RTLS have not been effectively applied to optimize interaction with EHR systems. Objectives We conducted a pilot study with the intention of improving the human–computer interaction of EHR systems by incorporating a RTLS. The aim of this study is to determine the impact of RTLS on process metrics (i.e., provider time, number of rooms searched to find a patient, and the number of interactions with the computer interface), and the outcome metric of patient identification accuracy Methods A pilot study was conducted in a simulated emergency department using a locally developed camera-based RTLS-equipped EHR that detected the proximity of subjects to simulated patients and displayed patient information when subjects entered the exam rooms. Ten volunteers participated in 10 patient encounters with the RTLS activated (RTLS-A) and then deactivated (RTLS-D). Each volunteer was monitored and actions recorded by trained observers. We sought a 50% improvement in time to locate patients, number of rooms searched to locate patients, and the number of mouse clicks necessary to perform those tasks. Results The time required to locate patients (RTLS-A = 11.9 ± 2.0 seconds vs. RTLS-D = 36.0 ± 5.7 seconds, p < 0.001), rooms searched to find patient (RTLS-A = 1.0 ± 1.06 vs. RTLS-D = 3.8 ± 0.5, p < 0.001), and number of clicks to access patient data (RTLS-A = 1.0 ± 0.06 vs. RTLS-D = 4.1 ± 0.13, p < 0.001) were significantly reduced with RTLS-A relative to RTLS-D. There was no significant difference between RTLS-A and RTLS-D for patient identification accuracy. Conclusion This pilot demonstrated in simulation that an EHR equipped with real-time location services improved performance in locating patients and reduced error compared with an EHR without RTLS. Furthermore, RTLS decreased the number of mouse clicks required to access information. This study suggests EHRs equipped with real-time location services that automates patient location and other repetitive tasks may improve physician efficiency, and ultimately, patient safety.

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Importance of safety climate, teamwork climate and demographics: understanding nurses, allied health professionals and clerical staff perceptions of patient safety

BMJ Open Quality ◽

10.1136/bmjoq-2018-000433 ◽

2018 ◽

Vol 7 (4) ◽

pp. e000433

Author(s):

Shahram Zaheer ◽

Liane R Ginsburg ◽

Hannah J Wong ◽

Kelly Thomson ◽

Lorna Bain

Keyword(s):

Patient Safety ◽

Health Professionals ◽

Allied Health ◽

Safety Climate ◽

Outcome Variable ◽

Senior Leadership ◽

Staff Perceptions ◽

Allied Health Professionals ◽

Leadership Support ◽

The Impact

BackgroundThere is growing evidence regarding the importance of contextual factors for patient/staff outcomes and the likelihood of successfully implementing safety improvement interventions such as checklists; however, certain literature gaps still remain—for example, lack of research examining the interactive effects of safety constructs on outcomes. This study has addressed some of these gaps, together with adding to our understanding of how context influences safety.PurposeThe impact of staff perceptions of safety climate (ie, senior and supervisory leadership support for safety) and teamwork climate on a self-reported safety outcome (ie, overall perceptions of patient safety (PS)) were examined at a hospital in Southern Ontario.MethodsCross-sectional survey data were collected from nurses, allied health professionals and unit clerks working on intensive care, general medicine, mental health or emergency department.ResultsHierarchical regression analyses showed that perceptions of senior leadership (p<0.001) and teamwork (p<0.001) were significantly associated with overall perceptions of PS. A non-significant association was found between perceptions of supervisory leadership and the outcome variable. However, when staff perceived poorer senior leadership support for safety, the positive effect of supervisory leadership on overall perceptions of PS became significantly stronger (p<0.05).Practice implicationsOur results suggest that leadership support at one level (ie, supervisory) can substitute for the absence of leadership support for safety at another level (ie, senior level). While healthcare organisations should recruit into leadership roles and retain individuals who prioritise safety and possess adequate relational competencies, the field would now benefit from evidence regarding how to build leadership support for PS. Also, it is important to provide on-site workshops on topics (eg, conflict management) that can strengthen working relationships across professional and unit boundaries.

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