SAFER: A mnemonic to improve safety-netting advice

2020 ◽  
Vol 31 (1) ◽  
pp. 26-28 ◽  
Author(s):  
Paul Silverston
Keyword(s):  
Patient Safety ◽  
Correct Diagnosis ◽  
Diagnostic Error ◽  
Diagnostic Uncertainty ◽  
Minor Illness ◽  
Primary Care Patients ◽  
A Minor ◽  
Specific Symptoms ◽  
Safety Netting

Paul Silverston describes a mnemonic to help facilitate the development of symptom-based, patient safety-focused, safety-netting advice In primary care, patients often present during the early stages of an illness, before the findings required to establish the correct diagnosis have developed. This creates the potential for both diagnostic uncertainty and diagnostic error. There is also the possibility that a patient diagnosed with a minor illness may subsequently develop an uncommon but serious complication of that illness. Patients must be made aware of these risks and given advice as to when they should seek a medical re-assessment of their symptoms. This is referred to as safety-netting advice. Patients and relatives need to know the specific symptoms and signs to check for and the criteria that would mandate the need for a re-assessment. It is essential that safety-netting advice is patient-centred and that the medical content of that advice is symptom-based and patient safety-focused. This article describes a mnemonic, SAFER, which can be used to improve the quality of the safety-netting advice given to patients.

SAFER: A mnemonic to improve safety-netting advice in prescribing practice

2019 ◽  
Vol 1 (11) ◽  
pp. 552-555
Author(s):  
Paul Silverston
Keyword(s):  
Patient Safety ◽  
Clinical Assessment ◽  
Correct Diagnosis ◽  
Initial Diagnosis ◽  
Minor Illness ◽  
Prescribing Practice ◽  
A Minor ◽  
The Relationship ◽  
Safety Netting

One of the most fundamental concepts in medicine is that our ability to prescribe the correct medication is based upon our ability to make the correct diagnosis first. However, the relationship between illness, time and clinical assessment often means that the initial diagnosis may either be uncertain or incorrect. In addition, a patient may experience a serious complication of what is normally a minor illness. The dynamic and unpredictable nature of illness needs to be managed safely through the provision of safety-netting advice. However, it is essential that the medical content of that advice covers the specific medical criteria that would require a patient to seek a medical re-assessment of their symptoms and of their diagnosis. This article describes a mnemonic to help facilitate the development of symptom-based, patient safety-focused, safety-netting advice.

Harnessing the electronic health care record to optimise patient safety in primary care: a framework for evaluating “electronic safety netting” tools (Preprint)

2021 ◽  
Author(s):  
Georgia Black ◽  
Afsana Bhuiya ◽  
Claire Friedemann-Smith ◽  
Yasmin Hirst ◽  
Brian D Nicholson
Keyword(s):  
Primary Care ◽  
Patient Safety ◽  
Improve Patient Safety ◽  
Text Messages ◽  
Future Research ◽  
Diagnostic Uncertainty ◽  
Software Products ◽  
Care Systems ◽  
Electronic Health ◽  
Safety Netting

UNSTRUCTURED The management of diagnostic uncertainty is part of every primary care physician’s role. Electronic safety netting (e-safety-netting) tools are designed to assist healthcare professionals in managing diagnostic uncertainty either within or separate to the electronic healthcare record. Using software in addition to verbal and/or paper based safety-netting methods could make the process more rigorous, robust, traceable and auditable. There is no consistent definition or approach to e-safety-netting despite an increasing number of software products identifying as such and being offered to clinical teams, particularly since the COVID-19 pandemic. E-safety-netting tools have developed to perform a variety of functions including clinician alerts, administrative tasking, decision support and triggering reminder text messages to patients. However, these tools have not been evaluated using robust research designs for patient safety interventions. We present a framework of criteria for effective e-safety netting tools, to improve patient safety through more targeted development of software. The framework is based on similar criteria from electronic health record development and principles of patient safety. There are currently no tools available that meet all of the criteria in the framework. When new tools have been developed and validated through robust research, the framework will enable national and local audit and analysis, highlighting differences in performance and presenting potential solutions for improvement. We outline key areas for future research, both in primary care and within integrated care systems. E-safety-netting tools that align with the individual, social and technical aspects of primary care working are more likely to succeed.

Safer consulting in minor illness: Evaluation of an online educational programme for community pharmacists

2019 ◽  
Vol 1 (12) ◽  
pp. 616-620
Author(s):  
Paul Silverston
Keyword(s):  
Patient Safety ◽  
Community Pharmacists ◽  
Educational Programme ◽  
Serious Illness ◽  
Early Stages ◽  
Minor Illness ◽  
Increased Risk ◽  
A Minor

Community pharmacists are playing an increasingly important role in the assessment and management of patients with the symptoms of a minor illness, which may now also include issuing a prescription to the patient. However, it is important to appreciate that these symptoms may also be present during the early stages of a serious illness and that some patients with a minor illness are at increased risk of developing a serious complication of that illness. This article describes an online educational programme for community pharmacists that adopts a symptom-based, patient safety-focused approach to the assessment and management of patients with the symptoms of minor illness. This article also discusses the feedback from the first cohort of participants in the programme. 94% of the participants felt that the programme had improved their practice, and 97% felt that the programme had helped them to decide which patients should be referred for further assessment or treatment.

scholarly journals Exploring patient safety outcomes for people with learning disabilities in acute hospital settings: a scoping review

BMJ Open ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. e047102
Author(s):  
Gemma Louch ◽  
Abigail Albutt ◽  
Joanna Harlow-Trigg ◽  
Sally Moore ◽  
Kate Smyth ◽  
...  
Keyword(s):  
Learning Disabilities ◽  
Patient Safety ◽  
Adverse Events ◽  
Grey Literature ◽  
Good Practice ◽  
Hospital Setting ◽  
Eligibility Criteria ◽  
Infant Outcomes ◽  
Safety Outcomes

ObjectivesTo produce a narrative synthesis of published academic and grey literature focusing on patient safety outcomes for people with learning disabilities in an acute hospital setting.DesignScoping review with narrative synthesis.MethodsThe review followed the six stages of the Arksey and O’Malley framework. We searched four research databases from January 2000 to March 2021, in addition to handsearching and backwards searching using terms relating to our eligibility criteria—patient safety and adverse events, learning disability and hospital setting. Following stakeholder input, we searched grey literature databases and specific websites of known organisations until March 2020. Potentially relevant articles and grey literature materials were screened against the eligibility criteria. Findings were extracted and collated in data charting forms.Results45 academic articles and 33 grey literature materials were included, and we organised the findings around six concepts: (1) adverse events, patient safety and quality of care; (2) maternal and infant outcomes; (3) postoperative outcomes; (4) role of family and carers; (5) understanding needs in hospital and (6) supporting initiatives, recommendations and good practice examples. The findings suggest inequalities and inequities for a range of specific patient safety outcomes including adverse events, quality of care, maternal and infant outcomes and postoperative outcomes, in addition to potential protective factors, such as the roles of family and carers and the extent to which health professionals are able to understand the needs of people with learning disabilities.ConclusionPeople with learning disabilities appear to experience poorer patient safety outcomes in hospital. The involvement of family and carers, and understanding and effectively meeting the needs of people with learning disabilities may play a protective role. Promising interventions and examples of good practice exist, however many of these have not been implemented consistently and warrant further robust evaluation.

scholarly journals A Narrative Review of Clinical Decision Support for Inpatient Clinical Pharmacists

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.

Relationship Between Performance Measurement and Accreditation: Implications for Quality of Care and Patient Safety

2005 ◽  
Vol 20 (5) ◽  
pp. 239-252 ◽  
Author(s):  
Marlene R. Miller ◽  
Peter Pronovost ◽  
Michele Donithan ◽  
Scott Zeger ◽  
Chunliu Zhan ◽  
...  
Keyword(s):  
Patient Safety ◽  
Quality Of Care ◽  
Performance Measurement

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.

Shareholder risk-taking incentives in the presence of contingent capital

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Mahmoud Fatouh ◽  
Ayowande A. McCunn
Keyword(s):  
Risk Taking ◽  
Banking System ◽  
Capital Requirements ◽  
Content Type ◽  
Basic Model ◽  
Conversion Rates ◽  
A Minor ◽  
The Impact ◽  
Practical Implications

Purpose This paper aims to present a model of shareholders’ willingness to exert effort to reduce the likelihood of bank distress and the implications of the presence of contingent convertible (CoCo) bonds in the liabilities structure of a bank. Design/methodology/approach This study presents a basic model about the moral hazard surrounding shareholders willingness to exert effort that increases the likelihood of a bank’s success. This study uses a one-shot game and so do not capture the effects of repeated interactions. Findings Consistent with the existing literature, this study shows that the direction of the wealth transfer at the conversion of CoCo bonds determines their impact on shareholder risk-taking incentives. This study also finds that “anytime” CoCos (CoCo bonds trigger-able anytime at the discretion of managers) have a minor advantage over regular CoCo bonds, and that quality of capital requirements can reduce the risk-taking incentives of shareholders. Practical implications This study argues that shareholders can also use manager-specific CoCo bonds to reduce the riskiness of the bank activities. The issuance of such bonds can increase the resilience of individual banks and the whole banking system. Regulators can use restrictions on conversion rates and/or requirements on the quality of capital to address the impact of CoCo bonds issuance on risk-taking incentives. Originality/value To model the risk-taking incentives, authors generally modify the asset processes to introduce components that reflect asymmetric information between CoCo holders and shareholders and/or managers. This paper follows a simpler method similar to that of Holmström and Tirole (1998).

scholarly journals Discrepancies in interpretation of night-time emergency computed tomography scans by radiology residents

2018 ◽  
Vol 7 (10) ◽  
pp. 205846011880723
Author(s):  
Elias Vaattovaara ◽  
Marko Nikki ◽  
Mika Nevalainen ◽  
Mervi Ilmarinen ◽  
Osmo Tervonen
Keyword(s):  
Computed Tomography ◽  
Emergency Radiology ◽  
Correct Diagnosis ◽  
Anatomical Variations ◽  
Night Time ◽  
Radiology Resident ◽  
Computed Tomography Scans ◽  
Time Work ◽  
Radiology Residents

Background In many emergency radiology units, most of the night-time work is performed by radiology residents. Residents’ preliminary reports are typically reviewed by an attending radiologist. Accordingly, it is known that discrepancies in these preliminary reports exist. Purpose To evaluate the quality of night-time computed tomography (CT) interpretations made by radiology residents in the emergency department. Material and Methods Retrospectively, 1463 initial night-time CT interpretations given by a radiology resident were compared to the subspecialist’s re-interpretation given the following weekday. All discrepancies were recorded and classified into different groups regarding their possible adverse effect for the emergency treatment. The rate of discrepancies was compared between more and less experienced residents and between different anatomical regions. Results The overall rate of misinterpretations was low. In 2.3% (33/1463) of all night-time CT interpretations, an important and clinically relevant diagnosis was missed. No fatalities occurred due to CT misinterpretations during the study. The total rate of discrepancies including clinically irrelevant findings such as anatomical variations was 12.2% (179/1463). Less experienced residents were more likely to miss the correct diagnosis than more experienced residents (18.3% vs. 10.9%, odds ratio [OR] = 1.82, P = 0.001). Discrepancies were more common in body CT interpretations than in neurological CTs (18.1% vs. 9.1%, OR = 2.30, P < 0.0001). Conclusion The rate of clinically important misinterpretations in CT examinations by radiology residents was found to be low. Experience helps in lowering the rate of misinterpretations.

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