Simulation in pediatric nursing education: Are there enough evidence for future practice?

Research on simulation is still a developing field in nursing and simulation-based learning is gaining momentum with its application over the past two decades in nursing education. Simulation is utilized as a method of training, by helping the learners for competent practice and to improve patient safety, but not much evidence is available for its application in pediatric nursing education.This study aimed to (1) describe the application of simulation in teaching pediatric nursing education and (2) explore the evidence for its application in developing clinical competencies and skills in nursing students taking pediatric courses.A literature search was conducted in Google Scholar, PubMed, Medline, Science Direct & ProQuest for the relevant articles available on the internet. Descriptive, experimental, and systematic reviews concerning simulation in pediatric nursing were included.Mixed results were cited in studies about imparting the knowledge concerning the applicability of simulation in pediatric nursing courses. Available evidence shows that simulation can improve the competency of students in clinical practice and in improving patient care outcomes and communication skills. There is a paucity of studies about the applicability of simulation in pediatric nursing education. Simulation is found to be a useful strategy in providing a near-to-real experience for the students to practice high-risk, rare procedural skills in pediatric nursing education. However, further, evidence is required to replace clinical practice experience with simulation, for sustained improvement in patient care outcomes, and in critical thinking and knowledge retention in nursing students.

Prediction of acute appendicitis among patients with undifferentiated abdominal pain at emergency department

Background Early screening and accurately identifying Acute Appendicitis (AA) among patients with undifferentiated symptoms associated with appendicitis during their emergency visit will improve patient safety and health care quality. The aim of the study was to compare models that predict AA among patients with undifferentiated symptoms at emergency visits using both structured data and free-text data from a national survey. Methods We performed a secondary data analysis on the 2005-2017 United States National Hospital Ambulatory Medical Care Survey (NHAMCS) data to estimate the association between emergency department (ED) patients with the diagnosis of AA, and the demographic and clinical factors present at ED visits during a patient’s ED stay. We used binary logistic regression (LR) and random forest (RF) models incorporating natural language processing (NLP) to predict AA diagnosis among patients with undifferentiated symptoms. Results Among the 40,441 ED patients with assigned International Classification of Diseases (ICD) codes of AA and appendicitis-related symptoms between 2005 and 2017, 655 adults (2.3%) and 256 children (2.2%) had AA. For the LR model identifying AA diagnosis among adult ED patients, the c-statistic was 0.72 (95% CI: 0.69–0.75) for structured variables only, 0.72 (95% CI: 0.69–0.75) for unstructured variables only, and 0.78 (95% CI: 0.76–0.80) when including both structured and unstructured variables. For the LR model identifying AA diagnosis among pediatric ED patients, the c-statistic was 0.84 (95% CI: 0.79–0.89) for including structured variables only, 0.78 (95% CI: 0.72–0.84) for unstructured variables, and 0.87 (95% CI: 0.83–0.91) when including both structured and unstructured variables. The RF method showed similar c-statistic to the corresponding LR model. Conclusions We developed predictive models that can predict the AA diagnosis for adult and pediatric ED patients, and the predictive accuracy was improved with the inclusion of NLP elements and approaches.

Hospital revisits after paediatric tonsillectomy: a cohort study

Background Tonsillectomy, with or without adenoidectomy, is the leading reason for paediatric unplanned hospital readmission, some of which are potentially avoidable. Reducing unplanned hospital revisits would improve patient safety and decrease use of healthcare resources. This study aimed to describe the incidence, timing and risk factors for any surgery-related hospital revisits (both emergency presentation and readmission) following paediatric tonsillectomy and adenotonsillectomy in a large state-wide cohort. Methods We conducted a population-based cohort study using linked administrative datasets capturing all paediatric tonsillectomy and adenotonsillectomy surgeries performed between 2010 and 2015 in the state of Victoria, Australia. The primary outcome was presentation to the emergency department or hospital readmission within 30-day post-surgery. Results Between 2010 and 2015, 46,583 patients underwent 47,054 surgeries. There was a total of 4758 emergency department presentations (10.11% total surgeries) and 2750 readmissions (5.84% total surgeries). Haemorrhage was the most common reason for both revisit types, associated with 33.02% of ED presentations (3.34% total surgeries) and 67.93% of readmissions (3.97% total surgeries). Day 5 post-surgery was the median revisit time for both ED presentations (IQR 3–7) and readmission (IQR 3–8). Predictors of revisit included older age, public and metropolitan hospitals and peri-operative complications during surgery. Conclusions Haemorrhage was the most common reason for both emergency department presentation and hospital readmission. The higher risk of revisits associated with older children, surgeries performed in public and metropolitan hospitals, and in patients experiencing peri-operative complications, suggest the need for improved education of postoperative care for caregivers, and avoidance of inappropriate early discharge. Graphical Abstract

Pre-analytical specimen labelling and processing errors in the ICU

Introduction: Specimen rejections have been associated with increased in-hospital stay and cost. The majority of errors occur in the pre-analytic phase. Specimen rejection can lead to high rate of recollection, delay in result availability, and high rate of test abandonment. These factors affect patient care and safety. Methods: This study conducted a retrospective review of Patient Safety Learning System (PSLS) reports for the intensive care unit (ICU) at The Ottawa Hospital General Campus (TOH) between 2010 and 2018, and a prospective review using interviews, surveys, and process mapping. Results: From 2098 PSLS reports, 52.6% were related to laboratory specimen collection and processing (pre-analytic phase). Specimen mislabelling with the wrong patient identifier accounted for 9.8% of pre-analytical error reports, while 16.4% of errors were due to non-sufficient quantity (NSQ) of specimen. 12.2 % of pre-analytical error reports involved cytology specimens. Conclusions: Pre-analytical errors are not only costly and resource draining, but may also place a burden on patients. Areas where errors were found include labels and requisitions stored in bedside cabinets, inconsistencies between specimen labels and requisitions, out-dated and difficult to access laboratory manuals, and non-sufficient quantity specimen collection. In the future we hope to start new initiatives to tackle these issues to improve patient safety and hospital efficiencies. This includes the development of a website for the laboratory manual, so that it is more easily accessible and user-friendly. With a new electronic medical record (EMR) system at TOH in 2019, we will explore the affects of pre-analytical processing of specimens.

Estimated Costs Associated with Surgical Site Infections in Patients Undergoing Cholecystectomy

Among healthcare-associated infections, surgical site infections (SSIs) are the most frequent in Spain. The aim of this work was to estimate the costs of SSIs in patients who underwent a cholecystectomy at the Hospital General Universitario de Alicante (Spain) between 2012–2017. This was a prospective observational cohort study. The Active Epidemiological Surveillance Program at our hospital recorded all the cholecystectomies performed. Risk factors associated with the development of SSIs were determined by multivariate analysis and two homogeneous comparison groups were obtained by using the propensity score. The number of extra days of hospital stay were recorded for patients with an SSI and with the cost per hospitalised day data, the additional cost attributed to SSIs was calculated. A total of 2200 cholecystectomies were considered; 110 patients (5.0%) developed an SSI. The average length of hospital stay was 5.6 days longer among patients with an SSI. The cost per SSI was EUR 1890.60 per patient, with the total cost for this period being EUR 207,961.60. SSIs after cholecystectomy lead to a prolongation of hospital stay and an increase in economic costs. It is essential to implement infection surveillance and control programs to reduce SSIs, improve patient safety, and reduce economic burden.

Patient Handoff Among General Surgery Residents in Saudi Arabia: A Cross-Sectional Study

Background Communication failure is a common cause of adverse events. An essential element of communication among healthcare providers is patient handoffs. To explore this practice, we assessed patient handoffs among general surgery residents in Saudi Arabia. Methods A cross-sectional survey was conducted with individuals in accredited general surgery residency programs in Saudi Arabia between 2020 to 2021. Results Participants comprised 118 general surgery residents—66 (57.3%) were females; 67 (72.8%) did not receive any formal training on patient handoff; 35 (38.8%) reported that they were sometimes interrupted during the patient handoff process. The most common reason for such interruptions was medical personnel paging. Further, 60 (68.1%) general surgery residents stated that such interruptions led to a decreased quality of effective communication, 39 (44.3%) believed it led to decreased quality of patient care, 63(71.5%) believed it led to the loss of some information related to patient handoff, and 16 (18.1%) believed it led to patient harm. Finally, 31 (34.4%) general surgery residents believed that the existing handoff system at their institutions neither adequately protected the patient’s safety nor allowed for continuity of care; and 51 (68%) reported that they did not have a standardized protocol for patients’ verbal handoff process at their institution. There were higher proportion of patients with minor harm in residents who did not, rare or some time received verbal or written hand off (67% vs 33%). Conclusion The patient handoff process among general surgery residents in Saudi Arabia is subjective, not standardized, and can contribute to patient harm. Standardizing it is paramount to improve patient safety.

Affective influences on clinical reasoning and diagnosis: insights from social psychology and new research opportunities

Psychological research consistently demonstrates that affect can play an important role in decision-making across a broad range of contexts. Despite this, the role of affect in clinical reasoning and medical decision-making has received relatively little attention. Integrating the affect, social cognition, and patient safety literatures can provide new insights that promise to advance our understanding of clinical reasoning and lay the foundation for novel interventions to reduce diagnostic errors and improve patient safety. In this paper, we briefly review the ways in which psychologists differentiate various types of affect. We then consider existing research examining the influence of both positive and negative affect on clinical reasoning and diagnosis. Finally, we introduce an empirically supported theoretical framework from social psychology that explains the cognitive processes by which these effects emerge and demonstrates that cognitive interventions can alter these processes. Such interventions, if adapted to a medical context, hold great promise for reducing errors that emerge from faulty thinking when healthcare providers experience different affective responses.

Building an Integrated Radiotherapy Information System to Improve Patient Safety

In our hospital, the medical records of patients receiving tumor radiotherapy were paper-base. The purpose of this study was to develop an integrated radiotherapy information system to improve the quality and efficiency of treatment for patients with cancer. What’s more, it’s expected that the system can reduce time and errors caused by manual record.

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

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.