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Journal of Patient Safety

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https://www.readbyqxmd.com/read/27922906/patient-outcomes-after-early-versus-late-tracheostomy-in-the-puerto-rico-trauma-hospital
#1
Ana M Romero Vázquez, Omar García Rodríguez, Ediel Ramos Meléndez, Pablo Rodríguez Ortiz
OBJECTIVE: This study aimed to evaluate the impact of early tracheostomy (ET, ≤7 days) versus that of late tracheostomy (LT, >7 days) on outcomes such as hospital length of stay (LOS), intensive care unit (ICU) days, mechanical ventilation (MV) days, and mortality ratio. METHODS: A historical cohort study was undertaken using charts of patients admitted to the Puerto Rico Trauma Hospital who required MV and underwent tracheostomies, from 2000 to 2013. A logistic regression was performed to evaluate the association between timing of tracheostomy and complications and mortality...
December 5, 2016: Journal of Patient Safety
https://www.readbyqxmd.com/read/27906817/classifying-patients-complaints-for-regulatory-purposes-a-pilot-study
#2
Renée Bouwman, Manja Bomhoff, Paul Robben, Roland Friele
OBJECTIVES: It is assumed that classifying and aggregated reporting of patients' complaints by regulators helps to identify problem areas, to respond better to patients and increase public accountability. This pilot study addresses what a classification of complaints in a regulatory setting contributes to the various goals. METHODS: A taxonomy with a clinical, management, and relationship domain was used to systematically analyze 364 patients' complaints received by the Dutch regulator...
November 30, 2016: Journal of Patient Safety
https://www.readbyqxmd.com/read/27820722/a-multilevel-analysis-of-u-s-hospital-patient-safety-culture-relationships-with-perceptions-of-voluntary-event-reporting
#3
Jonathan D Burlison, Rebecca R Quillivan, Lisa M Kath, Yinmei Zhou, Sam C Courtney, Cheng Cheng, James M Hoffman
OBJECTIVES: Patient safety events offer opportunities to improve patient care, but, unfortunately, events often go unreported. Although some barriers to event reporting can be reduced with electronic reporting systems, insight on organizational and cultural factors that influence reporting frequency may help hospitals increase reporting rates and improve patient safety. The purpose of this study was to evaluate the associations between dimensions of patient safety culture and perceived reporting practices of safety events of varying severity...
November 3, 2016: Journal of Patient Safety
https://www.readbyqxmd.com/read/27811599/physician-perspectives-on-interhospital-transfers
#4
Stephanie K Mueller, Jeffrey L Schnipper
OBJECTIVE: The transfer of patients between acute care hospitals (interhospital transfer [IHT]) is a common but nonstandardized process leading to variable quality and safety. The goal of this study was to survey accepting physicians regarding problems encountered in the transfer process. METHODS: A cross-sectional survey of residents and inpatient attendings from internal medicine, neurology, and surgery services at a large tertiary care referral hospital was undertaken to identify problematic aspects of the IHT process as perceived by accepting frontline providers...
November 2, 2016: Journal of Patient Safety
https://www.readbyqxmd.com/read/27811598/a-patient-reported-approach-to-identify-medical-errors-and-improve-patient-safety-in-the-emergency-department
#5
Seth W Glickman, Abhi Mehrotra, Christopher M Shea, Celeste Mayer, Jeffrey Strickler, Sandra Pabers, James Larson, Brian Goldstein, Larry Mandelkehr, Charles B Cairns, Jesse M Pines, Kevin A Schulman
OBJECTIVE: Medical errors in the emergency department (ED) occur frequently. Yet, common adverse event detection methods, such as voluntary reporting, miss 90% of adverse events. Our objective was to demonstrate the use of patient-reported data in the ED to assess patient safety, including medical errors. METHODS: Analysis of patient-reported survey data collected over a 1-year period in a large, academic emergency department. All patients who provided a valid e-mail or cell phone number received a brief electronic survey within 24 hours of their ED encounter by e-mail or text message with Web link...
November 2, 2016: Journal of Patient Safety
https://www.readbyqxmd.com/read/27811597/predictors-of-at-home-arterial-oxygen-desaturation-events-in-ambulatory-surgical-patients
#6
Chuck Biddle, Charles Elam, Laura Lahaye, Gordon Kerr, Laura Chubb, Brad Verhulst
OBJECTIVES: Little is known about the early recovery phase occurring at-home after anesthesia and surgery in ambulatory surgical patients. We studied quantitative oximetry and quality-of-life metrics in the first 48 hours after same-day orthopedic surgery examining the association between the recovery metrics and specific patient and procedural factors. METHODS: We used the STOP-Bang score to quantify patient risk for obstructive sleep apnea in 50 adult patients at 2 centers using continuous portable oximetry and patient journaling...
November 2, 2016: Journal of Patient Safety
https://www.readbyqxmd.com/read/27811596/qualitative-study-about-the-experiences-of-colleagues-of-health-professionals-involved-in-an-adverse-event
#7
Lena Ferrús, Carmen Silvestre, Guadalupe Olivera, José Joaquín Mira
OBJECTIVES: Identify what occurs among health-care providers (HCPs) after an adverse event (AE) and what colleagues could do to help them. METHOD: A qualitative study with participation by physicians and nurses from hospitals and primary care facilities. RESULTS: Fifteen HCPs and 12 health professionals with quality management responsibilities with between 8 and 30 years of experience participated; 15 (56%) were physicians (9 general practitioners, 3 surgeons, 2 intensivists, and 1 from an emergency unit), and 12 (44%) were nurses (5 worked in primary care and 7 in hospitals)...
November 2, 2016: Journal of Patient Safety
https://www.readbyqxmd.com/read/27811595/objective-assessment-of-checklist-fidelity-using-digital-audio-recording-and-a-standardized-scoring-system-audit
#8
Douglas Salgado, Kimberly R Barber, Michael Danic
OBJECTIVES: The use of the World Health Organization Surgical Safety Checklist (SSC) has been reported to significantly reduce operative morbidity and mortality rates. Recent findings have cast doubt on the efficacy of such checklists in improving patient safety. The effectiveness of surgical safety checklists cannot be fully measured or understood without an accurate assessment of implementation fidelity, most effectively through direct observations of the checklist process. Here, we describe the use of a secure audio recording protocol in conjunction with a novel standardized scoring system to assess checklist compliance rates...
November 2, 2016: Journal of Patient Safety
https://www.readbyqxmd.com/read/27811594/effect-of-implementing-a-standardized-shoulder-dystocia-documentation-form-on-quality-of-delivery-notes
#9
Lisa C Zuckerwise, Madison M Hustedt, Heather S Lipkind, Edmund F Funai, Cheryl A Raab, Christian M Pettker
OBJECTIVES: Complete and accurate documentation by the delivering provider in cases of shoulder dystocia is critical for providing clinical information and care to the patient and protecting providers from litigation risks. Standardized forms improve inclusion of certain data elements in the medical record, but the impact on subsequent narrative notes is unknown. We aimed to determine if implementation of a standardized shoulder dystocia documentation form improves obstetric provider written narrative delivery notes...
November 2, 2016: Journal of Patient Safety
https://www.readbyqxmd.com/read/27811593/the-effects-of-the-second-victim-phenomenon-on-work-related-outcomes-connecting-self-reported-caregiver-distress-to-turnover-intentions-and-absenteeism
#10
Jonathan D Burlison, Rebecca R Quillivan, Susan D Scott, Sherry Johnson, James M Hoffman
OBJECTIVES: Second victim experiences can affect the well-being of healthcare providers and compromise patient safety. The purpose of this study was to assess the relationships between self-reported second victim-related distress to turnover intention and absenteeism. Organizational support was examined concurrently because it was hypothesized to explain the potential relationships between distress and work-related outcomes. METHODS: A cross-sectional, self-report survey (the Second Victim Experience and Support Tool) of nurses directly involved in patient care (N = 155) was analyzed by using hierarchical linear regression...
November 2, 2016: Journal of Patient Safety
https://www.readbyqxmd.com/read/27811592/hip-metallosis-and-corrosion-a-million-harmed-due-to-fda-inaction
#11
Stephen Tower
No abstract text is available yet for this article.
November 2, 2016: Journal of Patient Safety
https://www.readbyqxmd.com/read/27811591/similarities-and-differences-in-nurse-reported-care-rationing-between-critical-care-surgical-and-medical-specialties
#12
Megan Higgs, Ritin Fernandez, Suzanne Polis, Vicki Manning
OBJECTIVE: The aim of this study was to determine the similarities and differences in elements of nursing care that are commonly rationed in the critical care, medical, and surgical specialties within an acute hospital environment. METHODS: Registered nurses who provide bedside nursing care within the medical, surgical, and critical specialties at a single center were invited to anonymously complete the self-administered MISSCARE questionnaire. The frequency of rationing for each individual care element within the 4 broader care groups (assessment, intervention-individual needs, intervention-basic care, and planning) of the MISSCARE questionnaire was determined...
November 2, 2016: Journal of Patient Safety
https://www.readbyqxmd.com/read/27811590/triggers-contributing-to-health-care-clinicians-disruptive-behaviors
#13
Sung-Heui Bae, Deborah Dang, Karen A Karlowicz, Miyong T Kim
OBJECTIVES: This study's objective was to explore the possible triggers of clinicians' disruptive behavior and to consider whether the type of trigger resulting in disruptive behavior differed by type of clinician, clinician characteristics, professional role, and ethnic background. METHODS: Using data collected from 1559 clinicians working at an urban academic medical center in the United States, we examined intrapersonal, interpersonal, and organizational triggers...
November 2, 2016: Journal of Patient Safety
https://www.readbyqxmd.com/read/27811589/compelled-disclosure-of-confidential-information-in-patient-safety-research
#14
Li Du, Blake Murdoch, Carina Chiu, Timothy Caulfield
The protection of confidential research data is of key importance to clinical patient safety research. A review of selected Canadian and American case law indicates that although the relationship between researcher and participant has not been recognized as privileged, court-ordered disclosure of confidential research information seems to be a rare occurrence. In this review, we examine how confidentiality issues are presented in informed consent form templates and in relevant research ethics policies. We find an agreement among research policy documents that all information gathered should be treated as confidential, unless otherwise required by law...
November 2, 2016: Journal of Patient Safety
https://www.readbyqxmd.com/read/27811588/system-issues-leading-to-found-on-floor-incidents-a-multi-incident-analysis
#15
James Shaw, Marina Bastawrous, Susan Burns, Sandra McKay
BACKGROUND: Although attention to patient safety issues in the home care setting is growing, few studies have highlighted health system-level concerns that contribute to patient safety incidents in the home. Found-on-floor (FOF) incidents are a key patient safety issue that is unique to the home care setting and highlights a number of opportunities for system-level improvements to drive enhanced patient safety. METHODS: We completed a multi-incident analysis of FOF incidents documented in the electronic record system of a home health care agency in Toronto, Canada, for the course of 1 year between January 2012 and February 2013...
November 2, 2016: Journal of Patient Safety
https://www.readbyqxmd.com/read/27811587/rock-paper-scissors
#16
Jacob Adashek
No abstract text is available yet for this article.
November 2, 2016: Journal of Patient Safety
https://www.readbyqxmd.com/read/27811586/verbal-communication-during-airway-management-and-emergent-endotracheal-intubation-observations-of-team-behavior-among-multi-institutional-pediatric-intensive-care-unit-in-situ-simulations
#17
Ranna A Rozenfeld, Anna P Nannicelli, Alexandra R Brown, Walter J Eppich, Donna M Woods, Steven O Lestrud, Zehava L Noah, Jane L Holl
OBJECTIVE: To assess health-care teams' verbal communication, an observable teamwork behavior, during simulations involving pediatric emergency airway management and intubation. METHODS: We conducted video-recorded, risk-informed in situ simulations at 5 hospitals with pediatric intensive care units in the Chicago, Illinois, area. Clinicians participated in their clinical roles (eg, attending physician, bedside nurse) and had access to hospital operational systems (eg, electronic health record, medical imaging, laboratory services)...
November 2, 2016: Journal of Patient Safety
https://www.readbyqxmd.com/read/27768655/measures-to-improve-diagnostic-safety-in-clinical-practice
#18
Hardeep Singh, Mark L Graber, Timothy P Hofer
Timely and accurate diagnosis is foundational to good clinical practice and an essential first step to achieving optimal patient outcomes. However, a recent Institute of Medicine report concluded that most of us will experience at least one diagnostic error in our lifetime. The report argues for efforts to improve the reliability of the diagnostic process through better measurement of diagnostic performance. The diagnostic process is a dynamic team-based activity that involves uncertainty, plays out over time, and requires effective communication and collaboration among multiple clinicians, diagnostic services, and the patient...
October 20, 2016: Journal of Patient Safety
https://www.readbyqxmd.com/read/27768654/measuring-patient-safety-the-medicare-patient-safety-monitoring-system-past-present-and-future
#19
David C Classen, William Munier, Nancy Verzier, Noel Eldridge, David Hunt, Mark Metersky, Chesley Richards, Yun Wang, P Jeffrey Brady, Amy Helwig, James Battles
The explicit declaration in the landmark 1999 Institute of Medicine report "To Err Is Human" that, in the United States, 44,000 to 98,000 patients die each year as a consequence of "medical errors" gave widespread validation to the magnitude of the patient safety problem and catalyzed a number of U.S. federal government programs to measure and improve the safety of the national healthcare system. After more than 10 years, one of those federal programs, the Medicare Patient Safety Monitoring System (MPSMS), has reached a level of maturity and stability that has made it useful for the consistent measurement of the safety of inpatient care...
October 20, 2016: Journal of Patient Safety
https://www.readbyqxmd.com/read/27768653/clinical-risk-factors-for-orthostatic-hypotension-results-among-elderly-fallers-in-long-term-care
#20
Deanna Gray-Miceli, Sarah J Ratcliffe, Arwin Thomasson, Patricia Quigley, Kang Li, William Craelius
BACKGROUND: Patients at greatest risk for fall-related injuries are older adults with orthostatic hypotension (OH), a condition which drops blood pressure. This study sought to determine salient demographic and patient-level factors increasing risk for OH among a sample of elderly fallers. METHODS: Data analysis for this retrospective study sought to assess the relationship between various demographic and clinical risk factors and the likelihood of OH. Because fallers could experience multiple falls, generalized estimating equations were used to account for patient-level correlations...
October 20, 2016: Journal of Patient Safety
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