The AHRQ PSNet Collection comprises an extensive selection of resources relevant to the patient safety community. These resources come in a variety of formats, including literature, research, tools, and Web sites. Resources are identified using the National Library of Medicine’s Medline database, various news and content aggregators, and the expertise of the AHRQ PSNet editorial and technical teams.
Etheridge JC, Moyal-Smith R, Sonnay Y, et al. Int J Surg. 2022;98:106210.
Non-technical skills such as communication, teamwork, decision-making, and situational awareness are responsible for a significant proportion of surgical errors. The COVID-19 pandemic increased the stress in the operating room, associated with increased risk of exposure and shortage of resources. This study compared pre- and post-COVID direct observations during live operations and found that non-technical skills were equivalent; there was a small, but statistically significant, improvement in teamwork and cooperation skills.
Missed or incomplete nursing care can adversely affect care quality and safety. Based on survey responses from 295 frontline nurses in the Philippines, this study explored factors contributing to missed nursing care during the COVID-19 pandemic. Findings suggest that nurses most frequently missed tasks such as patient surveillance, comforting patients, skin care, ambulation, and oral hygiene. The authors suggest that increasing nurse staffing, adequate use of personal protective equipment, and improved safety culture may reduce instances of missed care.
Pilosof NP, Barrett M, Oborn E, et al. Int J Environ Res Public Health. 2021;18:8391.
The COVID-19 pandemic has led to dramatic changes in healthcare delivery. Based on semi-structured interviews and direct observations, researchers evaluated the impact of a new model of remote inpatient care using telemedicine technologies in response to the pandemic. Intensive care and internal medicine units were divided into contaminated and clean zones and an integrated control room with audio-visual technologies allowed for remote supervision, communication, and support. The authors conclude that this model can increase flexibility in staffing via remote consultations and allow staff to supervise and monitor more patients without compromising patient and staff safety.
Kakemam E, Chegini Z, Rouhi A, et al. J Nurs Manag. 2021;29:1974-1982.
Clinician burnout, characterized by emotional exhaustion, depersonalization, and decreased sense of accomplishment, can result in worse patient safety outcomes. This study explores the association of nurse burnout and self-reported occurrence of adverse events during COVID-19. Results indicate higher levels of nurse burnout were correlated with increased perception of adverse events, such as patient and family verbal abuse, medication errors, and patient and family complaints. Recommendations for decreasing burnout include access to psychosocial support and human factors approaches.
Li Q, Hu P, Kang H, et al. J Nutr Health Aging. 2020;25:492-500.
Missed and delayed diagnosis are a known cause of preventable adverse events. In this cohort of 107 patients with severe or critical COVID-19 in Wuhan, China, 45% developed acute kidney injury (AKI). However, nearly half of those patients (46%) were not diagnosed during their stay in the hospital. Patients with undiagnosed AKI experienced greater hospital mortality than those without AKI or diagnosed AKI. Involvement of intensive care kidney specialists is recommended to increase diagnostic awareness.
Panda N, Sinyard RD, Henrich N, et al. J Patient Saf. 2021;17:256-263.
The COVID-19 pandemic has presented numerous challenges for the healthcare workforce, including redeploying personnel to different locations or retraining personnel for different tasks. Researchers interviewed hospital leaders from health systems in the United States, United Kingdom, New Zealand, Singapore and South Korea about redeployment of health care workers during the COVID-19 pandemic. The authors discuss effective practices and lessons learned preparing for and executing workforce redeployment, as well as concerns regarding redeployed personnel
Denning M, Goh ET, Tan B, et al. PLoS One. 2021;16:e0238666.
This cross-sectional study conducted from March to June 2020 measured anxiety, depression, and burnout in clinicians working in the United Kingdom, Poland, and Singapore. Approximately 70% of respondents reported feeling anxious, depressed and/or burnt out. Burnout was significantly inversely correlated with being tested for COVID-19 and perceiving high levels of safety. These findings highlight the importance of supporting staff well-being and proactive COVID-19 testing.
Sharara-Chami R, Sabouneh R, Zeineddine R, et al. Simul Healthc. 2020;15:303-309.
Simulation training is used by hospitals to improve patient care. This article describes the use of a preparedness assessment and training intervention featuring in situ simulations followed by debriefing to prepare staff for challenges arising due to the COVID-19 pandemic. Observations and debriefings identified several latent safety threats related to infection control, leadership, and communication.
Denning M, Goh ET, Scott A, et al. Int J Environ Res Public Health. 2020;17:7034.
This study used the Safety Attitudes Questionnaire to evaluate the impact of COVID-19 on safety culture at a large UK teaching hospital compared to baseline scores collected in 2017. Overall, respondents reported more positive perceptions of safety; training and support for redeployment were associated with higher perceptions of safety. However, the analysis identified a significant decrease in error reporting after the onset of the COVID-19 pandemic.
Haghani M, Bliemer MCJ, Goerlandt F, et al. Safety Sci. 2020;129:104806.
This review discusses the most common research on COVID-19 and safety issues to date (e.g., occupational safety of heath professionals, patient transport safety) and identifies several safety issues attributable to the pandemic which have been relatively understudied, including issues around supply-chain safety and occupational safety of non-healthcare essential workers.
Luo M, Guo L, Yu M, et al. Psychiatry Res. 2020;291:113190.
This meta-analysis of the psychological and mental impacts of COVID-19 among healthcare workers, patients at increased risk for the virus, and the general public found that anxiety and depression among all individuals was common. For example, over half of patients with pre-existing conditions and COVID-19 infection reported anxiety or depression.
Johnson CD, Green BN, Konarski-Hart KK, et al. J Manipulative Physiol Ther. 2020;43:403.e1-403.e21.
An international sample of chiropractic practitioners described actions taken by their practices in response to the COVID-19 pandemic. Practitioners discuss using innovative strategies such as telehealth to continue providing patient-centered care while complying with local regulations.
Parush A, Wacht O, Gomes R, et al. J Med Internet Res. 2020;22:e19947.
This study surveyed healthcare professionals in Israel and Portugal to identify key human factors that influence the use of personal protective equipment (PPE) when caring for patients with suspected or confirmed COVID-19. Respondents attributed difficulties in wearing PPE to discomfort, challenges in hearing and seeing, and doffing. Analyses also found an association between PPE discomfort and situational awareness, but this association reflected difficulties in communication (e.g., hearing and understanding speech).
Wee LE, Fua T‐P, Chua YY, et al. Acad Emerg Med. 2020;27:379-387.
This article describes the use of a broad suspect case criteria for detecting COVID-19 in the emergency department of one large, hospital in Singapore. Both the initial official case criteria and the broadened case definition, which included patients presenting with acute respiratory disease with no alternative etiology and a history of travel or residence in a country with ongoing local transmission were used with the broadened criteria having higher sensitivity. The broader criterion may increase the numbers of suspected positive cases but can help minimize nosocomial ED transmission.
Using a social and behavioral sciences perspective, the authors present insights for aligning behavior with recommendations from experts for managing the COVID-19 pandemic and its impact. Topics include threat perception, leadership, individual and collective interests, science communication, social context, and stress and coping.
Tartari E, Saris K, Kenters N, et al. PLoS One. 2020;15.
Presenteeism among healthcare workers can lead to burnout and healthcare-associated infections, but prior research has found that significant numbers of healthcare workers continue to work despite having influenza-like illness. This study surveyed 249 healthcare workers and 284 non-healthcare workers from 49 countries about their behaviors when experiencing influenza-like illness between October 2018 and January 2019. Overall, 59% of workers would continue to work when experiencing influenza-like illness, and the majority of healthcare workers (89.2-99.2%) and non-healthcare workers (80-96.5%) would continue to work with mild symptoms, such as a mild cough, fatigue or sinus cold. Fewer non-healthcare workers (16.2%) than healthcare workers (26.9%) would continue working with fever alone.
This article describes the use of strong matrix management and the plan-do-check-act cycle in the management of severe COVID-19 patients in one hospital in China. These tools were used to ensure efficient task delegation in healthcare teams and quality care for COVID-19 patients.
Zhao Z, Bai H, Duan J, et al. Thorac Cancer. 2020.
The COVID-19 pandemic is negatively impacting patients with non-COVID-related disease and providers are being faced with challenges in delivering ongoing care to patients with chronic health conditions, such as cancer. This article provides recommendations for alternative treatment for lung cancer patients undergoing chemotherapy and other targeted therapies. The authors also suggest approaches to managing treatment-related adverse events outside the hospital to reduce virus exposure among an immunocompromised population.
Long Y, Hu T, Liu L, et al. J Evid Based Med. 2020.
This systematic review pooled data from six trials involving over 9,100 patients to assess the effectiveness of N95 respirators versus surgical masks for flu prevention in hospital and community settings. The meta-analysis found no significant difference between N95 respirators and surgical masks in preventing laboratory- confirmed influenza, respiratory infections or influenza-like illness. The authors conclude that N95 respirators should not be recommended for the general public and should be reserved for high-risk medical staff in close contact with diagnosed or suspected influenza patients.
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