Preconceptions of disease can impact the medical and social response to patients with chronic conditions. This article discusses patients with COVID-19 who survive the virus and describes ineffective support due to lack of understanding and empathy regarding the long-term debilitation survivors experience.
Clarkson MD, Haskell H, Hemmelgarn C, et al. BMJ. 2019;364:l1233.
The term "second victim," coined by Dr. Albert Wu, has engendered mixed responses from patients and health care professionals. This commentary raises concerns that the term negates the sense of responsibility for errors that result in harm and advocates for abandoning it.
Despite years of investment and government support, electronic health records (EHR) continue to face challenges as a patient safety strategy. This news article outlines the unintended consequences of EHR implementation, including patient harm linked to software glitches and user errors, fraudulent behavior (upcoding), interoperability problems, clinician burnout due to poorly designed digital health records, and lack of industry transparency.
Hemmelgarn C. Health Aff (Millwood). 2018;37:1332-1334.
Lack of transparency regarding errors in patient care contributes to harm, mistrust, and inclination toward legal action. This commentary offers insights from a parent whose daughter died from medical error and the resistance she faced when trying to understand what happened. The author encourages health care to embrace strategies that improve dialogue and explanation regarding errors including communication-and-resolution programs.
Schenk EC, Bryant RA, Van Son CR, et al. J Nurs Care Qual. 2019;34:73-79.
Patients and families enhance safety when invited to express concerns and provide feedback about their care. Qualitative interviews of hospital staff, patients, and families highlighted both patients' and families' unique skills as safety advocates as well as barriers to speaking up. An Annual Perspective delineates tools to promote patient engagement in safety.
Bell SK, Roche SD, Mueller A, et al. BMJ Qual Saf. 2018;27:928-936.
A critical component of strong safety culture is that patients and families feel empowered to speak up about safety concerns. Patients and families are often the first to notice changes in their well-being and consistently identify unique adverse events that are not detected through provider-driven means. This cross-sectional survey asked patients currently hospitalized in an intensive care unit (ICU) and their families about their comfort discussing safety concerns with their health care team, then validated those responses with an Internet-recruited nationwide cohort of patients and families who had been previously cared for in ICUs. Many current ICU patients and families expressed some reticence to speak up. Common reasons cited were concern that the health care team was too busy, fear of being labeled a troublemaker, and worry that the team would judge them for not understanding the medical details of their care.
Bell SK, Etchegaray JM, Gaufberg E, et al. Jt Comm J Qual Patient Saf. 2018;44:424-435.
Preventable harm can inflict lasting emotional damage on patients and families. Although many safety experts have examined how adverse events affect health care workers (second victims), patients' emotional experience of these events has garnered less scientific attention. The Agency for Healthcare Research and Quality convened diverse stakeholders, including patients, to identify research priorities to better elucidate how adverse events emotionally impact patients and families. They identified 4 priorities and delineated 20 steps organizations can take immediately to support those who experience adverse events, such as involving patients and families in developing solutions, incorporating emotional harm in organizational approaches to safety, and engaging patient advocates and leaders in improvement work. An Annual Perspective examined the shift toward a just culture in patient safety, which requires reckoning with the impact of errors on patients and families.
Bhise V, Meyer AND, Menon S, et al. Int J Qual Health Care. 2018;30:2-8.
Reducing diagnostic error is an area of increasing focus within patient safety. However, little is known about how patients perceive physician communication regarding diagnostic uncertainty. In this study, participants (parents of pediatric patients) were assigned to read one of three clinical vignettes each describing a different approach to a physician communicating diagnostic uncertainty; they were then asked to answer a questionnaire. Researchers found that explicit expression of diagnostic uncertainty by a physician was associated with negative perceptions of physician competence as well as diminished trust and satisfaction with care, whereas more implicit language was not. A past Annual Perspective highlighted some of the challenges associated with diagnostic error.
Lyndon A, Wisner K, Holschuh C, et al. J Obstet Gynecol Neonatal Nurs. 2017;46:716-726.
Parents and families are crucial partners in pediatric patient safety. This qualitative study of parents whose infants were hospitalized in the neonatal intensive care unit developed a conceptual model for how and when parents articulate safety concerns.
Health care workers face high levels of stress and production pressures, which can contribute to clinician burnout and diminish the safety of care delivery. This commentary describes stressors that affect the psychological health of clinicians, the importance of establishing an organizational culture that supports clinicians, and proactive ways to build clinician resilience in various stressful circumstances.
Rosenberg RE, Rosenfeld P, Williams E, et al. J Nurs Care Qual. 2016;31:318-326.
Engaging patients and families as partners in safety is increasingly recognized as an important strategy in health care. This qualitative study examined parents' perspectives regarding their role in maintaining the safety of their children in the hospital setting. Investigators uncovered components of hospital culture and practice that affect parent engagement and recommend staff training to enhance clinician–parent partnerships.
Lang A, Toon L, Cohen SR, et al. Safety Health. 2015;1:3.
This qualitative study of palliative care recipients, family caregivers, and paid home health staff found that they conceive of safety as encompassing emotional as well as functional safety, and they accept some risk in order to remain in the home environment. This work emphasizes the need for setting-specific patient engagement to tailor safety efforts.
Herrin J, Harris KG, Kenward K, et al. BMJ Qual Saf. 2016;25:182-9.
This survey of acute care hospitals found significant variation for patient and family engagement activities. Most hospitals reported unrestricted visitor access, nearly two-thirds had formal error disclosure policies, and less than half had a patient advisory council. These findings demonstrate the gap between patient engagement recommendations and current hospital practice.
Chicago, IL: Health Research & Educational Trust; 2015.
Patient and family advisor programs have been implemented in health care as a way to incorporate the experiences of consumers into safety improvement work. This guide provides a framework to help hospitals develop partnership initiatives that focus on advisor recruitment, education, and teamwork to enhance efforts to engage patients and families in this role.
Stickney CA, Ziniel SI, Brett MS, et al. J Pediatr. 2014;165:1245-1251.e1.
In this study, health care providers and parents of children in a pediatric intensive care unit described their perceptions of family involvement in morning rounds. Although parents were overwhelmingly enthusiastic about being included in rounds, providers expressed some concerns and potential drawbacks, such as the avoidance of discussing uncomfortable topics due to presence of family.
Rockville, MD: Agency for Healthcare Research and Quality; June 2013.
Studies have shown that a surprisingly large proportion of hospitalized patients are not aware of their diagnoses or treatment plan and that their preferences are often not taken into account in advanced care planning. This failure to provide patient-centered care indicates a need for increased patient engagement in safety and quality efforts. This toolkit published by the Agency for Healthcare Research and Quality is designed to help hospitals develop partnerships with patients around improving safety. Developed with input from clinicians and patients, the guide emphasizes four strategies—working with patients as advisors, improving bedside communication, integrating patients and families into shift changes, and using patient input to improve the discharge process. An AHRQ WebM&M perspective by Dr. Saul Weingart discusses the practical challenges of engaging patients in improvement efforts.
Advance care planning (ACP) has become an increasingly utilized process for exploring and communicating patients' preferences for end-of-life care. This multicenter audit of ACP practices across 12 hospitals in Canada found that even when patients and families have completed ACP, inpatient health care providers are not discussing these preferences during hospitalization nor are they documenting these decisions in the medical record. When there was chart documentation, it did not match the patients' expressed wishes more than two-thirds of the time. The majority of audited cases found that patients were prescribed more aggressive care than they would have preferred. An accompanying editorial argues that these types of "silent misdiagnoses" should be considered medical errors, noting that discussions about code status and ACP are "every bit as important to patient safety as a central line placement or a surgical procedure." A previous AHRQ WebM&M commentary discussed ACP and other tools for expressing end-of-life preferences.
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