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Search results for "Health Care Executives and Administrators"

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  • Health Care Executives and Administrators
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Journal Article > Review

Managing and mitigating conflict in healthcare teams: an integrative review.

Almost J, Wolff AC, Stewart-Pyne A, McCormick LG, Strachan D, D'Souza C. J Adv Nurs. 2016;72:1490-1505.

This narrative review found that factors associated with personality, attitudes, role ambiguity, and work environment all contribute to interpersonal conflict in health care settings. The authors describe possible interventions to reduce conflict, which should in turn improve patient safety.

Journal Article > Study

Outcomes of daytime procedures performed by attending surgeons after night work.

  • Classic

Govindarajan A, Urbach DR, Kumar M, et al. N Engl J Med. 2015;373:845-853.

The link between lack of sleep and subsequent medical errors served as an impetus for physician duty-hours reform. In trainee physicians, sleep loss is associated with attentional failures, but little is known about the relationship between attending physician performance and sleep loss. This retrospective cohort study examined outcomes of elective surgical procedures among attending surgeons who had worked after midnight on the previous night versus those who had not. The investigators found no differences in mortality, complications, or readmissions between procedures performed by surgeons with sleep loss compared to those without sleep loss, mirroring results of an earlier simulation study. This may be due to greater technical skill among attending surgeons, or the ability to cancel or postpone elective procedures as needed at times of fatigue. This study included many institutions, physicians, and procedure types, suggesting that short-term sleep deprivation might not be a high-yield safety target for attending surgeons.

Journal Article > Commentary

Crib of horrors: one hospital's approach to promoting a culture of safety.

Korah N, Zavalkoff S, Dubrovsky AS. Pediatrics. 2015;136:4-5.

Games illustrating what could go wrong can reveal insights into culture and teamwork in a health care organization. This commentary describes a low-tech simulation activity in a pediatric setting designed to foster learning by engaging staff to identify, correct, and discuss safety hazards.

Journal Article > Study

Quality improvement, patient safety, and continuing education: a qualitative study of the current boundaries and opportunities for collaboration between these domains.

Kitto S, Goldman J, Etchells E, et al. Acad Med. 2015;90:240-245.

Leaders of quality improvement/patient safety and continuing education in Canada felt that efforts in these two domains were separated and that there were many opportunities to collaborate. However, they had differing views on how to best integrate programs.

Journal Article > Study

Making hospital care safer and better: the structure-process connection leading to adverse events.

El-Jardali F, Lagacé M. Healthc Q. 2005;8:40-48.

The authors propose a model for identifying factors that contribute to adverse events in hospital care. Using secondary data from a large Canadian nursing survey, the authors found that perceived understaffing, inadequate support services, and poor teamwork impacted the incidence of adverse events.

Journal Article > Study

Associations between patient factors and adverse events in the home care setting: a secondary data analysis of two Canadian adverse event studies.

Sears NA, Blais R, Spinks M, Paré M, Baker GR. BMC Health Serv Res. 2017;17:400.

Adverse events occur frequently in the home care setting. A previous study estimated that about 10% of patients receiving home care experienced an adverse event, and research suggests that a significant proportion of these may be preventable. Early identification of patients at increased risk for harm in the home care setting may help inform hospital discharge planning and improve patient safety. Analyzing data from two prior Canadian home care patient safety studies, researchers found that both increased dependency for instrumental activities of daily living and a higher number of comorbid medical conditions placed patients at greater risk for adverse events. A past PSNet perspective discussed safety issues associated with care transitions after hospital discharge.

Journal Article > Review

Mobilising or standing still? A narrative review of Surgical Safety Checklist knowledge as developed in 25 highly cited papers from 2009 to 2016.

Mitchell B, Cristancho S, Nyhof BB, Lingard LA. BMJ Qual Saf. 2017 Jun 3; [Epub ahead of print].

Checklists have been heralded as an important tool to improve health care safety. This review examined whether the science supports that recognition. Numerous studies have been published, but the literature base hasn't been developed to fully understand the complexities of surgical checklist implementation programs.

Book/Report

CMPA Good Practices Guide.

Ottawa, Ontario: Canadian Medical Protective Association; 2016.

Key patient safety topics include human factors, teamwork, adverse events, communication, professionalism, and risk management. This website provides resources regarding patient safety concepts, strategies for addressing risks, and guidance for faculty using the material.

Journal Article > Commentary

Root-cause analysis: swatting at mosquitoes versus draining the swamp.

Trbovich P, Shojania KG. BMJ Qual Saf. 2017;26:350-353.

Although root cause analysis is an established strategy to investigate incidents, some have questioned its effectiveness in health care. Drawing from a recent study, this editorial suggests that robust health care investment in human factors engineering and safety science is needed to help root cause analysis achieve its full potential as an improvement mechanism. A recent Annual Perspective discussed ongoing problems with the root cause analysis process and described opportunities to improve its application in health care.

Journal Article > Study

Overdose risk in young children of women prescribed opioids.

Finkelstein Y, Macdonald EM, Gonzalez A, Sivilotti MLA, Mamdani MM, Juurlink DN; Canadian Drug Safety And Effectiveness Research Network (CDSERN). Pediatrics. 2017;139:e20162887.

Opioid-related harm is a critical patient safety priority. This case control study examined the risk of opioid overdose among children whose mothers were prescribed either opioids or nonsteroidal anti-inflammatory agents in the prior year. The cases were children aged 10 or younger who were hospitalized or died from opioid overdose, and the controls were children of the same age without overdose. Compared to the children without overdose, those who were hospitalized or died were more likely to have a mother who was prescribed opioids. Antidepressant prescription was also more common among mothers of children who experienced opioid overdose. The authors recommend specific practices for safe opioid use, including prescription of smaller quantities and secure storage of medications, which prior studies demonstrate are not yet routine. This study emphasizes the urgent need to enhance the safety of outpatient opioid use.

Journal Article > Review

A primer on PDSA: executing plan–do–study–act cycles in practice, not just in name.

Leis JA, Shojania KG. BMJ Qual Saf. 2017;26:572-577.

Although plan–do–study–act (PDSA) cycles were promoted as an in-depth rapid-cycle improvement mechanism, this process can fall short of advancing an organization's improvement work. Exploring shortcomings as reflected in the literature, this article relates insights drawn from a project review to discuss how to effectively use PDSA cycles in patient safety work.

Book/Report

Electronically Generated Medication Administration and Electronic Medication Administration Records for the Prevention of Medication Transcription Errors: Review of Clinical Effectiveness and Safety.

Ottawa, ON: Canadian Agency for Drugs and Technologies in Health; 2016.

Use of medication administration technologies can reduce transcription errors. This review examined computerized order entry systems, barcode medication administration systems, and other tools that can prevent medication transcription errors.

Journal Article > Review

Cognitive biases associated with medical decisions: a systematic review.

Saposnik G, Redelmeier D, Ruff CC, Tobler PN. BMC Med Inform Decis Mak. 2016;16:138.

Cognitive bias can contribute to diagnostic error, leading to delays in treatment and unnecessary harm to patients. Consistent with prior research, this systematic review found that multiple types of cognitive bias are associated with diagnostic mistakes and inadequate medical management of patients.

Journal Article > Study

The impact of critical event checklists on medical management and teamwork during simulated crises in a surgical daycare facility.

Everett TC, Morgan PJ, Brydges R, et al. Anaesthesia. 2017;72:350-358.

Checklists are commonly used in surgery to promote patient safety. Challenges associated with checklist implementation are well described. In this study, implementing critical events checklists did not facilitate improvement of medical management or teamwork during observed simulated operating room emergencies in the ambulatory surgery environment.

Journal Article > Review

Impact of age on anaesthesiologists' competence: a narrative review.

Giacalone M, Zaouter C, Mion S, Hemmerling TM. Eur J Anaesthesiol. 2016;33:787-793.

Aging physicians should be assessed for cognitive and functional decline to ensure patient safety. This review discusses the impact of aging on anesthesiologists, criteria to assess competencies, and the use of simulation to ascertain providers' ability to practice safely.

Journal Article > Commentary

JAMA professionalism: disclosure of medical error.

  • Classic

Levinson W, Yeung J, Ginsburg S. JAMA. 2016;316:764-765.

Disclosing medical errors to patients is essential for maintaining a therapeutic relationship and preventing further harm. This commentary describes a case in which a physician inadvertently used nonsterile instruments to perform procedures on two patients and presents options for what the physician might do next. Recommended best practices for error disclosure include being honest about what happened, explicitly stating that an error occurred, and explaining to the patient any relevant specific information that might be helpful in terms of necessary follow-up. The authors suggest that all errors be formally reviewed to prevent future harm and that health care systems should create an environment that facilitates error reporting.

Journal Article > Study

Errors, omissions, and outliers in hourly vital signs measurements in intensive care.

Maslove DM, Dubin JA, Shrivats A, Lee J. Crit Care Med. 2016;44:e1021-e1030.

Vital signs remain a mainstay of monitoring for deterioration, and early identification of and rapid response to clinical deterioration is critical to preventing patient harm. This observational study used an automated technique to characterize vital sign measurement for nearly 50,000 intensive care unit stays. Investigators found that omission of vital sign recording occurred more than one third of the time. The analysis identified logically inconsistent blood pressure measurements, which suggested data-entry error. The data included a significant proportion of unusual, outlier vital sign values. Taken together, these results demonstrate important inaccuracy in vital sign documentation in the intensive care unit. The authors recommend seeking alternatives to hourly vital sign monitoring in order to optimize safety. A previous WebM&M commmentary discussed challenges in monitoring vital signs.

Journal Article > Study

A framework to assess patient-reported adverse outcomes arising during hospitalization.

Barbara O, Jose SM, Jayna HL, et al. BMC Health Serv Res. 2016;16:357.

Patient reports of adverse outcomes are one critical method to detect safety hazards. This study used patient reports of adverse outcomes to develop a framework for identifying adverse events. The authors suggest that patient reports could be used as a trigger tool to prompt review of cases for adverse events.

Journal Article > Review

Burnout in the nursing home health care aide: a systematic review.

Cooper SL, Carleton HL, Chamberlain SA, Cummings GG, Bambrick W, Estabrooks CA. Burnout Res. 2016;3:76-87.

Burnout is a pervasive problem in health care that can affect clinician performance and patient safety. This systematic review found that nursing home health aides experience significant burnout, exacerbated by workplace factors such as staffing and work environment. The authors advocate for research to examine the environmental characteristics that lead to increased workload and subsequent burnout.

Journal Article > Study

A reduced duty hours model for senior internal medicine residents: a qualitative analysis of residents' experiences and perceptions.

Mathew R, Gundy S, Ulic D, Haider S, Wasi P. Acad Med. 2016;91:1284-1292.

Although duty hour restrictions were enacted to improve patient safety, evidence regarding their impact has been mixed. This focus group study examined resident perceptions of quality of life and patient safety before and after implementation of a reduced duty hours model. Participants reported less fatigue but also expressed concern about the greater number of handoffs, echoing the ongoing duty-hours debate discussed in a recent PSNet perspective.

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