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Search results for "United States of America"

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Newspaper/Magazine Article

Day passes for vulnerable patients of psychiatric hospitals can have dangerous, even fatal consequences.

Woodruff E. Baltimore Sun. June 9, 2017.

Psychiatric patients are vulnerable to particular safety hazards. This news article reports on unintended consequences associated with a strategy to help patients adapt to being discharged home by providing passes for them to adjust to independent living.

Journal Article > Study

Death by suicide within 1 week of hospital discharge: a retrospective study of root cause analysis reports.

Riblet N, Shiner B, Watts BV, Mills P, Rusch B, Hemphill RR. J Nerv Ment Dis. 2017;205:436-442.

This review of root cause analysis reports about suicide within 7 days of discharge from inpatient mental health facilities determined that most cases of suicide occurred prior to scheduled outpatient postdischarge follow-up. Many patients who went on to die by suicide left against medical advice but did not meet criteria to be held against their wishes, highlighting the conflict between safety and patient autonomy.

Journal Article > Commentary

Ensuring staff safety when treating potentially violent patients.

Roca RP, Charen B, Boronow J. JAMA. 2016;316:2669-2670.

Patients with psychiatric conditions can affect the safety of others in the care setting. This commentary recommends strategies to reduce risks associated with potentially violent patients, such as providing training for staff regarding how to respond to aggressive behaviors and developing incident management approaches.

Journal Article > Study

Incident and long-term opioid therapy among patients with psychiatric conditions and medications: a national study of commercial health care claims.

Quinn PD, Hur K, Chang Z, et al. Pain. 2017;158:140-148.

Opioid medications are associated with an increased risk of adverse drug events, including overdose. Certain populations may be at greater risk for adverse outcomes from opioids and may be more likely to receive them. This study looked at health insurance claims data for more than 10 million patients who filled opioid prescriptions. Researchers found that those with underlying psychiatric and behavioral conditions (including opioid and nonopioid substance use disorders) were more likely to receive long-term opioid therapy than patients without such conditions.

Newspaper/Magazine Article

Safety for all: integrated design for inpatient units.

Hunt JM, Sine DM. Patient Saf Qual Healthc. May/June 2016;13:20-28.

Design is emerging as an important tactic to augment safe care delivery. Hospitals that provide care for psychiatric patients must make unique considerations to protect this vulnerable population from harming themselves and other individuals that come into contact with them. This magazine article provides recommendations for hospitals to enhance room and fixture designs to reduce risks for mental health patients.

Journal Article > Study

PSYCH: a mnemonic to help psychiatric residents decrease patient handoff communication errors.

Mariano MT, Brooks V, Digiacomo M. Jt Comm J Qual Patient Saf. 2016;42:316-320.

This study describes a quality improvement project to enhance handoffs among psychiatry residents. The use of a mnemonic PSYCH (Patient information, Situation leading to hospitalization, Your assessment, Critical information, and Hindrance to discharge) led to more complete and efficient handoffs, consistent with other studies of structured handoff communications.

Journal Article > Study

Patient safety events and harms during medical and surgical hospitalizations for persons with serious mental illness.

Daumit GL, McGinty EE, Pronovost P, et al. Psychiatr Serv. 2016;67:1068-1075.

Patients with serious psychiatric disorders, such as schizophrenia and bipolar disorder, often require high-risk medications and experience medical comorbidities. This cohort study assessed the frequency of preventable adverse events during medical hospitalizations in patients with serious mental illness. Preventable adverse events, primarily medication errors, were very common among these patients and were associated with physical injury during hospitalization. The study could not assess the causes of the adverse events, but prior studies have shown that medication administration errors are frequent in psychiatric inpatients. A WebM&M commentary discussed a case of a preventable death occurring shortly after a patient with schizophrenia was discharged from a medical hospitalization.

Journal Article > Study

Missing clinical and behavioral health data in a large electronic health record (EHR) system.

Madden JM, Lakoma MD, Rusinak D, Lu CY, Soumerai SB. J Am Med Inform Assoc. 2016;23:1143-1149.

Electronic health records (EHRs) were promoted as a patient safety improvement strategy, but their promise has not been fully realized. Comparing data from an EHR to information from insurance claims, this study found that EHRs inadequately capture mental health care, including inpatient and outpatient visits, medications, and specialty care. This information gap carries significant risk to patients and suggests a need for improved care integration and EHR interoperability.

Journal Article > Study

Pharmacist medication reviews to improve safety monitoring in primary care patients.

Gallimore CE, Sokhal D, Zeidler Schreiter E, Margolis AR. Fam Syst Health. 2016;34:104-113.

In this study performed in a community behavioral health center, medication reviews by pharmacists helped improve appropriate monitoring of patients prescribed high-risk psychotropic medications. A WebM&M commentary describes a case of a potentially harmful medication error in an outpatient psychiatry clinic.

Audiovisual

When the hospital fires the bullet.

Rosenthal E. New York Times. February 12, 2016.

Raising concerns around the use of armed security guards in health care settings, this newspaper article and companion podcast report on the experience of a patient who disclosed a need for mental health treatment upon arriving at a hospital where staff failed to appropriately address his psychiatric condition and instead treated his physical injuries. The patient became increasingly agitated and hospital security personnel ultimately used weapons to subdue him.

Journal Article > Review

The impact of resident duty hour and supervision changes: a review.

Greenberg WE, Borus JF. Harv Rev Psychiatry. 2016;24:69-76.

The benefits of duty hour restrictions have been debated since their implementation. This review provides an overview of the controversy surrounding duty hour limits and discusses how the restrictions affect psychiatry residents. Highlighting concerns regarding residents feeling less prepared for senior roles and having insufficient time to spend with patients, the authors suggest that further research is needed to understand the impact of resident duty hours on patient safety.

Journal Article > Commentary

Virginia Tech as a sentinel event: the role of psychiatry in managing emotionally troubled students on college and university campuses.

Giggie MA. Harv Rev Psychiatry. 2015;23:413-425.

Exploring a sentinel event at a college involving a student with mental health issues, this commentary highlights complex psychological problems among students on college campuses and the need for college psychiatrists to better understand confidentiality policies. The author advocates for a more robust process for involving psychiatrists in the care of troubled students could help to prevent large-scale system failures.

Book/Report

Diagnostic experiences of children with attention-deficit/hyperactivity disorder.

Visser SN, Zablotsky B, Holbrook JR, Danielson ML, Bitsko RH. Natl Health Stat Report. 2015;(81):1-8.

This survey of parents of children with attention-deficit/hyperactivity disorder examined how this diagnosis was established. There was variation in the diagnostic process, including testing methods and types of practitioners involved (primary care physician, psychologist, psychiatrist). These results demonstrate the inherent challenge of diagnosing a heterogeneous condition even when diagnostic guidelines and criteria exist.

Journal Article > Study

A prospective study of suicide screening tools and their association with near-term adverse events in the ED.

Chang BP, Tan TM. Am J Emerg Med. 2015;33:1680-1683.

Suicidal ideation is a challenging clinical problem in the emergency department. This prospective study found that commonly used suicide screening questionnaires did not predict which patient would require unscheduled psychiatric evaluation, sedating medications, or physical restraints. These results highlight the need for improved tools to identify which patients are most at risk for instability in the emergency department.

Journal Article > Commentary

Among the elderly, many mental illnesses go undiagnosed.

Bor JS. Health Aff (Millwood). 2015;34:727-731.

This commentary spotlights missed and delayed diagnosis of psychiatric conditions in older patients. The authors explore how insufficient physician experience with mental illness in geriatric patients, patient reluctance to discuss emotional challenges, and comorbidities with physical problems can contribute to errors.

Journal Article > Study

Misdiagnosis and missed diagnoses in foster and adopted children with prenatal alcohol exposure.

Chasnoff IJ, Wells AM, King L. Pediatrics. 2015;135:264-270.

Diagnostic errors are a known cause of preventable adverse events. The vast majority of children ultimately determined to have fetal alcohol spectrum disorder in this cohort study had been previously misdiagnosed, despite having undergone clinical evaluation for developmental or behavioral problems.

Journal Article > Study

Residency training in handoffs: a survey of program directors in psychiatry.

Arbuckle MR, Reardon CL, Young JQ. Acad Psychiatry. 2015;39:132-138.

According to this survey study, a substantial minority of psychiatry residency training programs reported that they did not provide formal training in handoffs, which is now required by the Accreditation Council for Graduate Medical Education. Barriers to developing such training included difficulty attaining buy-in from clinicians and standardizing handoffs across different sites.

Journal Article > Study

Barriers to the reporting of medication administration errors and near misses: an interview study of nurses at a psychiatric hospital.

Haw C, Stubbs J, Dickens GL. J Psychiatr Ment Health Nurs. 2014;21:797-805.

Researchers interviewed mental health nurses to determine perceived obstacles to reporting medication administration errors or near misses. Many factors were identified, including insufficient knowledge, fear of consequences, or burden of work associated with reporting. These have also been cited as reasons for under-reporting of errors in prior nursing studies.

Journal Article > Commentary

Development of a professionalism committee approach to address unprofessional medical staff behavior at an academic medical center.

Speck RM, Foster JJ, Mulhern VA, Burke SV, Sullivan PG, Fleisher LA. Jt Comm J Qual Patient Saf. 2014;40:161-167.

Unprofessional behavior can hinder patient safety and create a disruptive work environment for other staff. The Joint Commission requires that organizations have clear processes for detecting and reporting unacceptable behaviors. This commentary describes the development and experience of a Professionalism Committee at the University of Pennsylvania Health System. The committee chair serves as the first point of contact for any behavioral concerns. In this system, the committee chair is a trained psychiatrist, which the authors argue is an important aspect of the program since it allows for early identification of behavioral health issues that could contribute to unprofessionalism. The article includes the specific problems addressed and the referral outcomes of 79 cases over 2 years, along with 3 illustrative case vignettes. A prior AHRQ WebM&M commentary focused on the importance of professionalism in patient safety, and an AHRQ WebM&M perspective reviewed strategies to identify and manage problem behaviors.

Journal Article > Study

Understanding safety culture in long-term care: a case study.

Halligan MH, Zecevic A, Kothari AR, Salmoni AW, Orchard T. J Patient Saf. 2014;10:192-201.

This study provides an in-depth case report of the suboptimal safety culture at a long-term care facility for patients with cognitive impairments. The framework used to evaluate this unit may be useful for other similar organizations looking to improve the care of their residents.

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