Effectiveness and feasibility of an interprofessional training program to improve patient safety-A cluster-randomized controlled pilot study.

Introduction: Interprofessional healthcare teams are important actors in improving patient safety. To train these teams, an interprofessional training program (IPTP) with two interventions (eLearning and blended learning) was developed to cover key areas of patient safety using innovative adult learning methods. The aims of this study were to pilot test IPTP regarding its effectiveness and feasibility. The trial was registered with DRKS-ID: DRKS00012818. Methods: The design of our study included both a pilot investigation of the effectiveness of the two interventions (eLearning and blended learning) and testing their feasibility (effectiveness-implementation hybrid design). For testing the effectiveness, a multi-center cluster-randomized controlled study with a three-arm design [intervention group 1 (IG1): eLearning vs. intervention group 2 (IG2)]: blended learning (eLearning plus interprofessional in-person training) vs. waiting control group (WCG) and three data collection periods (pre-intervention, 12 weeks post-intervention, and 24 weeks follow-up) was conducted in 39 hospital wards. Linear mixed models were used for the data analysis. The feasibility of IPTP was examined in 10 hospital wards (IG1) and in nine hospital wards (IG2) using questionnaires (formative evaluation) and problem-focused interviews with 10% of the participants in the two intervention groups. The collected data were analyzed in a descriptive exploratory manner. Results: Pilot testing of the effectiveness of the two interventions (eLearning and blended learning) showed no consistent differences between groups or a clear pattern in the different outcomes (safety-related behaviors in the fields of teamwork, error management, patient involvement, and subjectively perceived patient safety). Feasibility checks of the interventions showed that participants used eLearning for knowledge activation and self-reflection. However, there were many barriers to participating in eLearning, for example, lack of time or access to computers at the ward. With regard to in-person training, participants stated that the training content sensitized them to patient-safety-related issues in their everyday work, and that awareness of patient safety increased. Discussion: Although the interventions were judged to be feasible, no consistent effects were observed. A possible explanation is that the duration of training and the recurrence rate may have been insufficient. Another conceivable explanation would be that participants became more sensitive to patient safety-critical situations due to their knowledge acquired through the IPTP; therefore, their assessment post-intervention was more critical than before. In addition, the participants reported high pre-measurement outcomes. Future studies should examine the evidence of the intervention within a confirmatory study after adapting it based on the results obtained.

Patient Safety in Hospitals: What We Do and What We Need-Focus Groups With Stakeholders of Hospitals in Southern Germany.

OBJECTIVES: To provide the basis for designing an interprofessional patient safety training for medical treatment teams, the current situation regarding patient safety and existing training programs in southern German hospitals should be explored. Moreover, need-based content regarding the subject areas teamwork, safety culture, and patient involvement should be derived, a conducive learning format suggested, and wishes and concerns regarding the training explored. METHODS: Qualitative design (focus groups) in five hospitals with different levels of care involving a total of 39 members of interprofessional teams, administration, and quality management team. Structured contents analysis was used for evaluation. RESULTS: The need for training to improve patient safety was highlighted. Related contents regarding the subject areas were derived: teamwork (team-building exercises, interprofessional teamwork, interprofessional communication), safety culture (dealing with criticism, appraisals, open handling of errors/proactive error reporting), and patient involvement (inclusion of patients and/or relatives, question types). The combination of e-learning and interprofessional in-person training was emphasized as a conducive learning format. The desire for practical tips, Continuing Medical Education credits, and intuitive review of theories was expressed. CONCLUSIONS: The study initially presents the current situation regarding patient safety, existing training, teamwork, safety culture, and patient involvement in southern German hospitals and gives recommendations for related content and learning format. Based on our results, we recommend to develop a combination of e-learning and interprofessional in-person training. This training should systematically link all three subject areas and address the derived content from the focus groups to improve patient safety.

Inter-professional teamwork and its association with patient safety in German hospitals-A cross sectional study.

BACKGROUND: Inter-professional teamwork is a prominent factor in quality of care and may lead to improved patient safety. Although team members' points of view are highly relevant when trying to improve inpatient procedures, there is a lack of systematic assessment of their perceptions. Therefore, study aims were to explore inter-professional teamwork, safety-related behavior, and patient safety in German hospitals from team members' point of view. Furthermore, we wanted to examine the association between inter-professional teamwork and safety-related behavior as well as the association between inter-professional teamwork and patient safety. METHODS: We used cross-sectional pre-intervention data of a multicenter longitudinal study (German KOMPAS project). We gathered descriptive statistics for sample characteristics and to describe the current state of inter-professional teamwork, safety-related behavior, and patient safety. We used one-way variance analyses to assess differences between groups, and linear regression analyses to examine the association between inter-professional teamwork and the outcomes safety-related behavior, and patient safety. RESULTS: 326 inpatient care team members participated in the study. Participants perceived a moderate to high level of inter-professional teamwork, and a moderate level of patient safety. Moreover, they reached rather high values in safety-related behavior. Professional group, work experience, and period of employment had an impact on the perceptions of inter-professional teamwork, and patient safety. Higher inter-professional teamwork was associated with better patient safety. We did not find an association between inter-professional teamwork and safety-related behavior. CONCLUSIONS: Based on the association between inter-professional teamwork and patient safety, we recommend the implementation of team interventions. Because professional group, period of employment, and work experience had an impact on the perceptions of inter-professional teamwork and patient safety, we suggest future qualitative research to explore reasons for caregivers' critical evaluation. Moreover, we recommend longitudinal studies to reveal causal relationships, and subsequently to determine areas of improvement for a safer health care.

Long-term effects of an e-learning course on patient safety: A controlled longitudinal study with medical students.

BACKGROUND: To improve patient safety, educational interventions on all system levels, including medical school are necessary. Sound theoretical knowledge on elements influencing patient safety (such as error management or team work) is the basis for behavioral changes of health care professionals. METHODS: A controlled, quasi-experimental study with repeated measures was deployed. The intervention group participated in a mandatory e-learning course on patient safety (ELPAS) between October 2016 and December 2016. The control group did not receive any didactic session on patient safety. In both groups we measured technical knowledge and attitudes towards patient safety before the intervention (T0), directly after the intervention (T1) and one year after the intervention (T2). Participants were 309 third-year medical students in the intervention group and 154 first- and second-year medical students in the control group. RESULTS: Technical knowledge in the intervention group (but not the control group) improved significantly after the intervention and remained high after one year (F(2, 84) = 13.506, p < .001, η2 = .243). Students of the intervention group felt better prepared for safe patient practice, even one year after the intervention F(2, 85) = 6.743, p < .002, η2 = .137). There was no sustainable significant effect on attitudes towards patient safety. CONCLUSION: This study shows, that eLearning interventions can produce significant long-term effects on patient safety knowledge, however, the study did not show long-term effects on attitudes towards patient safety. Our study implies two potential developments for future research: e-learning might be used in combination with face-to-face sessions, or more intensive (in terms of frequency and duration) e-learning sessions may be needed to achieve lasting changes in attitude.

Piloting and evaluating feasibility of a training program to improve patient safety for inter-professional inpatient care teams - study protocol of a cluster randomized controlled trial.

BACKGROUND: Improving patient safety is a major goal in healthcare systems worldwide. There are several international training programs to improve patient safety, but they are often focused on single topics and professions. Therefore, one inter-professional training program for inpatient care teams, which combines key areas of patient safety (Teamwork, Error management and Patient involvement), was developed by our research group. In the present study we aim to (1) pilot this training program by comparing two different training formats (e-learning only versus blended learning) with a waiting control group and (2) evaluate the feasibility of the intervention. METHODS AND ANALYSIS: (1) To pilot the intervention a cluster randomized controlled trial will be performed at three study sites. Therefore, an e-learning group and a blended learning group will be compared to a waiting control group at three points of assessment; (2) The feasibility of the intervention will be evaluated using qualitative methods. We will conduct problem-focused individual interviews as part of the post-intervention measurement in order to collect information on acceptance, implementation, promoting factors and barriers from the staffs' perspective. DISCUSSION: The study puts forth a training program which has the potential to improve patient safety in inpatient care. Members of inter-professional inpatient care teams can receive systematic training in three competencies which are central to patient safety management. Thus, we expect the greatest improvement in staff Safety-related behavior regarding Teamwork, Error management and Patient involvement as well as Subjectively perceived patient safety in the blended learning group. In addition, the development of an optimal implementation strategy can foster implementation of the intervention in healthcare practice. Consequently, the intervention could be used continuously and comprehensively for advanced training of hospital staff. TRIAL REGISTRATION: The study has been registered in the German Register of Clinical Trials ( DRKS-ID: DRKS00012818 ). Registered on August 8, 2017.