Description and Implications of Falls in Patients Hospitalized Due to COVID-19.

BACKGROUND: Many hospital quality indicators, including falls, worsened during the COVID-19 pandemic. Patients hospitalized with COVID-19 may be at risk for falling due to the disease itself, patient characteristics, or aspects of care delivery. PURPOSE: To describe and explore falls in patients hospitalized with COVID-19. METHODS: We pooled data from 107 hospitalized adult patients who fell between March 2020 and April 2021. Patients who fell had a current, pending, or recent diagnosis of COVID-19. We analyzed patient characteristics, fall circumstances, and patient and organizational contributing factors using frequencies, the chi-square test, and Fisher's exact test. RESULTS: Patient contributing factors included patients' lack of safety awareness, impaired physical function, and respiratory concerns. Organizational contributing factors related to staff and the isolation environment. CONCLUSIONS: Recommendations for managing fall risk in patients hospitalized with COVID-19 include frequent reassessment of risk, consideration of respiratory function as a risk factor, ongoing patient education, assisted mobility, and adequate staff training.

Perceived social support: A study of genetic counseling graduate students in the United States (US) and Canada.

Social support is described as having positive psychological and physical outcomes and offers some protective benefits against mental illness. However, research has not addressed social support for genetic counseling graduate students, although this population is prone to elevated levels of stress in addition to field-specific phenomena like compassion fatigue and burnout. Therefore, an online survey was distributed to genetic counseling students in accredited programs in the United States and Canada to synthesize information about (1) demographic information, (2) self-identified sources of support, and (3) the availability of a strong support network. In total, 238 responses were included in the analysis, yielding a mean social support score of 3.84 on a 5-point scale, where higher scores indicate increased social support. The identification of friends or classmates as forms of social support significantly increased social support scores (p < 0.001; p = 0.006, respectively). There was also a positive correlation between increased social support scores and the number of social support outlets (p = 0.01). Subgroup analysis focused on potential differences in social support for racially/ethnically underrepresented participants (comprising less than 22% of respondents), revealing that this population identified friends as a form of social support significantly less often than their White counterparts; and mean social support scores were also significantly lower. Our study underscores the importance of classmates as a source of social support for genetic counseling graduate students while uncovering discrepancies that exist in social support sources between White and underrepresented students. Ultimately, stakeholders in genetic counseling student success should foster a community and culture of support within a training program (whether traditionally in-person or online) to encourage success among all students.

The impact of post-fall huddles on repeat fall rates and perceptions of safety culture: a quasi-experimental evaluation of a patient safety demonstration project.

BACKGROUND: Conducting post-fall huddles is considered an integral component of a fall-risk-reduction program. However, there is no evidence linking post-fall huddles to patient outcomes or perceptions of teamwork and safety culture. The purpose of this study is to determine associations between conducting post-fall huddles and repeat fall rates and between post-fall huddle participation and perceptions of teamwork and safety culture. METHODS: During a two-year demonstration project, we developed a system for 16 small rural hospitals to report, benchmark, and learn from fall events, and we trained them to conduct post-fall huddles. To calculate a hospital's repeat fall rate, we divided the total number of falls reported by the hospital by the number of unique medical record numbers associated with each fall. We used Spearman correlations with exact P values to determine the association between the proportion of falls followed by a huddle and the repeat fall rate. At study end, we used the TeamSTEPPS® Teamwork Perceptions Questionnaire (T-TPQ) to assess perceptions of teamwork support for fall-risk reduction and the Hospital Survey on Patient Safety Culture (HSOPS) to assess perceptions of safety culture. We added an item to the T-TPQ for respondents to indicate the number of post-fall huddles in which they had participated. We used a binary logistic regression with a logit link to examine the effect of participation in post-fall huddles on respondent-level percent positive T-TPQ and HSOPS scores. We accounted for clustering of respondents within hospitals with random effects using the GLIMMIX procedure in SAS/STAT. RESULT: Repeat fall rates were negatively associated with the proportion of falls followed by a huddle. As compared to hospital staff who did not participate in huddles, those who participated in huddles had more positive perceptions of four domains of safety culture and how team structure, team leadership, and situation monitoring supported fall-risk reduction. CONCLUSIONS: Post-fall huddles may reduce the risk of repeat falls. Staff who participate in post-fall huddles are likely to have positive perceptions of teamwork support for fall-risk reduction and safety culture because huddles are a team-based approach to reporting, adapting, and learning.

Naturalistic Decision Making in After-Action Review Meetings: The Implementation of and Learning from Post-Fall Huddles.

The purpose of this study was to add to our understanding of Naturalistic Decision Making (NDM) in healthcare, and how After Action Reviews (AARs) can be utilized as a learning tool to reduce errors. The study focused on the implementation of a specific form of AAR, a post-fall huddle, to learn from errors and reduce patient falls. Utilizing 17 hospitals that participated in this effort, information was collected on 226 falls over a period of 16 months. The findings suggested that the use of self-guided post-fall huddles increased over the time of the project, indicating adoption of the process. Additionally, the results indicate that the types of errors identified as contributing to the patient fall changed, with a reduction in task and coordination errors over time. Finally, the proportion of falls with less adverse effects (such as non-injurious falls) increased during the project time period. The results of this study fill a void in the NDM and AAR literature, evaluating the role of NDM in healthcare specifically related to learning from errors. Over time, self-guided AARs can be useful for some aspects of learning from errors.

Listening campaigns: engaging clinicians to assess system factors contributing to burnout.

BACKGROUND: Even prior to the pandemic, many US physicians experienced burnout affecting patient care quality, safety and experience. Institutions often focus on personal resilience instead of system-level issues. Our leaders developed a novel process to identify and prioritise key system-related solutions and work to mitigate factors that negatively impact clinician well-being through a structured listening campaign. METHODS: The listening campaign consists of meeting with each clinician group leader, a group listening session, a follow-up meeting with the leader, a final report and a follow-up session. During the listening session, clinicians engage in open discussion about what is going well, complete individual reflection worksheets and identify one 'wish' to improve their professional satisfaction. Participants rate these wishes to assist with prioritisation. RESULTS: As of January 2020, over 200 clinicians participated in 20 listening sessions. One hundred and twenty-two participants completed a survey; 80% stated they benefited from participation and 83% would recommend it to others. CONCLUSION: Collecting feedback from clinicians on their experience provides guidance for leaders in prioritising initiatives and opportunities to connect clinicians to organisational resources. A listening campaign is a tool recommended for healthcare systems to elicit clinician perspectives and communicate efforts to address systemic factors.

Teams in Small Organizations: Conceptual, Methodological, and Practical Considerations.

Research on teams and teamwork has flourished in the last few decades. Much of what we know about teams and teamwork comes from research using short-term student teams in the lab, teams in larger organizations, and, more recently, teams in rather unique and extreme environments. The context in which teams operate influences team composition, processes, and effectiveness. Small organizations are an understudied and often overlooked context that presents a rich opportunity to augment our understanding of teams and team dynamics. In this paper, we discuss how teams and multi-team systems in small organizations may differ from those found in larger organizations. Many of these differences present both methodological and practical challenges to studying team composition and processes in small complex organizational settings. We advocate for applying and accepting new and less widely used methodological approaches to advance our understanding of the science of teams and teamwork in such contexts.

Fix Your Leaky Pipeline: Support Women in Pursuit of Advanced Degrees.

Completing a doctoral program is a daunting journey for any individual. Working full-time and juggling personal demands make the journey more complex. This monograph explores the unique motivations women who travel this path possess, identifies barriers in completion of a doctoral program for women, and tells the story of one group of women who developed a working model for a supportive writing group. As numbers of female health professions students and education leaders increase, institutions must identify mechanisms for support of women interested in pursuing an academic doctoral degree, preparing academic institutions for future diversity changes in health care.

Group and Organizational Safety Norms Set the Stage for Good Post-Fall Huddles.

We explored group and organizational safety norms as antecedents to meeting leader behaviors and achievement of desired outcomes in a special after-action review case-a post-fall huddle. A longitudinal survey design was used to investigate the relationship between organizational/group safety norms, huddle leader behavior, and huddle meeting effectiveness. The sample included healthcare workers in critical access hospitals (N = 206) who completed a baseline safety norm assessment and an assessment of post-fall huddle experiences three to six months later. Findings indicate that organizational and group safety norms relate to perceived huddle meeting effectiveness through appropriate huddle leader behavior in a partial mediated framework. In contrast to previous research showing after-action reviews predicting group and organizational safety norms, the longitudinal study presented here suggests that group and organizational safety norms set the stage for the enactment of post-fall huddles in an effective manner.

Evaluating the use of multiteam systems to manage the complexity of inpatient falls in rural hospitals.

OBJECTIVE: To evaluate the implementation and outcomes of evidence-based fall-risk-reduction processes when those processes are implemented using a multiteam system (MTS) structure. DATA SOURCES/STUDY SETTING: Fall-risk-reduction process and outcome measures from 16 small rural hospitals participating in a research demonstration and dissemination study from August 2012 to July 2014. Previously, these hospitals lacked a fall-event reporting system to drive improvement. STUDY DESIGN: A one-group pretest-posttest embedded in a participatory research framework. We required hospitals to implement MTSs, which we supported by conducting education, developing an online toolkit, and establishing a fall-event reporting system. DATA COLLECTION: Hospitals used gap analyses to assess the presence of fall-risk-reduction processes at study beginning and their frequency and effectiveness at study end; they reported fall-event data throughout the study. PRINCIPAL FINDINGS: The extent to which hospitals implemented 21 processes to coordinate the fall-risk-reduction program and trained staff specifically about the program predicted unassisted and injurious fall rates during the end-of-study period (January 2014-July 2014). Bedside fall-risk-reduction processes were not significant predictors of these outcomes. CONCLUSIONS: Multiteam systems that effectively coordinate fall-risk-reduction processes may improve the capacity of hospitals to manage the complex patient, environmental, and system factors that result in falls.

Shifting the paradigm: an assessment of the quality of fall risk reduction in Nebraska hospitals.

PURPOSE: To assess the prevalence of evidence-based fall risk reduction structures and processes in Nebraska hospitals; whether fall rates are associated with specific structures and processes; and whether fall risk reduction structures, processes, and outcomes vary by hospital type--Critical Access Hospital (CAH) versus non-CAH. METHODS: A cross-sectional survey of Nebraska's 83 general community hospitals, 78% of which are CAHs. We used a negative binomial rate model to estimate fall rates while adjusting for hospital volume (patient days) and the exact Pearson chi-square test to determine associations between hospital type and the structure and process of fall risk reduction. FINDINGS: Approximately two-thirds or more of 70 hospitals used 6 of 9 evidence-based universal fall risk reduction interventions; 50% or more used 14 of 16 evidence-based targeted interventions. After adjusting for hospital volume, hospitals in which teams integrated evidence from multiple disciplines and reflected upon data and modified polices/procedures based upon data had significantly lower total and injurious fall rates per 1,000 patient days than hospitals that did not. Non-CAHs were significantly more likely than CAHs to perform 5 organizational-level fall risk reduction processes. CAHs reported significantly greater total (5.9 vs 4.0) and injurious (1.7 vs 0.9) fall rates per 1,000 patient days than did non-CAHs. CONCLUSIONS: Hospital type was a significant predictor of fall rates. However, shifting the paradigm for fall risk reduction from a nursing-centric approach to one in which teams implement evidence-based practices and learn from data may decrease fall risk regardless of hospital type.