What are the experiences of team members involved in root cause analysis? A qualitative study.

BACKGROUND: Conducting root cause analysis (RCA) is complex and challenging. The aim of this study was to better understand the experiences of RCA team members and how they value their involvement in the RCA to inform future recruitment, conduct and implementation of RCA findings into clinical practice. METHODS: The study was set in a health network in Adelaide, South Australia. A qualitative exploratory descriptive approach was undertaken to provide an in-depth understanding of team member's experience in participating in an RCA. Eight of 27 RCA team members who conducted RCAs in the preceding 3-year period were included in one of three semi-structured focus groups. Thematic analysis was used to synthesise the transcribed data into themes. RESULTS: We derived four major themes: Experiences and perceptions of the RCA team, Limitations of RCA recommendations, Facilitators and barriers to conducting an RCA, and Supporting colleagues involved in the adverse event. Participants' mixed experience of RCAs ranged from enjoyment and the perception of worth and value to concerns about workload and lack of impact. Legislative privilege protecting RCAs from disclosure was both a facilitator and a barrier. Concern and a desire to better support their colleagues was widely reported. CONCLUSIONS: Clinicians perceived value in reviewing significant adverse events. Improvements can be made in sharing learnings to make effective improvements in health care. We have proposed a process to better support interviewees and strengthen post interview follow up.

Comparing rates of adverse events detected in incident reporting and the Global Trigger Tool: a systematic review.

Many hospitals continue to use incident reporting systems (IRSs) as their primary patient safety data source. The information IRSs collect on the frequency of harm to patients [adverse events (AEs)] is generally of poor quality, and some incident types (e.g. diagnostic errors) are under-reported. Other methods of collecting patient safety information using medical record review, such as the Global Trigger Tool (GTT), have been developed. The aim of this study was to undertake a systematic review to empirically quantify the gap between the percentage of AEs detected using the GTT to those that are also detected via IRSs. The review was conducted in adherence to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Studies published in English, which collected AE data using the GTT and IRSs, were included. In total, 14 studies met the inclusion criteria. All studies were undertaken in hospitals and were published between 2006 and 2022. The studies were conducted in six countries, mainly in the USA (nine studies). Studies reviewed 22 589 medical records using the GTT across 107 institutions finding 7166 AEs. The percentage of AEs detected using the GTT that were also detected in corresponding IRSs ranged from 0% to 37.4% with an average of 7.0% (SD 9.1; median 3.9 and IQR 5.2). Twelve of the fourteen studies found <10% of the AEs detected using the GTT were also found in corresponding IRSs. The >10-fold gap between the detection rates of the GTT and IRSs is strong evidence that the rate of AEs collected in IRSs in hospitals should not be used to measure or as a proxy for the level of safety of a hospital. IRSs should be recognized for their strengths which are to detect rare, serious, and new incident types and to enable analysis of contributing and contextual factors to develop preventive and corrective strategies. Health systems should use multiple patient safety data sources to prioritize interventions and promote a cycle of action and improvement based on data rather than merely just collecting and analysing information.

Missed nursing care, nurse staffing levels and patient safety outcomes in low-income country acute care settings: An observational study.

AIMS: The aim of this study was to measure the level of missed nursing care and determine its relationship with nurse staffing and patient safety outcomes in acute care settings in Ethiopia. BACKGROUND: Missed nursing care in hospitals increases the likelihood of patient adverse events, complications, disability and death. However, little is known about the level of missed nursing care and its impact on patient outcomes in low-income countries. METHODS: An observational study was conducted comprising of a survey of nurses at two time points (n = 74 and 80, respectively) and a medical record review of 517 patients in four units across two hospitals between September 2018 and March 2019. RESULTS: The level of missed nursing care in the study units was very high. The hospital type and hours nurses worked during the last week were significantly associated with missed nursing care. A unit increase in missed nursing care score increased the incidence of adverse patient outcomes by 10%. CONCLUSION: There was a higher level of missed nursing care in the study units compared with similar studies from high-income countries. Higher level of missed nursing care was significantly associated with higher incidence of adverse patient safety outcomes.

The experiences and perceptions of nurses regarding patient care provision in acute medical and surgical care units of two hospitals in Ethiopia.

BACKGROUND: Patient safety is a major concern for health care systems in both high-income and low- and middle-income countries (LMICs). Nurses play a key role in ensuring patient safety. Existing research on nurses' perception of patient safety is limited to high-income countries and there is a relative scarcity of evidence on the perceptions of nurses from LMICs. Therefore, the aim of this study was to explore nurses' perceptions and experiences of the provision of patient care and its impact on patient safety, and nurses' own health and wellbeing. METHODS: An exploratory descriptive qualitative study using in-depth semi-structured interviews was conducted in two hospitals' medical and surgical units in Amhara Regional State, Ethiopia. Purposeful sampling was used for the selection of participants. Thirteen nurses were interviewed. Thematic analysis was conducted using NVivo 12. RESULTS: Three major themes were identified: nurses are concerned about patient safety and quality of care provided; nurses' own health and wellbeing; and lack of support for nursing practice from hospital administration. Nurses reported that their working units were not suitable to ensure safe and quality patient care. Their level of concern differed from one unit to another. Inadequate nurse staffing and material resources, unfavourable work environment, and lack of appropriate leadership support for nursing practice were among the main challenges reported by nurses. CONCLUSIONS: Nurses described that they were committed to providing high-quality nursing care. However, they did not feel that their work environment was conducive to facilitating this care. Ensuring a favourable work environment for nurses would help to improve the quality of patient care, and in the reduction of nurses' turnover.

An infodemiological framework for tracking the spread of SARS-CoV-2 using integrated public data.

The outbreak of the SARS-CoV-2 novel coronavirus has caused a health crisis of immeasurable magnitude. Signals from heterogeneous public data sources could serve as early predictors for infection waves of the pandemic, particularly in its early phases, when infection data was scarce. In this article, we characterize temporal pandemic indicators by leveraging an integrated set of public data and apply them to a Prophet model to predict COVID-19 trends. An effective natural language processing pipeline was first built to extract time-series signals of specific articles from a news corpus. Bursts of these temporal signals were further identified with Kleinberg's burst detection algorithm. Across different US states, correlations for Google Trends of COVID-19 related terms, COVID-19 news volume, and publicly available wastewater SARS-CoV-2 measurements with weekly COVID-19 case numbers were generally high with lags ranging from 0 to 3 weeks, indicating them as strong predictors of viral spread. Incorporating time-series signals of these effective predictors significantly improved the performance of the Prophet model, which was able to predict the COVID-19 case numbers between one and two weeks with average mean absolute error rates of 0.38 and 0.46 respectively across different states.

Factors influencing nurses' intention to work in the oncology specialty: multi-institutional cross-sectional study.

BACKGROUND: Nursing care for terminally ill cancer patients is routinely provided by oncology nurses in Saudi Arabia. Shortages and retention of oncology nurses is an important concern for healthcare leaders. OBJECTIVES: To identify and describe predictors of nurses' intention toward working in the oncology specialty amongst three groups: undergraduate nursing students, oncology registered nurses and postgraduate oncology nursing students. In particular, the study sought to analyse association between individual characteristics, job-related factors, palliative care knowledge, attitude toward caring for dying patients, general self-efficacy, job satisfaction and intention to work in oncology. METHODS: A cross-sectional study was conducted involving 477 participants in five major hospitals in Saudi Arabia. The Palliative Care Quiz for Nursing, Frommelt Attitudes Toward Care of the Dying Scale, General Self-Efficacy Scale and Minnesota Satisfaction Questionnaire short form were used for data collection. Multilevel logistic regression analysis was used to identify predictors associated with intention to work in oncology. RESULTS: 43.9% (n = 208) of the sample reported an intention to work in oncology. Only one variable was a significant predictor of intention to work in oncology across all three groups studied: a more positive attitude toward caring for dying patients (Odds ratio (OR) = 1.09 [95% confidence interval (CI) 1.04-1.16]), (OR = 1.08 [95% CI 1.04-1.12]), (OR = 1.078 [95% CI 1.053-1.103] with P ≤ 0.001 for undergraduate, registered and postgraduate groups respectively. At post-graduate level, higher levels of palliative care knowledge and general self-efficacy were significantly associated with increased intention, whilst at undergraduate level, general self-efficacy was a significant predictor. Job satisfaction was a significant predictor of intention amongst registered nurses. CONCLUSIONS: Attitude toward caring for dying patients and general self-efficacy appear to be the most important predictors of intention to work in the oncology nursing specialty. However, the significance of influencing factors varied between the different groups of nurses studied. Perhaps surprisingly, palliative care knowledge was an influential factor amongst the postgraduate group only. The study results provide important insights for nursing leaders and policymakers in Saudi Arabia to inform the future planning of nursing workforce strategies to address shortages and retention of oncology nurses.

Developing a Model of Care for a 4- to 6-Bedded Postanesthetic Recovery Unit: A Delphi Study.

PURPOSE: Recovery units are typically open-plan rooms where all patients can be seen at all times; however, a new hospital has been built with 4- to 6-bed perioperative bays. The purpose of the study was to establish expert consensus regarding problems, benefits, and suggested solutions for the new design across four domains: patient safety, staff satisfaction, organizational efficiency, and maintenance of professional standards. DESIGN: We conducted a Delphi study to inform the development of a model of care for this new design. METHODS: A two-round Delphi study involved 71 recovery unit nurses from 13 countries. Problems, solutions, and any potential benefits of the new design were collected in round 1 and ranked in round 2. FINDINGS: The highest ranked problems were mixing conscious and unconscious patients and need for safe skilled staffing levels. The highest ranked solutions were division of patients, increased safe skilled staffing, and staff education. CONCLUSIONS: Participants identified clear risks and mitigation strategies. Implementing these strategies should allow for a safer environment for both patients and staff. A model of care to ensure safety and quality in 4- to 6-bedded bay postanesthetic recovery units should address mixing of patients, staffing levels and staff education.

Nurse staffing models in medical-surgical units of acute care settings: A cross-sectional study.

BACKGROUND: Nurse staffing models have been developed across different countries to address nursing shortages and improve quality of nursing care. However, there is no published study that describes nurse staffing models in Ethiopian hospitals. AIMS: To describe the existing staffing models for nursing practice in acute care units of two hospitals (one public and one private) in Ethiopia. METHODS: A cross-sectional study was conducted from July to December 2018. A self-administered questionnaire was used to collect data such as shift patterns, hours worked, and number of patients cared for per shift. Unit-level data on nurse staffing were collected using a checklist developed specifically for this study. RESULTS: Fifty-nine percent (59.9%) of participants reported that they worked six or seven days per week. On average, they worked 50 hours per week and 12% working over 60 hours per week. The number of patients they provided care for during their last shift ranged from four to 45 with an average of 13 patients. CONCLUSION: This study demonstrates that nurses working in acute care settings in Ethiopia are typically working more than 40 hours per week and caring for many patients per shift, which has the potential to impact patient safety.

Hospital nurse-staffing models and patient- and staff-related outcomes.

BACKGROUND: Nurses comprise the largest component of the health workforce worldwide and numerous models of workforce allocation and profile have been implemented. These include changes in skill mix, grade mix or qualification mix, staff-allocation models, staffing levels, nursing shifts, or nurses' work patterns. This is the first update of our review published in 2011. OBJECTIVES: The purpose of this review was to explore the effect of hospital nurse-staffing models on patient and staff-related outcomes in the hospital setting, specifically to identify which staffing model(s) are associated with: 1) better outcomes for patients, 2) better staff-related outcomes, and, 3) the impact of staffing model(s) on cost outcomes. SEARCH METHODS: CENTRAL, MEDLINE, Embase, two other databases and two trials registers were searched on 22 March 2018 together with reference checking, citation searching and contact with study authors to identify additional studies. SELECTION CRITERIA: We included randomised trials, non-randomised trials, controlled before-after studies and interrupted-time-series or repeated-measures studies of interventions relating to hospital nurse-staffing models. Participants were patients and nursing staff working in hospital settings. We included any objective reported measure of patient-, staff-related, or economic outcome. The most important outcomes included in this review were: nursing-staff turnover, patient mortality, patient readmissions, patient attendances at the emergency department (ED), length of stay, patients with pressure ulcers, and costs. DATA COLLECTION AND ANALYSIS: We worked independently in pairs to extract data from each potentially relevant study and to assess risk of bias and the certainty of the evidence. MAIN RESULTS: We included 19 studies, 17 of which were included in the analysis and eight of which we identified for this update. We identified four types of interventions relating to hospital nurse-staffing models:- introduction of advanced or specialist nurses to the nursing workforce;- introduction of nursing assistive personnel to the hospital workforce;- primary nursing; and- staffing models.The studies were conducted in the USA, the Netherlands, UK, Australia, and Canada and included patients with cancer, asthma, diabetes and chronic illness, on medical, acute care, intensive care and long-stay psychiatric units. The risk of bias across studies was high, with limitations mainly related to blinding of patients and personnel, allocation concealment, sequence generation, and blinding of outcome assessment.The addition of advanced or specialist nurses to hospital nurse staffing may lead to little or no difference in patient mortality (3 studies, 1358 participants). It is uncertain whether this intervention reduces patient readmissions (7 studies, 2995 participants), patient attendances at the ED (6 studies, 2274 participants), length of stay (3 studies, 907 participants), number of patients with pressure ulcers (1 study, 753 participants), or costs (3 studies, 617 participants), as we assessed the evidence for these outcomes as being of very low certainty. It is uncertain whether adding nursing assistive personnel to the hospital workforce reduces costs (1 study, 6769 participants), as we assessed the evidence for this outcome to be of very low certainty. It is uncertain whether primary nursing (3 studies, > 464 participants) or staffing models (1 study, 647 participants) reduces nursing-staff turnover, or if primary nursing (2 studies, > 138 participants) reduces costs, as we assessed the evidence for these outcomes to be of very low certainty. AUTHORS' CONCLUSIONS: The findings of this review should be treated with caution due to the limited amount and quality of the published research that was included. We have most confidence in our finding that the introduction of advanced or specialist nurses may lead to little or no difference in one patient outcome (i.e. mortality) with greater uncertainty about other patient outcomes (i.e. readmissions, ED attendance, length of stay and pressure ulcer rates). The evidence is of insufficient certainty to draw conclusions about the effectiveness of other types of interventions, including new nurse-staffing models and introduction of nursing assistive personnel, on patient, staff and cost outcomes. Although it has been seven years since the original review was published, the certainty of the evidence about hospital nurse staffing still remains very low.

Health behaviours of Australian men and the likelihood of attending a dedicated men's health service.

BACKGROUND: Redesigning primary health services may enhance timely and effective uptake by men. The primary aim of this study was to assess the likelihood of Australian men attending a dedicated men's health service (DMHS). The further aims were to better understand the reasons for their preferences and determine how health behaviours influence likelihood. METHODS: A survey on health service use and preferences, health help-seeking behaviours, and the likelihood of attending a DMHS was administered by telephone to 1506 randomly selected men (median age 56 years, range 19-95). Likelihood of attending a DMHS was rated using a single item Likert scale where 0 was not at all likely and 10 highly likely. Respondents were classified by age (< or > = 65 years) and health status. Principal component analyses were used to define health behaviours, specifically help-seeking and delay/avoidance regarding visiting a doctor. Multivariable linear and logistic regression analyses were used to examine predictors of likelihood of attending a DMHS. RESULTS: The mean likelihood of attending a DMHS was 5.8 (SD 3.3, median 6, moderate likelihood) and 21%, 26% and 23% of men rated likelihood as moderate, high and very high respectively. Being happy with their existing doctor was the most common reason (52%) for being less likely to attend a DMHS. In unadjusted analyses, younger men reported being more likely to attend a DMHS (p < 0.001) with older-sick men reporting being least likely (p < 0.001). Younger men were more likely than older men to score higher on delay/avoidance and were more likely to self-monitor. In the full model, men with current health concerns (p ≤ 0.01), who scored higher on delay/avoidance (p ≤ 0.0006), who were more likely to be information-seekers (p < 0.0001) and/or were motivated to change their health (p ≤ 0.0001) reported a higher likelihood of attending a DMHS irrespective of age and health status. CONCLUSIONS: Seventy percent of men reported a moderate or higher likelihood of attending a DMHS. As young healthy men are more likely than older men to display health behaviours that are associated with a higher likelihood of attending a DHMS, such as delay/avoidance, marketing a DMHS to such men may be of value.

Adaptation and validation into Portuguese language of the six-item cognitive impairment test (6CIT).

BACKGROUND: The six-item cognitive impairment test (6CIT) is a brief cognitive screening tool that can be administered to older people in 2-3 min. OBJECTIVE: To adapt the 6CIT for the European Portuguese and determine its psychometric properties based on a sample recruited from several contexts (nursing homes; universities for older people; day centres; primary health care units). METHOD: The original 6CIT was translated into Portuguese and the draft Portuguese version (6CIT-P) was back-translated and piloted. The accuracy of the 6CIT-P was assessed by comparison with the Portuguese Mini-Mental State Examination (MMSE). A convenience sample of 550 older people from various geographical locations in the north and centre of the country was used. RESULTS: The test-retest reliability coefficient was high (r = 0.95). The 6CIT-P also showed good internal consistency (α = 0.88) and corrected item-total correlations ranged between 0.32 and 0.90. Total 6CIT-P and MMSE scores were strongly correlated. The proposed 6CIT-P threshold for cognitive impairment is ≥10 in the Portuguese population, which gives sensitivity of 82.78% and specificity of 84.84%. The accuracy of 6CIT-P, as measured by area under the ROC curve, was 0.91. CONCLUSION: The 6CIT-P has high reliability and validity and is accurate when used to screen for cognitive impairment.

Knowledge translation in health care: a concept analysis.

BACKGROUND: Although knowledge translation is one of the most widely used concepts in health and medical literature, there is a sense of ambiguity and confusion over its definition. The aim of this paper is to clarify the characteristics of KT. This will assist the theoretical development of it and shape its implementation into the health care system Methods: Walker and Avant's framework was used to analyze the concept and the related literature published between 2000 and 2010 was reviewed. A total of 112 papers were analyzed. RESULTS: Review of the literature showed that "KT is a process" and "implementing refined knowledge into a participatory context through a set of challenging activities" are the characteristics of KT. Moreover, to occur successfully, KT needs some necessary antecedents like an integrated source of knowledge, a receptive context, and preparedness. The main consequence of successful process is a change in four fields of healthcare, i.e. quality of patient care, professional practice, health system, and community. In addition, this study revealed some empirical referents which are helpful to evaluate the process. CONCLUSION: By aiming to portray a clear picture of KT, we highlighted its attributes, antecedents, consequences and empirical referents. Identifying the characteristics of this concept may resolve the existing ambiguities in its definition and boundaries thereby facilitate distinction from similar concepts. In addition, these findings can be used as a knowledge infrastructure for developing the KT-related models, theories, or tools.

Local Level Economic Evaluation: What is it? What is its Value? Is it Sustainable?

In Australia, local health services with allocated budgets manage public hospital services for defined geographical areas. The authors were embedded in a local health service for around 2 years and undertook a range of local level economic evaluations for which three decision contexts were defined: intervention development, post-implementation and prioritisation. Despite difficulties in estimating opportunity costs and in the relevance of portfolio-based prioritisation approaches, economic evaluation added value to local decision-making. Development-focused (ex ante) economic evaluations used expert elicitation and calibration methods to synthesise published evidence with local health systems data to evaluate interventions to prevent hospital acquired complications. The use of economic evaluation facilitated the implementation of interventions with additional resource requirements. Decision analytic models were used alongside the implementation of larger scale, more complex service interventions to estimate counterfactual patient pathways, costs and outcomes, providing a transparent alternative to the statistical analyses of intervention effects, which were subject to high risk of bias. Economic evaluations of more established services had less impact due to data limitations and lesser executive interest. Prioritisation-focused economic evaluations compared costs, outcomes and processes of care for defined patient populations across alternative local health services to identify, understand and quantify the effects of unwarranted variation to inform priority areas for improvement within individual local health services. The sustained use of local level economic evaluation could be supported by embedding health economists in local continuous improvement units, perhaps with an initial focus on supporting the development and evaluation of prioritised new service interventions. Shared resources and critical mass are important, which could be facilitated through groups of embedded economists with joint appointments between different local health services and the same academic institution.

Barriers and facilitators to the implementation of the Flinders Chronic Condition Management Program in outpatient drug and alcohol settings in Australia.

INTRODUCTION: There has been a growing call for drug and/or alcohol dependence to be managed as a chronic condition. The Flinders Chronic Condition Management Program (Flinders Program) was implemented in a drug and alcohol service in Australia in 2019-2022 to explore the feasibility of chronic condition management in outpatient clinics. Implementation involved: adaptation of the Flinders Program; adaptation of clinical procedures; training clinicians and managers; training Flinders Program Accredited Trainers; and system integration. This study aims to explore barriers and enablers to implementation. METHODS: A qualitative formative evaluation was undertaken. Data included implementation documents (n = 7), responses to open-ended questions in post-training surveys (n = 27), and focus groups and interviews with implementation staff, clinicians, managers and a trainer (n = 16). Data were analysed using the Consolidated Framework for Implementation Research in a 'coding reliability' approach to thematic analysis. RESULTS: Participants responded positively to the Flinders Program's philosophy, processes, tools and training. However, barriers were identified across three Consolidated Framework for Implementation Research domains: (i) outer setting (client suitability and incompatibility with external policies and incentives); (ii) characteristics of individuals (low self-efficacy); and (iii) inner setting (lack of system and workflow integration). DISCUSSION AND CONCLUSIONS: Executive support and systems integration are important for the implementation of the Flinders Program in drug and alcohol services. This needs to be achieved within externally mandated key performance indicators for outpatient services. Further research is needed to fully evaluate the potential of a chronic condition management framework in Australian outpatient drug and alcohol services.

Barriers to Advance Care Planning in Older Adults With Dementia, Their Families and Healthcare Professionals: An Umbrella Review of Qualitative Evidence.

This umbrella review aimed to examine and synthesize qualitative studies that explored the barriers and facilitators of advance care planning for persons with dementia, their families, and their healthcare professionals and caregivers. The modified umbrella review approach developed by the Joanna Briggs Institute was followed. Five major English databases were searched. Four reviews based on 38 primary qualitative studies were included. The methodological quality of the included reviews was moderate to high. The synthesis yielded 16 descriptive themes and five analytical themes: making the wishes/preferences of persons with dementia visible; constructive collaboration based on stakeholders having positive relationships; emotional chaos in facing end-of-life substitute decision-making; initiating the advance care planning process; and preparedness and commitment of healthcare providers to advance care planning. Comprehensive and workable strategies are required to overcome complex and interrelated barriers involving not only healthcare professionals but also organizational and systemic challenges.

Patient experiences and outcomes in a South Australian stand-alone Hospital in the Home program.

ObjectivesThis study aimed to compare clinical outcomes for patients admitted to Hospital in the Home (HITH) and traditional (bricks-and-mortar) hospitals and explore patient and carer experiences.MethodsA mixed methods approach including triangulation of quantitative and qualitative data was used. Quantitative outcomes were compared using augmented inverse propensity weighting to adjust for differences in patient characteristics between groups. Qualitative data was collected by focus groups and interviews and analysed using reflexive thematic analysis. The study took place in metropolitan Adelaide and one adjacent regional health network in 2020-22. Participants were patients discharged from either hospital setting with 1 of 22 eligible diagnoses. Hospital administrative data informed a comparison of outcomes that included mortality, rate of emergency department re-presentations and re-admissions, length of stay and incidence of complications.ResultsPatients treated in HITH were less unwell than traditional hospital patients. There were no safety or quality concerns identified in the clinical outcomes. Of 2095 HITH patients, the in-patient mortality rate was 0.2%, and 2.3% experienced a return to a bricks-and-mortar hospital during the HITH admission. For HITH patients, the mortality rate after 30days was lower (-1.3%, 95% CI -2 to -0.5, P=0.002), as were re-presentations in 28days (-7.2%, 95% CI -9.5 to -5, P<0.0001), re-admissions in 28days (-4.9%, 95% CI -6.7 to -3.2, P<0.001) and complications (-0.6%, 95% CI -0.8 to -0.5, P<0.001). Interviews of 35 patients and six carers found that HITH was highly accepted and preferred by patients. HITH was perceived to free up resources for other, more acutely unwell patients.ConclusionsHITH was preferred by patients and at least as effective in delivering quality health care as a traditional hospital, although the potential for unobserved confounding must be acknowledged.

Patient characteristics of, and remedial interventions for, complaints and medico-legal claims against doctors: a rapid review of the literature.

BACKGROUND: It is uncertain if patient's characteristics are associated with complaints and claims against doctors. Additionally, evidence for the effectiveness of remedial interventions on rates of complaints and claims against doctors has not been synthesised. METHODS: We conducted a rapid review of recent literature to answer: Question 1 "What are the common characteristics and circumstances of patients who are most likely to complain or bring a claim about the care they have received from a doctor?" and Question 2 "What initiatives or interventions have been shown to be effective at reducing complaints and claims about the care patients have received from a doctor?". We used a systematic search (most recently in July 2023) of PubMed, Scopus, Web of Science and grey literature. Studies were screened against inclusion criteria and critically appraised in duplicate using standard tools. Results were summarised using narrative synthesis. RESULTS: From 8079 search results, we reviewed the full text of 250 studies. We included 25 studies: seven for Question 1 (6 comparative studies with controls and one systematic review) and 18 studies for Question 2 (14 uncontrolled pre-post studies, 2 comparative studies with controls and 2 systematic reviews). Most studies were set in hospitals across a mix of medical specialties. Other than for patients with mental health conditions (two studies), no other patient characteristics demonstrated either a strong or consistent effect on the rate of complaints or claims against their treating doctors. Risk management programs (6 studies), and communication and resolution programs (5 studies) were the most studied of 6 intervention types. Evidence for reducing complaints and medico-legal claims, costs or premiums and more timely management was apparent for both types of programs. Only 1 to 3 studies were included for peer programs, medical remediation, shared decision-making, simulation training and continuing professional development, with few generalisable results. CONCLUSION: Few patient characteristics can be reliably related to the likelihood of medico-legal complaints or claims. There is some evidence that interventions can reduce the number and costs of claims, the number of complaints, and the timeliness of claims. However, across both questions, the strength of the evidence is very weak and is based on only a few studies or study designs that are highly prone to bias.

Effectiveness of nurse-led interventions versus usual care to manage hypertension and lifestyle behaviour: a systematic review and meta-analysis.

AIMS: This review aimed to investigate the effectiveness of nurse-led interventions vs. usual care on hypertension management, lifestyle behaviour, and patients' knowledge of hypertension and associated risk factors. METHODS: A systematic review with meta-analysis was conducted following Joanna Briggs Institute (JBI) guidelines. MEDLINE (Ovid), EmCare (Ovid), CINAHL (EBSCO), Cochrane library, and ProQuest (Ovid) were searched from inception to 15 February 2022. Randomized controlled trials (RCTs) examining the effect of nurse-led interventions on hypertension management were identified. Title and abstract, full text screening, assessment of methodological quality, and data extraction were conducted by two independent reviewers using JBI tools. A statistical meta-analysis was conducted using STATA version 17.0. RESULTS: A total of 37 RCTs and 9731 participants were included. The overall pooled data demonstrated that nurse-led interventions may reduce systolic blood pressure (mean difference -4.66; 95% CI -6.69, -2.64; I2 = 83.32; 31 RCTs; low certainty evidence) and diastolic blood pressure (mean difference -1.91; 95% CI -3.06, -0.76; I2 = 79.35; 29 RCTs; low certainty evidence) compared with usual care. The duration of interventions contributed to the magnitude of blood pressure reduction. Nurse-led interventions had a positive impact on lifestyle behaviour and effectively modified diet and physical activity, but the effect on smoking and alcohol consumption was inconsistent. CONCLUSION: This review revealed the beneficial effects of nurse-led interventions in hypertension management compared with usual care. Integration of nurse-led interventions in routine hypertension treatment and prevention services could play an important role in alleviating the rising global burden of hypertension. REGISTRATION: PROSPERO: CRD42021274900.

The prevention and reduction of weight loss in an acute tertiary care setting: protocol for a pragmatic stepped wedge randomised cluster trial (the PRoWL project).

BACKGROUND: Malnutrition, with accompanying weight loss, is an unnecessary risk in hospitalised persons and often remains poorly recognised and managed. The study aims to evaluate a hospital-wide multifaceted intervention co-facilitated by clinical nurses and dietitians addressing the nutritional care of patients, particularly those at risk of malnutrition. Using the best available evidence on reducing and preventing unplanned weight loss, the intervention (introducing universal nutritional screening; the provision of oral nutritional supplements; and providing red trays and additional support for patients in need of feeding) will be introduced by local ward teams in a phased way in a large tertiary acute care hospital. METHODS/DESIGN: A pragmatic stepped wedge randomised cluster trial with repeated cross section design will be conducted. The unit of randomisation is the ward, with allocation by a random numbers table. Four groups of wards (n = 6 for three groups, n = 7 for one group) will be randomly allocated to each intervention time point over the trial. Two trained local facilitators (a nurse and dietitian for each group) will introduce the intervention. The primary outcome measure is change in patient's body weight, secondary patient outcomes are: length of stay, all-cause mortality, discharge destinations, readmission rates and ED presentations. Patient outcomes will be measured on one ward per group, with 20 patients measured per ward per time period by an unblinded researcher. Including baseline, measurements will be conducted at five time periods. Staff perspectives on the context of care will be measured with the Alberta Context Tool. DISCUSSION: Unplanned and unwanted weight loss in hospital is common. Despite the evidence and growing concern about hospital nutrition there are very few evaluations of system-wide nutritional implementation programs. This project will test the implementation of a nutritional intervention across one hospital system using a staged approach, which will allow sequential rolling out of facilitation and project support. This project is one of the first evidence implementation projects to use the stepped wedge design in acute care and we will therefore be testing the appropriateness of the stepped wedge design to evaluate such interventions. TRIAL REGISTRATION: ACTRN12611000020987.

'The way that we are collecting and using data has evolved' evaluating the Australian National Stroke Audit programme to inform strategic direction.

BACKGROUND: The National Stroke Audit has been used to audit and provide feedback to health professionals and stroke care services in Australia since 2007. The Australian Stroke Clinical Registry was piloted in 2009 and numbers of hospitals participating in the registry are increasing. Considering the changing data landscape in Australia, we designed this study to evaluate the stroke audit and to inform strategic direction. METHODS: We conducted a rapid review of published literature to map features of successful data programmes, followed by a mixed-methods study, comprising national surveys and interviews with clinicians and administrators about the stroke audit. We analysed quantitative data descriptively and analysed open-ended survey responses and interview data using qualitative content analysis. We integrated data from the two sources. RESULTS: We identified 47 Australian data programs, successful programs were usually funded by government sources or professional associations and typically provided twice yearly or yearly reports.106 survey participants, 14 clinician and 5 health administrator interview participants were included in the evaluation. The Stroke Audit was consistently perceived as useful for benchmarking, but there were mixed views about its value for local quality improvement. Time to enter data was the most frequently reported barrier to participation (88% of survey participants), due to the large number of datapoints and features of the audit software.Opportunities to improve the Stroke Audit included refining Audit questions, developing ways to automatically export data from electronic medical records and capturing accurate data for patients who transferred between hospitals. CONCLUSION: While the Stroke Audit was not perceived by all users to be beneficial for traditional quality improvement purposes, the ability to benchmark national stroke services and use these data in advocacy activities was a consistently reported benefit. Modifications were suggested to improve usability and usefulness for participating sites.