Gastrointestinal endoscopic practice during COVID-19 pandemic: a multi-institutional survey.

Introduction. An on-going coronavirus disease 2019 (COVID-19) has become a challenge all over the world. Since an endoscopy unit and its staff are at potentially high risk for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, we conducted a survey for the management of the gastrointestinal endoscopic practice, personal protective equipment (PPE), and risk assessment for COVID-19 during the pandemic at multiple facilities.Methods. The 11-item survey questionnaire was sent to representative respondent of Department of Gastroenterology, Osaka City University Hospital, and its 19 related facilities.Results. A total of 18 facilities submitted valid responses and a total of 373 health care professionals (HCPs) participated. All facilities (18/18: 100%) were screening patients at risk for SARS-CoV-2 infection before endoscopy. During the pandemic, we found that the total volume of endoscopic procedures decreased by 44%. Eleven facilities (11/18: 61%) followed recommendations of the Japan Gastroenterological Endoscopy Society (JGES); consequently, about 35%-50% of esophagogastroduodenoscopy and colonoscopy were canceled. Mask (surgical mask or N95 mask), face shield/goggle, gloves (one or two sets), and gown (with long or short sleeves) were being used by endoscopists, nurses, endoscopy technicians, and endoscope cleaning staff in all the facilities (18/18: 100%). SARS-CoV-2 infection risk assessment of HCPs was conducted daily in all the facilities (18/18: 100%), resulting in no subsequent SARS-CoV-2 infection in HCPs.Conclusion. COVID-19 has had a dramatic impact on the gastrointestinal endoscopic practice. The recommendations of the JGES were appropriate as preventive measures for the SARSCoV-2 infection in the endoscopy unit and its staff.

Effect of COVID-19 pandemic decisions on tertiary-level surgical services in Pietermaritzburg, KwaZulu-Natal Province, South Africa.

BACKGROUND: The COVID-19 pandemic has led to the implementation of restrictive policies on theatre procedures, with profound impacts on service delivery and theatre output. OBJECTIVES: To quantify these effects at a tertiary hospital in KwaZulu-Natal Province, South Africa. METHODS: A retrospective review of morbidity and mortality data was conducted. The effects on emergency and elective caseload, intensive care unit (ICU) admissions from theatre, theatre cancellations and regional techniques were noted. RESULTS: Theatre caseload decreased by 30% from January to April 2020 (p=0.02), ICU admissions remained constant, and theatre cancellations were proportionally reduced, as were the absolute number of regional techniques. CONCLUSIONS: The resulting theatre case deficit was 1 260 cases. It will take 315 days to clear this deficit if four additional surgeries are performed per day.

Safe performance of diagnostic bronchoscopy/EBUS during the SARS-CoV-2 pandemic.

The SARS-CoV-2 pandemic is unprecedented in our professional lives and much effort and resources will be devoted to care of patients (and HCW) affected by this illness. We must also continue to aim for the same standard of care for our non-COVID respiratory patients, while minimizing risks of infection transmission to our colleagues. This commentary addresses the key paired issues of minimizing performance of diagnostic/staging bronchoscopy in patients with suspected/known lung cancer while maximizing the safety of the procedure with respect to HCW transmission of COVID-19.

[What regulations have launched autonomous communities to going forward on patient safety culture in healthcare organizations?] / ¿Qué normativas han desarrollado las comunidades autónomas para avanzar en cultura de seguridad del paciente en sus organizaciones sanitarias?

INTRODUCTION: Patient Safety Culture is based on learning from incidents, developing preventive strategies to reduce the likelihood to happen and recognizing and accompanying those who have suffered unnecessary and involuntary harm derived from the health care received. To go ahead on patient safety culture entails facilitating the implementation of these behaviors and attitudes in healthcare professionals. Objective was to describe the regulations of some autonomous communities and national proposals for regulations changes. MATERIAL AND METHODS: Search of normative changes made in the autonomous communities of Catalonia, Navarra and the Basque Country. Proposals for legislative changes at national level were agreed. RESULTS: Activities and normative changes made in the autonomous communities of Catalonia, Navarre and the Basque Country are described and proposals for normative changes at the national level at short-term and long-term changes are made. In such a way that it is easier to advance in creating culture of patient safety in the whole National Health System CONCLUSION: Currently there is no global regulation that facilitates to advance in patient safety culture. Changes at the national legislation level are essential. It is at the Inter-territorial Council where the proposed legislative amendment should be defined, promoted by the representatives of the health systems of the autonomous communities.

Implementing Patient Safety Initiatives.

Implementing change is difficult; few people want to wade into this area because of the challenge. However, it is highly rewarding and does not have to be complicated. Success requires a clear understanding of health care context, patient safety, and behavioral psychology. To achieve its goal, this article is divided into 3 parts: (1) the problem with engagement in health care, (2) patient safety in a new age, and (3) implementation.

Assessment of safety culture in a public hospital in the Federal District, Brazil / Evaluación de la cultura de seguridad en un hospital público en el Distrito Federal, Brasil / Avaliação da cultura de segurança em um hospital público no Distrito Federal, Brasil

ABSTRACT Objective: to assess the perception of health professionals regarding safety culture of a high complexity public hospital of the Federal District, Brazil. Method: cross-sectional and descriptive study. The Safety Attitudes Questionnaire was used in electronic format. Descriptive and inferential analyses were carried out. Results: 358 professionals participated, with 242 (67.6%) being female. Of these, 224 (62.6%) worked directly or indirectly with patients in assistance activities; 79 (22.1%) in administrative activities; 14 (3.9%) in management; and 41 (11.5%) in others. The total score was 57.1. Job satisfaction factors and stress perception had the most expressive results, 76.2 and 68.8, respectively. The category "working conditions" presented the lowest result, 40.7. Conclusion: the results are below the score of 75, value recommended as indicative of a positive safety atmosphere. We suggest the implementation of actions for the promotion of safety culture and new studies with representative samples of all segments of workers.

RESUMEN Objetivo: evaluar la percepción de los profesionales de salud sobre la cultura de seguridad de un hospital público de alta complejidad del Distrito Federal, Brasil. Método: estudio transversal y descriptivo. Se utilizó el Cuestionario Actitudes de Seguridad en el formato electrónico. Se realizaron análisis descriptivos e inferenciales. Resultados: participaron 358 profesionales, siendo 242 (67,6%) mujeres. De estos, 224 (62,6%) trabajaban directa o indirectamente con el paciente en actividades asistenciales; 79 (22,1%) en administrativas; 14 (3,9%) en gerenciales; y 41 (11,5%) en otras. La puntuación total fue de 57,1; los factores de satisfacción en el trabajo y percepción del estrés tuvieron los resultados más expresivos, 76,2 y 68,8, respectivamente. La categoría de las condiciones de trabajo tuvo el resultado más bajo, 40,7. Conclusión: los resultados están por debajo de la puntuación 75, valor recomendado como indicativo de un clima de seguridad positivo. Se sugiere la implementación de acciones para la promoción de la cultura de seguridad y nuevos estudios con muestra representativa de todos los segmentos de trabajadores.

RESUMO Objetivo: avaliar a percepção dos profissionais de saúde sobre a cultura de segurança de um hospital público de alta complexidade do Distrito Federal, Brasil. Método: estudo transversal e descritivo. Utilizou-se o Questionário Atitudes de Segurança no formato eletrônico. Foram realizadas análises descritivas e inferenciais. Resultados: participaram 358 profissionais, sendo 242 (67,6%) do sexo feminino. Destes, 224 (62,6%) trabalhavam direta ou indiretamente com o paciente em atividades assistenciais; 79 (22,1%) em administrativas; 14 (3,9%) em gerenciais; e 41 (11,5%) em outras. O escore total foi de 57,1; os fatores satisfação no trabalho e percepção do estresse tiveram os resultados mais expressivos, 76,2 e 68,8, respectivamente. O quesito condições de trabalho teve o resultado mais baixo, 40,7. Conclusão: os resultados estão abaixo do escore 75, valor recomendado como indicativo de um clima de segurança positivo. Sugere-se a implementação de ações para a promoção da cultura de segurança e novos estudos com amostra representativa de todos os segmentos de trabalhadores.

Patient safety culture in the Primary Health Care / Cultura de seguridad del paciente en la Atención Primaria de Salud / Cultura de segurança do paciente na Atenção Primária à Saúde

ABSTRACT Objective: To evaluate thepatient safety culturein thePrimary Health Care (PHC). Method: A cross-sectional study with 349 health professionals and PHC managers from a city of Rio Grande do Sul, Brazil. The tool used was Safety Attitudes Questionnaire Ambulatory Version. Data-independent double typing and descriptive and inferential statistical analysis were performed. Results: The total score varied between 3.4 and 8.4 with mean (7.0 ± 1.3), positive evaluation in the "Patient Safety" domain (8.2 ± 2.0). Working on the Family Health Strategy and having five to 12 years of work was significant for positive culture. The recommendations to improve the safety culture were: Implementation of protocols, training, communication improvement and resolvability. Conclusion: The patient safety culture prevailed. Establishing a constructive safety culture with safe behaviors represents factors for improving patient safety in Primary Care settings.

RESUMEN Objetivo: Evaluar la cultura de seguridad del paciente en la Atención Primaria de Salud (APS). Método: Estudio transversal, con 349 profesionales de la salud y gestores de la APS de un municipio de Rio Grande do Sul, Brasil. El instrumento utilizado fue Safety Attitudes Questionnaire Ambulatory Version. Se realizó doble digitación independiente de los datos y el análisis estadístico descriptivo e inferencial. Resultados: La puntuación total varía entre 3,4 y 8,4 con media (7,0 ± 1,3), evaluación positiva en el dominio "Seguridad del Paciente" (8,2 ± 2,0). Trabajar en la Estrategia de Salud de la Familia y tener de cinco a doce años de trabajo fue significativo para la cultura positiva. Las recomendaciones para mejorar la cultura de seguridad fueron: Implantación de protocolos, capacitaciones, mejora de la comunicación y resolutividad. Conclusión: Prevalece la evaluación negativa de la cultura de seguridad del paciente. Establecer una cultura de seguridad constructiva, con comportamientos seguros, representa factores para mejorar la seguridad del paciente en ambientes de atención primaria.

RESUMO Objetivo: Avaliar a cultura de segurança do paciente na Atenção Primária à Saúde (APS). Método: Estudo transversal, com 349 profissionais da saúde e gestores da APS de um município do Rio Grande do Sul, Brasil. O instrumento utilizado foi Safety Attitudes Questionnaire Ambulatory Version. Realizou-se dupla digitação independente dos dados e a análise estatística descritiva e inferencial. Resultados: O escore total variou entre 3,4 e 8,4 com média (7,0±1,3), avaliação positiva no domínio "Segurança do Paciente" (8,2±2,0). Trabalhar na Estratégia de Saúde da Família e ter de cinco a 12 anos de trabalho foi significativo para cultura positiva. As recomendações para melhorar a cultura de segurança foram: Implantação de protocolos, capacitações, melhoria da comunicação e resolutividade. Conclusão: Prevaleceu a avaliação negativa da cultura de segurança do paciente. Estabelecer uma cultura de segurança construtiva, com comportamentos seguros representa fatores para aprimorar a segurança do paciente em ambientes de cuidados primários.

Principles of Pediatric Patient Safety: Reducing Harm Due to Medical Care.

Pediatricians render care in an increasingly complex environment, which results in multiple opportunities to cause unintended harm. National awareness of patient safety risks has grown since the National Academy of Medicine (formerly the Institute of Medicine) published its report "To Err Is Human: Building a Safer Health System" in 1999. Patients and society as a whole continue to challenge health care providers to examine their practices and implement safety solutions. The depth and breadth of harm incurred by the practice of medicine is still being defined as reports continue to reveal a variety of avoidable errors, from those that involve specific high-risk medications to those that are more generalizable, such as patient misidentification and diagnostic error. Pediatric health care providers in all practice environments benefit from having a working knowledge of patient safety language. Pediatric providers should serve as advocates for best practices and policies with the goal of attending to risks that are unique to children, identifying and supporting a culture of safety, and leading efforts to eliminate avoidable harm in any setting in which medical care is rendered to children. In this Policy Statement, we provide an update to the 2011 Policy Statement "Principles of Pediatric Patient Safety: Reducing Harm Due to Medical Care."

[Safety Culture in Orthopaedic Surgery and Trauma Surgery - Where Are We Today?] / Sicherheitskultur in Orthopädie und Unfallchirurgie ­ wo stehen wir heute?

INTRODUCTION: The development of a new safety culture in orthopaedics and trauma surgery needs to be based on the knowledge of the status quo. The objective of this research was therefore to perform a survey of orthopaedic and trauma surgeons to achieve a subjective assessment of the frequency and causes of "insecurities" or errors in daily practice. METHODS: Based on current literature, an online questionnaire was created by a team of experts (26 questions total) and was sent via e-mail to all active members of a medical society (DGOU) in April 2015. This was followed by two reminder e-mails. The survey was completed in May 2015. The results were transmitted electronically, anonymously and voluntarily into a database and evaluated by univariate analyses. RESULTS: 799 active members took part in the survey. 65% of the interviewed people stated that they noticed mistakes in their own clinical work environment at least once a week. The main reasons for these mistakes were "time pressure", "lack of communication", "lack of staff" and "stress". Technical mistakes or lack of knowledge were not of primary importance. CONCLUSIONS: The survey indicated that errors in orthopaedics and trauma surgery are observed regularly. "Human factors" were regarded as a major cause. In order to develop a new safety culture in orthopaedics and trauma surgery, new approaches must focus on the human factor.

Prevalence of Needlestick Injuries, Attitude Changes, and Prevention Practices Over 12 Years in an Urban Academic Hospital Surgery Department.

OBJECTIVE: Needlestick injury prevalence, protection practices, and attitudes were assessed. Current medical students were compared with 2003 data to assess any changes that occurred with engineered safety feature implementation. BACKGROUND: Risk of occupational exposure to bloodborne pathogens is elevated in the operating room particularly with surgeons in training and nurses. METHODS: A cross-sectional survey was distributed to medical students (n = 358) and Department of Surgery staff (n = 247). RESULTS: The survey response rate was 24.8%. Needlestick injuries were reported by 38.7% of respondents (11% high risk), and the most common cause was "careless/accidental." Needlestick injury prevalence increased from medical students to residents and fellows (100%). Thirty-three percent of injured personnel had at least one unreported injury, and the most common reason was "inconvenient/too time consuming." Needlestick injury prevalence and double-glove use in medical students did not differ from 2003, and 25% of fellows reported always wearing double gloves. The true seroconversion rate for bloodborne pathogens was underestimated or unknown. The concern for contracting a bloodborne pathogen significantly decreased (65%) compared to 2003, and there were significantly less medical students with hepatitis B vaccinations (78.3%). Level of concern for contracting a bloodborne pathogen was predictive of needlestick injury. CONCLUSIONS: Needlestick injury and occupational exposure to bloodborne pathogens are significant hazards for surgeons and nurses. Attitudes regarding risk are changing, and the true seroconversion risk is underestimated. Educational efforts focused on needlestick injury prevalence, seroconversion rates, and double-glove perforation rates may be effective in implementing protective strategies.

Advances in Mexico in the middle of the decade of action for road safety 2011-2020 / Avances en México a la mitad del decenio de acción para la seguridad vial 2011-2020

ABSTRACT OBJECTIVE To analyze the progress towards the accomplishment of the expected goal in the middle of the Decade of Action for Road Safety 2011-2020 in Mexico and its states. METHODS This is a secondary analysis of road traffic deaths in Mexico between 1999 and 2015. We projected the trend for the period 2011-2020 using a time series analysis (autoregressive integrated moving average models). We used the value of the Aikaike Information Criterion to determine the best model for the national level and its 32 states. RESULTS Mexico is progressing, approaching the proposed goal, which translates into 10,856 potentially prevented deaths in the five-year period from 2011 to 2015. This was due to a decrease in the number of deaths of motor vehicle occupants, as the deaths of pedestrians and motorcyclists were higher than expected. At least one third of the states had values below their goal; although the mortality rate remains unacceptably high in five of them. We identified four states with more deaths than those originally projected and other states with an increasing trend; thus, both cases need to strengthen their prevention actions. CONCLUSIONS The analysis can allow us to see the progress of the country in the middle of the Decade of Action, as well as identify the challenges in the prevention of traffic injuries in vulnerable users. It contributes with elements that provide a basis for a need to rethink both the national goal and the goal of the different states.

RESUMEN OBJETIVO Analizar el avance de la meta esperada a mitad del Decenio de Acción para la Seguridad Vial 2011-2020 en México y sus entidades federativas. MÉTODOS Análisis secundario de las muertes por accidentes de tránsito en México para el 1999-2015. Se proyectó la tendencia para el periodo 2011-2020 utilizando análisis de series de tiempo (modelos autorregresivos integrados de medias móviles). Se utilizó el valor del Criterio de Información de Aikaike para determinar el mejor modelo para el nivel nacional y sus 32 entidades federativas. RESULTADOS México va avanzando cercano a la meta propuesta, lo que se ha traducido en 10,856 defunciones potencialmente prevenidas en el quinquenio 2011 a 2015. Esto ha sido a expensas de una disminución en el número de muertes de ocupantes de vehículos de motor; ya que las muertes en peatones y motociclistas han ido por arriba de lo que se esperaba. Al menos una tercera parte de las entidades federativas tuvo el número de defunciones por debajo de su meta; aunque en cinco de ellas la tasa de mortalidad continúa inaceptablemente alta. Se identificaron cuatro entidades con más muertes que las proyectadas originalmente y otras con tendencia al incremento donde se requiere, para ambos casos, fortalecer las acciones de prevención. CONCLUSIONES El análisis realizado permite observar los avances del país a mitad del Decenio de Acción, así como identificar los retos en materia de prevención de lesiones causadas por el tránsito en usuarios vulnerables. Aporta elementos para soportar la necesidad de replantear tanto la meta nacional como la de las distintas entidades federativas.

Improvements in Radiation Monitoring Trending.

One of the main goals for Radiation Safety Professionals is to help maintain radiation worker doses below administrative control levels. In the radiation safety field there is an increasing recognition of the value of dosimetry-related data that can be used to enhance safety programs and regulatory compliance. Mining radiation dosimetry data and rendering results in the form of dashboards provides insights for the Radiation Safety Professionals that could help improve the radiological protection programs effectiveness, enhances quality, and reduces cost. Quite often the professionals spend more time assembling data than analyzing for trends and acting to improve the radiation safety program. Data analysis tools were developed allowing the radiation safety professionals to perform surveillance on key parameters in the dosimetry program that can help identifying risks and insure early intervention. More than 2,200 institutions chosen from different industries were surveyed for more than 2 years after the implementation of this tool. Four indicators: dose per participant, collective dose, dosimeter return compliance, and number of workers exceeding ALARA levels were chosen as meaningful parameters in characterizing the health of the program. These parameters were tracked, analyzed, and compared to benchmarks developed based on more than 1 million monitored workers.

Analysis of Incident and Accident Reports and Risk Management in Spine Surgery.

STUDY DESIGN: A review of accident and incident reports. OBJECTIVE: To analyze prevalence, characteristics, and details of perioperative incidents and accidents in patients receiving spine surgery. SUMMARY OF BACKGROUND DATA: In our institution, a clinical error that potentially results in an adverse event is usually submitted as an incident or accident report through a web database, to ensure anonymous and blame-free reporting. All reports are analyzed by a medical safety management group. These reports contain valuable data for management of medical safety, but there have been no studies evaluating such data for spine surgery. METHODS: A total of 320 incidents and accidents that occurred perioperatively in 172 of 415 spine surgeries were included in the study. Incidents were defined as events that were "problematic, but with no damage to the patient," and accidents as events "with damage to the patient." The details of these events were analyzed. RESULTS: There were 278 incidents in 137 surgeries and 42 accidents in 35 surgeries, giving prevalence of 33% (137/415) and 8% (35/415), respectively. The proportion of accidents among all events was significantly higher for doctors than non-doctors [68.0% (17/25) vs. 8.5% (25/295), P < 0.01] and in the operating room compared with outside the operating room [40.5% (15/37) vs. 9.5% (27/283), P < 0.01]. There was no significant difference in years of experience among personnel involved in all events. The major types of events were medication-related, line and tube problems, and falls and slips. Accidents also occurred because of a long-term prone position, with complications such as laryngeal edema, ulnar nerve palsy, and tooth damage. CONCLUSION: Surgery and procedures in the operating room always have a risk of complications. Therefore, a particular effort is needed to establish safe management of this environment and to provide advice on risk to the doctor and medical care team. LEVEL OF EVIDENCE: 4.

From sanctioning culture to safety culture: Let's stop making errors on error.

The punitive culture continues to prevail in health care organizations that rely primarily on functional systems hierarchies based on conformity. This type of culture is recognized as a major source of an unacceptable number of medical errors. The safety culture has emerged as an imperative to improve the quality and safety of patient care, but also as a shield against the judgments targeted towards the caregivers (doctor and / or nurse) involved in an undesirable event. The safety culture allows a broader view of the error by analyzing both system failures and staff incompetence. Therefore, it places caregivers in their workplace with mutual interactions and protects them from "second victim" status. It is imperative to have a reflection on the safety culture that constitutes a proof of transparency and openness towards society about the mistake that remains taboo. This attitude will avoid the risk of "judicialization of health".

Challenging the cost of clinical negligence.

Healthcare professionals in South Africa (SA) are facing challenging times. As the clinical negligence claims environment in SA deteriorates, the impact is being felt by healthcare professionals, but also by the wider public owing to the strain that costs place on the public purse. The authors look at the current claims environment, and explain why a debate about reform is so important.

[Patient safety: a topic of the future, the future of the topic]. / Patientensicherheit : Ein Thema mit Zukunft, die Zukunft des Themas.

Almost 10 years ago, the German Coalition for Patient Safety (Aktionsbündnis Patientensicherheit) was founded as a cooperation covering most institutions of the German health care system. As in other countries facing the issue of patient safety, methods for the analysis of "never events" have been developed, instruments for the identification of the "unknown unknowns" have been established (e.g., CIRS), and the paradigm of individual blame has been replaced by organizational, team and management factors. After these first steps, further developments can only be achieved in so far as patient safety is understood as a system property, which leads to specific implications for the further evolution of the healthccare system. The "patient safety movement" has to participate in this discussion in order to avoid misuse of the patient safety concept as a defensive means, merely confined to overcome the adverse events of payment and structural incentives (e.g., diagnosis related groups in the inpatient sector). Because the dominant requirements for the future healthcare system consist of care for an elderly population with chronic and multiple diseases, the focus has to be shifted away from acute and surgical procedures and diseases, as given in the present quality assurance programs in Germany, to prevention and coordination of chronic care. Efforts to improve drug and medication safety of elderly people can be regarded as perfect examples, but other efforts are still missing. Second, the structural problems as the sector-associated optimization of care should be addressed, because typical safety issues are not limited to single sectors but represent problems of missing integration and suboptimal population care (e.g., MRSA). In the third line, the perspectives of society and institutions on safety (and quality of care) must urgently be enlarged to the perspectives of patients on the one hand and the benefit of treatments (e.g., overuse) on the other hand. All these issues are only to be implemented as far as the general societal attitude supportings further improvement of patient safety and is ready to regard it as a major aim for future developments. Cost arguments alone - costs of suboptimal safety can be estimated to around 1 billion in Germany per year - are considered as insufficient to guarantee further improvements because other issues in the healthcare system show similar magnitudes. As a consequence, ethical implications remain as major arguments for ongoing professional and public discussions.