Understanding experiences of cancer-related fatigue in patients with lung cancer after their cancer treatment: a qualitative content analysis.

PURPOSE: Cancer-related fatigue (CRF) is an important symptom affecting the quality of life of patients with lung cancer. However, research on the characteristics of CRF in lung cancer and their relationship to cancer treatment is limited. We aimed to explore the unique features of CRF in patients with lung cancer, and investigate the influencing factors. METHODS: Semi-structured interviews were conducted with 21 adult patients with lung cancer until data saturation was reached. The collected data were analyzed using qualitative content analysis. An inductive coding process and deductive content analysis incorporating the established CRF domains were employed. Patient data from electronic medical records were used for data triangulation. RESULTS: The analysis revealed five themes of CRF: (1) energy depletion, the double burden of illness and treatment, and daily life impediments; (2) feeling down and anxious; (3) neurovascular disturbances and changes in sensory perception; (4) cognitive impairment; and (5) personal and social isolation. CRF tended to improve over time, except for persistent emotional fatigue beyond 6 months. Patients who underwent surgery followed by adjuvant cancer treatment exhibited the most diverse CRF symptoms. The concurrent chemoradiation therapy group experienced significant physical fatigue, whereas the radiosurgery group reported distinct emotional fatigue. Certain factors, such as exercise, can serve as both alleviating and aggravating factors for CRF. CONCLUSION: Tailored interventions that take into account the multidimensional symptoms of CRF and patient characteristics are crucial. These findings will guide healthcare professionals when implementing patient-centered symptom management and patient education.

Can patient and family education prevent medical errors? A descriptive study.

BACKGROUND: This study aims to increase understanding of how patient and family education affects the prevention of medical errors, thereby providing basic data for developing educational contents. METHODS: This descriptive study surveyed patients, families, and Patient Safety Officers to investigate the relationship between educational contents and medical error prevention. The Chi-square test and ANOVA were used to derive the results of this study. The educational contents used in this study consisted of health information (1. current medicines, 2. allergies, 3. health history, 4. previous treatments/tests and complications associated with them) and Speak Up (1. handwashing, 2. patient identification, 3. asking about medical conditions, 4. asking about test results, 5. asking about behaviour and changes in lifestyle, 6. asking about the care plan, 7. asking about medicines, and 8. asking about medicine interactions). RESULTS: In this study, the first criterion for choosing a hospital for treatment in Korea was 'Hospital with a famous doctor' (58.6% patient; 57.7% families). Of the patients and their families surveyed, 82.2% responded that hospitals in Korea were safe. The most common education in hospitals is 'Describe your medical condition', given to 69.0% of patients, and 'Hospitalisation orientation', given to 63.4% of families. The most important factors in preventing patient safety events were statistically significant differences among patients, family members, and Patient Safety Officers (p = 0.001). Patients and families had the highest 'Patient and family participation' (31.0% of patients; 39.4% of families) and Patient Safety Officers had the highest 'Patient safety culture' (47.8%). CONCLUSIONS: Participants thought that educational contents developed through this study could prevent medical errors. The results of this study are expected to provide basic data for national patient safety campaigns and standardised educational content development to prevent medical errors.

Variation between hospitals and reviewers in detection of adverse events identified through medical record review in Korea.

OBJECTIVES: This study utilized the method of medical record review to determine characteristics of adverse events that occurred in the inpatient units of hospitals in Korea as well as the variations in adverse events between institutions. DESIGN: A two-stage retrospective medical record review was conducted. The first stage was a nurse review, where two nurses reviewed medical records of discharged patients to determine if screening criteria had been met. In the second stage, two physicians independently reviewed medical records of patients identified in the first stage, to determine whether an adverse event had occurred. SETTING: Inpatient units of six hospitals. PARTICIPANTS: Medical records of 2 596 patients randomly selected were reviewed in the first stage review. INTERVENTION(S): N/A. MAIN OUTCOME MEASURE(S): Adverse events. RESULTS: A total of 277 patients (10.7%) were confirmed to have had one or more adverse event(s), and a total of 336 adverse events were identified. Physician reviewers agreed about whether an adverse event had occurred for 141 patients (5.4%). The incidence rate of adverse events was at least 1.3% and a maximum of 19.4% for each hospital. Most preventability scores were less than four points (non-preventable), and there were large variations between reviewers and institutions. CONCLUSIONS: Given the level of variation in the identified adverse events, further studies that include more medical institutions in their investigations are needed, and a third-party committee should be involved to address the reliability issues regarding the occurrence and characteristics of the adverse events.

Relationships between the National Early Warning Score 2, clinical worry and patient outcome at discharge: Retrospective observational study.

AIMS AND OBJECTIVES: To examine the performance of the National Early Warning Score 2 and composite score for clinical worry in identifying patients at risk of clinical deterioration, and to determine relationships between National Early Warning Score 2, clinical worry score and patient outcome at discharge. BACKGROUND: The efficacy of early warning systems depends on patient population and care settings. Based on a theoretical framework on factors affecting clinical deterioration and patient outcomes, studies exploring the relationship between early warning systems and patient outcomes at discharge are sparse. DESIGN: Retrospective observational study. METHODS: A random sample of 732 medical records were reviewed. The area under the receiver operating characteristic curve was calculated to evaluate predictive abilities regarding the events of unanticipated in-hospital mortality, unplanned intensive care unit/ higher dependency bed admission and cardiac arrest. Multiple logistic regression analyses were performed to determine relationships between National Early Warning Score 2, clinical worry score and patient outcome. Reporting followed the STROBE checklist. RESULTS: National Early Warning Score 2 and clinical worry score significantly predicted the events within 24 hr of the assessment. After controlling for other patient, treatment and organisational characteristics, National Early Warning Score 2 was a significant factor associated with patient outcome, but clinical worry score was not. Specifically, patients at high risk based on National Early Warning Score 2 were less likely to have improved outcome. CONCLUSIONS: National Early Warning Score 2 and clinical worry score performed well for predicting deteriorating condition of patients. National Early Warning Score 2 was significantly associated with patient outcome. It can be used for efficient patient management for safe, quality care. RELEVANCE TO CLINICAL PRACTICE: National Early Warning Score 2 can be used for early assessment of not only clinical deterioration but also patient outcome and provide timely intervention, when coupled with clinical worry score.

Psychometric properties of transitional care instruments and their relationships with health literacy: Brief PREPARED and Care Transitions Measure.

OBJECTIVE: To assess the psychometric properties of the Brief PREPARED (B-PREPARED) and the Care Transitions Measure (CTM) in patients discharged from hospitals in Korea, and examine their relationships with health literacy. DESIGN: A cross-sectional study with a follow-up telephone survey 4 weeks post-discharge. SETTING: Six medical and surgical wards in a tertiary hospital in Seoul. PARTICIPANTS: 293 patients discharged from general wards. MAIN OUTCOME MEASURES: Psychometric properties of the Korean versions of the B-PREPARED and the 15- and 3-item CTM (CTM-15 and CTM-3), and the 3-item Brief Screening Questionnaire for health literacy. RESULTS: All instruments discriminated well between patients who were satisfied with hospital care and the discharge process, and those who were not. One month post-discharge, the CTM-15 score was significantly higher in patients with good health status than the others, and the CTM-3 score was significantly higher in patients who used outpatient care than the others. However, no significant difference was found in the scores for all instruments by emergency department visits, rehospitalization, and medication adherence. Cronbach's alpha values were 0.69 for B-PREPARED, 0.91 for CTM-15 and 0.67 for CTM-3. Intraclass correlation coefficients were 0.64, 0.75 and 0.66, respectively. Approximately 33% of the participants had limited health literacy. After adjusting for other patient variables, those with inadequate health literacy had lower scores on all instruments. CONCLUSIONS: Although the three instruments had acceptable validity and reliability, they showed limited criterion validity. Patients with limited health literacy should be supported to ensure the quality of transitional care.

Cancer site differences in the health-related quality of life of Korean cancer survivors: Results from a Population-based Survey.

OBJECTIVES: We investigated cancer site differences in the health-related quality of life (HRQOL) of cancer survivors. DESIGN AND SAMPLE: A secondary data analysis was conducted using the sixth Korea National Health and Nutrition Examination Survey (2013-2015). Participants were 15,461 adults (664 cancer survivors) with available EuroQol-5 Dimensions (EQ5D) information. MEASUREMENTS: Constructs from the revised Wilson and Cleary's model were examined. HRQOL status was measured using the EQ5D. EQ5D dimensional problems and indices were compared across cancer sites using multiple linear and quantile regression analyses. RESULTS: The most common problems across cancer sites were pain/discomfort and mobility. There were differences in EQ5D dimensional problems by cancer site: problems of usual activities in the cervix-cancer group and anxiety/depression in the thyroid cancer group were prevalent. Those with cervix cancer (vs. stomach) had higher EQ5D index scores; however, no significant differences were observed between other site subgroups. Subjective health perception and socioeconomic factors were significant determinants affecting HRQOL among cancer survivors with low EQ5D index scores. CONCLUSIONS: Subjective health status and socioeconomic characteristics are predicted to have a greater impact on survivors with low (vs. high) HRQOL. Socioeconomic and psychological support is essential to increase cancer survivors' HRQOL, regardless of cancer site.

Venous Thromboembolism Following Hip and Knee Replacement Arthroplasty in Korea: A Nationwide Study Based on Claims Registry.

The aim of this study was to examine the incidence and trends of clinically relevant venous thromboembolism (VTE) including deep vein thrombosis (DVT) and pulmonary embolism (PE) after hip and knee replacement arthroplasty (HKRA) in Korea. Between January 1 and December 31, 2010, 22,127 hip replacement arthroplasty (HRA) patients and 52,882 knee replacement arthroplasty (KRA) patients were enrolled in the analysis using the administrative claims database of the Health Insurance Review and Assessment Service (HIRA). All available parameters including procedure history and clinically relevant VTE during the 90 days after HKRA were identified based on diagnostic and electronic data interchange (EDI) codes. The overall incidence of VTE, DVT, and PE during the 90 days was 3.9% (n=853), 2.7% (n=597), and 1.5% (n=327) after HRA, while the incidence was 3.8% (n=1,990), 3.2% (n=1,699), and 0.7% (n=355) after KRA. The incidence of VTE after HKRA was significantly higher in patients who had previous VTE history (odds ratio [OR], 10.8 after HRA, OR, 8.5 after KRA), chronic heart failure (2.1, 1.3), arrhythmia (1.8, 1.7), and atrial fibrillation (3.4, 2.1) than in patients who did not. The VTE incidence in patients with chemoprophylaxis was higher than that in patients without chemoprophylaxis. The incidence of VTEs revealed in this retrospective review was not low compared with the results of the studies targeting other Asian or Caucasian populations. It may warrant routine prevention including employment of chemoprophylaxis. However, the limitation of the reviewed data mandates large scale prospective investigation to affirm this observation.

Patient safety competence for final-year health professional students: Perceptions of effectiveness of an interprofessional education course.

As final-year medical and nursing students will soon play key roles in frontline patient care, their preparedness for safe, reliable care provision is of special importance. We assessed patient safety competencies of final-year health profession students, and the effect of a 1-day patient safety education programme on these competencies. A cross-sectional survey was conducted with 233 students in three colleges of medicine, nursing, and traditional medicine in Seoul. A before-and-after study followed to evaluate the effectiveness of the curriculum. Patient safety competency was measured using the Health-Professional Education for Patients Safety Survey (H-PEPSS) and an objective patient safety knowledge test. The mean scores were 3.4 and 1.7 out of 5.0, respectively. The communication domain was rated the highest and the teamwork domain was rated the lowest. H-PEPSS scores significantly differed between the students from three colleges. The 1-day patient safety education curriculum significantly improved H-PEPSS and knowledge test scores. These results indicated that strengthening patient safety competencies, especially teamwork, of students is required in undergraduate healthcare curricula. A 1-day interprofessional patient safety education programme may be a promising strategy. The findings suggest that interprofessional patient safety education needs to be implemented as a core undergraduate course to improve students' safety competence.

What are hospital nurses' strengths and weaknesses in patient safety competence? Findings from three Korean hospitals.

OBJECTIVE: To examine hospital nurses' patient safety competencies and the association between these competencies and safety climate. DESIGN: Cross-sectional questionnaire survey. SETTING: Three teaching hospitals in Seoul, Korea. PARTICIPANTS: In total, 459 nurses from general adult nursing care units, intensive care units or operating rooms (response rate = 87.4%). METHOD: Self-administered questionnaires were distributed to measure patient safety competency. Multiple regression analyses were performed to examine relationships between patient safety competency and safety climate. MAIN OUTCOME MEASURE S: Patient safety competency scores ('teamwork', 'communication', 'managing safety risks', 'human and environmental factors', 'adverse event recognition' and 'safety culture' dimensions) and perceived safety climate. RESULTS: The mean patient safety competency score was 3.3 (SD = 0.4) out of 5.0; 396 nurses (86.3%) rated their competency as above average. Among subscales, 'managing safety risks' scores were the highest, and 'teamwork' scores were the lowest. Patient safety competency differed significantly by participants' age, educational level, clinical experience and position. Patient safety competency was higher in older nurses with master's or higher degrees and clinical experience of longer duration. Nurse managers' scores were higher than those of staff nurses. Safety climate was perceived as moderate. After adjusting for other individual and organizational characteristics, patient safety competency was positively associated with safety climate perception. CONCLUSIONS: Nurses' safety competency was rated as moderate. In particular, nurses lacked confidence in teamwork. Nurses with higher safety competency perceived safety climate more positively. Efforts emphasizing teamwork to enhance nurses' safety competency should be prioritized, thereby contributing to improvement of safety climates.

Development and testing of a patient-centred care competency scale for hospital nurses.

This study aimed to develop and test the psychometric soundness of a patient-centred care competency (PCC) scale for hospital nurses. A cross-sectional questionnaire survey was conducted among 594 nurses in two teaching hospitals (response rate 99.5%). Reliability and validity analyses were performed. The PCC scale consisted of 17 items divided into four subscales: respecting patients' perspectives (6 items), promoting patient involvement in care processes (5 items), providing for patient comfort (3 items) and advocating for patients (3 items). The Cronbach's alpha coefficient of the entire scale was 0.92, and those for the subscales were 0.85, 0.81, 0.84 and 0.80, respectively. Multitrait scaling analysis indicated that the four subscales had satisfactory convergent and discriminant validity. Significant correlations were found between total PCC scores and overall self-ratings of patient-centred care performance (r = 0.60, P < 0.001). The PCC scale was therefore determined to be a highly valid and reliable tool.

Relationships between evidence-based practice, quality improvement and clinical error experience of nurses in Korean hospitals.

AIM: This study investigated individual and work-related factors associated with nurses' perceptions of evidence-based practice (EBP) and quality improvement (QI), and the relationships between evidence-based practice, quality improvement and clinical errors. BACKGROUND: Understanding the factors affecting evidence-based practice and quality improvement activities and their relationships with clinical errors is important for designing strategies to promote evidence-based practice, quality improvement and patient safety. METHOD: A cross-sectional survey was conducted with 594 nurses in two Korean teaching hospitals using the evidence-based practice Questionnaire and quality improvement scale developed in this study. RESULT: Four hundred and forty-three nurses (74.6%) returned the completed survey. Nurses' ages and educational levels were significantly associated with evidence-based practice scores whereas age and job position were associated with quality improvement scores. There were positive, moderate correlations between evidence-based practice and quality improvement scores. Nurses who had not made any clinical errors during the past 12 months had significantly higher quality improvement skills scores than those who had. CONCLUSION: The findings indicated the necessity of educational support regarding evidence-based practice and quality improvement for younger staff nurses who have no master degrees. Enhancing quality improvement skills may reduce clinical errors. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse managers should consider the characteristics of their staff when implementing educational and clinical strategies for evidence-based practice and quality improvement.

Nurses' perception of ethical climate, medical error experience and intent-to-leave.

We examined nurses' perceptions of the ethical climate of their workplace and the relationships among the perceptions, medical error experience and intent to leave through a cross-sectional survey of 1826 nurses in 33 Korean public hospitals. Ethical climate was measured using the Hospital Ethical Climate Survey. Although the sampled nurses perceived their workplace ethical climate positively, 19% reported making at least one medical error during the previous year, and 25% intended to leave their jobs in the near future. Controlling for individual and organizational characteristics, we found that nurses with a more positive perception of the 'patient' dimension of ethical climate were less likely to have made medical errors. Nurses with a more positive perception of the 'patient', 'manager', 'hospital' and 'physician' dimensions of ethical climate were less likely to leave their current job. Enhancing workplace ethical climate could reduce medical errors and improve nurses' retention in public hospitals.

[Development of the Hospital Nurses' Silence Behavior Scale].

PURPOSE: This study aimed to develop a scale to measure hospital nurses' silence behavior and examine its validity and reliability. METHODS: A total of 52 preliminary items on hospital nurses' silence behavior were selected using a content validity test by seven experts on 53 candidate items derived from a literature review and in-depth interviews with 14 nurses. A total of 405 hospital nurses participated in a psychometric testing. Data analysis comprised item analysis, exploratory and confirmatory factor analyses, and convergent and discriminant validity tests. Pearson's correlation coefficient was used for assessing concurrent validity, and Cronbach's alpha was used for the reliability test. RESULTS: The final scale consisted of nine factors with 31 items, exhibiting acceptable model fit indices, convergent validity, and discriminant validity. The score of the entire scale was positively correlated with the 'Organizational Silence Scale (OSS)-the issues on which nurses remain silent' (r = .60, p < .001) and 'OSS-the reasons why nurses remain silent' (r = .68, p < .001). Cronbach's α of the scale was .92, and α of each subscale ranged from .71 to .90. CONCLUSION: The Hospital Nurses' Silence Behavior Scale is a useful tool for assessing multifaceted silence behavior among nurses. It can provide basic data for developing better communication strategies among nurses and other hospital staff.

Patient safety incident-reporting items in Korean hospitals.

OBJECTIVE: To examine incident-reporting items in tertiary hospitals using the framework of the World Health Organization's International Classification for Patient Safety (ICPS). DESIGN: Cross-sectional survey. SETTING AND PARTICIPANTS: Forty acute-care tertiary hospitals in Korea (response rate = 90.9%). METHODS: Data were collected using a semistructured questionnaire during on-site interviews or via e-mail. Items were extracted from incident-reporting forms that required a reporter's input, and were analyzed using the ICPS framework. After removing redundant items, unique reporting items were mapped onto ICPS elements. The data are summarized using descriptive statistics. RESULTS: On average, hospitals used 2.4 incident-reporting forms (range = 1-9) and 136.7 reporting items (range = 31-310). All of the hospitals had incident-reporting items that described 'incident type' and 'incident characteristics'; however, only 7 hospitals (17.5%) had reporting items on incident 'detection', and 18 hospitals (45.0%) collected information on the 'organizational outcomes'. Of the 1145 unique reporting items, 297 (25.9%) were completely mapped onto ICPS elements at different levels of granularity, and 12.7% (n = 145) were mapped onto ICPS elements that had more granular subcategories. CONCLUSIONS: The ICPS framework is a useful reference model for the classification of incident-reporting items. However, further refinements to both the ICPS framework and incident-reporting items are needed in order to better represent data on patient safety. Furthermore, the use of a common reporting form at the national level is recommended for reducing variations in reporting items and facilitating the efficient collection and analysis of patient safety data.

Performance of Early Warning Scoring Systems Regarding Adverse Events of Unanticipated Clinical Deterioration in Complementary and Alternative Medicine Hospitals.

PURPOSE: This study aims to examine the performance of early warning scoring systems regarding adverse events of unanticipated clinical deterioration in complementary and alternative medicine hospitals. METHODS: A medical record review of 500 patients from 5-year patient data in two traditional Korean medicine hospitals was conducted. Unanticipated clinical deterioration events included unexpected in-hospital mortality, cardiac arrest, and unplanned transfers to acute-care conventional medicine hospitals. Scores of the Modified Early Warning Score (MEWS), National Early Warning Score (NEWS), and National Early Warning Score 2 (NEWS2) were calculated. Their performance was evaluated by calculating areas under the receiver-operating characteristic curve for the event occurrence. Multiple logistic regression analyses were performed to determine the factors associated with event occurrence. RESULTS: The incidence of unanticipated clinical deterioration events was 1.1% (225/21101). The area under the curve of MEWS, NEWS, and NEWS2 was .68, .72, and .72 at 24 hours before the events, respectively. NEWS and NEWS2, with almost the same performance, were superior to MEWS (p = .009). After adjusting for other variables, patients at low-medium risk (OR = 3.28; 95% CI = 1.02-10.55) and those at medium and high risk (OR = 25.03; 95% CI = 2.78-225.46) on NEWS2 scores were more likely to experience unanticipated clinical deterioration than those at low risk. Other factors associated with the event occurrence included frailty risk scores, clinical worry scores, primary medical diagnosis, prescribed medicine administration, acupuncture treatment, and clinical department. CONCLUSIONS: The three early warning scores demonstrated moderate-to-fair performance for clinical deterioration events. NEWS2 can be used for early identification of patients at high risk of deterioration in complementary and alternative medicine hospitals. Additionally, patient, care, and system factors need to be considered to improve patient safety.

Experiences of using clinical pathways in hospitals: Perspectives of quality improvement personnel.

AIM: This study aimed to explore the experiences of quality improvement personnel in implementing clinical pathways (CPs) in Korean hospitals. DESIGN: A qualitative study using focus-group interviews was conducted with healthcare professionals in charge of CP development and management in hospitals. METHODS: Sixteen quality improvement personnel from eight tertiary and seven general hospitals were recruited using purposive sampling. The verbatim transcribed data were analysed using qualitative content analysis. RESULTS: Three key themes emerged: (1) the primary focus of CP development on surgeries through concerted efforts between management and frontline healthcare professionals; (2) CP fidelity management using indicators and feedback to relevant staff or departments; and (3) positive outcomes, despite concerns about system safety. The factors affecting CP use included availability of clinical evidence, flexibility of CPs, top management and clinical leadership, physicians' perceptions of CPs, computerized support systems, and external policies and regulations.

Using an Early Warning Score for Nurse Shift Patient Handover: Before-and-after Study.

PURPOSE: This study aimed to examine the impact of using an early warning score for shift patient handover on nurse and patient outcomes. METHODS: A before-and-after study was conducted with nurses and patients in three general wards in a tertiary teaching hospital. A short-time nurse education on the National Early Warning Score 2 and the use of a checklist for score calculation were performed from June 4, 2019 to June 30, 2019. Outcomes of nurse response (safety competency, handover quality, teamwork, safety climate, and documentation of vital signs and clinical concerns), patient response (deterioration occurrence postadmission, hospitalization length, and discharge status), and adverse events (mortality, cardiopulmonary arrest, and unplanned intensive care unit admission) were measured using questionnaires and medical record reviews. Data from 89 nurses and 388 patients were analyzed. RESULTS: Regarding nurse outcomes, handover quality (p < .001), teamwork (p = .004), safety climate (p = .018), and recordings of vital signs (p = .047) and clinical concerns (p = .008) increased after early warning score use. However, no significant change in the safety competency scores was observed. Regarding patient outcomes, there were no significant changes in the occurrence of deterioration, hospitalization length, discharge status, and occurrence of adverse events between preintervention and postintervention. CONCLUSION: Despite no significant changes in patient outcomes, using a simple, evidence-based early warning score for patient handover enhanced socio-cultural factors for patient safety, with improved patient monitoring. The findings provide evidence that supports the active implementation of an early warning score to improve patient safety.

The Korea National Patient Safety Incidents Inquiry Survey: Feasibility of Medical Record Review for Detecting Adverse Events in Regional Public Hospitals.

OBJECTIVES: We aimed to examine the Korea National Patient Safety Incidents Inquiry conducted in the Republic of Korea; specifically, we assessed the validity of screening criteria, interreviewer reliability, quality of medical records, and the time required for reviewing medical records. METHODS: A 3-stage retrospective medical record review was performed. The sensitivity and positive predictive value of the screening criteria for the adverse events were calculated, and interreviewer reliability was verified using the overall agreement rate and κ value. In addition, the results of medical record quality assessment and time required for review were analyzed. RESULTS: There were a total of 4159 patients (55.5%) with at least 1 of the 41 screening criteria. In stage 1, the overall percent of agreement was 81.9% when all negatives from the 2 reviewers were included, and the κ value was 0.64 (95% confidence interval [CI], 0.61-0.66). In stage 2, 84.6% of cases were a perfect match, and 87.4% were a partial match. The κ values were 0.159 (95% CI, 0.12-0.20) and 0.389 (95% CI, 0.35-0.43), respectively. The mean quality assessment scores were 3.18 of 4 points in stage 1 and 3.05 of 4 points in stage 2. In stage 1, it took an average of 13.02 minutes to asses each patient file; in stage 2, it took an average of 5.06 minutes. CONCLUSIONS: To increase the feasibility of medical record review for detecting adverse events, it is important not only to improve the reliability between reviewers but also to monitor the quality of medical records and the time required for review.

The Korea National Patient Safety Incidents Inquiry Survey: Characteristics of Adverse Events Identified Through Medical Records Review in Regional Public Hospitals.

OBJECTIVES: In 2019, the Korean National Patient Safety Incidents Inquiry was conducted in the Republic of Korea to identify the national-level incidence of adverse events. This study determined the incidence and detailed the characteristics of adverse events at 15 regional public hospitals in the Republic of Korea. METHODS: Medical records data of 500 randomly selected patients (discharged in 2016) were extracted from each of the 15 studied hospitals and reviewed in 3 stages. First, for each hospital, 2 nurses independently reviewed the medical records, using 41 screening criteria. Second, 2 physicians independently reviewed the records of those patients with at least 1 screening criterion from the first stage for adverse events occurrence and their characteristics. Third, a 9-member committee conducted a final review and compiled the final adverse event report. RESULTS: Among 7500 patients, 4159 (55.5%) had at least 1 screening criterion; 745 (9.9%) experienced 901 adverse events (incidence, 12.0%). By type of institution, adverse event incidence varied widely from 1.2% to 45.6%. In 1032 adverse events, the majority (33.5%) were "patient care-related." By severity, the majority (638; 70.8%) were temporary, requiring intervention, whereas 38 (4.2%) resulted in death. The preventability score was high for "patient care-related" and "diagnosis-related" adverse events. Duration of hospitalization was extended for 463 (44.9%) adverse events, with "diagnosis-related" (30.8%) and "surgery/procedural-related" (30.1%) types extended by at least 21 days. CONCLUSIONS: A review of medical records aids in identifying adverse events in medical institutions with varying characteristics, thus helping prioritize interventions to reduce their incidence.