Patient Safety Climate: A Study of Southern California Healthcare Organizations.

EXECUTIVE SUMMARY: Human error remains the most important factor in unnecessary deaths and suffering in U.S. hospitals. Human error results from healthcare providers' attitudes and behaviors toward patients in different settings. Therefore, taking periodic snapshots of the attitudes and behaviors prevalent in an organization and manifested in its patient safety climate (PSC) is essential.We developed and tested a short survey instrument intended as an organization-level measure of PSC with good psychometric properties that can be used in hospitals, clinics, or other healthcare provider settings. Analysis of data from 61 Southern California healthcare organizations resulted in a PSC model with four distinct, reliable factors: (1) Assistance From Others and the Organization, (2) Leadership Messages of Support in Policy and Behavior, (3) Resources and Work Environment, and (4) Error Reporting Behavior. A PSC score, ranging from 0 to 100, was generated for each organization.For a subsample of hospitals in our study, preliminary results indicate a predictive quality of the model. The higher the PSC score, the lower the number of violations detected by the Centers for Medicare & Medicaid Services in complaint inspections, and the fewer the safety problems reported by The Leapfrog Group.Given the association between PSC and health outcomes, we urge healthcare leaders to use various means, such as our survey, to monitor the degree to which their organizations maintain a climate that fosters patient safety and use such data to pinpoint areas for improvement.

Sex differences in neuromuscular fatigability in response to load carriage in the field in British Army recruits.

OBJECTIVES: Women are resistant to neuromuscular fatigue compared to men in response to a range of exercise tasks. The sex differences in the neuromuscular responses to load carriage have yet to be investigated. DESIGN: Prospective cohort study. METHODS: Twenty-three male and 19 female British Army recruits completed a 9.7km loaded march within 90min, with the weight carried dependent on military trade (16±2kg for men and 15±1kg for women). Isometric maximal voluntary contraction (MVC) force of the knee extensors and vertical jump (VJ) height were examined pre- and post-loaded march to examine neuromuscular fatigue. Heart rate (HR) was recorded throughout and ratings of perceived exertion (RPE) was recorded following the march. RESULTS: HR was higher for women (173±9bmin-1, 83±6% heart rate reserve) than men (158±8bmin-1, 72±6% heart rate reserve) (p≤0.001). RPE following the march was also higher for women than men (6±2 vs 4±2, respectively, p<0.001). The loss in MVC force was greater for men than women (-12±9% vs -9±13%, respectively, p=0.031), however VJ height was impaired to a similar extent (-5±11% vs -5±6%, respectively, p=0.582). CONCLUSIONS: The greater physiological stress during load carriage for women compared to men did not translate to a greater severity of knee extensor muscle fatigue, with women demonstrating fatigue resistance.

Sex Differences in Training Loads during British Army Basic Training.

PURPOSE: To compare training loads between men and women during 14 wk of British Army standard entry basic training. METHODS: Thirty-one male (mean ± SD: age, 21 ± 4 yr; height, 1.78 ± 0.08 m; mass, 77.1 ± 10.5 kg) and 28 female (age, 22 ± 4 yr; height, 1.65 ± 0.05 m; mass, 63.9 ± 8.9 kg) British Army recruits had external (distance) and internal (HR, training impulse [TRIMP], RPE) training loads measured during weeks 1, 2, 6, 12, and 13 of basic training. Total energy expenditure was measured during weeks 1 to 2 and weeks 12 to 13. RESULTS: Daily distance was higher for men than women (13,508 ± 666 vs 11,866 ± 491 m, respectively, P < 0.001). Average daily HR (29% ± 3% vs 30% ± 3% HR reserve) and RPE (4 ± 1 vs 4 ± 1) were not different between men and women, respectively (P ≥ 0.495). Daily TRIMP was higher for women than men (492 ± 130 vs 261 ± 145 au, respectively, P < 0.001). Total energy expenditure was higher for men than women during weeks 1 to 2 (4020 ± 620 vs 2847 ± 323 kcal·d, respectively) and weeks 12 to 13 (4253 ± 556 kcal·d vs 3390 ± 344 kcal·d, respectively) (P < 0.001). Daily RPE, HR, and TRIMP were related to daily distance (R = 0.18-0.57, P ≤ 0.037), and daily RPE was related to daily TRIMP and HR (R = 0.37-0.77, P ≤ 0.001). CONCLUSIONS: Sex differences in training loads could contribute to the greater injury risk for women during basic training. Daily RPE appears a practical option for measuring internal training load during military training.

Estimates of Tibial Shock Magnitude in Men and Women at the Start and End of a Military Drill Training Program.

INTRODUCTION: Foot drill is a key component of military training and is characterized by frequent heel stamping, likely resulting in high tibial shock magnitudes. Higher tibial shock during running has previously been associated with risk of lower limb stress fractures, which are prevalent among military populations. Quantification of tibial shock during drill training is, therefore, warranted. This study aimed to provide estimates of tibial shock during military drill in British Army Basic training. The study also aimed to compare values between men and women, and to identify any differences between the first and final sessions of training. MATERIALS AND METHODS: Tibial accelerometers were secured on the right medial, distal shank of 10 British Army recruits (n = 5 men; n = 5 women) throughout a scheduled drill training session in week 1 and week 12 of basic military training. Peak positive accelerations, the average magnitude above given thresholds, and the rate at which each threshold was exceeded were quantified. RESULTS: Mean (SD) peak positive acceleration was 20.8 (2.2) g across all sessions, which is considerably higher than values typically observed during high impact physical activity. Magnitudes of tibial shock were higher in men than women, and higher in week 12 compared with week 1 of training. CONCLUSIONS: This study provides the first estimates of tibial shock magnitude during military drill training in the field. The high values suggest that military drill is a demanding activity and this should be considered when developing and evaluating military training programs. Further exploration is required to understand the response of the lower limb to military drill training and the etiology of these responses in the development of lower limb stress fractures.

Speeding up the emergency department: the RADIT emergency program at St. Joseph Hospital of Orange.

St. Joseph Hospital of Orange implemented a new emergency department (ED) program, the Rapid Assessment and Discharge in Triage (RADIT) program, designed to reduce patient waiting time and improve overall patient satisfaction. ED visitors presenting nonurgent problems were served by a roving RADIT team. The hospital established a goal of 90 min average time in RADIT and sought to reduce overall time in ED. After 6 months, results indicated that RADIT patients were discharged on average in 97 min; however, there was a slight increase in average time in ED. A patient satisfaction survey indicated that about 96% of RADIT patients rated the quality of service received as either good or excellent. The authors provide the background and context that resulted in the decision to implement RADIT.

Training in Readmission Reduction in an Indonesian Hospital.

The authors implemented a new discharge protocol to reduce readmission rates in a hospital in West Java, Indonesia. Forty nurses were trained in the use of the protocol. Results indicate that posttest group readmission rates were significantly lower after the implementation of protocol, from 6.11% to 4.21%. The protocol was effective in reducing readmissions for patients discharged from internal medicine, pulmonology, and women. Differences were also found by type of insurance or payment method, generally suggesting that the lower the socioeconomic status of the patients was, the more effective the discharge protocol was.