Sea snake harvest in the gulf of Thailand.

Conservation of sea snakes is virtually nonexistent in Asia, and its role in human-snake interactions in terms of catch, trade, and snakebites as an occupational hazard is mostly unexplored. We collected data on sea snake landings from the Gulf of Thailand, a hotspot for sea snake harvest by squid fishers operating out of the ports of Song Doc and Khanh Hoi, Ca Mau Province, Vietnam. The data were collected during documentation of the steps of the trading process and through interviewers with participants in the trade. Squid vessels return to ports once per lunar synodic cycle and fishers sell snakes to merchants who sort, package, and ship the snakes to various destinations in Vietnam and China for human consumption and as a source of traditional remedies. Annually, 82 t, roughly equal to 225,500 individuals, of live sea snakes are brought to ports. To our knowledge, this rate of harvest constitutes one of the largest venomous snake and marine reptile harvest activities in the world today. Lapemis curtus and Hydrophis cyanocinctus constituted about 85% of the snake biomass, and Acalyptophis peronii, Aipysurus eydouxii, Hydrophis atriceps, H. belcheri, H. lamberti, and H. ornatus made up the remainder. Our results establish a quantitative baseline for characteristics of catch, trade, and uses of sea snakes. Other key observations include the timing of the trade to the lunar cycle, a decline of sea snakes harvested over the study period (approximately 30% decline in mass over 4 years), and the treatment of sea snake bites with rhinoceros horn. Emerging markets in Southeast Asia drive the harvest of venomous sea snakes in the Gulf of Thailand and sea snake bites present a potentially lethal occupational hazard. We call for implementation of monitoring programs to further address the conservation implications of this large-scale marine reptile exploitation.

Creating a Process for the Implementation of Tiered Huddles in a Veterans Affairs Medical Center.

INTRODUCTION: In 2019, the Veteran's Health Administration began its journey in pursuit of becoming an enterprise-wide High Reliability Organization (HRO). Improving the delivery of safe, high quality patient care is a central focus of HROs. Requisite to meeting this goal is the timely identification and resolution of problems. This is best achieved by empowering and engaging both clinical and non-clinical staff across the healthcare organization through the promotion of robust collaboration and communication between various disciplines. Improved care coordination and increased accountability are two important subsequent outcomes. One method for accomplishing this is through the implementation of tiered huddles. MATERIALS AND METHODS: An extensive review of the current literature from 2013 until June 2021 was conducted for evidence highlighting the experiences of other healthcare organizations during implementation of huddles. Following the review, a tiered huddle proposal was developed and presented to the executive leadership team of a healthcare system for approval. Pilot testing of the tiered huddle implementation plan began in October 2021 over a 12-week period with three services. On average, the pilot services had between three to four tiers from frontline staff to the executive level of leadership. RESULTS: Over the 12-week period, out of the possible 120 tiered huddles that could have been conducted, 68% (n = 81) were completed. Of the tiered huddles conducted, 99% (n = 80) started and ended on time. During the pilot test, seven issues were identified by frontline staff: coordination of pre-procedural coronavirus testing, equipment/computer issues, rooms out of service, staffing levels, and lack of responsiveness from other departments. Issues related to staffing, unresponsiveness from other departments, and equipment concerns required elevation to a higher-level tier with no issues remaining open. Delays in patient care, or prolongation of shift hours for staff because of tiered huddles, was low at 2.5% (n = 2). For the duration of the pilot test, a total of 75 minutes accounted for shifts being extended among five staff members. CONCLUSIONS: The success of this initiative demonstrates the importance of thoughtfully creating a robust process when planning for the implementation of tiered huddles. The findings from this initiative will be of immense value with the implementation of tiered huddles across our healthcare system. We believe that this approach can be used by other healthcare institutions along their journey to improving patient safety and quality.

A High-reliability Organization Mindset.

In 2020, the US Department of Veterans Affairs Connecticut Healthcare System began its journey to becoming a high-reliability organization as part of Veterans Affairs efforts to become an enterprise-wide high-reliability organization through the Veterans Health Administration. The initiative was launched to create safe enterprise-wide health care systems and environments with robust continuous process improvements as a method for providing patients with safer and higher quality care. In this article, the authors describe a continuous process improvement initiative aimed at implementing system-wide initiatives along the journey to becoming a high-reliability organization. The initiatives are described from the perspectives of individuals representing staff from the frontline to executive leadership. The authors believe that the processes, strategies, and example initiatives described can be readily adopted and implemented in other health care organizations along the journey to high reliability.

Improving Patient Safety Culture: A Report of a Multifaceted Intervention.

OBJECTIVE: The aim of the study was to improve the safety culture at a Veterans Administration hospital using evidence-based approaches. METHODS: We implemented a patient safety summit with follow-up actions. We measured safety climate before and after the summit using the Agency for Healthcare Research and Quality (AHRQ) Hospital Survey of Patient Safety Culture with modifications and the Safety Attitudes Questionnaire (SAQ). The summit brought hospital leaders together to discuss patient safety topics and relate them to our hospital. At the summit's end, hospital workgroups collectively submitted Safety Culture Action forms, indicating their intended actions to improve safety culture. We analyzed all survey results using the χ2 test. We shared lessons learned. RESULTS: The hospital leadership started safety walk rounds. There were 107 hospital employees at the summit. Attendees submitted 53 Safety Culture Action forms. We received 232 AHRQ survey responses in 2014 and 116 in 2016, for response rates of approximately 11% and 8.9%, respectively. We received 140 SAQ responses (11%) from 1244 employees in 2016 and 242 responses (18%) from 1342 employees in 2017. The AHRQ survey results indicated that perception of teamwork within hospital units improved. The SAQ results indicated that employees' comfort with reporting errors and expressing disagreement with physicians improved, and employees' perceptions of leadership's safety efforts and the levels of staffing worsened. CONCLUSIONS: Although some aspects of safety culture improved after the summit and follow-up interventions, others did not. Future interventions should be targeted toward individual microsystems or units and measure safety climate perceptions for intervention recipients exclusively.