Trend Analysis of Inpatient Medical Adverse Events in Taiwan (2014-2020): Findings From Taiwan Patient Safety Reporting System.

OBJECTIVES: Medical adverse event (MAE) reporting and management are essential for patient safety campaigns. An epidemiological assessment of MAE trends is crucial for understanding the effectiveness of patient safety improvement efforts. This study analyzed the trends of inpatient MAEs, focusing on MAE incidence and harm severity. METHODS: Longitudinal secondary data (over 2014-2020) on MAEs reported by 18 hospitals were retrieved from the Taiwan Patient-safety Reporting system. The numbers and incidence rates (per 1000 inpatient days) of reported MAEs were calculated. The harm severity levels of six major MAE categories were analyzed. Trend and generalized estimating equation analyses were conducted to investigate changes in MAE patterns. RESULTS: Trend analyses revealed significant decreasing trends in the number (4763-3107 per year; Jonckheere-Terpstra test = -1.952, P = 0.05) and incidence rates (0.92-0.62 per 1000 inpatient days; ß = -0.5017, P = 0.00) of harmful MAEs over 7-year study period. Among the most frequently reported MAEs, tube-related events exhibited the most significant decreasing trend (28%-23.8%; Jonckheere-Terpstra test = -2.854, P = 0.00). The reported numbers, incidence rates, and severity of falls and tube-related events dropped significantly. CONCLUSIONS: By analyzing representative longitudinal MAE data, this study demonstrated the effectiveness of nationwide patient safety improvement campaigns in Taiwan. Our data reveal significant reductions in the reported numbers, incidence rates, and severity of several major MAEs. Specifically, our data indicate significant reductions in the incidence and severity of tube-related events, which can be beneficial for patient safety improvement efforts.

The impact of the COVID-19 pandemic on emergency care of acute myocardial infarction: findings from the Taiwan Clinical Performance Indicator.

Acute myocardial infarction (AMI) treatment requires timely diagnosis and treatment for optimal health outcomes. The Coronavirus Disease (COVID-19) pandemic has caused changes in health-care delivery and utilization; therefore, the present study explored the changes in emergency care quality indicators for patients with AMI before and during different periods of government response to the COVID-19 outbreak in Taiwan. The Taiwan Clinical Performance Indicators database was used to evaluate the impact of COVID-19 on acute care quality indicators for patients with AMI during four periods: before the COVID-19 outbreak (Period I-1 January to 31 December 2019) and during three periods in which the central government imposed different levels of epidemic prevention and response alerts (Period II-1 January 2020 to 30 April 2021; Period III-1 May to 31 July 2021; and Period IV-1 August to 31 December 2021). A 15.9% decrease in monthly emergency department admission for patients with AMI occurred during Period III. The hospital 'door-to-electrocardiogram time being <10 min' indicator attainment was significantly lower during Periods III and IV. The attainment of 'dual antiplatelet therapy received within 6 hr of emergency department arrival' indicator improved in Period IV, whereas 'the primary percutaneous coronary intervention being received within 90 min of hospital arrival' indicator significantly decreased during Periods III and IV. The indicator 'in-hospital mortality' was unchanged within the study duration. Overall, the quality of care for patients with AMI was mildly influenced during the assessed pandemic periods, especially in terms of door-to-electrocardiogram time of <10 min and primary percutaneous coronary intervention received within 90 min of hospital arrival (Period III). Using our study results, hospitals can develop strategies regarding care delivery for patients with AMI during a COVID-19 outbreak on the basis of central government alert levels, even during the height of the pandemic.

Can simulation-based team resource management training help students to pass entrustable professional activities 13?

Objective: Simulation technology has been integrated into team resource management (TRM) training in many hospitals. We designed a simulation-based TRM training scenario (SBTRM) aiming to help post graduate year (PGY) physicians to fulfil the requirements of the entrustable professional activities 13 (EPA 13). In this study, we investigate and report the SBTRM effectiveness. Methods: A total of 61 physicians received the SBTRM from March to November 2017. The SBTRM covers the core contents of teamwork skills. The trainees were evaluated with qualified clinical instructors after SBTRM training. The evaluation form is a 15-item questionnaire that evaluates the communication, situation monitoring, attitudes and clinical treatment of trainee behaviour. Results: A total of 75% of trainees agreed that the simulation is close to the usual care behaviour and helpful in thinking about changes in the surrounding conditions. More than 80% of trainees can actively communicate the care process; 82% of trainees can provide appropriate clinical treatment for patients. We found that physicians did not pay enough attention to the definition of 'nursing work'. 75% of the overall performance of teamwork and patient safety reached only 'good' level. Conclusions: Current medical education is increasingly using simulation to learn teamwork skills, with the hope that trainees use systematic thinking to carry out the care process. In this study, we designed a SBTRM and evaluation form that meets the requirements of EPA 13 for trainees. This training should improve physicians' safety awareness in the first post-graduate year.

Epidemiology of medical adverse events: perspectives from a single institute in Taiwan.

BACKGROUND/PURPOSE: Epidemiology data of medical adverse events (MAEs) are crucial for patient safety policymaking. However, no epidemiological data on MAE exist in Taiwan. In this study, we aimed to investigate the incidence of MAEs at a major medical center in northern Taiwan. METHODS: The Harvard Medical Practice Study methodology was modified using a criterion-based screening algorithm and critical medical record review process to investigate the risks and incidences of MAEs. A Criterion-Based Screening for Medical Adverse Events (CBSMAE) checklist was developed, and a three-tier strategy was applied to screen and review 2007 inpatient hospitalizations from a single institution. RESULTS: A total of 2934 charts was sampled (Tier 1) and 950 possible MAEs were identified (Tier 2). One hundred and sixty-one probable MAE cases were subsequently critically reviewed (Tier 3). Nineteen (0.7%) MAE cases were confirmed. The MAEs involved 10 women and nine men (mean age, 70 years). Most MAEs were from the surgery department [11 (57.9%) patients]. The major admission diagnoses were cardiac diseases [7 (36.8%) patients] with a cardiac problem [13 (31.7%) patients] as the major comorbidity. Major MAE attributes were a staff technique problem [12 (46.2%) patients] and patients' underlying conditions (likelihood rating, 2.2). Eight (42.1%) patients required additional medical management, four (21.1%) patients had a disability, and five (26.3%) patients had in-hospital mortality. Night MAEs (47.4%) were considered preventable. CONCLUSION: Surgical patients with cardiac conditions were at risk of MAE, particularly patients who received invasive procedures. The epidemiology information from this study can serve as baseline data to monitor a patient safety improvement campaign.

Integration of Value Stream Map and Healthcare Failure Mode and Effect Analysis into Six Sigma Methodology to Improve Process of Surgical Specimen Handling.

Specimen handling is a critical patient safety issue. Problematic handling process, such as misidentification (of patients, surgical site, and specimen counts), specimen loss, or improper specimen preparation can lead to serious patient harms and lawsuits. Value stream map (VSM) is a tool used to find out non-value-added works, enhance the quality, and reduce the cost of the studied process. On the other hand, healthcare failure mode and effect analysis (HFMEA) is now frequently employed to avoid possible medication errors in healthcare process. Both of them have a goal similar to Six Sigma methodology for process improvement. This study proposes a model that integrates VSM and HFMEA into the framework, which mainly consists of define, measure, analyze, improve, and control (DMAIC), of Six Sigma. A Six Sigma project for improving the process of surgical specimen handling in a hospital was conducted to demonstrate the effectiveness of the proposed model.

RFID-initiated workflow control to facilitate patient safety and utilization efficiency in operation theater.

OBJECTIVE: To control the workflow for surgical patients, we in-cooperate radio-frequency identification (RFID) technology to develop a Patient Advancement Monitoring System (PAMS) in operation theater. METHODS: The web-based PAMS is designed to monitor the whole workflow for the handling of surgical patients. The system integrates multiple data entry ports Across the multi-functional surgical teams. Data are entered into the system through RFID, bar code, palm digital assistance (PDA), ultra-mobile personal computer (UMPC), or traditional keyboard at designated checkpoints. Active radio-frequency identification (RFID) tag can initiate data demonstration on the computer screens upon a patient's arrival at any particular checkpoint along the advancement pathway. RESULTS: The PAMS can manage the progress of operations, patient localization, identity verification, and peri-operative care. The workflow monitoring provides caregivers' instant information sharing to enhance management efficiency. CONCLUSION: RFID-initiate surgical workflow control is valuable to meet the safety, quality, efficiency requirements in operation theater.

An evaluation of a weight-loss program incorporating E-learning for obese junior high school students.

Obesity in adolescents is continuing to rise at an alarming rate and is becoming an important public health problem in Taiwan. Therefore, the aims of this study were (1) to evaluate the effectiveness of a Weight-loss E-learning Program (WEP) on obese Chinese adolescents and (2) to gauge this group's satisfaction with the WEP. The design was quasi-experimental, using purposive samples from two junior high schools in Taipei, Taiwan. Obese adolescents between 12 and 14 years of age with body mass indexes (BMI) over 25 kg/m2 were recruited. A 14-week WEP was developed to expedite weight loss for the selected adolescents. Data such as BMI, waist-to-hip ratio, waist circumference, hip circumference, mid-arm circumference, triceps skinfold, blood pressure, and physical fitness were collected through standardized instruments and methods before and after the WEP. The satisfaction of the subjects and four psychosocial variables were evaluated and taken into account by authoritative scales and questionnaires. In total, 37 adolescents participated in this study. After the WEP, we found significant decreases in BMI (p < 0.05), waist circumference (p < 0.05), and triceps skinfold (p < 0.001) in the sample population. Improvements were found in three of four tests of physical fitness (p < 0.001, p < 0.05, and p < 0.01, respectively). All psychosocial variables showed significant favorable changes (p < 0.01 for self-esteem scores, p < 0.001 for the other three variables) and satisfaction levels for the WEP ranged from 56.6% to 83.8% in four different criteria. The WEP was effective in helping obese Chinese adolescents lose weight. However, there is still room for improvement.