Unplanned 30-day readmission rate after ophthalmological surgery as a quality-of-care indicator.

BACKGROUND: The 30-day readmission rate provides a standardised quantitative evaluation of some postoperative complications. It is widely used worldwide in many medical and surgical specialities, and the World Health Organization recommends its use for monitoring healthcare system performance. In ophthalmology, its measurement is biased by the frequent and close planned surgery on one eye and then the other, particularly in the case of cataract surgery. This study measures the 30-day unplanned readmission rate in ophthalmology, globally and by surgery subtype, and describes the causes of readmission. METHODS: All patients readmitted within 30 days of ophthalmic surgery at Nantes University Hospital between January 2017 and December 2020 were identified in the Medical Information System. An ophthalmologist examined each medical record and collected the following data: the reason for readmission, comorbidities, the pathology treated, surgery type, surgery duration, the surgeon's experience, anaesthesia type, severity and readmission morbidity. RESULTS: For the 8522 ophthalmic surgeries performed in the four-year study period, 282 30-day unplanned readmissions were identified. The overall 30-day unplanned readmission rate was 2.07% for elective surgery, with a high variability depending on the surgery type: 0.95% for phacoemulsification, 4.95% for vitreoretinal surgery (3.42% for non-elective vitreoretinal surgery, 5.44% for retinal detachment surgery), 5.66% for deep lamellar keratoplasty and 11.90% for trabeculectomy. The unplanned 30-day readmission rate for ocular trauma surgery (emergency care) was 11.0%. Seven percent of all unplanned 30-day readmissions were not associated with an ophthalmological problem. CONCLUSIONS: This study is the first to report 30-day unplanned readmission in ophthalmology, globally and by surgical subtype, for elective and urgent procedures. This indicator can be used longitudinally to detect an increase in risk or transversely to compare the quality of care between different public or private hospitals.

Improving care safety by characterizing task interruptions during interactions between healthcare professionals: an observational study.

Few studies have investigated interruptions to the work of professionals practicing in inpatient hospitals, and even fewer take account of the functions that make up the system. Safety of care can be improved by considering avoidable interruptions during interactions between managerial and care delivery functions. The present study describes the characteristics of interruptions to the work of professionals working in the inpatient hospital sector, with respect to their typology, frequency, duration, and avoidability in the context of interactions between functions. This direct observational study of interruptions in hospital care was performed in the Pays de la Loire (west coast) area of France. A total of 23 teams (17 institutions) working in medical or surgical specialties (excluding intensive care) were included. Observations were performed between May and September 2019, and lasted seven consecutive hours per team. A pair of observers simultaneously observed the same professional for ∼30 min. Each occupational category was examined. Reported characteristics were: (i) the method and duration of the request, (ii) the location of interrupted and interrupting persons, (iii) the reaction of the interrupted person, (iv) the characteristics of the interrupting person, and (v) the classification of interrupted and interrupting tasks according to their function. An avoidable interruption was defined. Interruptions during interactions between professionals were categorised in terms of their function and avoidability. Descriptive statistical analyses (mean, standard deviation, and distribution) were run. In particular, cross-comparisons were run to highlight avoidability interruptions and interactions between managerial and care delivery functions during the working day, for different professional categories, and for the location of the request. Overall, 286 interrupted professionals were observed and 1929 interruptions were characterised. The majority of interruptions were due to a face-to-face request (58.7%), lasting ≤30 s (72.5%). Professionals engaged in the response in 49.3% of cases. A total of 57.4% of interruptions were avoidable. The average number of interruptions was 10.5 (SD = 3.2) per hour per professional. An analysis of avoidability and interactions between managerial and care delivery functions found that the period between 12:00 and 13:00 was the riskiest in terms of care safety. This study highlighted the characteristics of interruptions to the activity of professionals working in inpatient hospitals. Care teams could focus on making medical and nursing professionals much more aware of the importance of interruptions, and each team could decide how to best-manage interruptions, in the context of their specific working environment.

Task interruptions from the perspective of work functions: The development of an observational tool applied to inpatient hospital care in France The Team'IT tool.

BACKGROUND: In France, hospital units responsible for providing inpatient care have few opportunities to address the issue of task interruptions. In Australia, the Dual Perspectives Method (DMP) has been developed to assess interruptions. The method makes it possible to link teamwork and interruptions, by considering the work functions that constitute the system. OBJECTIVE: To develop a tool that can characterize interruptions from the point of view of work functions that is tailored to French hospital units providing inpatient care. The aim was to adapt the items recorded using the DPM and their response categories, and to study the acceptability of observing interruptions for participating teams. METHOD: The items recorded in the DPM were translated and adapted taking into account the French definition of interruptions. This step identified 19 items that targeted the interrupted professional, and 16 that targeted the interrupting professional. The characteristics of interruptions were recorded in September 2019 among 23 volunteer teams in a region in western France. Two observers simultaneously observed the same professional. Observations lasted seven consecutive hours, and targeted all professional categories within the same team. RESULTS: The characteristics of 1,929 interruptions were noted. The observation period was well-received by teams. The following terminology regarding the work functions of the interrupting professional was clarified: "coordination of institutional resources", in relation to "the establishment's support processes", "patient services", and "the patient's social life". We believe that our categorization of response modes is exhaustive. CONCLUSIONS: We have developed an observational tool, Team'IT, which is tailored to inpatient hospital care in France. Its implementation is the first step in a system to support teams in managing interruptions, and will enable them to reflect on their working methods, and whether interruptions can be avoided. Our work is part of an approach that seeks to improve and enhance the safety of professional practices, by contributing to the longstanding, complex debate about the flow and effectiveness of patient care. TRIAL REGISTRATION: ClinicalTrials.gov NCT03786874 (December 26, 2018).

Interaction between CYP2D6 inhibitor antidepressants and codeine: is this relevant?

INTRODUCTION: Co-occurring pain impairs depression's prognosis. Selective serotonin reuptake inhibitors (SSRIs) or serotonin and norepinephrine reuptake inhibitors (SNRIs) are first-line pharmacotherapies for depression and inhibit many cytochrome 2D6 enzymes. Codeine is a first-line treatment for pain and needs to be metabolized into morphine by cytochrome 2D6 to exert its analgesic effect. Concomitant prescription of both pharmacotherapies leads to inadequate analgesia. Areas covered: We performed a systematic review of the literature to amalgamate the current knowledge regarding the clinical effect of this association and quantified its prevalence in clinical practice in the French Pays de la Loire area using a retrospective observational cohort study design. Expert opinion: The literature review highlighted that antidepressants with moderate-to-strong inhibition of CYP2D6 should be avoided in patients receiving codeine. However, 0.44% of the 12,296 sampled patients received concomitant codeine and CYP2D6 inhibitor between January 2015 and June 2015. Switching drugs in both painful and depressive patients depends on the pain and depression subtypes. Promising drugs that both show an effect on pain and depression are currently being studied but are not usable in clinical practice. Until then, tailored communication reinforcement toward health-care professionals is needed to prevent these problematic occurrences of concomitant prescription administration.