A clinical audit of red blood cell transfusion practices at a district hospital in South Africa.

BACKGROUND:  Red blood cell (RBC) transfusion is one of the most critical and expensive lifesaving treatment modalities. A clinical audit is a valuable instrument to determine whether transfusion practices align with the guidelines and identify knowledge deficiencies. The study aimed to evaluate the RBC transfusion practices and patient outcomes at the National District Hospital in Bloemfontein, South Africa, and to determine adherence to transfusion guidelines. METHODS:  A retrospective descriptive study was conducted. All blood transfusion registers in the hospital were used to identify transfusion episodes during the study period. Files were retrieved from the admissions office and information captured on a paper-based datasheet. The appropriateness of the transfusion and adherence to the South African transfusion guidelines were evaluated using specific criteria. RESULTS:  Of the 118 transfusion episodes during the study period, 78 files were retrieved and 76 included in the study. The patients' median age was 47 years (interquartile range [IQR]: 32-66 years), with human immunodeficiency viruses (HIV) (n = 34; 44.7%) being the most common comorbid condition. Pre-transfusion haemoglobin was documented for all patients with a median of 4.6 g/dL (IQR: 3.95 g/dL - 5.5 g/dL). The audit revealed that in 68.4% (n = 52) of the cases, the guidelines were applied appropriately. CONCLUSION:  The study described the blood transfusion practices and identified shortcomings when compared with the standard clinical guidelines.Contribution: The study highlights the importance of applying rationale, caution and consideration of the specific patient profile when performing transfusions.

Retrospective Analysis of Specimen Quality in Temporal Artery Biopsies for Giant Cell Arteritis and Disease Association in North Midlands, England.

Background Temporal artery biopsy (TAB) is the recommended index diagnostic method for giant cell arteritis (GCA). Per the British Society for Rheumatology (BSR) guidelines, we assessed our procedural performance. Additionally, we evaluated the occurrence of GCA diagnosis in immunosuppressed patients and other comorbidities. Methods Following the audit registration, a retrospective analysis of prospectively collected data was conducted from 2017 to 2022 at a large university hospital in North Midlands, England. Data on demographics and comorbidities were gathered. The study's primary outcome was adherence to BSR guidelines and our service provisions. Secondary outcomes included examining the relationship between biopsy-confirmed GCA and other comorbidities. Statistical analysis was carried out using SPSS version 29 (IBM Corporation, Armonk, New York, United States of America). Two-sample t-test and Chi-square/Fisher exact test were used for continuous and categorical variables, respectively. Holm-Bonferroni method was incorporated to adjust for multiple comparisons. Results A total of 156 patients who underwent temporal artery biopsy (TAB) were included in the study, with a male-to-female ratio of 0.44:1. The median age was 73. Among the patients, 19% were smokers. The procedures were performed by either a vascular surgeon (119, 76%) or by an ophthalmologist (37, 24%). Two-thirds of the patients underwent TAB within seven days of referral. In 73, 47% of cases, the post-fixation biopsy sample size exceeded 10 mm. Positive biopsy results were found in 45 patients (29%). GCA was confirmed in 39% of patients with polymyalgia rheumatica (PMR), 24% with diabetics, 20% with hypothyroidism, 29% with hypertension, 32% with hyperlipidaemia, and 26% with other inflammatory diseases. However, the p-value was below the statistically significant threshold. The biopsy outcome was also not dependent on the speciality, time from referral to biopsy, nor on the length of the post-fixation specimen. Conclusions Temporal artery biopsy remains a valuable and crucial diagnostic tool in challenging equivocal cases of giant cell arteritis (GCA), although it is limited by its sensitivity, but there is also room for improvement. There is still uncertainty regarding the relationship between biopsy positivity, post-fixation sample size, and the interval between referral and procedure. Additionally, the speciality of the clinician performing the biopsy does not appear to significantly influence the likelihood of a positive result. We still do not fully understand why this is, but the association of the GCA with other comorbidities was unpredictably insignificant.

Improving eye care in an intensive care unit.

In Intensive Care Units (ICUs), patients are at risk of developing ocular complications, especially exposure keratopathy. Plan, Do, Study, Act for PDSA cycle. Despite national guidelines, implementation remains challenging. Using the PDSA cycle, we devised an eye care protocol integrated into the electronic patient record system, complemented by a poster summary of guidelines. An initial audit showed 2% adherence to eye exposure guidelines; post-intervention, adherence rose to 76%. A 9-month analysis revealed 16% of patients experienced eye exposure in ICU. This initiative emphasises the new protocol's efficacy and the role of education in its adoption, advocating a more standardised approach to eye care in ICUs.

Current Application of the Medical Device Single Audit Program (MDSAP) as a Global Regulatory Reliance Framework for the Inspection of Medical Devices.

The globalization and rapid advancements in medical technologies necessitate the harmonization of international regulatory frameworks to ensure the efficient and timely clinical application of medical products, including pharmaceuticals and medical devices. Regulatory reliance, a critical component of this harmonization process, is a powerful tool that provides efficient access for economic entities and regulatory authorities, promoting predictable decision-making and accelerating approvals. The Medical Device Single Audit Program (MDSAP) serves as a regulatory reliance framework for medical device inspections. Implemented by countries including Japan, the United States, Canada, Australia, and Brazil, MDSAP allows third-party certification bodies, recognized by these regulatory authorities, to conduct audits on medical device manufacturers. The outcomes of these audits are shared with the regulatory authorities, who use them for regulatory assessments and decision-making. Since transitioning to its implementation phase in 2017, MDSAP has been widely utilized in various countries. This review provides an overview of the adoption and utilization of MDSAP in major countries, exploring the program's impact on regulatory processes and its potential as a method of regulatory reliance to facilitate timely access to effective and safe medical devices.

Dosimetric impact of calibration coefficients determined using linear accelerator photon and electron beams for ionization chamber in an on-site dosimetry audit.

This study aimed to clarify the dosimetric impact of calibration beam quality for calibration coefficients of the absorbed dose to water for an ionization chamber in an on-site dosimetry audit. Institution-measured doses of 200 photon and 184 electron beams were compared with the measured dose using one year data before and after the calibration of the ionization chamber used. For photon and electron reference dosimetry, the agreements of the institution-measured dose against two measured doses in this audit were evaluated using the calibration coefficients determined using 60Co (${N}_{D,\mathrm{w},{}^{60}\mathrm{Co}}$) and linear accelerator (linac) (${N}_{D,\mathrm{w},Q}$) beams. For electron reference dosimetry, the agreement of two institution-measured doses against the measured dose was evaluated using${N}_{D,\mathrm{w},Q}$. Institution-measured doses were evaluated using direct- and cross-calibration coefficients. For photon reference dosimetry, the mean differences and standard deviation (SD) of institution-measured dose against the measured dose using ${N}_{D,\mathrm{w},{}^{60}\mathrm{Co}}$ and ${N}_{D,\mathrm{w},Q}$ were -0.1% ± 0.4% and -0.3% ± 0.4%, respectively. For electron reference dosimetry, the mean differences and SD of institution-measured dose using the direct-calibration coefficient against the measured dose using ${N}_{D,\mathrm{w},{}^{60}\mathrm{Co}}$ and ${N}_{D,\mathrm{w},Q}$ were 1.3% ± 0.8% and 0.8% ± 0.8%, respectively. Further, the mean differences and SD of institution-measured dose using the cross-calibration coefficient against the measured dose using ${N}_{D,\mathrm{w},Q}$ were -0.1% ± 0.6%. For photon beams, the dosimetric impact of introducing calibration coefficients determined using linac beams was small. For electron beams, it was larger, and the measured dose using ${N}_{D,\mathrm{w},Q}$ was most consistent with the institution-measured dose, which was evaluated using a cross-calibration coefficient.

Optimizing patient-controlled analgesia: a narrative review based on a single center audit process.

Intravenous patient-controlled analgesia (PCA) is valuable for delivering opioids in a flexible and timely manner. Although it is designed to offer personalized analgesia driven by the patients themselves, users often report insufficient pain relief, which can be addressed by optimizing its settings and multimodal analgesia. We adopted a systematic approach to modify PCA protocols by utilizing a serial audit process based on institutional PCA data. This review retrospectively examined the process, encompassing data from 13,230 patients who had used PCA devices. The two modifications to the fentanyl-based PCA protocols resulted in three distinct phases. In the first phase, high opioid consumption and unintended PCA withdrawal were the common issues. These were addressed in the second phase by omitting the routine use of basal infusion. However, this led to increased delivery-to-demand ratios, mitigated in the third phase by increasing the bolus dose from 15 µg to 20 µg. These serial protocol changes have produced varied outcomes across different surgical departments, underscoring the need for careful and gradual adjustments and thorough impact assessments. Drawing insights from this audit process, we incorporated findings from the literature on PCA settings and multimodal analgesic approaches. This review underscores the significance of iterative feedback and refinement of analgesic protocols to achieve optimal postoperative pain management. Additionally, it discusses critical considerations regarding the postoperative audit processes.

Establishing a common ground: the future of triage systems.

Triage systems, crucial for Emergency Departments, face unresolved doubts and issues that have not been addressed, coupled with increasing fragmentation due to a growing body of new evidence. International collaboration is essential for evidence-based triage solutions.

Energy efficiency in medium-scale airports: Two Mexican airports as case of study.

Reducing energy consumption in the operation of airports has been identified as one of the approaches to achieve the commitments of the countries in reducing their greenhouse gas (GHG) emissions. The first step in this approach is the development of an energy diagnostic. However, multiple practical aspects remain unresolved when applying the existing methodologies to perform energy diagnostics, especially in the case of small and medium-scale airports. Seeking to address these issues, this work presents energy diagnostics of two Mexican international airports so that it can be used to carry out energy diagnostics in other airports with similar characteristics. Emphasis is given to identifying and prioritizing, from a sustainable point of view, the strategies to reduce energy consumption and GHG emissions. The Ciudad del Carmen Airport (CME) is located in a nearshore region with high ambient temperatures (27 °C) and humidities. It was found that in 2019, the CME airport consumed 123 MWh with an average of 577 Wh per passenger, with the HVAC system being the primary energy consumer. Critical strategies for the CME airport include photovoltaic systems and HVAC renovation. In contrast, the Puebla airport (PBC) is located in a region with comfortable ambient conditions (16 °C). In 2019, the PBC airport consumed 61.31 MWh/year and 442 Wh per passenger. The main strategies for PBC include expanding its photovoltaic energy generation system, employee awareness programs, and renewing the vehicle fleet with electric vehicles.

Implementing an Internal Audit: Evaluating Hand Scrub Compliance in a Tertiary Care Hospital.

Background Aseptic protocol adherence and sterilization are the most important factors in a patient's satisfactory recovery after surgery. The standard hand scrubbing procedure helps control infection and keeps the surgical site clean by adhering to aseptic principles. Methods Thirty-six young residents and house officers participated in this prospective audit after ethical clearance was obtained. The World Health Organization (WHO) standard criteria were adhered to both before and after the intervention. Participants were observed in the surgical operation theatre (OT) without prior notice to ensure hand hygiene compliance before surgical procedures. The intervention included a video presentation as well as a live demonstration. Results Only 64.41% (n=23) of residents and house officers followed the recommended standard hand hygiene procedures before the intervention. This percentage rose to 93.92% (n=33) following the intervention, suggesting a noteworthy improvement. Conclusion Significant changes in the acceptance rates for the essential requirements of hand hygiene were observed after the evaluation in the second cycle. Adhering to WHO guidelines for procedures will help reduce the risk of infections and promote awareness of asepsis in practice.

Optimising the indications for biliary stent placement during endoscopic retrograde cholangiopancreatography: a quality improvement initiative to enhance patient care and reduce healthcare resource utilisation.

BACKGROUND: A retrospective chart audit was performed to review biliary stent utilisation from January 2020 to January 2021. Non-guideline-based stent insertion was identified in 16% of patients with common bile duct (CBD) stones presenting for endoscopic retrograde cholangiopancreatography (ERCP). To improve this knowledge-practice gap, a quality improvement (QI) intervention was devised and trialled. AIM: To synchronise clinical indications for biliary stent insertion in patients with CBD stones in accordance with published guidelines. METHODS: Using a QI pre-post study design, chart audits were completed and shared with the ERCP team (n=6). Indication for biliary stent insertion was compared to published guidelines assessed by two reviewers independently (kappa statistic calculated). The QI intervention included an education session and quarterly practice audits. An interrupted time series with segmented regression was completed. RESULTS: A total of 661 patients (337 F), mean age 59±19 years (range 12-98 years), underwent 885 ERCPs during this postintervention period. Of 661 patients, 384 (58%) were referred for CBD stones. A total of 192 biliary stents (105 plastic, 85 metal) were placed during the first ERCP (192/661, 29%), as compared with the preintervention year (223/598, 37%, p=0.2). Furthermore, 13/192 stents (7%) were placed not in accordance with published guidelines (kappa=0.53), compared with 63/223 (28%) in the preintervention year (p<0.0001). A 75% reduction in overall avoidable stent placement was achieved with a direct cost avoidance of $C97 500. For the CBD stone subgroup, there was an 88% reduction in avoidable biliary stent placement compared with the preintervention year (8/384, 2% vs 61/375, 16%, p<0.0001). CONCLUSIONS: Education with audit and feedback supported the closing of a knowledge-to-practice gap for biliary stent insertion during ERCP, especially in patients with CBD stones. This has resulted in a notable reduction of avoidable stent placements and additional follow-up ERCPs and an overall saving of healthcare resources.

Harnessing policy to promote inclusive medical product evidence: development of a reference standard and structured audit of clinical trial diversity policies.

Objective: To develop a reference standard based on US Food and Drug Administration and stakeholder guidance for pharmaceutical companies' policies on diversity in clinical trials and to assess these policies. Design: Development of a reference standard and structured audit for clinical trial diversity policies. Setting: 50 pharmaceutical companies selected from the top 500 by their market capitalizations in 2021 (the 25 largest companies and 25 non-large companies, randomly selected from the remaining 475 companies). Population: Data from pharmaceutical company websites and annual reports. Policy guidance from the Pharmaceutical Research and Manufacturers of America, International Federation of Pharmaceutical Manufacturers and Associations, Biotechnology Industry Organization, International Committee of Medical Journal Editors, the US Food and Drug Administration, European Medicines Agency, and World Health Organization, up to 15 May 2023. Main outcome measures: Multicomponent measure based on distinct themes derived from FDA and stakeholder guidance. Results: Reviewing FDA and stakeholder guidance identified 14 distinct themes recommended for improving diversity in clinical trials, which were built into a reference standard: (1) enrollment targets that reflect the prevalence of targeted conditions in populations, (2) broad eligibility criteria for trials, (3) diversity in the workforce, (4) identification and remedy of barriers to trial recruitment and retention, (5) incorporation of patient input into trial design, (6) health literacy, (7) multidimensional approaches to diversity, (8) sites with diverse providers and patient populations, (9) data collection after product approval, (10) diverse enrollment in every country where trials are conducted, (11) diverse enrollment should be a focus for all phases of clinical trials, not just later stage or pivotal trials, (12) varied trial design, (13) expanded access, and (14) public reporting of the personal characteristics of participants in trials. Applying this reference standard, 48% (24/50) of companies had no public policy on diversity in clinical trials; among those with policies, content varied widely. Large companies were more likely to have a public policy than non-large companies (21/25, 84% v 5/25, 20%, P<0.001). Large companies most frequently committed to using epidemiological based trial enrollment targets representing the prevalence of indicated conditions in various populations (n=15, 71%), dealing with barriers to trial recruitment (n=15, 71%), and improving patient awareness of trial opportunities (n=14, 67%). The location of the company was not associated with having a public diversity policy (P=0.17). The average company policy had five of the 14 commitments (36%, range 0-8) recommended in FDA and stakeholder guidance. Conclusions: The findings of the study showed that many pharmaceutical companies did not have public policies on diversity in clinical trials, although policies were more common in large than non-large companies. Policies that were publicly available varied widely and lacked important commitments recommended by stakeholder guidance. The results of the study suggest that corporate policies can be better leveraged to promote representation and fair inclusion in research, and implementation of FDA and stakeholder guidance.

Analysis of bariatric surgical complications requiring interhospital transfers using a modified Victorian Audit of Surgical Mortality framework.

BACKGROUND: Surgical audit is key in upholding the standards of surgical care but may be inadequate in capturing morbidity experienced by patients being transferred across different health systems. The aim of this study was to assess the utility of an objective framework in the evaluation of clinical issues surrounding interhospital transfers (IHTs). METHODS: A retrospective cohort study was conducted at a Victorian state bariatric hospital. Patients transferred with bariatric surgery related complications between 2014 and 2021 were included. Each case was reviewed by two surgeons using an objective framework developed via a modified Delphi-process. Key issues and preventability surrounding each transfer were evaluated. Inter-observer agreement was assessed using weighted Cohen's Kappa coefficient. RESULTS: Seventy-three patients were included. The most common indication for transfer was proximal staple line leak post sleeve gastrectomy (34/73, 46.6%). Length of stay was 38.3 ± 58.8 days. Cost of care amounted to AUD $110 666.18 per patient. Delay in transfer and complication recognition were present in 20% of cases (Cohen's Kappa 0.51;0.61). Human factors and patient related factors were the most common principal underlying causes (Cohen's Kappa 0.59). A third of the complications (n = 25/73, 34.2%), were potentially preventable (Cohen's Kappa 0.58) and more than half (39/73, 53.4%) did not have documented objective feedback to referring clinicians. CONCLUSION: IHTs associated with bariatric surgery complications have significant morbidity and costs. A structured framework in reviewing IHT can consistently identify potentially modifiable factors that improve clinical outcomes, and constructive feedback to the referring clinician should be actively facilitated and documented.

Patch Infection Following Carotid Endarterectomy: A Single-Center Audit and Literature Review.

INTRODUCTION: Carotid endarterectomy (CEA) is a surgical procedure that carries a rare but serious risk of patch infection. This study examines the management and outcomes of patch infections in CEA patients treated in our department over 23 years. A literature review of studies on prosthetic patch infection following CEA published from January 1992 up to December 31, 2022 was also carried out. METHODS: We conducted a retrospective audit of patients who underwent CEA in a hospital in Athens, Greece, between January 1, 1999, and December 31, 2022. RESULTS: Between January 1999 and December 2022, we treated seven patients with carotid patch infections who had their original CEA at our department. Staphylococcus epidermidis and Staphylococcus aureus were the most common infecting organisms. One patient (14%) died from hemorrhagic shock before surgery, while the remaining six (86%) underwent debridement, patch excision, and great saphenous vein patching. No peri-operative deaths or strokes occurred, and there were no re-infections during a median follow-up of 159 months. CONCLUSIONS: Excision of infected material followed by revascularization using a vein graft remains the prevailing treatment.

Evaluating Compliance With the Ottawa Rules: A Retrospective Clinical Audit at a District General Hospital in the UK.

BACKGROUND: The Ottawa Rules are clinical decision tools designed to assist healthcare providers in determining the need for radiographs in patients with ankle or knee injuries. Compliance with these rules can lead to more efficient use of resources and reduced radiation exposure. OBJECTIVE: This retrospective clinical audit aimed to evaluate healthcare provider's compliance with the Ottawa Rules in an Emergency Department setting and assess the positivity rates of requested knee and ankle X-rays. METHODS: A two-cycle retrospective audit was conducted at Lincoln County Hospital's Emergency Department, involving 648 X-rays collected in two cycles. In between, multiple interventions were implemented to improve the outcomes. RESULTS: The study revealed varying levels of compliance with the Ottawa Rules, with higher compliance observed for knee X-rays than ankle X-rays. The compliance for knee X-rays improved from 74.6% to 89.9% and ankle X-rays improved from 33.1% to 75.8%. Positivity rates for ankle radiographs were higher than knee radiographs in both cycles. The interventions implemented between the cycles significantly improved compliance rates with the Ottawa Rules. CONCLUSION: The findings underscore the importance of adherence to the Ottawa Rules in optimizing patient care and resource utilization. The study suggests the need for continued education and periodic audits to maintain and further improve compliance rates. Additionally, the higher positivity rates for ankle radiographs highlight the importance of targeted imaging strategies based on clinical guidelines.

Impact of pharmacist-driven antimicrobial stewardship interventions in a secondary care facility in Japan: A pragmatic quasi-experimental study.

BACKGROUND: Efforts to promote antimicrobial stewardship aimed at reducing antimicrobial resistance are necessary regardless of hospital scale owing to delays in new antimicrobial development. We aimed to evaluate the effects of pharmacist-driven interventions on broad-spectrum antimicrobial usage and the prognosis of patients with bacteremia in a medium-sized hospital lacking infectious disease physicians and a microbiology laboratory. METHODS: This single-center, retrospective, pragmatic, quasi-experimental study was conducted to compare pre- and post-intervention effects at Saiseikai Futsukaichi Hospital. We analyzed the days of therapy (DOT) for carbapenems and days of antibiotic spectrum coverage (DASC) for antimicrobials using an interrupted time series analysis. Cox proportional hazards analysis was performed to assess 30-day mortality using propensity score and inverse probability of treatment weighting in patients with bacteremia. RESULTS: Pharmacist-driven interventions significantly reduced the DOT (incidence rate ratio [IRR]: 0.53, 95 % confidence intervals [CI]: 0.33-0.81, p = 0.003) and DASC (IRR: 0.87, 95 % CI: 0.78-0.97, p = 0.016). The 30-day mortality due to bacteremia did not significantly differ between pre- and post-intervention in all patients (adjusted hazard ratio [HR]: 0.92, 95 % CI: 0.56-1.51, p = 0.74). Conversely, pharmacist-driven interventions significantly reduced the 30-day mortality owing to bacteremia with Pitt bacteremia score (PBS) ≥4 (adjusted HR: 0.52, 95 % CI: 0.28-0.99, p = 0.047). CONCLUSIONS: Pharmacist-driven interventions may represent a valuable approach for optimizing antimicrobial treatment and improving prognosis, especially in patients with PBS ≥4, which will potentially benefit patients in similar healthcare environments facing challenges related to antimicrobial stewardship and patient prognosis.

Sampling Targets to Assess Occupational Health in Occupational Health and Safety Management System Audits s: A Mixed-Methods Research in Japan.

BACKGROUND: Occupational health and safety management systems (OHSMS) are the foundation of occupational health and safety activities within an organization. An important element of these systems is audits. However, OHSMS auditors often lack confidence in conducting occupational health audits compared with their proficiency in conducting occupational safety audits. For occupational health to be effectively managed by OHSMS, the sampling competence of auditors engaged in third-party audits should be improved. Therefore, we conducted this study to identify appropriate sampling targets for occupational health related to ISO 45001. METHODS: we adopted a mixed methods approach to identify appropriate sampling targets. This involved conducting focus group discussions with experts in occupational health and performing systematic text condensation analysis. The validity of our findings was further reinforced through confirmation by external auditors who specialize in ISO 45001. RESULTS: In the qualitative phase, six occupational health sampling targets were identified, and of these, five were subsequently validated in the quantitative phase, 1: Health issues, legal requirements, and occupational health goals identified by the organization; 2: Occupational health risk assessment and control processes; 3: Processes related to occupational health and documented information showing the results of efforts; 4: Organizational roles and functions of occupational health professionals and opportunities for their professional development; 5: Processes to ensure commitment to occupational health issues and objectives. CONCLUSION: To ensure effective and comprehensive occupational health audits, auditors should review these targets. This study will enhance the competence of auditors by identifying appropriate occupational health sampling targets.

[Evaluation of medication self-administration feasibility in a university hospital: Clinical audits and recommendations]. / Évaluation de la faisabilité du dispositif d'auto-administration des médicaments par le patient dans un centre hospitalier universitaire : audits de pratique et recommandations pour une mise en œuvre sûre.

The French Health Authority recently published guidelines about patient self-administration of medications for voluntary hospitalized patients under medical supervision. This study aimed to assess medication management practices in our hospital and provide recommendations for self-administration medication. A prospective monocentric study was performed from January to June 2023, involving patient and nurse surveys based on the guidelines from the French Health Authority. A total of 207 patients participated in the survey, with a mean age of 59.6years. Among them, 56% were inclined to self-manage treatments initiated during hospitalization. Among patients with regular treatments, 62% were inclined to self-manage them in the hospital. In weekday hospitalization units, 92% of patients were inclined to self-manage their regular treatments, and 75% of those initiated during hospitalization. Among the 26 surveyed nurses, 71% reported patient autonomy for taking drugs in narrative transmissions, and 88% verified medication intake through self-administration, while 96% digitally traced it. The concept of self-administration of medication appears promising, especially within weekday hospitalization units, particularly for patients with a good understanding of their treatment. Nurses currently assess patient autonomy without specific monitoring tools. Collaborative efforts among healthcare professionals, with pharmacists playing a central role, are essential for the success of this innovative approach.

Proposal of a Knowledge Management Model for Complex Systems: Case of the Supervision and Control Subsystem of the Colombian Health System.

BACKGROUND: Considering regulatory, supervision, and control health policy, an innovative knowledge management model is proposed for the Colombian health system, which is recognized as a complex system. METHODS: A model is constructed through a comparative analysis of various theoretical and conceptual frameworks, and an original methodology is proposed based on an analysis of the macroprocesses of the Supervision and Control System (SSC) of the Colombian General Social Security System in Health (SGSSS). After formulating hypotheses and conceptual references, information errors are determined within the different macroprocesses of the SGSSS, including those of governance and the SSC. RESULTS: The risks of generating duplicate, wrong, hidden, or non-existent information arise when the associated regulations need more specificity to be applied in all cases, thus leading to the risk of different interpretations by some actors. In this way, it is possible to hinder the generation of unified information, as there is no clarity as to who is responsible for the generation or creation of certain data. CONCLUSIONS: The proposed model is characterized by its flexibility and adaptability, integrating several processes that can be executed simultaneously or cyclically (depending on the system's needs) and allowing for the generation and feedback of knowledge at different stages, with some processes simultaneously executed to complement each other.

Transfusion sample mislabelling and wrong blood in tube in the UK: Insights from the national comparative audits of blood transfusion in 2012 and 2022.

BACKGROUND: Samples for transfusion rejected due to mislabelling can lead to harm when a patient has to be re-bled or has a transfusion or procedure delayed. Electronic labelling systems which scan the patient's identification band and generate a label at their side aim to reduce mislabelling and misidentification leading to wrong blood in tube (WBIT) errors. The 2022 National Comparative audit of sample collection aimed to compare national rates of sample mislabelling and WBIT to the 2012 audit and to examine the impact of electronic systems. METHOD: All UK hospitals were invited to provide data on rejected transfusion samples and WBIT incidents in 1 month (October 2022) and were asked if they had electronic labelling. RESULTS: Twenty-three thousand five hundred and eighty-four rejected samples were reported by 179 sites in 1 month. The rejection rate of 4.4% represents a 47% increase compared to 2012 (2.99%). There were 92 WBIT incidents, an incidence of 1 in 5882 samples-a 45% increase compared to 1 in 8547 in 2012. Twenty-three percent of sites can print a sample label at the patient's side, up by 224%. The six sites using only electronic sample labelling had a 46.9% lower rejection rate than sites using only hand-labelling but still reported WBIT. CONCLUSIONS: The increase in sample rejection and WBIT may reflect pressures facing clinical staff, zero tolerance policies and the two-sample rule. A human factors approach to understanding and tackling underlying reasons locally is recommended. Electronic systems are associated with fewer labelling errors, but careful implementation and training is needed to maximise their safety benefits.

The Impact of Minimum Wage Policy on Alcohol Use Disorder: A Quasi-Experimental Study in South Korea.

South Korea's 2018 minimum wage hike was examined for its impact on potential alcohol use disorders among affected individuals, using data from the Korea Welfare Panel Study (2015-2019). The study sample was restricted to workers aged 19-64 employed over the study years. The treatment group was identified as those below minimum wages, and the control group as those earning more than minimum wages in 2016-2017 (n=3,117 control, n=578 treatment). Using outcomes derived from the Alcohol Use Disorders Identification Test, our results from difference-in-differences models showed that the 2018 wage hike was linked to a 1.9% increase in the 'high risk' of alcohol use disorder and a 3.6% rise in hazardous consumption in the treatment group. Notably, the effects were more pronounced among men and those aged 50-64. Additionally, we confirmed that the spillover effects extended to workers earning up to 20% above the minimum wage. This study underscores the unintended substance use risk of minimum wage policies in the East Asian context. As wage policies are implemented, integrated public health campaigns targeting at-risk groups are required.