The effect of contextual information on professional judgment: Reliability and biasability of expert workplace safety inspectors.

INTRODUCTION: A critical aspect of occupational safety is workplace inspections by experts, in which hazards are identified. Scientific research demonstrates that expectation generated by context (i.e., prior knowledge and experience) can bias the judgments of professionals and that individuals are largely unaware when their judgments are affected by bias. METHOD: The current research tested the reliability and biasability of expert safety inspectors' judgments. We used a two-study design (Study 1, N = 83; Study 2, N = 70) to explore the potential of contextual, task-irrelevant, information to bias professionals' judgments. We examined three main issues: (1) the effect that biasing background information (safe and unsafe company history) had on professional regulatory safety inspectors' judgments of a worksite; (2) the reliability of those judgments amongst safety inspectors and (3) inspectors' awareness of bias in their judgments and confidence in their performance. RESULTS: Our findings establish that: (i) inspectors' judgments were biased by historical contextual information, (ii) they were not only biased, but the impact was implicit: they reported being unaware that it affected their judgments, and (iii) independent of our manipulations, inspectors were inconsistent with one another and the variations were not a product of experience. CONCLUSION: Our results are a replication of findings from a host of other professional domains, where honest, hardworking professionals underappreciate the biasing effect of context on their decision making. The current paper situates these findings within the relevant research on safety inspection, cognitive bias and decision making, as well as provides suggestions for bias mitigation in workplace safety inspection. Practical Application: Our results have implications for occupational health and safety given that inspection is an integral aspect of an effective safety system. In addition to our findings, this study contributes to the literature by providing recommendations regarding how to mitigate the effect of bias in inspection.

Improving Quality of Care Through a Mandatory Provincial Audit Program: Ontario's Emergency Department Return Visit Quality Program.

The Emergency Department Return Visit Quality Program was launched in Ontario, Canada, to promote a culture of quality. It mandates the province's largest-volume emergency departments (EDs) to audit charts of patients who had a return visit leading to hospital admission, including some of their 72-hour all-cause return visits with admission and all of their 7-day ones with sentinel diagnoses (ie, acute myocardial infarction, subarachnoid hemorrhage, and pediatric sepsis), and submit their findings to a governmental agency. This provides an opportunity to identify possible adverse events and quality issues, which hospitals can then address through quality improvement initiatives. A group of emergency physicians with quality improvement expertise analyzed the submitted audits and accompanying narrative templates, using a general inductive approach to develop a novel classification of recurrent quality themes. Since the Return Visit Quality Program launched in 2016, 125,698 return visits with admission have been identified, representing 0.93% of the 86 participating EDs' 13,559,664 visits. Overall, participating hospitals have conducted 12,852 detailed chart audits, uncovering 3,010 (23.4%) adverse events/quality issues and undertaking hundreds of quality improvement provincewide projects as a result. The inductive analysis revealed 11 recurrent themes, classified into 3 groupings: patient characteristics (ie, patient risk profile and elder care), ED team actions or processes (ie, physician cognitive lapses, documentation, handover/communication between providers, radiology, vital signs, and high-risk medications or medication interactions), and health care system issues (ie, discharge planning/community follow-up, left against medical advice/left without being seen, and imaging/testing availability). The Return Visit Quality Program is the largest mandatory audit program for EDs and provides a novel approach to identify local adverse events/quality issues to target for improved patient safety and quality of care. It provides a blueprint for health system leaders to enable clinicians to develop an approach to organizational quality, as well as for teams to construct an audit system that yields defined issues amenable to improvement.

Using routine, independent, scientific-data audits as an early-warning for potentially fraudulent toxic-site cleanup: PCE, TCE, and other VOCs at the former Naval-Ordnance Test Station, Pasadena, California.

Two of the most prevalent Superfund-site contaminants are carcinogenic solvents PCE (perchloroethylene) and TCE (trichloroethylene). Because their cleanup is difficult and costly, remediators have repeatedly falsified site-cleanup data, as Tetra Tech apparently did recently in San Francisco. Especially for difficult-to-remediate toxins, this paper hypothesizes that scientific misrepresentations occur in toxic-site assessments, before remediation even begins. To begin to test this hypothesis, the paper (1) defines scientific-data audits (assessing whether published conclusions contradict source data), (2) performs a preliminary scientific-data audit of toxic-site assessments by consultants Ninyo and Moore for developer Trammell Crow. Trammel Crow wants to build 550 apartments on an unremediated Pasadena, California site - once a premier US Navy weapons-testing/development facility. The paper (3) examines four key Ninyo-and-Moore conclusions, that removing only localized metals-hotspots will (3.1) remediate TCE/PCE; (3.2) leave low levels of them; (3.3) clean the northern half of soil, making it usable for grading, and (3.4) ensure site residents have lifetime cancer risks no greater than 1 in 3,000. The paper (4) shows that source data contradict all four conclusions. After summarizing the benefits of routine, independent, scientific-data audits (RISDA), the paper (5) argues that, if these results are generalizable, RISDA might help prevent questionable toxic-site assessments, especially those of expensive-to-remediate toxins like PCE/TCE.

Práticas de auditoria no sistema único de saúde: uma revisão integrativa / Prácticas de auditoría en el sistema único de salud: una revisión integrativa / Auditing practices in the Brazilian unified health system: an integrative literature review

Objective: The study's purpose has been to analyze the auditing practices in the Sistema Único de Saúde (SUS) [Brazilian Unified Health System]. Methods: It is an integrative literature review that was carried out in the Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS) [Latin American and Caribbean Literature in Health Sciences], Virtual Health Library (VHL), and Web of Science databases. By using the inclusion and exclusion criteria, 12 scientific articles were selected for in-depth analysis. Results: The findings demonstrate the political and institutional advances regarding to the auditing practices in the SUS. There have been also identified many challenges that must be overcome in order to support such practices, such as the need to qualify the tools of the National Audit Department from the SUS and to improve the communication between State, Municipal, and Federal auditing. Conclusion: Auditing practices in the SUS are still under development, then requiring more studies and dissemination, aiming to bring contributions to both practice and the academic milieu

Objetivo: Analisar as práticas de auditoria no Sistema Único de Saúde (SUS). Métodos: Trata-se de uma revisão integrativa de literatura realizada na Biblioteca Virtual em Saúde (BVS), Literatura Latino-Americana e do Caribe em Ciências da Saúde (Lilacs), e Web of Science. Ao total, utilizando-se os critérios de inclusão e exclusão selecionou-se 12 artigos científicos para análise. Resultados: Os resultados apontam avanços políticos e nas instituições com relação as práticas de auditoria no SUS. Identificam-se também muitos desafios para fortalecer tais práticas, como a necessidade de qualificar as ferramentas do Departamento Nacional de Auditoria do SUS e melhorar a comunicação entre o componente, estadual, municipal e federal de auditoria. Conclusão: As práticas de auditoria no SUS estão em construção, necessitando de mais estudos e divulgação, afim de que traga contribuições para a prática e o meio acadêmico

Objetivo: Analizar las prácticas de auditoría en el Sistema Único de Salud (SUS). Método: Se trata de una revisión integrativa de literatura realizada en la Biblioteca Virtual en Salud (BVS), Literatura Latinoamericana y del Caribe en Ciencias de la Salud (Lilacs), y Web of Science. Al total, utilizando los criterios de inclusión y exclusión se seleccionaron 12 artículos científicos para análisis. Resultados: Los resultados apuntan avances políticos y en las instituciones con relación a las prácticas de auditoría en el SUS. Se identifican también, muchos desafíos para fortalecer tales prácticas, como la necesidad de calificar las herramientas del Departamento Nacional de Auditoría del SUS y mejorar la comunicación entre el componente, estatal, municipal y municipal, federal de auditoría. Conclusión: Las prácticas de auditoría en el SUS están en construcción, necesitando más estudios y divulgación, a fin de que traiga contribuciones para la práctica y el medio académico

Correcting India's Chronic Shortage of Drug Inspectors to Ensure the Production and Distribution of Safe, High-Quality Medicines.

BACKGROUND: Good drug regulation requires an effective system for monitoring and inspection of manufacturing and sales units. In India, despite widespread agreement on this principle, ongoing shortages of drug inspectors have been identified by national committees since 1975. The growth of India's pharmaceutical industry and its large export market makes the problem more acute. METHODS: The focus of this study is a case study of Maharashtra, which has 29% of India's manufacturing units and 38% of its medicines exports. India's regulations were reviewed, comparing international, national and state inspection norms with the actual number of inspectors and inspections. Twenty-six key informant interviews were conducted to ascertain the causes of the shortfall. RESULTS: In 2009-2010, 55% of the sanctioned posts of drug inspectors in Maharashtra were vacant. This resulted in a shortfall of 83%, based on the Mashelkar Committee's recommendations. Less than a quarter of the required inspections of manufacturing and sales units were undertaken. The Indian Drugs and Cosmetics Act and its Rules and Regulations make no provisions for drug inspectors and workforce planning norms, despite the growth and increasing complexity of India's pharmaceutical industry. CONCLUSION: The Maharashtra Food and Drug Administration (FDA) falls short of the Mashelkar Committee's recommended workforce planning norms. Legislation and political and operational support are required to produce needed changes.

Hospitalizaciones evitables por insuficiencia cardíaca. Variables relacionadas / Avoidable hospital admissions for heart failure, Spain

Fundamentos: Los ingresos hospitalarios evitables por insuficiencia cardiaca (IC) son un problema para los sistemas de salud, consumen recursos, generan morbilidades adicionales y alta mortalidad. El objetivo del estudio fue conocer los factores de riesgo de las personas hospitalizadas por insuficiencia cardiaca. Métodos: Se constituyó un grupo con médicos de atención primaria y hospitalaria. Se realizaron auditorías de las historias clínicas de 110 pacientes de la poblacion de la comarca del Aljarafe con mayores tasas de ingreso por insuficiencia cardiaca y estudio descriptivo y comparativo con T-Student y U-Mann Whitney para cuantitativas y λ2 y Fisher para cualitativas. Resultados: Los pacientes que ingresaron por IC tenían 78,1 años (SD: 9,56) de media; 73 (66,4%) fueron mujeres; un Índice Barthel de 45,0 de media; un 53,5% con grado III de la NYHA y 17 (15,5%) institucionalizados. El 70% presentaban 3-5 comorbilidades, hipertensión (87,3%), dislipemia (60,0%) diabetes (57,3%), enfermedad renal crónica (56,4%), anemia (53,2%) o fibrilación auricular (52,7%). Fallecieron al ingreso 23 (20,9%) pacientes. Conclusiones: Los ingresos se dieron en personas mayores con múltiples enfermedades (hipertensión, diabetes, EPOC, enfermedad renal) y escasa capacidad para actividades básicas de la vida diaria. El fallecimiento hospitalario se asoció a edad avanzada, ser mujer, menor uso de betabloqueantes y la no inclusión del paciente en el proceso asistencial (AU)

Background: The avoidable hospital admissions for heart failure are a problem for health systems worldwide, as they waste resources, generate additional morbidities and high mortality. The objective of this study was to determine the risk factors in patients hospitalized for heart failure to prevent further unplanned admissions. Methods: A group of medical from Hospital and Primary Care was established. We realized an audit of a sample of 110 patients from Aljarafe towns with highest hospital admissions for heart failure. The analysis used Student T test and Mann Whitney for quantitative variables; λ2 test and Fisher exact test for qualitative variables. Results: Patients admitted for HF had a mean age of 78.1 years (SD: 9.56); 73 (66.4%) were women; Barthel Index was 45.0 on average; 53.5% had NYHA class III and 17 (15.5%) were institutionalized, 70% had between 3 and 5 comorbidities, mainly hypertension (87.3%), dyslipidemia (60.0%), diabetes (57.3%), chronic kidney disease (56.4%), anemia (53.2% ) or atrial fibrillation (52.7%). During hospitalization, 23 patients (20.9%) died. They were mostly women, elderly, had a previous admission and without beta-blockers treatment. The admission in the last 12 months was associated with identification of the primary caregiver; ischemic HF; revascularization; inclusion in the COMPARTE Program; treatment change decompensation. Conclusiones: The hospital admissions were more frequently an aging population with multiple diseases (hypertension, diabetes, COPD, renal disease) and low capacity for basic activities of daily life. The hospital mortality associated with elderly, women, less use of beta-blockers and the non-inclusion of the patient in the care process (AU)

Development of certified environmental management in hospital and outpatient haemodialysis units.

INTRODUCTION: The environmental impact of haemodialysis is very high. Institutional activity in this sense is important, even in the production of references. Voluntary environmental management systems (EMS), environmental management and auditing systems (EMAS) and the International Organization for Standardization standards (ISO 14001) are important tools for environmental protection, together with legislation, taxation and tax benefits. OBJECTIVES: To determine the degree of implementation of EMS in hospital units and outpatient haemodialysis in the Spanish National Health System to provide a group of reference centres in environmental management in this healthcare activity. METHODS: Development of a list by autonomous communities showing hospital and outpatient dialysis units using an EMAS and/or ISO 14001 in 2012-2013. The sources of information were the Spanish National Catalogue of Hospitals, Spanish Registry of Healthcare Certification and Accreditation, European and regional EMAS records, world ISO registrations, dialysis centre lists from scientific societies and patients, responses from accredited entities in Spain for environmental certification and the institutional website of each haemodialysis centre identified. RESULTS: Of the 210 hospitals with a dialysis unit, 53 (25%) have the ISO 14001 and 15 of these also have an EMAS). This constitutes 30% of all hospital dialysis chairs in Spain: 1,291 (of 4,298). Only 11 outpatient clinics are recorded, all with the ISO 14001. DISCUSSION: There is no official documentation of the implementation of EMS in dialysis units. Making this list provides an approach to the situation, with special reference to haemodialysis because of its significant environmental impact.

Manufacturing of Plasma-Derived Medicinal Products: Qualification Process of Plasma Suppliers.

Manufacturers of human plasma-derived products ensure, through their qualification departments, the quality and safety of human plasma-the biological starting material of the industrial fractionation process. The qualification department has established written procedures to approve the plasma supplier (i.e., initial qualification) according to current regulations and to the manufacturer's plasma specifications. Once the plasma supplier is approved, a periodical assessment is necessary (i.e., continuous qualification) to guarantee the level of compliance. In addition, a signed quality agreement between the plasma supplier and the manufacturer defines the duties and the responsibilities of both parties. The qualification department implements the following requirements to ensure the quality of plasma from suppliers: (i) a regular audit program to confirm the satisfactory initiation of the quality arrangements and (ii) monitoring of the quality and safety of plasma including critical quality parameters. For several years, the Grifols Qualification Department has worked with several plasma suppliers of the European Union (EU) and has performed a detailed, continuous assessment of the audits, deviations, operational incidences, epidemiological data, and quality controls. In this article, we will report data from this Grifols assessment from 2010 through 2013 on plasma suppliers from four EU countries. In the future, additional data will be collected and studied to confirm and verify the conclusions and trends observed in this study.

Evaluación de los recursos de información en el Centro de Estudio, Documentación e Información de Medicamentos, Villa Clara / Assessment of information resources in the Center of Study, Documentation and Drug Information in Villa Clara province

OBJETIVO: evaluar los recursos de información disponibles en el Centro de Estudio, Documentación e Información de Medicamentos (CEDIMED). MÉTODOS: se identificaron aquellas fuentes, servicios y sistemas que pudieran llegar a alcanzar la categoría de entidad o recurso de información dentro del CEDIMED, empleando la metodología INFOMAP. Se recolectaron datos sobre el costo de los recursos identificados y se desarrolló un ordenamiento de estos según su característica. Se determinó el índice de valor para cada ERIs y se elaboraron las matrices de usuario, gerente y suministradores, lo que posibilitó conocer el rol de cada miembro de la organización con respecto a los recursos de información. Se analizó la variable fondos de información, en la que se estudiaron un total de 15 indicadores. RESULTADOS: se identificaron 47 entidades o recursos de información disponibles en el centro; de estas 36 internas y 11 externas. Los fondos documentales con los que cuenta el CEDIMED no presentaron un alto grado de actualización; sin embargo, las temáticas contenidas en estos, resultaron altamente pertinentes a las funciones de este tipo de organización. Alrededor de la mitad de los indicadores analizados fue evaluado de excelente; sin embargo, la variable fondos de información fue regular. CONCLUSIONES: todo centro o servicio de información sobre medicamentos debe contar con recursos de información de calidad y fácil acceso por los usuarios; así como establecer una política para el desarrollo de los fondos y la realización de estudios sobre el uso de las diversas colecciones disponibles en la institución(AU)

OBJECTIVE: to evaluate the information resources available at the Center of Study, Documentation and Information on Drugs (CEDIMED). METHODS: identification of those sources, services and systems that might attain the category of entity or of information resource within CEDIMED by using the INFOMAD methodology. Data on the cost of identified resources were collected and ordered according to their characteristics. The value index was determined for each ERI and the user, manager and supplier matrices were prepared, all of which made it possible to know the role of each member of the organization in relation to the information resources. The variable called information stocks was analyzed including the study of 15 indicators. RESULTS: forty seven information entities or resources were available at the center, 36 domestic and 11 external. The documentary stocks of CEDIMED were not highly updated; however, their topics were highly relevant for the functions of this type of organization. The evaluation of almost half of the analyzed indicators was excellent but the variable information stocks were rated as regular. CONCLUSIONS: every information center or service on drugs should have quality easy-to-access resources for users and should also set a policy aimed at developing the stocks and at carrying out studies on the use of the various collections located in the institution(AU)

Auditoría del conocimiento orientada a procesos principales en un área: biomédica / Knowledge audit aimed at core processes in a biomedical area: a case study

Identificar el conocimiento existente en los procesos principales del Centro de Biofísica Médica mediante una auditoría del conocimiento. Métodos: se desarrolló la auditoría del conocimiento enfocada a los procesos principales del Centro, sustentada en la metodología elaborada por el Dr Alonso Pérez Soltero y otros. Las variables elegidas fueron los criterios estratégicos, los procesos principales y el personal técnico y científico vinculados a proyectos de investigación. Se aplicaron entrevistas y cuestionarios a los miembros de los proyectos que figuraban en los procesos, y el análisis de los resultados se reflejó de manera descriptiva. Resultados: se caracterizó al capital humano que intervenía en los procesos principales de la institución, y se ofreció una visión panorámica de sus saberes, habilidades, competencias y carencias en lo referente al conocimiento necesario para el desempeño de sus actividades. Conclusiones: se ratifica la validez de la metodología empleada para caracterizar el conocimiento que interviene en los procesos principales. Se proponen criterios para mejorar el desempeño de los procesos principales del Centro de Biofísica Médica...

By means of a knowledge audit, identify the knowledge existing in the core processes at the Medical Biophysics Center. Methods: A knowledge audit was conducted aimed at core processes at the Center, based on the methodology developed by Dr Alonso Pérez Soltero et al. The variables selected were strategic criteria, core processes, and the technical and scientific personnel involved in research projects. The study was based on questionnaires and interviews with participants in projects included in the processes. Results were reported descriptively. Results: A characterization was conducted of the personnel involved in the main processes at the institution, and an overview was provided of their knowledge, skills, competencies and lacks concerning the knowledge required to perform their tasks. Conclusions: It was confirmed that the methodology employed is useful to characterize the knowledge involved in core processes. Criteria are proposed to improve the performance of core processes at the Medical Biophysics Center...

Evaluación de los recursos de información en el Centro de Estudio, Documentación e Información de Medicamentos, Villa Clara / Assessment of information resources in the Center of Study, Documentation and Drug Information in Villa Clara province

Objetivo: evaluar los recursos de información disponibles en el Centro de Estudio, Documentación e Información de Medicamentos (CEDIMED). Métodos: se identificaron aquellas fuentes, servicios y sistemas que pudieran llegar a alcanzar la categoría de entidad o recurso de información dentro del CEDIMED, empleando la metodología INFOMAP. Se recolectaron datos sobre el costo de los recursos identificados y se desarrolló un ordenamiento de estos según su característica. Se determinó el índice de valor para cada ERIs y se elaboraron las matrices de usuario, gerente y suministradores, lo que posibilitó conocer el rol de cada miembro de la organización con respecto a los recursos de información. Se analizó la variable fondos de información, en la que se estudiaron un total de 15 indicadores. Resultados: se identificaron 47 entidades o recursos de información disponibles en el centro; de estas 36 internas y 11 externas. Los fondos documentales con los que cuenta el CEDIMED no presentaron un alto grado de actualización; sin embargo, las temáticas contenidas en estos, resultaron altamente pertinentes a las funciones de este tipo de organización. Alrededor de la mitad de los indicadores analizados fue evaluado de excelente; sin embargo, la variable fondos de información fue regular. Conclusiones: todo centro o servicio de información sobre medicamentos debe contar con recursos de información de calidad y fácil acceso por los usuarios; así como establecer una política para el desarrollo de los fondos y la realización de estudios sobre el uso de las diversas colecciones disponibles en la institución(AU)

Objective: to evaluate the information resources available at the Center of Study, Documentation and Information on Drugs (CEDIMED). Methods: identification of those sources, services and systems that might attain the category of entity or of information resource within CEDIMED by using the INFOMAD methodology. Data on the cost of identified resources were collected and ordered according to their characteristics. The value index was determined for each ERI and the user, manager and supplier matrices were prepared, all of which made it possible to know the role of each member of the organization in relation to the information resources. The variable called information stocks was analyzed including the study of 15 indicators. Results: forty seven information entities or resources were available at the center, 36 domestic and 11 external. The documentary stocks of CEDIMED were not highly updated; however, their topics were highly relevant for the functions of this type of organization. The evaluation of almost half of the analyzed indicators was excellent but the variable information stocks were rated as regular. Conclusions: every information center or service on drugs should have quality easy-to-access resources for users and should also set a policy aimed at developing the stocks and at carrying out studies on the use of the various collections located in the institution(AU)

Auditoría del conocimiento orientada a procesos principales en un área: biomédica / Knowledge audit aimed at core processes in a biomedical area: a case study

Objetivo: identificar el conocimiento existente en los procesos principales del Centro de Biofísica Médica mediante una auditoría del conocimiento. Métodos: se desarrolló la auditoría del conocimiento enfocada a los procesos principales del Centro, sustentada en la metodología elaborada por el Dr Alonso Pérez Soltero y otros. Las variables elegidas fueron los criterios estratégicos, los procesos principales y el personal técnico y científico vinculados a proyectos de investigación. Se aplicaron entrevistas y cuestionarios a los miembros de los proyectos que figuraban en los procesos, y el análisis de los resultados se reflejó de manera descriptiva. Resultados: se caracterizó al capital humano que intervenía en los procesos principales de la institución, y se ofreció una visión panorámica de sus saberes, habilidades, competencias y carencias en lo referente al conocimiento necesario para el desempeño de sus actividades. Conclusiones: se ratifica la validez de la metodología empleada para caracterizar el conocimiento que interviene en los procesos principales. Se proponen criterios para mejorar el desempeño de los procesos principales del Centro de Biofísica Médica(AU)

Objective: By means of a knowledge audit, identify the knowledge existing in the core processes at the Medical Biophysics Center. Methods: A knowledge audit was conducted aimed at core processes at the Center, based on the methodology developed by Dr Alonso Pérez Soltero et al. The variables selected were strategic criteria, core processes, and the technical and scientific personnel involved in research projects. The study was based on questionnaires and interviews with participants in projects included in the processes. Results were reported descriptively. Results: A characterization was conducted of the personnel involved in the main processes at the institution, and an overview was provided of their knowledge, skills, competencies and lacks concerning the knowledge required to perform their tasks. Conclusions: It was confirmed that the methodology employed is useful to characterize the knowledge involved in core processes. Criteria are proposed to improve the performance of core processes at the Medical Biophysics Center(AU)

Improved incident reporting following the implementation of a standardized emergency department peer review process.

OBJECTIVE: Incident reporting is an important component of health care quality improvement. The objective of this investigation was to evaluate the effectiveness of an emergency department (ED) peer review process in promoting incident reporting. DESIGN: An observational, interrupted time-series analysis of health care provider (HCP) incident reporting to the ED during a 30-month study period prior to and following the peer review process implementation and a survey-based assessment of physician perceptions of the peer review process' educational value and its effectiveness in identifying errors. SETTING: Large, urban, academic ED. PARTICIPANTS AND INTERVENTIONS: HCPs were invited to participate in a standardized, non-punitive, non-anonymous peer review process that involved analysis and structured discussion of incident reports submitted to ED physician leadership. MAIN OUTCOME MEASURES: Monthly frequency of incident reporting by HCPs and physician perceptions of the peer review process. RESULTS: HCPs submitted 314 incident reports to the ED over the study period. Following the intervention, frequency of reporting by HCPs within the hospital increased over time. The frequencies of self-reporting, reporting by other ED practitioners and reporting by non-ED practitioners within the hospital increased compared with a control group of outside HCPs (P = 0.0019, P = 0.0025 and P < 0.0001). Physicians perceived the peer review process to be educational and highly effective in identifying errors. CONCLUSIONS: The implementation of a non-punitive peer review process that provides timely feedback and is perceived as being valuable for error identification and education can lead to increased incident reporting by HCPs.

Visualization of hospital cleanliness in three Japanese hospitals with a tendency toward long-term care.

BACKGROUND: Hospital cleanliness in hospitals with a tendency toward long-term care in Japan remains unevaluated. We therefore visualized hospital cleanliness in Japan over a 2-month period by two distinct popular methods: ATP bioluminescence (ATP method) and the standard stamp agar method (stamp method). METHODS: The surfaces of 752 sites within nurse and patient areas in three hospitals located in a central area of Sapporo, Japan were evaluated by the ATP and stamp methods, and each surface was sampled 8 times in 2 months. These areas were located in different ward units (Internal Medicine, Surgery, and Obstetrics and Gynecology). Detection limits for the ATP and stamp methods were determined by spike experiments with a diluted bacterial solution and a wipe test on student tables not in use during winter vacation, respectively. Values were expressed as the fold change over the detection limit, and a sample with a value higher than the detection limit by either method was defined as positive. RESULTS: The detection limits were determined to be 127 relative light units (RLU) per 100 cm2 for the ATP method and 5.3 colony-forming units (CFU) per 10 cm2 for the stamp method. The positive frequency of the ATP and stamp methods was 59.8% (450/752) and 47.7% (359/752), respectively, although no significant difference in the positive frequency among the hospitals was seen. Both methods revealed the presence of a wide range of organic contamination spread via hand touching, including microbial contamination, with a preponderance on the entrance floor and in patient rooms. Interestingly, the data of both methods indicated considerable variability regardless of daily visual assessment with usual wiping, and positive surfaces were irregularly seen. Nurse areas were relatively cleaner than patient areas. Finally, there was no significant correlation between the number of patients or medical personnel in the hospital and organic or microbiological contamination. CONCLUSIONS: Ongoing daily hospital cleanliness is not sufficient in Japanese hospitals with a tendency toward long-term care.

A risk-based auditing process for pharmaceutical manufacturers.

The purpose of this article is to share ideas on developing a risk-based model for the scheduling of audits (both internal and external). Audits are a key element of a manufacturer's quality system and provide an independent means of evaluating the manufacturer's or the supplier/vendor's compliance status. Suggestions for risk-based scheduling approaches are discussed in the article. LAY ABSTRACT: Pharmaceutical manufacturers are required to establish and implement a quality system. The quality system is an organizational structure defining responsibilities, procedures, processes, and resources that the manufacturer has established to ensure quality throughout the manufacturing process. Audits are a component of the manufacturer's quality system and provide a systematic and an independent means of evaluating the manufacturer's overall quality system and compliance status. Audits are performed at defined intervals for a specified duration. The intention of the audit process is to focus on key areas within the quality system and may not cover all relevant areas during each audit. In this article, the authors provide suggestions for risk-based scheduling approaches to aid pharmaceutical manufacturers in identifying the key focus areas for an audit.

Agreement between virtual and in-the-field environmental audits of assisted living sites.

The authors investigated the use of Google Earth's Street View option to audit the presence of built environment features that support older adults' walking. Two raters conducted virtual (Street View) and in-the-field audits of 48 street segments surrounding urban and suburban assisted living sites in metropolitan Vancouver, BC, Canada. The authors determined agreement using absolute agreement. Their findings indicate that Street View may identify the presence of features that promote older adults' walking, including sidewalks, benches, public washrooms, and destinations. However, Street View may not be as reliable as in-the-field audits to identify details associated with certain items, such as counts of trees or street lights; presence, features, and height of curb cuts; and sidewalk continuity, condition, and slope. Thus, the appropriateness of virtual audits to identify microscale built environment features associated with older adults' walking largely depends on the purpose of the audits-specifically, whether the measurer seeks to capture highly detailed features of the built environment.