The quality and safety culture in general hospitals: patients', physicians' and nurses' evaluation of its effect on patient satisfaction.

OBJECTIVE: To explore the disparities between patients' and health care workers' perception of the quality and safety culture and to explore the relationship between patient perceptions, and engagement in, and satisfaction with their care and treatment. DESIGN: A cross-sectional study was conducted in medical-surgical wards of four Israeli general hospitals. Data were collected using a self-administered questionnaire. SETTING: Fourteen medical-surgical wards of the four hospitals where data were collected. PARTICIPANTS: The sample comprised of 390 physicians and nurses and 726 inpatients admitted for at least 3 days. MAIN OUTCOME MEASURES: A self-administered questionnaire that covered the following topics: (i) quality and safety culture, (ii) patient engagement, (iii) patient satisfaction, (iv) an assessment of the care quality and safety in the ward and (v) sociodemographic data. The questionnaire was translated into Arabic and Russian. Sixty nine items were directed to the staff and 71 to patients. RESULTS: Patients evaluated the quality and safety culture significantly higher than did the health care workers. Significant correlations were found between patients' engagement in and satisfaction with their care and their quality and safety assessments. Their evaluation of this culture was the only predictor of their satisfaction and engagement. Arabic-speaking patients rated four variables, including patients' satisfaction with their care, lower than did Hebrew and Russian speakers. CONCLUSIONS: Patients have sufficient experience and understanding to form an opinion of the quality and safety of their care. The lower evaluation of the quality and safety culture expressed by health care workers might stem from their more realistic expectations.

Physical symptoms and emotional responses among women undergoing induced abortion protocols during the second trimester.

OBJECTIVE: To compare the physical and emotional effects of two medical protocols for induced abortion during the second trimester. METHODS: The present study was part of a prospective randomized controlled trial comparing mifepristone followed by oxytocin or misoprostol that was conducted at the Hadassah Hebrew University Medical Center, Jerusalem, Israel, from January 10, 2009, to February 22, 2012. Inclusion criteria were pregnancy (14-24weeks), epidural analgesia, and medical induction of abortion (either elective or following missed abortion). A structured questionnaire was used to assess the participants' physical symptoms and emotional responses. The primary outcome for the present analysis was the degree of physical symptoms reported. RESULTS: Overall, 68 women in the oxytocin group and 67 in the misoprostol group received epidural analgesia and completed the questionnaire. As assessed using a five-point Likert scale, women in the misoprostol group were more likely than those in the oxytocin group to experience diarrhea (1.34±0.84 vs 1.10±0.55; P=0.05) and shivers (3.03±1.75 vs 1.75±1.21; P<0.001). No other between-group differences were detected for the physical or emotional variables evaluated. CONCLUSION: Differences in physical symptoms experienced by the two treatment groups did not influence the participants' subsequent emotional response. ClinicalTrials.gov: NCT00784797.

Mifepristone followed by misoprostol or oxytocin for second-trimester abortion: a randomized controlled trial.

OBJECTIVE: To compare two methods for induction of second-trimester abortion after priming the cervix with mifepristone. METHODS: This was a randomized prospective trial carried out between January 2009 and February 2012. The participants were healthy women between 14 and 24 weeks of gestation with missed miscarriage or need for termination of pregnancy. All participants received oral 200 mg mifepristone and, after 36 hours, after randomization, were given either a high-concentration oxytocin drip (maximal dose of 150 milli-international units/min) for up to 36 hours or 800 micrograms misoprostol vaginally followed by 400 micrograms oral misoprostol every 3 hours with a maximum of four oral doses. If expulsion of the fetus was not achieved, another 200 mg mifepristone was administered and another course of misoprostol was delivered as described previously. The primary outcome measure was success expulsion of the fetus in 36 hours since starting on uterotonic agent. Secondary outcomes included time until expulsion of the fetus and rate of adverse outcomes. RESULTS: Success rates in the mifepristone-misoprostol and mifepristone-oxytocin arms were 100% (70/70 patients) and 95.8% (69/72), respectively (relative risk 1.043, 95% confidence interval 0.99-1.10, P=.13). Time until fetal expulsion was shorter in the mifepristone-misoprostol arm (7.0 ± 4.9 hours compared with 11.3 ± 7.4 hours, P<.001). However, the rate of adverse effects in the misoprostol group was higher than in the oxytocin group. Factors associated with a shorter time until expulsion were missed miscarriage compared with therapeutic abortion, increased ultrasonographic gestational age, and increased parity. CONCLUSION: The two regimens studied had comparable efficacy for induction of second-trimester abortion; however, the mifepristone-oxytocin regimen has a longer time until expulsion but with fewer side effects. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, www.clinicaltrials.gov, NCT00784797. LEVEL OF EVIDENCE: : I.

Establishing the position of neurosurgery nurse coordinator as a catalyst for advancing quality of care in a tertiary hospital in Israel.

BACKGROUND: The role of neurosurgery nurse coordinator is unique in Israel and was developed to provide a comprehensive response to the needs of patients undergoing cranial surgery to remove various types of tumors. The creation of the neurosurgery nurse coordinator role was based on patient and staff needs assessment and focused on two major areas: (1) the patient and his or her family-creating personal and empathic communication with the goal of offering emotional support, providing support to assist in relieving symptoms, coordinating between the patient and/or the patient's family and the physicians and consultants, and assisting with bureaucratic processes and with familiarization with the hospital's medical environment; and (2) establishing departmental processes related to improving patient care within a multidisciplinary team. OBJECTIVE: The aim of this study was to investigate the needs and level of satisfaction of patients and their families, hospitalized in the neurosurgery department for the surgical removal of cranial tumors. METHODS: Satisfaction survey is composed of 47 questions. SAMPLE: A convenience sample of 67 patients completed a satisfaction survey related to various aspects of their hospitalization. FINDINGS: The study results reflect patient needs for emotional support, information, and additional education. These findings emphasize the great importance of the position of nurse coordinator in the neurosurgery department.

Preferences of Israeli nursing students in choosing their future workplace.

AIM: To examine the decision-making process and factors influencing nursing students when choosing a workplace. BACKGROUND: In view of the global nursing shortage, nurse recruitment strategies should address multicultural factors and students' expectations, which may influence their workplace preference. METHODS: A combined study involving qualitative (focus groups) and quantitative (questionnaire survey) methods, was carried out in a University School of Nursing in Israel. RESULTS: Focus groups revealed that students focused on various aspects of job security and salary benefits. The perceived 'ideal' hospital is one with close proximity to home, offers good employment conditions and has a positive social atmosphere. Differences were found in the quantitative survey between female and male students as well as between students in the academic vs. non-academic track. CONCLUSIONS: IT is important to periodically review the considerations and motives of nursing students when choosing a workplace and responsively implement various strategies to recruit new nurses. IMPLICATIONS FOR NURSING MANAGEMENT: The hospital's image as a quality and friendly workplace should be strengthened and nursing students should be offered opportunities for professional and academic development.

Nurse liaison: the bridge between the perioperative department and patient accompaniers.

The role of the perioperative nurse liaison at Hadassah-Hebrew University Medical Center, Ein Kerem in Jerusalem, Israel, is to provide information and help patients' family members and others accompanying surgical patients cope with feelings of uncertainty, emotional stress, and fear. The nurse liaison is responsible for ongoing communication with patient accompaniers awaiting the conclusion of surgery and, in particular, for updating them on the surgery's progress. As part of a quality assurance project, the OR academic assistant, the OR nursing supervisor, and the coordinator of clinical quality and assurance in nursing conducted a quantitative descriptive survey to evaluate patient accompaniers' satisfaction with the updates provided by the nurse liaison throughout surgery and with the waiting room conditions. Results indicated that the nurse liaison makes a significant contribution to the welfare of patient accompaniers during surgery. In addition, results showed a need to improve the waiting room conditions to allow for more privacy.

Creating a vision for nursing practice in a tertiary medical organization in Israel.

Rapid changes in the healthcare system obligate Israeli nursing leaders to reassess current nursing roles and to identify new paradigms that are in line with the demanding needs of acute care settings. The challenge of engaging nurses to achieve the desired changes in nursing role performance and perception can be accomplished by defining a comprehensive organizational vision. The authors present a process creating and implementing a nursing vision intended to empower the nurse's role in a large acute general hospital.

Quality improvement program to assure the delivery of pathology test results: a systemic intervention in a large general hospital.

A late or missed notification of pathology results could be disastrous for the patient as well as for the medical staff and the institution involved. In this article, the authors describe a systemic intervention implemented and led by nurses to enhance the safety and the efficiency of the notification process. The two-fold intervention includes patient and medical staff education along with developing and implementing a computerized alert system throughout the hospital by a multidisciplinary team. The measurable outcomes were the rate of patient notification and the percentage of physicians reading the pathologist's report through the computerized system. Theses two outcomes improved significantly after the intervention. This study demonstrates how nurses can play a major role in both patient and staff education and with performing organizational chance to strengthen patient safety.

Antibiotic susceptibility, serotype distribution and vaccine coverage of nasopharyngeal and oropharyngeal Streptococcus pneumoniae in a day-care centre in St. Petersburg, Russia.

UNLABELLED: The objectives were to study serotypes and antibiotic susceptibility of Streptococcus pneumoniae carried by healthy children attending a day-care centre in St. Petersburg. S. pneumoniae colonization was investigated in 125 children aged 16-70 months. Antibiotic susceptibility was determined by E-test and disk diffusion. 83 S. pneumoniae cases were isolated in 75/125 (60%) children: 36/75 (48%) in the nasopharynx, 12/75 (16%) in the oropharynx and 27/75 (36%) in both. Carriage rates were 100%, 68%, 72%, 46% and 54% in children aged 12-23, 24-35, 36-47, 48-59 and >or=60 months, respectively. 97.6% of isolates were susceptible to penicillin. 61.4%, 32.5%, 19.3%, 16.7% and 6% isolates were non-susceptible to trimethoprim/sulfamethoxazole, tetracycline, clindamycin, erythromycin and chloramphenicol, respectively. 20.5% of isolates were multidrug resistant (MDR). 45% of isolates were of serotypes included in the 7-valent pneumococcal conjugate vaccine (7V-PCV); 64.9%, 56.8%, 32.4% and 27% of 7V-PCV serotypes were resistant to trimethoprim/sulfamethoxazole, tetracycline, clindamycin and erythromycin, respectively. The respective figures for MDR isolates were 100%, 94.1%, 70.6% and 76.5%; 76.5% of all MDR isolates were covered by 7V-PCV. IN CONCLUSION: 1) resistance to trimethoprim/sulfamethoxazole and tetracycline was high; 2) resistance to macrolides was higher than in other Russian regions; 3) 7V-PCV coverage was modest, but the vaccine may potentially reduce MDR-S. pneumoniae.

Adult pertussis is hazardous for the newborn.

We report 4 cases involving the likely transmission of pertussis from parents to newborns in a hospital setting. The adoption of proper infection control measures and targeted screening of parents may reduce the potential for such transmission.