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3.
Anaesthesia ; 76 Suppl 1: 27-39, 2021 01.
Artículo en Inglés | MEDLINE | ID: mdl-33426662

RESUMEN

Despite advances in clinical practice, local anaesthetic systemic toxicity continues to occur with the therapeutic use of local anaesthesia. Patterns of presentation have evolved over recent years due in part to the increasing use of ultrasound which has been demonstrated to reduce risk. Onset of toxicity is increasingly delayed, a greater proportion of clinical reports are secondary to fascial plane blocks, and cases are increasing where non-anaesthetist providers are involved. The evolving clinical context presents a challenge for diagnosis and requires education of all physicians, nurses and allied health professionals about these changing patterns and risks. This review discusses: mechanisms; prevention; diagnosis; and treatment of local anaesthetic systemic toxicity. The local anaesthetic and dose used, site of injection and block conduct and technique are all important determinants of local anaesthetic systemic toxicity, as are various patient factors. Risk mitigation is discussed including the care of at-risk groups, such as: those at the extremes of age; patients with cardiac, hepatic and specific metabolic diseases; and those who are pregnant. Advances in the changing clinical landscape with novel applications and settings for the use of local anaesthesia are also described. Finally, we signpost future directions to potentially improve the management of local anaesthetic systemic toxicity. The utility of local anaesthetics remains unquestionable in clinical practice, and thus maximising the safe and appropriate use of these drugs should translate to improvements in patient care.


Asunto(s)
Anestesia de Conducción/efectos adversos , Anestésicos Locales/efectos adversos , Anestésicos Locales/toxicidad , Humanos , Complicaciones Intraoperatorias/inducido químicamente , Complicaciones Intraoperatorias/terapia , Bloqueo Nervioso/efectos adversos , Seguridad del Paciente
4.
Int J Qual Health Care ; 33(Supplement_1): 11-12, 2021 Jan 12.
Artículo en Inglés | MEDLINE | ID: mdl-33432979

RESUMEN

Italy was the first country after China to be affected by COVID-19. The wave of the emergency found our country unprepared to cope with the surge of patients going to first aid departments to seek assistance in the almost complete paralysis of community health. Human factors and ergonomics (HFE) can effectively contribute to, and improve the effectiveness of, a pandemic response working on several key areas: training, adapting workflows and processes, restructuring teams and tasks, effective mechanisms and tools for communication, engaging patients and families and learning from failures and successes. In Italy, HFE expertise has been able to provide our healthcare systems with some easy-to-realize solutions (particularly dedicated to improving communication, team work and situational awareness) in order to cope with the need for rapid adaptations to new and unknown scenarios: ensuring information and communication continuity in the different levels of the healthcare system; identifying hazard opportunity through risk management tool; providing training through simulation; organizing regular briefing and debriefing; enhancing the reporting and learning system as an informal way of communicating adverse events and supporting information campaign and education initiatives for the public.


Asunto(s)
Comunicación , Prestación de Atención de Salud/organización & administración , Ergonomía , Prestación de Atención de Salud/métodos , Humanos , Italia , Seguridad del Paciente , Salud Pública/métodos
5.
Int J Qual Health Care ; 33(Supplement_1): 1-3, 2021 Jan 12.
Artículo en Inglés | MEDLINE | ID: mdl-33432980

RESUMEN

A human factors and ergonomics (HFE) systems approach offers a model for adjusting work systems and care processes in response to a healthcare crisis such as COVID-19. Using the Systems Engineering Initiative for Patient Safety (SEIPS) model of work system and patient safety, we describe various work system barriers and facilitators experienced by healthcare workers during the COVID-19 crisis. We propose a set of five principles based on this HFE systems approach related to novel pandemic: (i) deferring to local expertise, (ii) facilitating adaptive behaviors, (iii) enhancing interactions between system elements and levels along the patient journey, (iv) re-purposing existing processes and (v) encouraging dynamic continuous learning.


Asunto(s)
Prestación de Atención de Salud/métodos , Ergonomía/métodos , Personal de Salud , Prestación de Atención de Salud/normas , Humanos , Salud Laboral , Seguridad del Paciente , Análisis de Sistemas , Carga de Trabajo
6.
Int J Equity Health ; 20(1): 29, 2021 01 10.
Artículo en Inglés | MEDLINE | ID: mdl-33423682

RESUMEN

BACKGROUND: Despite high level of health care need amongst people experiencing homelessness, poor access is a major concern. This is sometimes due to organisational and bureaucratic barriers, but also because they often feel stigmatised and treated badly when they do seek health care. The COVID-19 pandemic and the required social distancing measures have caused unprecedented disruption and change for the organisation of primary care, particularly for people experiencing homelessness. Against this backdrop there are many questions to address regarding whether the recent changes required to deliver services to people experiencing homelessness in the context of COVID-19 will help to address or compound problems in accessing care and inequalities in health outcomes. METHODS: An action led and participatory research methodology will be employed to address the study objectives. Interviews with people experiencing homelessness were will be conducted by a researcher with lived experience of homelessness. Researchers with lived experience are able to engage with vulnerable communities in an empathetic, non-judgemental way as their shared experience promotes a sense of trust and integrity, which in turn encourages participation in research and may help people speak more openly about their experience. The experiences of health professionals and stakeholders delivering and facilitating care for people experiencing homelessness during the pandemic will also be explored. DISCUSSION: It is important to explore whether recent changes to the delivery of primary care in response to the COVID-19 pandemic compromise the safety of people experiencing homelessness and exacerbate health inequalities. This could have implications for how primary healthcare is delivered to those experiencing homelessness not only for the duration of the pandemic but in the future.


Asunto(s)
Accesibilidad a los Servicios de Salud/organización & administración , Personas sin Hogar/psicología , Atención Primaria de Salud/organización & administración , Disparidades en el Estado de Salud , Humanos , Seguridad del Paciente , Investigación Cualitativa , Calidad de la Atención de Salud , Consulta Remota/organización & administración , Proyectos de Investigación
7.
Int J Qual Health Care ; 33(Supplement_1): 45-50, 2021 Jan 12.
Artículo en Inglés | MEDLINE | ID: mdl-33432981

RESUMEN

BACKGROUND: The importance of human factors/ergonomics (HFE) is well established in all high-reliability systems but only applied in the healthcare sector relatively recently. Across many sectors, low-/middle-income countries (LMICs) lag behind more economically developed countries in their application of this safety science, due to resource and, in some cases, awareness and expertise. Most previous applications of HFE related to occupational ergonomics rather than healthcare safety. METHODS: The paper details how the reputation of HFE is being developed within healthcare communities of Latin America (LatAm), through increasing awareness and understanding of its role as safety science in the healthcare sector. It starts by articulating the need for HFE and then provides examples from Mexico, Colombia and Peru. RESULTS: The practical examples for research and education illustrate a developing awareness of the relevance of HFE to the healthcare sectors in LatAm and an appreciation of its worth to improve health service quality and patient safety through healthcare community engagement. A new LatAm Network of HFE in Healthcare Systems (RELAESA) was formed in 2019, which has provided a platform for HFE advice during the COVID-19 pandemic. CONCLUSION: There is a real opportunity in LatAm and other LMIC health services to make more rapid and sustainable progress in healthcare-embedded HFE than has been experienced within healthcare services of more developed nations.


Asunto(s)
Ergonomía/métodos , Seguridad del Paciente , Calidad de la Atención de Salud , Prestación de Atención de Salud/organización & administración , Prestación de Atención de Salud/normas , Humanos , América Latina
8.
Anaesthesia ; 76(2): 238-250, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33141959

RESUMEN

Intravenous lidocaine is used widely for its effect on postoperative pain and recovery but it can be, and has been, fatal when used inappropriately and incorrectly. The risk-benefit ratio of i.v. lidocaine varies with type of surgery and with patient factors such as comorbidity (including pre-existing chronic pain). This consensus statement aims to address three questions. First, does i.v. lidocaine effectively reduce postoperative pain and facilitate recovery? Second, is i.v. lidocaine safe? Third, does the fact that i.v. lidocaine is not licensed for this indication affect its use? We suggest that i.v. lidocaine should be regarded as a 'high-risk' medicine. Individual anaesthetists may feel that, in selected patients, i.v. lidocaine may be beneficial as part of a multimodal peri-operative pain management strategy. This approach should be approved by hospital medication governance systems, and the individual clinical decision should be made with properly informed consent from the patient concerned. If i.v. lidocaine is used, we recommend an initial dose of no more than 1.5 mg.kg-1 , calculated using the patient's ideal body weight and given as an infusion over 10 min. Thereafter, an infusion of no more than 1.5 mg.kg-1 .h-1 for no longer than 24 h is recommended, subject to review and re-assessment. Intravenous lidocaine should not be used at the same time as, or within the period of action of, other local anaesthetic interventions. This includes not starting i.v. lidocaine within 4 h after any nerve block, and not performing any nerve block until 4 h after discontinuing an i.v. lidocaine infusion.


Asunto(s)
Anestésicos Locales/administración & dosificación , Anestésicos Locales/uso terapéutico , Lidocaína/administración & dosificación , Lidocaína/uso terapéutico , Dolor Postoperatorio/prevención & control , Administración Intravenosa , Anestésicos Locales/efectos adversos , Comorbilidad , Consenso , Humanos , Infusiones Intravenosas , Lidocaína/efectos adversos , Bloqueo Nervioso , Seguridad del Paciente , Recuperación de la Función , Medición de Riesgo , Resultado del Tratamiento
9.
Surg Clin North Am ; 101(1): 1-13, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33212071

RESUMEN

This article explores the role of human factors engineering in patient safety in surgery. The authors discuss the history and evolution of human factors and the role of human factors in patient safety and provide a description of human factors methods used to study and improve patient safety.


Asunto(s)
Ergonomía , Seguridad del Paciente/normas , Procedimientos Quirúrgicos Operativos/normas , Humanos
10.
Surg Clin North Am ; 101(1): 121-134, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33212073

RESUMEN

Acquisition of data on clinical performance is essential to improve outcomes in surgery. Large, national datasets allow hospitals to monitor events involving patient safety, complications, and benchmark against peer hospitals and facilitate quality improvement (QI) development. Although clinical datasets are often preferable, administrative data also have potential for actionable QI. Hospitals should use whatever data resources may be available and be creative in combining data sources for the most clinically meaningful metrics. Although collection of data is essential in understanding the problems an individual hospital is facing, rigorous QI infrastructure is necessary to translate data to action and achieve sustained change.


Asunto(s)
Bases de Datos Factuales , Registros de Hospitales , Seguridad del Paciente/normas , Mejoramiento de la Calidad , Sistema de Registros , Procedimientos Quirúrgicos Operativos/normas , Humanos
11.
Surg Clin North Am ; 101(1): 135-148, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33212074

RESUMEN

Adverse surgical events are a major cause of morbidity, mortality, and disability worldwide. Serious reportable events, such as wrong site surgery, retained foreign bodies, and surgical fires, are preventable adverse events that have significant consequences. These "never events" are costly to the patient, health care systems, and society and have led to many efforts to reduce their occurrence. However, these costly events still occur, and more research is needed to obtain a better understanding of their causes and how to prevent them.


Asunto(s)
Errores Médicos/economía , Errores Médicos/prevención & control , Seguridad del Paciente/economía , Procedimientos Quirúrgicos Operativos/economía , Procedimientos Quirúrgicos Operativos/normas , Humanos
12.
Surg Clin North Am ; 101(1): 149-160, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33212075

RESUMEN

"The focus on patient safety offers a new framework not only for delivering health care but also for training physicians. Medical school and surgical graduate medical education must transition to a more holistic approach by teaching technical and nontechnical skills. Formalized safety curricula can be developed by adopting recommended guidelines and content from national and international organizations, existing validated practices of training programs, frequent simulation exercises, and objective evaluation tools."


Asunto(s)
Internado y Residencia , Seguridad del Paciente/normas , Procedimientos Quirúrgicos Operativos/educación , Procedimientos Quirúrgicos Operativos/normas , Humanos
13.
Surg Clin North Am ; 101(1): 15-27, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33212076

RESUMEN

Effective teamwork, both in and out of the operating room, is an essential component of safe and efficient surgical performance. There are multiple available assessment tools for evaluating teamwork and important contributors to teamwork such as safety culture and nontechnical skills. Multiple types of interventions exist to improve and train providers on teamwork, and many have been demonstrated to improve not only teamwork but also patient outcomes. Teamwork strategies can be adapted to different contexts, based on provider needs and resources.


Asunto(s)
Grupo de Atención al Paciente/normas , Seguridad del Paciente/normas , Procedimientos Quirúrgicos Operativos/educación , Procedimientos Quirúrgicos Operativos/normas , Humanos , Quirófanos
14.
Surg Clin North Am ; 101(1): 29-36, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33212077

RESUMEN

This article discusses the processes, interventions, and methods by which health care systems can change the culture of their workplace to promote safety. The importance of this culture shift is discussed, as well as an organizational approach, highlighting the importance of investment of time and resources to the cause. Efforts must include an educational focus on patient safety where a culture of patient safety is emphasized. This attitude along with several specific key interventions, including, measurement, teamwork, briefings, checklists, and developmental infrastructure, are discussed.


Asunto(s)
Seguridad del Paciente/normas , Administración de la Seguridad/métodos , Procedimientos Quirúrgicos Operativos/normas , Humanos
15.
Surg Clin North Am ; 101(1): 37-48, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33212078

RESUMEN

The success of patient safety and quality improvement interventions depends, in part, on the effectiveness of implementation. Surgical safety checklists have been introduced into thousands of operating rooms across 6 continents since the debut of the original World Health Organization 19-item checklist in 2008. However, the effect of checklists on patient outcomes has varied. Here, we review 5 examples of large-scale efforts (eg, population level or across health systems) where surgical checklists were introduced into the operating room and the associated effects on patient outcomes. Each experience provides an opportunity to reflect on best practices that inform strategies for effective implementation.


Asunto(s)
Lista de Verificación/normas , Seguridad del Paciente/normas , Procedimientos Quirúrgicos Operativos/normas , Humanos , Resultado del Tratamiento
16.
Surg Clin North Am ; 101(1): 49-56, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33212079

RESUMEN

The literature overwhelmingly supports standardized, evidence-based care to improve patient safety in the surgical setting, including checklists and enhanced recovery programs. Although local culture, patient complexity, and hospital setting can represent barriers to implanting standardized practices, they can be overcome with thoughtful strategies.


Asunto(s)
Vías Clínicas/normas , Seguridad del Paciente/normas , Procedimientos Quirúrgicos Operativos/normas , Humanos
17.
Surg Clin North Am ; 101(1): 57-69, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33212080

RESUMEN

Interhospital transfers play a key role in ensuring that patients receive necessary care. However, patients who are transferred between hospitals are a vulnerable population, and outcomes of transferred patients are suboptimal. Despite the critical nature of interhospital transfers, only limited effort has been dedicated to standardization and improvement of the transfer process. Studying and adapting quality improvement efforts directed at other transitions of care, particularly those that cross between different facilities and care teams "such as the transition from hospital to home or extended care facilities" may improve the care of surgical patients transferred between acute care institutions.


Asunto(s)
Seguridad del Paciente/normas , Transferencia de Pacientes/normas , Mejoramiento de la Calidad , Humanos , Transferencia de Pacientes/organización & administración
18.
Urology ; 147: 14-20, 2021 01.
Artículo en Inglés | MEDLINE | ID: mdl-33091386

RESUMEN

OBJECTIVE: To assess the effectiveness of a telemedicine service for ureteric colic patients in reducing the number of unnecessary face-to-face consultations and shortening waiting time for appointments. METHODS: A telemedicine workflow was implemented as a quality improvement study using the Plan-Do-Study-Act method. All patients presenting with ureteric colic without high-risk features of fever, severe pain, and hydronephrosis, were recruited, and face-to-face appointments to review scan results were replaced with phone consultations. Data were prospectively collected over 3 years (January 2017 to December 2019). Patient outcomes including the reduction in face-to-face review visits, time to review, reattendance and intervention rates, were tracked in an interrupted time-series analysis, and qualitative feedback was obtained from patients and clinicians. RESULTS: Around 53.2% of patients presenting with ureteric colic were recruited into the telemedicine workflow. A total of 465 patients (46.2%) had normal scan results and 250 patients (24.9%) did not attend their scan appointments, hence reducing the number of face-to-face consultations by 71.1%. A total of 230 patients (22.9%) required subsequent follow-up with urology, while 61 patients (6.1%) were referred to other specialties. Mean (SD) time to review was 30.0 (6.2) days, 6-month intervention rate was 3.4% (n = 34) and unplanned reattendance rate was 3.2% (n = 32). Around 93.1% of patients reported satisfaction with the service. CONCLUSION: The ureteric colic telemedicine service successfully and sustainably reduced the number of face-to-face consultations and time to review without compromising on patient safety. The availability of this telemedicine service has become even more important in helping us provide care to patients with ureteric colic in the current COVID-19 pandemic.


Asunto(s)
Mejoramiento de la Calidad , Consulta Remota/organización & administración , Cólico Renal/diagnóstico , Cálculos Ureterales/diagnóstico , Urología/organización & administración , Adulto , /prevención & control , Femenino , Implementación de Plan de Salud/organización & administración , Humanos , Control de Infecciones/organización & administración , Control de Infecciones/normas , Masculino , Persona de Mediana Edad , Pandemias/prevención & control , Seguridad del Paciente/normas , Satisfacción del Paciente , Proyectos Piloto , Estudios Prospectivos , Investigación Cualitativa , Consulta Remota/normas , Cólico Renal/etiología , Cólico Renal/terapia , Singapur/epidemiología , Teléfono , Centros de Atención Terciaria/organización & administración , Centros de Atención Terciaria/normas , Tomografía Computarizada por Rayos X , Uréter/diagnóstico por imagen , Cálculos Ureterales/complicaciones , Cálculos Ureterales/terapia , Urología/métodos , Urología/normas
19.
Neurodegener Dis Manag ; 11(1): 83-89, 2021 02.
Artículo en Inglés | MEDLINE | ID: mdl-33172352

RESUMEN

The Covid-19 pandemic forced providers to alter their delivery of care to special populations, including older adults with cognitive impairment. The Montefiore-Einstein Center for the Aging Brain, a specialty multidisciplinary center for the evaluation and management of patients with neurodegenerative disorders, developed a coordinated approach (Coordinated Care At Risk/Remote Elderly program [CCARRE]) to reach our diverse population during the initial Covid-19 crisis in New York City, USA. In the tele-evaluation of the first 85 patients seen with CCARRE, we recognized unique factors that could improve patient care, lessen burden and optimize access to community resources. Lessons learned from the experience are shared.


Asunto(s)
Directivas Anticipadas , Cuidadores/psicología , Disfunción Cognitiva/terapia , Demencia/terapia , Seguridad del Paciente , Desarrollo de Programa , Telemedicina , Comunicación por Videocoferencia , Actividades Cotidianas , Anciano , Anciano de 80 o más Años , Disfunción Cognitiva/diagnóstico , Asistencia Sanitaria Culturalmente Competente , Demencia/diagnóstico , Femenino , Humanos , Masculino , Ciudad de Nueva York , Determinantes Sociales de la Salud , Teléfono
20.
Klin Padiatr ; 233(1): 10-16, 2021 Jan.
Artículo en Alemán | MEDLINE | ID: mdl-32851632

RESUMEN

BACKGROUND: Patient safety is a major challenge and has high priority in the inpatient care. Notably, drug therapy is considered critical after surgery. The medication process is particularly difficult and problematic in newborns and children. METHOD: In a retrospective analysis, hospital-internal spontaneous reports on Drug-related Problems (DRP) from a children's hospital were analysed, which were reported between 2000 and 2014. RESULTS: 229 spontaneous reports on DRP were considered for analysis. 72.5% of these were due to a Medication Error. Nearly half of the DRP occurred during drug dispensing (44.5%), followed by problems during administration (38.0%) and prescribing (11.4%). 61.4% of Medication Errors were dispensing errors (esp. confusion of patients, wrong dose). Almost all Other Incidents happened during drug administration (mainly extravasations). 40.6% of DRP reports were associated with clinically relevant patient harm and occurred particularly during drug administration. CONCLUSION: These results show that drug therapy in paediatrics is a complex and hazardous process. The system of hospital-internal spontaneous reports has led to regular training and raising awareness of the employees for critical situations. In addition, it fosters a safety culture to report mistakes. Spontaneous reporting is suitable for increasing the safety of drug therapy in paediatrics.


Asunto(s)
Hospitales Pediátricos , Errores de Medicación , Seguridad del Paciente , Niño , Humanos , Recién Nacido , Estudios Retrospectivos
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