Knowledge, attitudes, and practices of secondary school students towards COVID-19 in Sana'a City, Yemen: A cross-sectional study.

Background: Understanding of public awareness on public health issues is very crucial, including the current health crisis of COVID-19. This research aimed to examine the Knowledge, Attitudes and Practices among Students towards COVID-19. Design and methods: A cross-sectional survey was conducted among secondary school students in grades 10-12. Proportional sample allocation was used in 16 randomly selected schools. Moreover, the schools were recruited by using a systematic random sampling technique. Socio-demographic data and questions of the knowledge, attitude and practice were collected by interview. Logistic regression analyses were employed to identify the associated factors and p-value < 0.05 was considered statistically significant. Results: Among the 357 participants the level of good knowledge, positive attitude, and optimal practice were 65.2%, 66.7% and 89.4% respectively. Regression analyses showed that being in the adolescent age group (15-16 years old), living with >5 family size, and family with a good income effectively predicted knowledge level. Attitudes towards COVID-19, male students were pessimistic about COVID-19 prevention and control measures as opposed to their female counterparts [aOR = 0.39; 95% CI: 0.21-0.71). Students with awareness of the virus demonstrated greater (two-fold) odds of a positive attitude as opposed to their less-conscious counterparts. The urban-area male students were demonstrated a higher (three-fold) odds of good practice level towards COVID-19 prevention and control measures as opposed to their rural-area female counterparts. Conclusion: A good knowledge level denoted a positive attitude despite the lack of information. Meanwhile, good preventive measure practices and behaviours reflected high levels.

Psychometric Evaluation of the Arabic Version of the Person-Centered Climate Questionnaire: Patient Version (PCQ-P).

BACKGROUND: Adopting a person-centered care approach has transformed different healthcare settings worldwide. However, this concept has gained little attention in many Middle Eastern countries, including Saudi Arabia and other Arab countries. This study aimed to evaluate the psychometric characteristics of the Arabic person-centered climate questionnaire-patient version, measuring to what extent the climate of health care settings is perceived as being person-centered. METHOD: This is a psychometric analysis study. The original validated version of the English Person-Centered Climate Questionnaire-Patient version (PCQ-P) was translated into Arabic and tested among a sample of hospital patients (n = 300) in Saudi Arabia using translation and back translation procedures. For psychometric evaluation, statistical analyses of validity and reliability were used, including exploratory factor analysis as well as conformity analysis. RESULTS: The Arabic version of the person-centered climate questionnaire-patient version-showed good reliability as the Cronbach's alpha value of the total of 17 items was 0.84, and the Cronbach's alpha values of the three sub-scales (safety, everydayness, and hospitality) were 0.83, 0.56, and 0.68, respectively. Internal consistency results were high in terms cof orrelation coefficient for all 17 items. The exploratory factor analysis identified the three factors (safety, everydayness, and hospitality) responsible for 47.174% of the total variance. CONCLUSION: The Arabic version of the PCQ-P showed satisfactory reliability and validity for measuring patients' perceptions of person-centeredness in Arab healthcare settings. This Arabic version will be accessible to those interested in generating and using empirical evidence to promote a patient-centered care approach in Arab healthcare settings. The results of this study can be used as a starting point for assessing and developing a person-centered care culture in Saudi hospitals and other Arab countries in the Middle East.

Impact of Patient Safety Culture on Job Satisfaction and Intention to Leave Among Healthcare Workers: Evidence from Middle East Context.

Background: The association between patient safety culture and staff outcomes remains unclear to date. This study aimed to identify the relationship between patient safety culture/job satisfaction and intention to leave among healthcare workers. Methods: A cross-sectional study was conducted using an online survey. Multinomial logistic regression analysis was used to investigate the association between the safety culture dimensions and the outcomes in terms of job satisfaction and intention to leave. Results: Majority were females (77.2%); age between (20-30) years were (66.1%). 1-5 years work experience was reported by (98.2%); nurses accounted for (75.7%). (62.1%) reported very good patient safety grade. (78.3%) of respondents had no intention to leave; (84.3%) reported they like their job, (70.5%) stated that working in this hospital is like being part of a large family. However, (38%) said the hospital is not a good place to work, and morale in their clinical area is low. The overall composite scores were highest for "teamwork within hospital units (81.4)", and "organizational learning (79.4)", while lowest for "communication openness (37)",staffing (26.5)", and "non-punitive response to error (22.1)". Females were two times more likely to leave their jobs compared to males (AOR: 2.36, 95% CI: 1.24-3.46); intention to leave was 3.35 (95% CI = 2.19-5.09). As for job satisfaction, ages between 31-40 years tend to like their job two times more than other age groups (AOR: 1.90, 95% CI = 1.02-3.55). The safety culture domains "staffing" and "hospital management support for patient safety" were linked to a higher odds ratio for job satisfaction. Conclusion: Aside from gender and age, the dimensions of safety culture, including staffing, hospital management support, hospital handover, and transition, may have a signification impact on job satisfaction and intention to leave among healthcare workers.

Person-Centered-Care Climate in a Tertiary Hospital: Staff Perspective.

INTRODUCTION: Most health care systems strive to improve the quality, safety and value of healthcare, with an emphasis on moving towards patient-centered care/person-centered care (PCC) approach. The aim of the current study was to assess health care providers' perspectives on PCC climate in hospital setting and to identify the role of providers in determining the perception of the PCC climate. METHODS: A survey, using person-centered climate questionnaire-staff version, was employed in health care providers of a tertiary care hospital. Data included variables age, gender, education level, occupation, and years of experience and three PCC dimensions. PCC overall and subscale scores were reported as mean and standard deviation. Factors associated with PCC climate perception were analyzed using a Poisson model. RESULTS: Out of 1216 respondents; the majority 47% aged between 18 and 34 years; 79% women, 68% were nurses. The overall mean score was 45.96±15.36 (range 0-70). Subscale scores were Safety 20.15±5.0 (range 0-30), Everydayness 12.02±3.52 (range 0-20) and Community 13.79±3.34 (range 0-20). Increasing age was a significant factor associated with PCC scores for the overall, safety, everydayness, and community scales, with a positive association. Lower scores were reported more by women compared with men, for overall (p=0.0005), and everydayness (p=0.006) scales. Higher safety scores were reported by health care providers with a diploma compared to master's degree (p=0.009), Ph.D. (p=0.007), for technicians compared with nurses (p=0.007), and for day shift compared with day/night shift workers (p=0.025). PCC scores were not significantly different across health care providers' years of experience. CONCLUSION: There is a room for PCC climate improvement based on the low scores compared to the literature. The study findings indicated that the main factors associated with HCPs' perception of PCC were higher age and female gender, and these factors would benefit from further research.

Person-Centered Care in a Tertiary Hospital Through Patient's Eyes: A Cross-Sectional Study.

BACKGROUND: The current trend in healthcare systems around the world is moving towards a person (or patient)-centered care (PCC) model. While some healthcare organizations have only recently embraced the PCC approach, there is no evidence of person-centered care in Saudi hospitals. This study aimed to assess patients' perspectives on the climate of person-centered care and its associated factors in a tertiary hospital in Saudi Arabia. METHODS: A cross-sectional study design was conducted in 16 inpatient departments at a tertiary hospital in Riyadh, Saudi Arabia. The validated version of the Person-centered Climate Questionnaire-Patient (PCQ-P) was distributed to 300 adult patients admitted to the hospital for more than 48 hours. The patients were interviewed face-to-face, using the PCQ-P. Descriptive and inferential statistical analysis were performed using SPSS (version 22; IBM, NY, USA). RESULTS: A total of 300 questionnaires were completed. More than half (53%) were females; 39.7% aged 21-40 years; 72.7% married; 49% hold a high school diploma; and 67.4% unemployed. For route of admission into hospital, 39.8% of the respondents were admitted as elective or outpatient appointments, and 45% had been admitted for less than a week. Most patients (84.3%) reported that they preferred to be treated in a governmental hospital. Inpatients' overall mean PCQ-P score was 73 ± 9.988 out of 85. Results suggested significant associations between patient characteristics and their perspectives on person-centered care, such as age (P=0.005), gender (P<0.001), nationality (P=0.026), area of residency (P=0.001), route to admission (P=0.002), length of stay (P=0.003), and hospital preference (P=0.010). CONCLUSION: Overall, patients' perspective on person-centered care seems positive. Patient and hospital characteristics could play an important role in shaping patients' perceptions of the climate of person-centered care domains.

Epidemiology of Frequent Visits to the Emergency Department at a Tertiary Care Hospital in Saudi Arabia: Rate, Visitors' Characteristics, and Associated Factors.

BACKGROUND: Emergency department overcrowding is becoming a challenge for the healthcare management system globally and locally. This study aimed to estimate the frequency of ED visits, describe the patients' profile along with visit-related characteristics, and associated factors in a tertiary care hospital. METHODS: A retrospective cohort study was conducted at a tertiary care hospital. The study included patients age 14 years and above visiting the main emergency department in year 2013. Data were extracted from electronic medical records by a qualified data extraction team. Statistical analyses were performed, including the odds ratio and 95% confidence interval for the factors associated with highly frequent (≥14 visits) ED visits using logistic regression models. RESULTS: There were 150,727 visits to the emergency department within a year. The number of frequent visitors was 7696 (9.38%), with 42,226 visits (28.01% of total ED visits). Highly frequent visitors totaled 249 (0.30%), with 5173 visits (3.43% of total ED visits). The frequent visitors' average age was 42.55 (SD 20.14), and 48.99 (SD 21.33) for the highly frequent visitors' group. More than half of the emergency visitors were females. The most common complaints among the highly frequent visitors were Gastrointestinal (21.34%), followed by Respiratory (13.47%), Orthopedic (12.57%), and Cardiovascular (12.43%). Multivariate analysis indicated that age, history of diabetes, history of cardiac diseases, insurance status, and nationality were significant predicators of highly frequent visits to the hospital emergency. CONCLUSION: Frequent and highly frequent visitors to emergency departments represent a significant proportion of adult patients presenting to ED. Their visits constitute almost one-third of total ED visits. Several factors associated with highly frequent ED visits have been identified. This study provides local empirical evidence to develop improvement policy and actions related to chronic issue of frequent and highly frequent visitation to hospital ED.

Road towards promoting patient safety practices among hospital pharmacists: Hospital-based baseline patient safety culture assessment cross-sectional survey.

ABSTRACT: Patient safety is a fundamental aspect of a healthcare system. The aim of this study was to assess the perception and determinants of the patient safety culture of pharmacists in hospitals, in Riyadh, Saudi Arabia.A survey was conducted with pharmacists in the pharmacies of governmental, /military and private hospitals in Riyadh, Saudi Arabia. The pharmacy survey on patient safety culture questionnaire developed by Agency for Healthcare Research and Qualtity, a hard copy was distriuted to the pharmacists. The positive response rate (RR) was calculated and compared across hospitals using a chi-square test. The predictors of patient safety grades were identified using the generalized estimating equation. The data was analyzed using SAS.A total of 538 questionnaires were distributed, of which 411 responded (RR 76.4%). Of the participants, 229 (56%) were females. The majority 255 (62%) were in the 18 to 34 years age range, and 361 (88%) had a bachelor's degree. The majority of the sample 376 (92%) was a pharmacist. The Positive RR (PRR) ranged between (25.6%-74%). The highest PRR was observed in teamwork (74.4%), followed by 'staff, training and skills' (68%), and 'organizational learning continuous improvement' (66%). The lowest PRR was observed in 'staffing, work pressure, and pace' (25.5%). Comparing the PPR of the various healthcare sectors, the governmental hospitals scored the highest in all patient safety domains. Generalized Estimating Equation analysis showed that with increase in scores of all patient safety culture domains increased the likelihood of reporting a better patient safety grade, whereas respondents' demographic characteristics had no effect except the working experience years 6 years and above had odds of poor reporting of the patient safety grade (odds ratio = 2.54, 95% confience interval (1.543, 4.194), (P = .0003).The grades achieved in the various domains of patient safety culture by pharmacists in Riyadh are below the expected standard. The highest scores were achieved in teamwork, with the lowest scores in staffing, work pressure and pace. Overall, pharmacists in government hospital settings have a better perception of patient safety than their peers in other settings. These results provide the baseline evidence for developing future interventional studies aiming at improving patient safety culture in hospital pharmacy settings.

The Impact of a National Accreditation Program on Patient Safety Culture in a Tertiary Hospital: Pre- and Post-Evaluation Study.

Introduction: The objective of this study was to assess the effectiveness of the Saudi national accreditation program on patient safety culture in a secondary-tertiary public hospital in Saudi Arabia. Methods: Three hundred health professionals were randomly selected to participate in a survey. The survey was used in three phases: baseline, before accreditation, and after accreditation. Primary and secondary outcome measures were teamwork within hospital units, feedback and communication about errors, hospital handoffs and transitions, overall perceptions of safety, frequency of event reporting, and perception of patient safety grade. Results: The survey response rate was 100%. A statistically significant impact of accreditation was found for teamwork within hospital units, feedback and communication about errors, and hospital handoffs and transitions (p = 0.002, 0.009, and 0.010, respectively). Ordinal logistic regression confirmed that the accreditation program had a significant effect on overall perceptions of safety (odds ratio [OR] [1.42-13.56], p = 0.010), frequency of event reporting (OR [0.91-7.96], p = 0.073), and staff awareness of grading safety culture (OR [0.02-0.70]) and reporting behavior (OR 0.10 [0.03-0.37]). Conclusion: The Saudi national accreditation program had a significant positive impact on some patient safety culture dimensions and outcomes. These findings provide local empirical evidence on the benefits of implementing national accreditation programs. Further research on a larger scale is highly recommended.

The Impact of Financial Incentives on Behavior and Self-Management of Uncontrolled Type 2 Diabetes: Pre- and Post-Quasiexperimental Study.

Introduction: Noncommunicable diseases are one of the main challenges that affect health worldwide and have been found to be increasing in both low- and middle-income countries compared with high-income countries. The aim of this study was to assess the impact of financial incentives and a comprehensive care program focusing on patients' behavior and self-management of uncontrolled type 2 diabetes (glycosylated hemoglobin [HbA1c] ≥ 7), as well as modifiable risk factors for disease complications in a Saudi Arabian population. Methods: This quasiexperimental study, using a pre- and postevaluation approach, was used to compare the level of HbA1c among patients with uncontrolled diabetes before and after the financial incentives and comprehensive care program were implemented. Financial awards were given to patients who achieved a significantly greater decrease in HbA1c levels with his/her responsible physician. The study population included 702 Saudi Arabian patients with type 2 diabetes from 14 regions and 34 primary healthcare centers in the Kingdom of Saudi Arabia. All of these patients (≥ 15 years old) with uncontrolled type 2 diabetes who attended local primary healthcare centers in Saudi Arabia for a follow-up visit from February to October 2018. Results: The mean age, in years, of the sample was 56.14 (± SD = 9.909); slightly more than half of the patients 401 (57.1%) were females. Most of the participants 645 (91.9%) were married, and 381(54.3%) patients were housewives. Linear mixed modeling revealed that all groups showed improvements over time in the primary outcome of HbA1c levels (p = 0.009), Including the secondary outcomes of body mass index and systolic and diastolic blood pressure (p = 0.04, < 0.001, 0.019 respectively). Conclusions: Patient behavior was improved, which was reflected by decreases in HbA1c, body mass index, and blood pressure levels. A comprehensive care program is recommended by healthcare providers to increase awareness among patients with diabetes to reduce other risk factors. These kinds of interventions positively motivate patients with diabetes to control their health measurements and to adopt a healthy lifestyle.

Incidence and severity of adverse events among platelet donors: A three-year retrospective study.

ABSTRACT: Adverse events (AEs) are unfortunate consequences of platelet donation. This study reports the incidence and severity of AEs and the associated risk factors in platelet donation at a major blood donation center in Riyadh, Saudi Arabia.A review of donation records was conducted between 2014 and 2017. Eligible study participants were 5007 platelet donors who had donated 7969 times. Each donation was accounted for as a single study subject. Participants' characteristics were described and analyzed as potential contributing factors to adverse events.The average age of platelet donors was 30.0±7.3 years. First-time donors comprised (n = 3,100, 61.9%) of the sample, and 1907 (38.1%) were multiple donors (periodic/routine). Their average BMI was 28.6 ±â€Š4.9 kg/m2. Most donors have blood type "O" and Rheo "positive". The range of blood volume processed was 0 to 5273 ml, while the procedure duration ranged from 0 to 90 minutes. The average platelet yield was 3.8 ±â€Š3.5 ∗1011 platelets per unit, and the average collected volume was 257.6 ±â€Š86.1 ml. Incidence of AEs was 4.2%, of which 91.3% were mild and 8.7% were severe. AEs were vascular injuries (65.3%), vasovagal reactions (11.6%), and citrate toxicity (5.3%). AEs were associated with first-time donation, adj.OR (95%CI) = 1.5 (1.1-1.8) and lower BMI, adj. OR (95% CI) = 1.4 (1.1-1.8). Citrate toxicity was present in severe forms, unlike vascular injuries and vasovagal reactions that tended to be milder. Donors with hemoglobin levels above 16 g/dl, adj. OR (95% CI) = 1.3 (1.1-1.7) and platelet levels below 250,000, adj. OR (95% CI) = 1.3 (1.1-1.6) were more likely to contract AEs than others.Reporting adverse events is essential to establish a benchmark for the annual incidence rates to be compared against local and international figures. Blood donor centers should also take notice of blood donors characteristics that are associated with higher incidence and more severe forms of AEs during or after platelet donation.

Prevalence of Workplace Bullying and Its Associated Factors at a Multi-Regional Saudi Arabian Hospital: A Cross-Sectional Study.

BACKGROUND: Workplace bullying (WPB) refers to any form of repeated and unreasonable verbal, physical or sexual harassment that an employee endures by a person or a group. In healthcare settings, practitioners are occasionally victims of WPB incidents. The aim of this study was to survey victims of WPB and determine factors associated with being a victim of WPB at a multiregional health care facility in Saudi Arabia. METHODS: This cross-sectional study was conducted in 2018, by distributing a self-administered questionnaire via a private electronic mail to all fulltime healthcare practitioners within a multi-regional hospital in Saudi Arabia. Healthcare practitioners included physicians, nurses, allied healthcare professionals and pharmacists who reported being exposed to WPB in the past year. Study outcomes were the prevalence rate ratio of WPB and its associated factors, such as victim, perpetrator and incident characteristics. RESULTS: WPB has been reported by 684 participants. Perpetrators were mainly patients (36.1%), their families/relatives (29.5%), and hospital staff (27.2%) or managers/supervisors (7.2%). The type of WPB incident was mostly verbal abuse (98.1%) followed by physical harassment (11.8%) and sexual connotations (5.8%). WPB was 30% more prevalent among younger nurses and 24% less prevalent among higher educated nurses compared to their counter groups, P<0.001 each. Among technicians and administrative employees, WPB was 54% more prevalent among females, 36% more prevalent among the younger group, and 25% more prevalent among expatriate workers compared to their counter groups P<0.014, P<0.001 and P=0.017, respectively. WPB was 20% less prevalent among higher educated allied health professionals, P=0.002. Among physicians, WPB was 33% more prevalent among females, P=0.041 and was 47% more prevalent among higher educated physicians compared to their counter groups, P=0.018. CONCLUSION: WPB might occur any time, anywhere and by any person within health care facilities. The prevalence of WPB varies within health occupational groups. Gender, age, educational level, and nationality were significantly associated factors with WPB.

Quality of home healthcare among Arab countries.

OBJECTIVE: To examine the quality of home healthcare services provided and to systematically review publications concerning the quality of home healthcare in Arab countries. Methods: In 2017, we conducted an online literature search to identify relevant published studies using the following electronic databases: Embase, CINAHL, PubMed, and the Cochrane library. First, we screened the publications according to titles. Second, we evaluated the titles and abstracts of the included publications. Third, we independently reviewed and assessed the full texts of the included publications. After the final selection, we extracted the following information from the full-text articles that met the inclusion criteria: author, year of publication, country, study design, number of participants, participant type, and the main findings. Results: In total, 6 of 214 studies met the inclusion criteria. These 6 studies were published from 3 countries. The country with the most number of studies was Saudi Arabia (4 articles), followed by Jordan (one article) and Iraq (one article). We found that all studies were assessed according to 3 indicators, namely, safety, efficiency, and effectiveness, out of the 6 indicators of quality by the Institute of Medicine. Conclusion: This review shows a clear gap in the literature regarding the quality of home healthcare in Arab countries, emphasizing the need for more studies, particularly quality studies on timely, equitable, and patient-centered care in home healthcare settings.

Prevalence and Risk Factors Associated with Anabolic-androgenic Steroid Use: A Cross-sectional Study among Gym Users in Riyadh, Saudi Arabia.

OBJECTIVES: Anabolic-androgenic steroids (AAS) have been used internationally for enhancing physical appearance and performance despite their significant side effects. We sought to identify the prevalence of AAS use and its different risk factors among gym users in Riyadh, Saudi Arabia. METHODS: A cross-sectional survey was distributed among gym users across 20 gyms in Riyadh. The cluster sampling technique was used to represent the four regions of Riyadh (North, South, East, and West). Univariate and multivariate analyses were performed to identify the factors associated with AAS. RESULTS: Out of 482 participants, 29.3% reported using AAS. The mean age of the study participants was 27.2±6.9 years, 61.0% were single, 67.1% were educated, 35.5% were government employees, and 31.1% were students. The use of AAS was more prevalent among gym members who practiced weightlifting (45.5%), were employed in the private sector (35.8%), and aged > 25 years old (53.3%). Multiple logistic regression showed that the most significant factors associated with the use of AAS among gym members were: weightlifting, using supplementary vitamins or minerals, following special diets, knowing individuals who used AAS, and being offered AAS. CONCLUSIONS: Our study provides clear evidence that the lifetime prevalence of AAS use is high among male gym members in Riyadh with modifiable risk factors. The results could help public health policymakers to take the necessary measures to alleviate the potential negative implications of AAS use at the community level.

Enhancing teamwork communication and patient safety responsiveness in a paediatric intensive care unit using the daily safety huddle tool.

BACKGROUND: Open communication between leadership and frontline staff at the unit level is vital in promoting safe hospital culture. Our hospital staff culture survey identified the failure to address safety issues as one of the areas where staff felt unable to express their concerns openly. Thus, this improvement project using the daily safety huddle tool has been developed to enhance teamwork communication and respond effectively to patient safety issues identified in a paediatric intensive care unit. METHODS: We used the TeamSTEPPS quality approach. TeamSTEPPS is an evidence-based set of teamwork tools developed by the US Agency of Healthcare Research and Quality to enhance teamwork and communication. We applied TeamSTEPPS using a tool called the Daily Safety Huddle, aiming at improving communication and interaction between healthcare workers and building trust by acting immediately when there is any patient safety issue or concern at the unit level. RESULTS: During the period from April to December 2017, the interaction between frontline staff and unit leadership increased through compliance with the daily safety huddle. Initially, compliance was at 73%, but it increased to 97%, with a total of 340 safety issues addressed. The majority of these safety issues pertained to infection control and medication errors (109; 32.05%), followed by communication (83; 24.41%), documentation (59; 17.35%), other issues (37; 10.88%), procedure (20; 5.88%), patient flow (16; 4.7%) and equipment and supplies (16; 4.7%). CONCLUSIONS: Systematic use of daily safety huddle is a powerful tool to create an equitable environment where frontline staff can speak up freely about daily patient safety concerns. The huddle leads to a more open and active discussion with unit leadership and to the ability to perform the right action at the right time.

Improving physician handover documentation process for patient transfer from paediatric intensive care unit to general ward.

BACKGROUND: Inadequate handover communication is responsible for many adverse events during the transfer of care, which can be attributed to many factors, including incomplete documentation or lack of standardised documentation process. The quality improvement project aimed to standardise the handover documentation process during patient transfer from paediatric intensive care unit (PICU) to the general paediatric ward. METHODS: Data analysis revealed lack of proper handover documentation with the omission of vital information when transferring patients from PICU to general ward. The quality improvement team assessed the current handover documentation practice using a brainstorming technique during multiple meetings. The team evaluated the process for possible causes of incomplete handover documentation, framed the existing challenges, and proposed improvement interventions, including a standardised handover form and conducting education sessions for the new proposed process. The main quality measures included physician's compliance with handover documentation elements, physician's satisfaction and PICU emergency readmission rate within 48 hours. RESULTS: Physician compliance to handover documentation improved from 29.5% to 95.5% before and after implanting the improvement interventions, respectively. The level of physician satisfaction with the quality of communicated information during the handover process improved from 47.5% to 84%, and the PICU emergency readmission rate declined from 3.8% to zero after all improvement interventions were implanted. CONCLUSION: Implementation of standardised handover form is essential to improve physician compliance for clear handover documentation and to avoid data omission during the patient transfer process. Documented handover in patient's medical record has positive impact on physician satisfaction when managing patients recently discharged from PICU.

Assessing the Feasibility and Effects of Introducing the USA National Surgical Quality Improvement Program on Clinical Outcomes and Cost in Saudi Arabia: An Observational Study.

Introduction: This study aimed at introducing a systematic clinical registry to assess the outcomes of surgical performances and the associated costs of surgical complications in hospitals of Saudi Arabia. Materials and Methods: This was an observational retrospective cohort study. Three large Saudi public hospitals from different regions participated in the study. A systematic sample consisting of 2077 medical records was retrospectively reviewed after being received from the hospitals' surgical wards. The inclusion criteria of the study were inpatients of the surgical cases, patients older than 18 years, and those who underwent major surgery under general anesthesia. The occurrence of adverse events in surgical wards and the direct costs associated with these surgical adverse events were estimated. Results were reported in terms of odds ratio and 95% confidence interval. A value of p < 0.05 was considered statistically significant. Results: Introducing the systematic clinical registry to assess surgical outcomes and complications across multiple hospital sites is feasible. The findings of the study suggest that some areas are exemplary and others need improvement, such as sepsis cases, renal failure, ventilator use for more than 48 h, urinary tract infection, surgical site infection (SSI), length of stay after colorectal surgery, and rehospitalization. Additional costs from surgical complications in Riyadh only were approximately 0.5 million Saudi Arabian Riyal (127,764.40 USD) during that year. Most of the additional costs were due to sepsis and SSI. Conclusion: Empirical evidence derived from the idea of introducing a National Surgical Quality Improvement Program might be generally applicable to other countries in the region and worldwide, and can be used to measure surgical adverse events and track interventions over time. As a result, quality improvement initiatives could be identified to be implemented immediately focusing on preventing several surgical adverse events. A future study is needed to explore the underlying factors that contribute to the occurrence of surgical adverse events to be prevented and/or mitigated.

Workplace bullying and its impact on the quality of healthcare and patient safety.

BACKGROUND: Workplace bullying (WPB) is a physical or emotional harm that may negatively affect healthcare services. The aim of this study was to determine to what extent healthcare practitioners in Saudi Arabia worry about WPB and whether it affects the quality of care and patient safety from their perception. METHODS: A cross-sectional study was conducted in 2018. An online survey was distributed among all practitioners at a multi-regional healthcare facility. A previously validated tool was sourced from an integrative literature review by Houck and Colbert. Responses to 15 themes were rated on a 5-point Likert scale, converted to percentage mean scores (PMS) and compared across participants' characteristics using bivariate and regression analyses. RESULTS: A total of 1074/1350 (79.5%) completed the questionnaire. The overall median [interquartile range] score of worrying about WPB was 81.7 [35.0]. Participants were mainly worried about the effect of WPB on their stress, work performance, and communication between staff members. A significant negative relationship developed between the quality of care and worrying about WPB, P < 0.001. More educated practitioners were 1.7 times more likely to be worried about WPB compared with their counter group, adj.P = 0.034. Junior practitioners were 1.6 times more likely to be worried about WPB, adj.P = 0.017. The group who has not been trained in handling WPB (1.7 times), and those who had been exposed to WPB (2.2 times) were both more likely to be worried about WPB compared with their counter groups, adj.P = 0.026 and adj.P < 0.001 respectively. CONCLUSIONS: Most healthcare practitioners worry about WPB, especially its negative impact on the quality of care and patient safety. A greater proportion of practitioners with higher levels of education and their less experienced counterparts were more worried about WPB. Previous exposure to a WPB incident amplifies the practitioners' worry, but being trained on how to counteract bullying incidents makes them less likely to be worried.

Correlates of Psychotropic Polypharmacy in outpatient psychiatric clinics of two military tertiary hospitals in Saudi Arabia.

BACKGROUND: Polypharmacy is meaningful and clinically justified under certain circumstances. However, the prescription of multiple psychiatric medicines is mostly based on practical experience rather than evidence. The aim of this study was to assess the current practice of and factors associated with the use of polypharmacy among patients attending outpatient psychiatric clinics. MATERIALS AND METHODS: A cross-sectional study was conducted among patients attending outpatient psychiatric clinics in two tertiary care hospitals in the kingdom of Saudi Arabia (KSA). Patients aged 18 years and above and who were taking any prescription or nonprescription medications were included. Data were collected by face-to-face interviews, followed by a review of electronic medical charts to determine the drugs being taken by patients, and track their current computerized drug prescriptions. Data were analyzed using SPSS statistical software version 21 (Chicago, IL, USA), applying both descriptive and inferential statistical analysis as appropriate. RESULTS: Of the 401 study participants, 53.6% were aged 25 years or older, and 63.6% were married and > 50% were unemployed. The overall prevalence of polypharmacy was 46.9%. The prevalence of polypharmacy was 67.3% in psychosis, 37.7% in depression, 27.1% in anxiety, 74.1% in bipolar disorders, and 53.6% for patients with two or more disorders, and 42.1% for patients diagnosed with "other" disorders. Overall, there was a significant association between polypharmacy and gender, marital status, and diagnosis of disorder. CONCLUSIONS: Psychotropic polypharmacy is common in outpatient practice. Patients with psychosis and bipolar disorders, especially those aged 25-45 years are exposed to high psychotropic polypharmacy. The concomitant use of large numbers of drugs should be periodically reviewed to improve the quality and safety of psychiatric care.

Reducing unnecessary delays during the transfer of patients from the paediatric intensive care unit to the general ward: a quality improvement project.

INTRODUCTION: Delaying the discharge of paediatric intensive care unit (PICU) patients is directly proportional to increased occupancy rate and cost. We aimed to study the process of transferring patients from the PICU to the general ward in order to improve the timeliness of this process while guaranteeing patient safety. METHODS: A multidisciplinary quality improvement (QI) team was formed to analyse the transfer process. Several Plan Do Study Act cycles were tested, targeting all steps of the transfer process, and applying turnaround time (TAT)-the duration from the time of clinical transfer decision until the physical transfer of the patient-as an outcome measure, aiming for a TAT of 4 hours. RESULTS: Baseline results showed that medical transfer decisions by PICU attending physicians were taken late for most patients: only 19% of decisions were made by 08:00 by the on-call team. Average TAT of the transfer process was over 7 hours, with duration ranging from 7 to 17 hours. After implementing all suggested improvement interventions, early decision compliance improved to 59%. TAT improved gradually, starting in January 2017, until it approached our target (284-261 min≈4 hours) in February-May 2017. CONCLUSION: PICU patient transfer process delays can be reduced by early evaluation, timely team communication and proper preparation. It is recommended that all personnel with early involvement avoid unnecessary delays by paying more attention to all process steps, starting with the clinical decision, until the physical transfer. Standardising transfer processes might lead to a decrease in the length of PICU stay, which is a desirable outcome, but this observation needs further exploration.

Job satisfaction, work commitment and intention to leave among pharmacists: a cross-sectional study.

OBJECTIVES: We assessed job satisfaction, work commitment and intention to leave among pharmacists working in different healthcare settings in Saudi Arabia. DESIGN: This was a cross-sectional study utilising a previously validated questionnaire. SETTING: We surveyed the workforce at different healthcare settings in Riyadh, Saudi Arabia. PARTICIPANTS: The participants were pharmacists licensed by the Saudi Commission for Health Specialties. OUTCOME MEASURES: We examined job satisfaction, work commitment and intention to leave. RESULTS: In total, 325 out of 515 pharmacists completed the questionnaire, yielding a response rate of 63%. Over half of them were women (57.8%), 78.2% were Saudi Arabian nationals and 61.8% were married. The majority (88.1%) worked between 36 and 44 hours per week; 96.6% were full-time employees, and 63.4% were government employees working in public hospitals or primary healthcare centres. Although most of the pharmacists were satisfied (satisfied and slightly satisfied) with their current job (39.1% and 24.6%, respectively), about two-thirds (61.9%) had the intention to leave. Multiple logistic regression analysis showed that the most important predictors of pharmacists' intentions to leave were related to job satisfaction and work commitment (OR=0.923; 95% CI 0.899 to 0.947; p<0.001 and OR=1.044; 95% CI 1.014 to 1.08; p=0.004, respectively), whereas respondents' demographic characteristics had no effect. CONCLUSIONS: Although the pharmacists surveyed were satisfied and committed to their current job, they had the intention to leave. Further research is recommended to clarify why pharmacists in Saudi Arabia have the intention to leave their pharmacy practice job.