Impact of hospital readiness on patient safety incidents during the COVID-19 pandemic in Indonesia: health worker perceptions.

OBJECTIVES: This study examined the impact of hospital readiness on patient safety from the healthcare workers' perspective. DESIGN: The study employed a mixed-methods explanatory sequential design, with the quantitative phase taking precedence. We conducted an online survey of 235 healthcare workers at COVID-19 referral hospitals, followed by an interview with 11 participants from various hospital types. SETTING: COVID-19 referral hospitals in Indonesia. PARTICIPANTS: Health workers working at COVID-19 referral hospitals. MEASURES: Hospital ownership; hospital accreditation status; hospital readiness including incident management system, surge capacity, infection control and prevention, and human resource management; patient safety incident. RESULTS: According to the survey, 66.4% of the participants worked at a hospital owned by the provincial or district government, and 69.4% worked at a hospital which had received an excellent status accreditation. More than 80% of the hospitals scored well in the categories of the incident management system (86%), surge capacity (80.9%), infection control and prevention (97.9%), and human resource management (84.7%). However, only 50.6% of the hospitals scored well in managing patient safety incidents. Hospital ownership, accreditation status and hospital readiness all have an impact on patient safety incidents, which were reported in all types of hospitals by both studies. CONCLUSIONS: This study provides significant results for Indonesia in terms of hospital preparedness and patient safety for the COVID-19 pandemic. The accreditation and ownership status of the hospital have aided hospital readiness. Despite the fact that no hospital in the world was prepared for the COVID-19 pandemic, hospital readiness has improved a year later; however, patient safety has not improved. Patient safety incidents occurred regardless of hospital status, with the most common occurrence being delayed treatment. Administrative errors were also recorded in COVID-19 field hospitals that were not accredited. Future research should focus on improving pandemic care quality and implementing initiatives that are applicable to all types of hospitals.

Patterns of oxygen debt repayment in cardiogenic shock patients sustained with extracorporeal life support: A retrospective study.

Cardiogenic shock is the most frequent kind of shock in cardiac intensive care, and cardiac dysfunction and hypoxia are often seen in critically ill patients. Inadequate organ and tissue perfusion and hypoxia result in anaerobic metabolism with hyperlactatemia and oxygen debt accumulation. However, the role of accumulated oxygen debt in the course of cardiogenic shock and hypoxia has not been clearly described. Here, we first described the existence of several patterns of oxygen debt repayment in cardiogenic shock patients maintained by an extracorporeal life support system. Oxygen debt was computed from the lactate concentration at five time points, covering the first 26 h of ECLS. Patterns representing basic pathophysiological processes were independent of the cause of the primary insult. Groups of patients classified into specific patterns differed in terms of survival rate from 51.5% to only 4.6%. It is very important that the initial group not predetermine the fate of the patient and may change in the course of treatment due to 'between-cluster migration'. We believe that our finding of different patterns of oxygen debt repayment in cardiogenic shock patients may offer new insights for a more rational, goal-directed treatment of highly morbid conditions such as hypoxia and cardiogenic shock.

Dynamic oxygenator blood volume during prolonged extracorporeal life support.

Current methods for identification of oxygenator clotting during prolonged extracorporeal life support include visual inspection, evaluation of oxygenator resistance and oxygen exchange performance, and assessment of clotting-related laboratory parameters. However, these observations do not provide a quantitative assessment of oxygenator clot formation. By measuring changes in the dynamic oxygenator blood volume this study aimed to evaluate the relation to oxygenator resistance and oxygen transfer performance. Sixty-seven oxygenators were studied during adult extracorporeal life support. Oxygenator blood volume, oxygenator resistance, and oxygen transfer efficiency were monitored. Oxygenator blood volume decreased with increasing runtime (r = -0.462; p <0.001). There was a statistically significant, fair negative correlation between oxygenator blood volume and oxygenator resistance (r = -0.476; p<0.001) in all oxygenators, which became stronger analyzing only exchanged oxygenators (r = -0.680; p<0.001) and oxygenators with an oxygenator blood volume <187 mL (r = 0.831; p<0.001). No relevant correlation between oxygenator blood volume and O2 transfer was found. Oxygenator blood volume declined over time and was clearly associated with an increasing oxygenator resistance during prolonged extracorporeal life support, though O2 transfer was less affected.

Implementation of Computerized Physician Order Entry in Primary Care: A Scoping Review.

PURPOSE: This scoping review aimed to assess the implementation and outcomes of computerized physician order entry (CPOE) in primary care. METHODS: A scoping review was carried out in accordance with the Joanna Briggs Institute's guidelines (JBI). The databases PubMed, CINAHL, Science Direct, and Google Scholar were all searched. The full text of each article was reviewed for eligibility after the title and abstract were evaluated. JBI data extraction were used to extract data. Donabedian's framework served as the foundation for the data discussion. RESULTS: Based on the inclusion criteria, seven studies were included. The studies' main goal in common was to analyze the outcome or impact of implementing CPOE systems in ambulatory or primary care settings. Several studies described the framework, current state of implementation, and evaluation or recommendation following CPOE system implementation. Many positive effects were felt by physicians or prescribers, pharmacists, patients, and primary care providers, with patient safety being the primary goal. CONCLUSION: Although this study discovered some issues and factors associated with CPOE implementation and adoption, such as infrastructure, workflow, level of engagement, and safety culture, CPOE has many positive outcomes for patients, physicians, and primary care. To improve CPOE adoption in healthcare, particularly primary care, more research into the structure, framework, and components of CPOE deployment is required.

Peripheral cannulae selection for veno-arterial extracorporeal life support: a paradox.

Explosive penetration of veno-arterial extracorporeal life support in everyday practice has drawn awareness to complications of peripheral cannulation, resulting in recommendations to use smaller size cannulae. However, using smaller cannulae may limit the effectiveness of extracorporeal support and thereby the specific needs of the patient. Selection of proper size cannulae may therefore pose a dilemma, especially since pressure-flow characteristics at different hematocrits are lacking. This study evaluates the precision of cannula pressure drop prediction with increase of fluid viscosity from water flow-pressure charts by M-number, dynamic similarity law, and via fitted parabolic equation. Thirteen commercially available peripheral cannulae were used in this in vitro study. Pressure drop and flow were recorded using water and a water-glycerol solution as a surrogate for blood, at ambient temperature. Subsequently, pressure-flow curves were modeled with increased fluid viscosity (0.0031 N s m-2), and then compared by M-number, dynamic similarity law, and fitted parabolic equation. The agreement of predicted and measured values were significantly higher when the M-number (concordance correlation = 0.948), and the dynamic similarity law method (concordance correlation = 0.947) was used in comparison to the fitted parabolic equation (concordance correlation = 0.898, p < 0.01). The M-number and dynamic similarity based model allow for reliable prediction of peripheral cannula pressure drop with changes of fluid viscosity and could therefore aid in well-thought-out selection of cannulae for extracorporeal life support.

Extracorporeal Life Support in Adult Patients: A Global Perspective of the Last Decade.

Extracorporeal life support (ECLS) is an external medical device to treat critically ill patients with cardiovascular and respiratory failure. In a nutshell, ECLS is only a "bridging" mechanism that provides life support while the heart and/or the lungs is recovering either by therapeutic medical interventions, transplantation, or spontaneously. Extracorporeal life support has been developed since 1950s, and many studies were conducted to improve ECLS techniques, but unfortunately, the survival rate was not improved. Because of Dr Bartlett's success in using ECLS to treat neonates with severe respiratory distress in 1975, ECLS is made as a standard lifesaving therapy for neonates with severe respiratory distress. However, its use for adult patients remains debatable. The objectives of this study are to outline and provide a general overview of the use of ECLS especially for adult patients for the past 10 years and to elaborate on the challenges encountered by each stakeholder involved in ECLS. The data used for this study were extracted from the ELSO Registry Report of January 2018. Results of this study revealed that the number of ECLS centers and the use of ECLS are increasing over the year for the past decade. There was also a shift of the patient's age category from neonatal to adult patients. However, the survival rates for adult patients are relatively low especially for cardiac and extracorporeal cardiopulmonary resuscitation cases. To date, the complications are still the major challenge of ECLS. Other challenges encountered by the stakeholders in ECLS are the limited amount of well-trained and experienced ECLS teams and centers, the limited government expenditure on health, and the lack of improvement and development of ECLS techniques and devices. Further studies are needed to evaluate the value of ECLS for adult patients.