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1.
J Surg Res ; 257: 221-226, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32858323

RESUMO

BACKGROUND: The Accreditation Council for Graduate Medical Education has defined six core competencies (CCs) that every successful physician should possess. However, the assessment of CC achievement among trainees is difficult. This project was designed to prospectively evaluate the impact of resident identification of CC as a component of morbidity review on error identification and standard of care (SOC) assessments. The platform was assessed for its reliability as a measure of resident critical analysis of complication causality across postgraduate year (PGY). MATERIALS AND METHODS: A total of 1945 general surgery cases with complications were assessed for error identification and SOC management between January 1, 2016, and December 31, 2018. CC identification was additionally assessed between January 1, 2019, and December 31, 2019, and included 708 general surgery cases. Data were evaluated for error assessments and overall SOC management. PGY4 and 5 residents were compared for number of cases and complications reviewed, severity, error causation, and CC relevance. RESULTS: Study groups were equivalent by Clavien-Dindo scores. Error identification significantly increased in all categories: diagnostic (P < 0.001), technical (P < 0.05), judgment (P < 0.001), system (P < 0.001), and communication (P < 0.001). Overall SOC assessments validated by a supervising surgical quality officer were unchanged. An increased exposure to cases with severe complications, error causation, and CC relevance was noted across PGY. CONCLUSIONS: The addition of CC assessment into morbidity review appears to improve the critical thinking of evaluating residents by increasing the identification of management errors. Used as an element of prospective self-assessment, teaching residents to identify CC principles in cases with complications may assist in learner progression toward clinical competence and critical thinking.


Assuntos
Educação Baseada em Competências/métodos , Cirurgia Geral/educação , Complicações Pós-Operatórias/prevenção & controle , Autoavaliação , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Competência Clínica , Seguimentos , Humanos , Internato e Residência , Erros Médicos/efeitos adversos , Erros Médicos/prevenção & controle , Dano ao Paciente/prevenção & controle , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Avaliação de Programas e Projetos de Saúde , Estudos Prospectivos , Reprodutibilidade dos Testes , Índice de Gravidade de Doença , Cirurgiões/psicologia , Procedimentos Cirúrgicos Operatórios/educação
2.
Int J Qual Health Care ; 33(Supplement_1): 13-18, 2021 Jan 12.
Artigo em Inglês | MEDLINE | ID: mdl-32901812

RESUMO

Despite the application of a huge range of human factors (HF) principles in a growing range of care contexts, there is much more that could be done to realize this expertise for patient benefit, staff well-being and organizational performance. Healthcare has struggled to embrace system safety approaches, misapplied or misinterpreted others, and has stuck to a range of outdated and potentially counter-productive myths even has safety science has developed. One consequence of these persistent misunderstandings is that few opportunities exist in clinical settings for qualified HF professionals. Instead, HF has been applied by clinicians and others, to highly variable degrees-sometimes great success, but frequently in limited and sometimes counter-productive ways. Meanwhile, HF professionals have struggled to make a meaningful impact on frontline care and have had little career structure or support. However, in the last few years, embedded clinical HF practitioners have begun to have considerable success that are now being supported and amplified by professional networks. The recent coronavirus disease of 2019 (COVID-19) experiences confirm this. Closer collaboration between healthcare and HF professionals will result in significant and ultimately beneficial changes to both professions and clinical care.


Assuntos
Ergonomia/métodos , Segurança do Paciente , Qualidade da Assistência à Saúde , Humanos , Erros Médicos/prevenção & controle
3.
Surg Clin North Am ; 101(1): 135-148, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33212074

RESUMO

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.


Assuntos
Erros Médicos/economia , Erros Médicos/prevenção & controle , Segurança do Paciente/economia , Procedimentos Cirúrgicos Operatórios/economia , Procedimentos Cirúrgicos Operatórios/normas , Humanos
4.
Cochrane Database Syst Rev ; 12: CD011545, 2020 12 16.
Artigo em Inglês | MEDLINE | ID: mdl-33325570

RESUMO

BACKGROUND: Simulation-based obstetric team training focuses on building a system that will anticipate errors, improve patient outcomes and the performance of clinical care teams. Simulation-based obstetric team training has been proposed as a tool to improve the overall outcome of obstetric health care. OBJECTIVES: To assess the effects of simulation-based obstetric team training on patient outcomes, performance of obstetric care teams in practice and educational settings, and trainees' experience. SEARCH METHODS: The Cochrane Pregnancy and Childbirth Group's Trials Register, ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform (ICTRP) were searched (14 April 2020), together with references checking and hand searching the available proceedings of 2 international conferences. SELECTION CRITERIA: We included randomised controlled trials (RCTs) (including cluster-randomised trials) comparing simulation-based obstetric team training with no, or other type of training. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by Cochrane, to identify articles, assess methodological quality and extract data. Data from three cluster-randomised trials could be used to perform generic inverse variance meta-analyses. The meta-analyses were based on risk ratios (RRs) and mean differences (MDs) with 95% confidence intervals (CIs). We used the GRADE approach to rate the certainty of the evidence. We used Kirkpatrick's model of training evaluation to categorise the outcomes of interest; we chose Level 3 (behavioural change) and Level 4 (patient outcome) to categorise the primary outcomes. MAIN RESULTS: We included eight RCTs, six of which were cluster-randomised trials, involving more than 1000 training participants and more than 200,000 pregnancies/births. Four studies reported on outcome measures on Kirkpatrick level 4 (patient outcome), three studies on Kirkpatrick level 3 (performance in practice), two studies on Kitkpatrick level 2 (performance in educational settings), and none on Kirkpatrick level 1 (trainees' experience). The included studies were from Mexico, the Netherlands, the UK and the USA, all middle- and high-income countries. Kirkpatrick level 4 (patient outcome) Simulation-based obstetric team training may make little or no difference for composite outcomes of maternal and/or perinatal adverse events compared with no training (3 studies; n = 28,731, low-certainty evidence, data not pooled due to different composite outcome definitions). We are uncertain whether simulation-based obstetric team training affects maternal mortality compared with no training (2 studies; 79,246 women; very low-certainty evidence). However, it may reduce neonatal mortality (RR 0.70, 95% CI 0.48 to 1.01; 2 studies, 79,246 pregnancies/births, low-certainty evidence). Simulation-based obstetric team training may have little to no effect on low Apgar score compared with no training (RR 0.99, 95% 0.85 to 1.15; 2 studies; 115,171 infants; low-certainty evidence), but it probably reduces trauma after shoulder dystocia (RR 0.50, 95% CI 0.25 to 0.99; 1 study; moderate-certainty evidence) and probably slightly reduces the number of caesarean deliveries (RR 0.79, 95% CI 0.67 to 0.93; 1 study; n = 50,589; moderate-certainty evidence) Kirkpatrick level 3 (performance in practice) We found that simulation-based obstetric team training probably improves the performance of the obstetric teams in practice, compared with no training (3 studies; 2398 obstetric staff members, moderate-certainty evidence, data not pooled due to different outcome definitions). AUTHORS' CONCLUSIONS: Simulation-based obstetric team training may help to improve team performance of obstetric teams, and it might contribute to improvement of specific maternal and perinatal outcomes, compared with no training. However, high-certainty evidence is lacking due to serious risk of bias and imprecision, and the effect cannot be generalised for all outcomes. Future studies investigating simulation-based obstetric team training compared to training courses with a different instructional design should carefully consider how and when to measure outcomes. Particular attention should be paid to effect measurement at the level of patient outcome, taking into consideration the low incidence of adverse maternal and perinatal events.


Assuntos
Obstetrícia/educação , Equipe de Assistência ao Paciente/organização & administração , Treinamento por Simulação/métodos , Índice de Apgar , Viés , Cesárea/estatística & dados numéricos , Competência Clínica , Intervalos de Confiança , Emergências , Feminino , Humanos , Lactente , Mortalidade Infantil , Recém-Nascido , Mortalidade Materna , Erros Médicos/prevenção & controle , Gravidez , Ensaios Clínicos Controlados Aleatórios como Assunto , Distocia do Ombro/epidemiologia , Resultado do Tratamento
6.
Medicine (Baltimore) ; 99(43): e22895, 2020 Oct 23.
Artigo em Inglês | MEDLINE | ID: mdl-33120838

RESUMO

BACKGROUND: Traditionally, S1 transforaminal epidural steroid injection (TFESI) has been performed using an anteroposterior (AP) fluoroscopic view. In 2007, the oblique "Scotty dog" (OS) approach was introduced as an alternative technique. We compared passage time of the needle into S1 foramen (Tf) between the anteroposterior (AP) and oblique "Scotty dog" (OS) approach during S1 TFESI. METHODS: In this prospective randomized controlled trial, seventy patients scheduled S1 TFESI were randomly allocated into AP or OS groups. In the AP group, a slight cephalad-caudad tilt was used. In the OS group, the C-arm was rotated ipsilateral oblique degrees to view the S1 Scotty dog. Both groups received injection of steroid mixed with local anesthetics. We measured the passage time of the needle into S1 foramen (Tf), primary outcome, and total procedure time (Tt) between the groups. We also recorded presence of intravascular injection, patients-assessed pain relief for one month and complications. RESULTS: The Tf and Tt were shorter in the OS than in the AP group (24.4 ±â€Š24.0 s vs 47. 8 ±â€Š53.2seconds; 93.3 ±â€Š35.0 seconds vs 160.0 ±â€Š98.7 seconds, P < .001, both). Incidence of intravascular injection (AP, 8 [22.8%]; OS, 4 [11.4%], P = .205), pain score, and complication rates were not statistically different between the two groups. In logistic regression analysis, the body mass index (BMI) was a risk factor for longer Tt (odds ratio [OR] = 1.27, 95% CI: 1.02-1.58, P = .030). CONCLUSION: The passage time of the needle into S1 foramen was shorter in OS approach and the OS approach reduced the procedure time compared with the AP approach during S1 TFESI. The practitioners should note that procedure time can be prolonged in obese patients.


Assuntos
Fluoroscopia/instrumentação , Injeções Epidurais/métodos , Erros Médicos/efeitos adversos , Radiculopatia/terapia , Esteroides/administração & dosagem , Administração Intravenosa/estatística & dados numéricos , Idoso , Anestésicos Locais/administração & dosagem , Índice de Massa Corporal , Feminino , Humanos , Incidência , Injeções Epidurais/efeitos adversos , Região Lombossacral/diagnóstico por imagem , Região Lombossacral/fisiopatologia , Masculino , Pessoa de Meia-Idade , Agulhas/efeitos adversos , Medição da Dor/métodos , Estudos Prospectivos , República da Coreia/epidemiologia , Distúrbios Somatossensoriais/psicologia , Fatores de Tempo
7.
PLoS One ; 15(10): e0240380, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33031473

RESUMO

The present study investigated physicians' perceptions regarding the need for, effects of, and barriers to disclosure of patient safety incidents (DPSI). An anonymous online questionnaire survey was conducted to investigate physicians' perception regarding DPSI, in particular of when DPSI was needed in various situations and of methods for facilitating DPSI. Physicians' perceptions were then compared to the general public's perceptions regarding DPSI identified in a previous study. A total of 910 physicians participated. Most participants (94.9%) agreed that any serious medical error should be disclosed to patients and their caregivers, whereas only 39.8% agreed that even near-miss errors, which did not cause harm to patients, should be disclosed. Among the six known effects of DPSI presented, participating physicians showed the highest level of agreement (89.6%) that "DPSI will lead physicians to pay more attention to patient safety in the future." Among six barriers to DPSI, participants showed the most agreement (75.9%) that "It is unreasonable to demand DPSI in only the medical field, and disclosure is not actively conducted in other fields." With respect to methods for facilitating DPSI, participants agreed that "A guideline for DPSI is needed" (91.2%) and "Manpower to support DPSI in hospitals is required" (89.1%). Meanwhile, 79.3% agreed that "If an apology law is enacted, physicians will perform more DPSI" and 72.4% that "I support the introduction of an apology law." Korean physicians generally have a positive perception of DPSI, but less than the general public.


Assuntos
Revelação/normas , Segurança do Paciente , Médicos/psicologia , Adulto , Atitude do Pessoal de Saúde , Estudos Transversais , Feminino , Humanos , Masculino , Erros Médicos/legislação & jurisprudência , Pessoa de Meia-Idade , República da Coreia , Inquéritos e Questionários , Adulto Jovem
8.
PLoS One ; 15(10): e0240934, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33075090

RESUMO

BACKGROUND: Healthcare provider wellness have been reported to correlate with patient care outcomes. It is not understood whether synergistic effects may exist between them. OBJECTIVE: We aim to investigate three provider wellness markers and determine their associations with provider self-reported medical errors and intent-to-leave outcomes among Emergency Department (ED) providers. DESIGN: This is a multi-center retrospective study. METHOD: Three wellness domains include professional fulfillment (PF), burnout (BO), and personal resilience (PR). Two outcomes measured as provider self-reported medical errors and provider intent-to-leave. Correlations between wellness markers and outcomes were analyzed. When adjusted for other confounders (provider demographics, provider experience, and operational environment), a multivariate logistic regression analysis was performed to further determine the interactions among these three domains on provider wellness affecting patient and provider related outcomes. RESULTS: Total 242 surveys were collected from providers at 16 different EDs. The median score of PF were 2.83 among physicians and 2.67 among APPs, BO were 1.00 (physicians) and 0.95 (APPs), and PR were 0.88 (physicians) and 0.81 (APPs). The median scores of self-reported medical errors were 1.50 (physicians) and 0.95 (APPs), and intent-to-leave were 1.00 (physicians and APPs). High correlations occurred among PF, BO, and PR. When analyzed together, high PF, low BO, and high PR functioned as a protective effect on provider intent-to-leave (adjusted odds ratios = 0.09, 95% CI 0.03-0.30). CONCLUSION: High correlations occurred among three provider wellness markers with no significant difference between physicians and APPs. Providers with high PR, low BO, and high PR tended to be more stable in their jobs.


Assuntos
Esgotamento Profissional/epidemiologia , Pessoal de Saúde/psicologia , Erros Médicos/psicologia , Resiliência Psicológica , Adulto , Esgotamento Profissional/psicologia , Medicina de Emergência , Feminino , Humanos , Modelos Logísticos , Masculino , Erros Médicos/estatística & dados numéricos , Pessoa de Meia-Idade , Avaliação de Resultados da Assistência ao Paciente , Satisfação Pessoal , Autorrelato
9.
Curr Opin Anaesthesiol ; 33(6): 793-799, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33002958

RESUMO

PURPOSE OF REVIEW: Recognition of the increasing maternal mortality rate in the United States has been accompanied by intense efforts to improve maternal safety. This article reviews recent advances in maternal safety, highlighting those of particular relevance to anesthesiologists. RECENT FINDINGS: Cardiovascular and other chronic medical conditions contribute to an increasing number of maternal deaths. Anesthetic complications associated with general anesthesia are decreasing, but complications associated with neuraxial techniques persist. Obstetric early warning systems are evolving and hold promise in identifying women at risk for adverse intrapartum events. Postpartum hemorrhage rates are rising, and rigorous evaluation of existing protocols may reveal unrecognized deficiencies. Development of regionalized centers for high-risk maternity care is a promising strategy to match women at risk for adverse events with appropriate resources. Opioids are a growing threat to maternal safety. There is growing evidence for racial inequities and health disparities in maternal morbidity and mortality. SUMMARY: Anesthesiologists play an essential role in ensuring maternal safety. While continued intrapartum vigilance is appropriate, addressing the full spectrum of contributors to maternal mortality, including those with larger roles beyond the immediate peripartum time period, will be essential to ongoing efforts to improve maternal safety.


Assuntos
Analgesia Obstétrica/tendências , Anestesia Obstétrica/tendências , Anestesiologistas/psicologia , Parto Obstétrico/tendências , Mortalidade Materna/tendências , Hemorragia Pós-Parto/prevenção & controle , Analgesia Obstétrica/efeitos adversos , Analgesia Obstétrica/métodos , Anestesia Obstétrica/efeitos adversos , Anestesia Obstétrica/métodos , Parto Obstétrico/efeitos adversos , Parto Obstétrico/métodos , Feminino , Humanos , Serviços de Saúde Materna/normas , Erros Médicos/prevenção & controle , Gravidez , Complicações na Gravidez , Estados Unidos
10.
Arch Pathol Lab Med ; 144(10): 1204-1208, 2020 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-33002153

RESUMO

CONTEXT.­: Glycemic control requires accurate blood glucose testing. The extent of hematocrit interference is difficult to assess to assure quality patient care. OBJECTIVE.­: To predict the effect of patient hematocrit on the performance of a glucose meter and its corresponding impact on insulin-dosing error. DESIGN.­: Multilevel mixed regression was conducted to assess the extent that patient hematocrit influences Roche Accu-Chek Inform II glucose meters, using the Radiometer ABL 837 as a reference method collected during validation of 35 new meters. Regression coefficients of fixed effects for reference glucose, hematocrit, an interaction term, and random error were applied to 4 months of patient reference method results extracted from the laboratory information system. A hospital inpatient insulin dose algorithm was used to determine the frequency of insulin dose error between reference glucose and meter glucose results. RESULTS.­: Fixed effects regression for method and hematocrit predicted biases to glucose meter results that met the "95% within ±12%" for the US Food and Drug Administration goal, but combinations of fixed and random effects exceeded that target in emergency and hospital inpatient units. Insulin dose errors were predicted from the meter results. Twenty-eight percent of intensive care unit, 20.8% of hospital inpatient, and 17.7% of emergency department results were predicted to trigger a ±1 insulin dose error by fixed and random effects. CONCLUSIONS.­: The current extent of hematocrit interference on glucose meter performance is anticipated to cause insulin error by 1-dose category, which is likely associated with low patient risk.


Assuntos
Glicemia/análise , Hipoglicemiantes/administração & dosagem , Insulina/administração & dosagem , Erros Médicos , Algoritmos , Hematócrito , Humanos , Medição de Risco , Estados Unidos
12.
Br J Oral Maxillofac Surg ; 58(9): 1073-1077, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32933788

RESUMO

High-risk organisations (HRO), including aviation, undergo formal communication training, with emphasis on safety-critical moments. Such training is not widespread or mandatory in healthcare, and while there are many differences both share the 'human element' with circumstances leading to an increased risk of harm. A typical operating theatre consists of an operating surgeon, and an assisting surgeon, roles that may change throughout the course of a procedure. Similarly, a training aircraft or multi-crew cockpit (flight deck) has a pilot in control, or 'pilot flying', and a 'pilot not flying'. Both interact with wider teams, for example the scrub team and air traffic controllers, respectively. Surgical error is the second most prevalent cause of preventable harm to patients after drug errors. Every year in the UK National Health Service (NHS), there are typically 500 never events, 21,000 serious incidents, and many more episodes of physical or psychological harm. Ineffective communication (46%) is the most common behavioural factor leading to a never event. In this review, we examine the concept of 'sterile cockpit', use of unambiguous terminology, callsigns, important information readback, sharing of mental models, and the mini-brief, and how these may be used to reduce patient harm during safety-critical moments.


Assuntos
Aviação , Medicina Estatal , Comunicação , Humanos , Erros Médicos , Segurança
13.
Sante Publique ; 32(2): 189-198, 2020.
Artigo em Francês | MEDLINE | ID: mdl-32985835

RESUMO

OBJECTIVE: To determine the incidence and risk factors of adverse events (AE) in a Tunisian university hospital. METHOD: We carried out a longitudinal observational study in 2016 over a period of 3 months in the Sahloul university hospital of Sousse, Tunisia. Data were collected using a pretested form filled by doctors previously trained in the collection methodology, upon each visit to all hospitalized patients. RESULTS: Overall, 1,357 patients were eligible. We identified 168 AEs in 131 patients with AEs incidence of 12.4% (95% CI: [7.41 – 17.38]), and patient incidence of 9.7% (95% CI: [4.63 – 14.76]). The incidence density of AEs was 1.8 events per 100 days of hospitalization. Hospital acquired infection and unplanned readmission related to previous healthcare management were the most common AEs (43.4 and 12.5% respectively). Multivariate analysis revealed as independent factors of AEs: surgery (P = 0.013; RR = 1.68; CI: [1.11-2.54]), the use of central-venous-catheter (P < 10–3; RR = 4.1 ; CI: [2.1-8]), tracheotomy (P = 0.001; RR = 21.8; CI: [3.7-127.8]), transfusion (P = 0.014; RR = 2.1; CI: [1.16-3.87]) and drug intake (P = 0.04; RR = 2.2; CI: [1.04-4.7]). CONCLUSION: The present study showed a high incidence of AEs and the involvement of invasive devices in their occurrence. Thus, targeted interventions are needed.


Assuntos
Hospitais Universitários , Erros Médicos/estatística & dados numéricos , Hospitalização , Humanos , Incidência , Fatores de Risco , Tunísia
14.
Harefuah ; 159(9): 697-702, 2020 Sep.
Artigo em Hebraico | MEDLINE | ID: mdl-32955815

RESUMO

INTRODUCTION: Silicone is a foreign material to our body and therefore, has been found to stimulate the immune system. Silicone breast implants (SBIs), made of silicone polymer, have been used for aesthetic and medical purposes since the 1960s, and were found to trigger acute/chronic inflammation, eventually leading to the formation of fibrotic capsules on the surface of the implant. Silicone implants have been found to be associated with the development of severe and sometimes unexplained clinical manifestations such as: chronic fatigue, sleep and memory problems, widespread pain, dry mouth and eye, depression, arthralgia, myalgia, palpitations, tinnitus and hearing loss, skin rash, hair loss, vision problems, hyperhidrosis, allergic reactions, etc. Furthermore, SBIs have been found to be associated with the development of rheumatologic/autoimmune diseases and the development of rare lymphoma. The FDA has expressed concern over the years about the implications of SBIs and requested that the companies involved provide data of any concern regarding the implants. However, the companies continued to sell the implants without reporting data, as agreed. In October 2019, the FDA recommended boxed warnings describing the dangers facing women applying for SBIs such as lymphoma. Importantly, our lab recently found the presence of autoantibodies against the autonomic nervous system in the blood of women with SBIs, which might explain some of the patients' severe symptoms. Owing to the numerous data that had been accumulated (since 1960s) indicating a direct link between silicone, autoimmune diseases and cancer, we believe that the use of SBIs has been a historical medical error.


Assuntos
Implantes de Mama , Erros Médicos , Doenças Autoimunes , Feminino , Humanos , Hipersensibilidade , Silicones
15.
Sante Publique ; 32(2): 189-198, 2020 09 15.
Artigo em Francês | MEDLINE | ID: mdl-32989948

RESUMO

OBJECTIVE: To determine the incidence and risk factors of adverse events (AE) in a Tunisian university hospital. METHOD: We carried out a longitudinal observational study in 2016 over a period of 3 months in the Sahloul university hospital of Sousse, Tunisia. Data were collected using a pretested form filled by doctors previously trained in the collection methodology, upon each visit to all hospitalized patients. RESULTS: Overall, 1,357 patients were eligible. We identified 168 AEs in 131 patients with AEs incidence of 12.4% (95% CI: [7.41 – 17.38]), and patient incidence of 9.7% (95% CI: [4.63 – 14.76]). The incidence density of AEs was 1.8 events per 100 days of hospitalization. Hospital acquired infection and unplanned readmission related to previous healthcare management were the most common AEs (43.4 and 12.5% respectively). Multivariate analysis revealed as independent factors of AEs: surgery (P = 0.013; RR = 1.68; CI: [1.11-2.54]), the use of central-venous-catheter (P < 10–3; RR = 4.1 ; CI: [2.1-8]), tracheotomy (P = 0.001; RR = 21.8; CI: [3.7-127.8]), transfusion (P = 0.014; RR = 2.1; CI: [1.16-3.87]) and drug intake (P = 0.04; RR = 2.2; CI: [1.04-4.7]). CONCLUSION: The present study showed a high incidence of AEs and the involvement of invasive devices in their occurrence. Thus, targeted interventions are needed.


Assuntos
Hospitais Universitários , Erros Médicos/estatística & dados numéricos , Humanos , Incidência , Fatores de Risco , Tunísia
16.
Artigo em Inglês | MEDLINE | ID: mdl-32872189

RESUMO

Clinical risk management constitutes a central element in the healthcare systems in relation to the reverberation that it establishes, and as regards the optimization of clinical outcomes for the patient. The starting point for a right clinical risk management is represented by the identification of non-conforming results. The aim of the study is to carry out a systematic analysis of all data received in the first three years of adoption of a reporting system, revealing the strengths and weaknesses. The results emerged showed an increasing trend in the number of total records. Notably, 86.0% of the records came from the medical category. Moreover, 41.0% of the records reported the possible preventive measures that could have averted the event and in 30% of the reports are hints to be put in place to avoid the repetition of the events. The second experimental phase is categorizing the events reported. Implementing the reporting system, it would guarantee a virtuous cycle of learning, training and reallocation of resources. By sensitizing health workers to a correct use of the incident reporting system, it could become a virtuous error learning system. All this would lead to a reduction in litigation and an implementation of the therapeutic doctor-patient alliance.


Assuntos
Coleta de Dados/métodos , Erros Médicos/prevenção & controle , Segurança do Paciente , Qualidade da Assistência à Saúde/estatística & dados numéricos , Gestão de Riscos/organização & administração , Gestão da Segurança/estatística & dados numéricos , Hospitais Universitários , Humanos , Itália , Auditoria Administrativa , Erros Médicos/estatística & dados numéricos , Sistemas Computadorizados de Registros Médicos , Gestão da Segurança/organização & administração , Gestão da Qualidade Total/organização & administração
17.
Anesth Analg ; 131(4): 1217-1227, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32925343

RESUMO

BACKGROUND: Manual processes for verifying patient identification before blood transfusion and documenting this pretransfusion safety check are prone to errors, and compliance with manual systems is especially poor in urgent operating room settings. An automated, electronic barcode scanner system would be expected to improve pretransfusion verification and documentation. METHODS: Audits were conducted of blood transfusion documentation under a manual paper system from January to October 2014. An electronic barcode scanning system was developed to streamline transfusion safety checking and automate documentation. This system was implemented in 58 operating rooms between October and December 2014, with follow-up compliance audits through December 2015. The association of barcode scanner implementation with transfusion documentation compliance was assessed using an interrupted time series analysis. Anesthesia providers were surveyed regarding their opinions on the electronic system. In mid-2016, the scanning system was modified to transfer from the Metavision medical record system to Epic OpTime. Follow-up analysis assessed performance of this system within Epic during 2017. RESULTS: In an interrupted time series analysis, the proportion of units with compliant documentation was estimated to be 19.6% (95% confidence interval [CI], 10.7-25.6) the week before scanner implementation, and 74.4% (95% CI, 59.4-87.4) the week after implementation. There was a significant postintervention level change (odds ratio 10.80, 95% CI, 6.31-18.70; P < .001) and increase in slope (odds ratio 1.14 per 1-week increase, 95% CI, 1.11-1.17; P < .001). After implementation, providers chose to use the new electronic system for 98% of transfusions. Across the 2 years analyzed (15,997 transfusions), the electronic system detected 45 potential transfusion errors in 27 unique patients, and averted transfusion of 36 mismatched blood products into 20 unique patients. A total of 69%, 86%, and 88% of providers reported the electronic system improved patient safety, blood transfusion workflow, and transfusion documentation, respectively. When providers used the barcode scanner, no transfusion errors or reactions were reported. The scanner system was successfully transferred from Metavision to Epic without retraining staff or changing workflows. CONCLUSIONS: A barcode-based system designed for easy integration to different commonly used anesthesia information management systems was implemented in a large urban academic hospital. The system allows a single user with the assistance of a software system to perform and document pretransfusion safety verification. The system improved transfusion documentation compliance, averted potential transfusion errors, and became the preferred method of blood transfusion safety checking.


Assuntos
Transfusão de Sangue/métodos , Processamento Eletrônico de Dados , Registros Eletrônicos de Saúde/organização & administração , Salas Cirúrgicas/organização & administração , Adulto , Documentação , Fidelidade a Diretrizes , Humanos , Análise de Séries Temporais Interrompida , Erros Médicos/prevenção & controle , Segurança do Paciente , Melhoria de Qualidade , Fluxo de Trabalho
18.
Rev. bioét. (Impr.) ; 28(3): 517-521, jul.-set. 2020.
Artigo em Português | LILACS | ID: biblio-1137127

RESUMO

Resumo O termo de consentimento informado é fundamental na relação jurídica entre médico e paciente. Visando avaliar seu impacto na sentença judicial, realizou-se estudo retrospectivo de 70 processos de responsabilidade civil envolvendo procedimentos médicos estéticos cirúrgicos e não cirúrgicos com termo de consentimento assinado pelos pacientes. Os casos analisados, julgados entre 2014 e 2016, foram selecionados nos sites dos tribunais brasileiros e classificados em dois grupos: médicos absolvidos (51%) e condenados (49%). No primeiro grupo, 39% das absolvições se embasaram na apresentação adequada do termo de consentimento informado, enquanto, no segundo, 50% dos médicos foram condenados por não o ter incluído. Portanto, o termo de consentimento informado se destaca nos julgamentos de erro médico. O dever de informar é um dos pilares da responsabilidade civil desse profissional e, quando negligenciado, constitui fator substancial para condenação.


Abstract The informed consent form is essential in the physician-patient relationship. To evaluate its impact on court decisions, we conducted a retrospective study of 70 civil suits involving surgical and non-surgical aesthetic medical procedures with an informed consent form signed by patients. The cases, judged between 2014 and 2016, were selected from Brazilian courts websites and classified into two groups: acquitted (51%) and convicted (49%) doctors. In the first group, 39% of acquittals were based on the proper presentation of the informed consent form, whereas in the second 50% of the professionals were convicted for not including the document. The informed consent thus stands out when judging medical errors, and the duty to warn is one of the pillars of the professional liability and, when neglected, becomes a substantial factor for their conviction.


Resumen El formulario de consentimiento informado es fundamental en la relación jurídica entre médico y paciente. Para evaluar su impacto en sentencias judiciales, se realizó un estudio retrospectivo con 70 procesos de responsabilidad civil relacionados con procedimientos médicos estéticos quirúrgicos y no quirúrgicos con el formulario de consentimiento firmado por los pacientes. Los casos analizados, juzgados entre 2014 y 2016, fueron seleccionados en los sitios web de los tribunales brasileños y clasificados en dos grupos: médicos absueltos (51%) y condenados (49%). En el primer grupo, el 39% de las absoluciones se basaron en la presentación adecuada del formulario de consentimiento; en el segundo, en el 50% de los casos se condenaron a los médicos por no incluir este documento. Por tanto, el formulario de consentimiento informado se destaca en los juicios por error médico. El deber de informar es uno de los pilares de la responsabilidad civil del médico, y su incumplimiento constituye un factor sustancial de condena.


Assuntos
Responsabilidade pela Informação , Erros Médicos , Responsabilidade Civil , Estética , Consentimento Livre e Esclarecido
19.
J Nurs Adm ; 50(10): 521-525, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32925663

RESUMO

OBJECTIVE: The purpose of this study was to describe hospital nurses' experiences with organizational support after an adverse event (AE). BACKGROUND: Most hospital staff nurses will experience an AE, being left and feeling traumatized. METHODS: Data collection and analysis followed a qualitative descriptive approach. RESULTS: Nurses yearn to feel valued and to receive timely support from nurse executives after an AE. CONCLUSIONS: To help lessen the suffering of the nurse after an AE, healthcare organizations and nurse executives must support the nurse in the aftermath.


Assuntos
Atitude do Pessoal de Saúde , Recursos Humanos de Enfermagem no Hospital/psicologia , Apoio Social , Adulto , Humanos , Erros Médicos , Pesquisa Qualitativa , Estresse Psicológico , Inquéritos e Questionários
20.
Medicine (Baltimore) ; 99(31): e20912, 2020 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-32756081

RESUMO

INTRODUCTION: Adverse events (AE) in care are recognized as a leading cause of mortality and injury in patients. Improving patients' safety is difficult to achieve. Therefore, innovative research strategies are needed to identify errors in subgroups of patients and related severity of outcomes as well as reliably measured efficiency of reproducible strategies to improve safety. This trial aims to evaluate the impact of a combined multiprofessional education program on the rate of AE in neonatal intensive care units (NICUs). METHODS AND ANALYSIS: This is a stepped-wedge cluster randomised controlled trial with 3 clusters each containing 4 units. The study time period will be 20 months. The education program will be implemented within each cluster following a random sequence with a control period, a 4-month transition period and a post-educational intervention period. Eligibility criteria: for clusters: 6 NICUs from Ile-de-France and 6 NICUs from different regions in France; for patients: in-hospital during the study period (November 23, 2015 and November 2, 2017 [inclusion start dates varying by unit]) in one of the 12 NICUs; corrected gestational age ≤42 weeks upon admission; hospitalization period >2 days; and parents informed and not opposed to the use of their newborn's data. A routine occurrence reporting of medical errors and their consequence will take place during the entire study period. The intervention will combine an education to implement a standardized root cause analysis method, creation of bundles (insertion, daily goals, maintenance bundles) to prevent catheter-associated blood-stream infection and a poster to prevent extravasation injuries. OUTCOME: We hypothesize a reduction from 60 (control) to 50 (intervention) AE/1000 patient-days. The primary outcome will be the rate of AE/1000 patient-days in the NICU. TRIAL REGISTRATION NUMBER: NCT02598609, trial registered November 6, 2015. https://clinicaltrials.gov/ct2/show/NCT02598609. ETHICS AND DISSEMINATION: Study approved by the regional ethic committee CPP Ile-de-France III (no 2014-A01751-46). The results will be published in peer-reviewed journals.


Assuntos
Unidades de Terapia Intensiva Neonatal , Erros Médicos/prevenção & controle , Neonatologia/educação , Infecções Relacionadas a Cateter/prevenção & controle , Educação Médica Continuada/métodos , Extravasamento de Materiais Terapêuticos e Diagnósticos/prevenção & controle , Humanos , Recém-Nascido , Segurança do Paciente , Ensaios Clínicos Controlados Aleatórios como Assunto
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