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1.
Medicine (Baltimore) ; 99(3): e18770, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32011467

RESUMO

Discrepancies between clinical and autopsy diagnoses range from 30% to 37%. The significance of deontological examinations remains high. In the pursuit of proper evaluation of diagnostic discrepancies, the establishment of pathogenesis, the mechanism of death, and a correct diagnosis are of particular importance.A retrospective study of deontological examinations, aimed at the detection of medical errors and carried out by the State Forensic Medicine Service during the period 1989 to 2016, was performed. The clinical and autopsy data from 1007 cases were collected in compliance with the research protocol.The number of deontological examinations tends to increase. In 60% of cases, the deceased were men. Most cases were in the age group of 50 to 59 years. Most examinations were carried out in relation to improperly provided healthcare services and the patient's death in surgery, admission, intensive care and obstetrics-gynecology departments. In 13% of cases, the diagnosis did not coincide and, in 79% of cases, the diagnoses fully coincided. In 68% of cases, the medical error was disproved.The number of deontological examinations is increasing. In most cases, clinical and autopsy diagnoses fully matched. Incorrectly clinically diagnosed intracranial injuries were the most common diagnostic mistakes. The data are similar to the results of research in other countries and would be relevant to ensuring the prevention of medical mistakes and the improvement of healthcare quality.


Assuntos
Causas de Morte , Erros de Diagnóstico/estatística & dados numéricos , Medicina Legal/métodos , Erros Médicos/estatística & dados numéricos , Qualidade da Assistência à Saúde/estatística & dados numéricos , Autopsia , Feminino , Humanos , Lituânia , Masculino , Estudos Retrospectivos
2.
Niger J Clin Pract ; 22(12): 1706-1714, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31793478

RESUMO

Background: Dental extraction is a common procedure that is subject to complications and errors including extraction of the wrong tooth. This study aimed to determine the prevalence and identify the causes of wrong tooth extractions and explore the attitude of dentists after extraction of a wrong tooth. Methods: A questionnaire was adapted to fit the needs of this project and was distributed among all the dentists in four teaching dental clinics. The questionnaire was available in both the English and Arabic languages. Results: Of the 486 questionnaires, 186 questionnaires were returned (response rate of 37%) and used for the analysis. The prevalence of wrong tooth extraction was 21.1%. The three most common reasons for extracting a wrong tooth were miscommunication (31.6%), inadequate referral (28.9%), and exhaustion of an overworked dentist (28.9%). Surprisingly, only 50% informed the patient and documented the incident in the patient's chart. Few dentists apologized to their patients or offered any kind of solution or compensation. Conclusion: Wrong tooth extraction is a prevalent yet preventable problem. Most of the common causes of this problem appear to be more system rather than individual related. There is a pressing need to implement the universal protocol for the prevention of wrong site, wrong procedure, and wrong person surgery.


Assuntos
Assistência Odontológica/estatística & dados numéricos , Odontólogos/psicologia , Erros Médicos/estatística & dados numéricos , Extração Dentária/estatística & dados numéricos , Adulto , Atitude do Pessoal de Saúde , Clínicas Odontológicas , Feminino , Humanos , Pessoa de Meia-Idade , Prevalência , Encaminhamento e Consulta , Arábia Saudita
3.
Lakartidningen ; 1162019 Dec 02.
Artigo em Sueco | MEDLINE | ID: mdl-31794048

RESUMO

This study reviewed 102 decisions on error reports in ophthalmic health care in Sweden between March 2017 and October 2018. The study included children, adults, women and men. We found that there was a clear association between long waiting times for ophthalmic health care and negative visual outcomes. As a result of care delay, 71 percent of the patients had moderate vision loss and 17 percent of the patients experienced severe vision loss. Patients with glaucoma and wet macular degeneration accounted for the majority of the patients with negative outcomes. Timely follow-up and prompt treatment are critical to patients' visual outcomes.


Assuntos
Erros Médicos/estatística & dados numéricos , Oftalmologia/normas , Tempo para o Tratamento , Adulto , Idoso , Criança , Feminino , Glaucoma/epidemiologia , Humanos , Degeneração Macular/epidemiologia , Masculino , Pessoa de Meia-Idade , Qualidade da Assistência à Saúde/normas , Suécia/epidemiologia , Resultado do Tratamento , Transtornos da Visão/epidemiologia , Listas de Espera
4.
Rev. Paul. Pediatr. (Ed. Port., Online) ; 37(4): 472-478, Oct.-Dec. 2019. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1041354

RESUMO

ABSTRACT Objective: To create an electronic instrument in order to analyze the adequacy of the preterm infants' nutritional therapy, checking the difference between the prescribed and the administered diet. Methods: A prospective and observational study on newborns with birthweight ≤1,500g and/or gestational age ≤32 weeks, without congenital malformations. The electronic instrument was developed based on Microsoft Excel 2010 spreadsheets and aimed at automatically calculating body weight gain, calories and macronutrients received daily by each patient from parenteral nutrition, intravenous hydration and enteral feedings. The weekly means of each nutrient were used to compare the prescribed and administered diets. Results: To evaluate the instrument, 60 newborns with a birth weight of 1,289±305 g and a gestational age of 30±2 weeks were included. Of them, 9.6% had restricted growth at birth and 55% at discharge. The median length of stay was 45±17 days. There were significant differences between prescribed and administered diet for all of the macronutrients and for total calories in the first three weeks. The lipid was the macronutrient with the greatest percentage error in the first week of life. Conclusions: The use of a computational routine was important to verify differences between the prescribed and the administered diet. This analysis is necessary to minimize calculation errors and to speed up health providers' decisions about the nutritional approach, which can contribute to patients' safety and to good nutritional practice. Very low birth weight infants are extremely vulnerable to nutritional deficiencies and any reduction in macronutrients they receive may be harmful to achieve satisfactory growth.


RESUMO Objetivo: Elaborar um instrumento eletrônico para análise da adequação da terapia nutricional dos recém-nascidos pré-termo, verificando a diferença entre a dieta prescrita e a administrada. Métodos: Estudo observacional prospectivo em recém-nascidos com peso de nascimento ≤1.500 g e/ou idade gestacional ≤32 semanas, sem malformações congênitas. O instrumento eletrônico foi desenvolvido com base em planilhas do Microsoft Excel 2010 para calcular automaticamente ganho de peso corporal, calorias e macronutrientes diariamente recebidos pelos pacientes por meio de dietas parenteral e enteral. Para comparar a dieta prescrita e a administrada, foram utilizados os resultados das médias semanais. Resultados: Para avaliar o instrumento, foram incluídos 60 recém-nascidos com peso de nascimento de 1.289±305 g e idade gestacional de 30±2 semanas. Destes, 9,6% apresentavam restrição de crescimento no nascimento e 55% no momento da alta. A média de internação foi de 45±17 dias. Foram verificadas diferenças significativas entre a dieta prescrita e a administrada para todos os macronutrientes e calorias totais nas três primeiras semanas. O lipídeo foi o macronutriente com o maior erro percentual na primeira semana. Conclusões: O emprego de uma rotina computacional foi importante para verificar discrepâncias entre a dieta prescrita e a administrada. Essa análise é necessária para minimizar erros de cálculo e agilizar as decisões da equipe de saúde acerca da abordagem nutricional, podendo contribuir para a segurança do paciente e para a boa prática nutricional. Os recém-nascidos de muito baixo peso são extremamente vulneráveis às deficiências nutricionais e qualquer redução nos macronutrientes recebidos pode ser deletéria para o crescimento satisfatório.


Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Apoio Nutricional/normas , Erros Médicos/estatística & dados numéricos , Registros Eletrônicos de Saúde , Cuidado do Lactente/normas , Padrões de Prática Médica , Brasil , Recém-Nascido Prematuro/fisiologia , Estudos Prospectivos , Apoio Nutricional/estatística & dados numéricos , Erros Médicos/prevenção & controle , Segurança do Paciente , Cuidado do Lactente/estatística & dados numéricos , Fenômenos Fisiológicos da Nutrição
5.
S Afr Med J ; 109(9): 693-697, 2019 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-31635596

RESUMO

BACKGROUND: There is growing realisation that human error contributes significantly to morbidity and mortality in modern healthcare. A number of taxonomies and classification systems have been developed in an attempt to categorise errors and quantify their impact. OBJECTIVES: To record and identify adverse events and errors as they impacted on acute trauma patients undergoing a computed tomography (CT) scan, and then quantify the effect this had on the individual patients. It is hoped that these data will provide evidence to develop error prevention programmes designed to reduce the incidence of human error. METHODS: The trauma database was interrogated for the period December 2012 - April 2017. All patients aged >18 years who underwent a CT scan for blunt trauma were included. All recorded morbidity for these patients was reviewed. RESULTS: During the period under review, a total of 1 566 patients required a CT scan at our institution following blunt trauma. Of these, 192 (12.3%, 134 male and 58 female) experienced an error related to the process of undergoing a CT scan. Of 755 patients who underwent a CT scan with intravenous contrast, detailed results were available for 312, and of these 46 (14.7%) had an acute deterioration in renal function. According to Chang's taxonomy, physical harm occurred as follows: grade I n=6, grade II n=62, grade III n=45, grade IV n=11, grade V n=27, grade VI n=21, grade VII n=15, grade VIII n=3 and grade IX n=2. Adverse events were performing an unnecessary scan (n=24), omitting an indicated scan (n=23), performing the scan incorrectly (n=8), scanning the wrong body part (n=7), equipment failure (n=18), omitting treatment following the scan (n=6), incorrect interpretation of the scan (n=65), deterioration during the scan (n=6) and others (n=35). The setting for the error was the ward (n=19), the radiology suite (n=126), the emergency department (n=45) and the operating theatre (n=2). The staff responsible for the adverse events were medical (n=155), nursing (n=4) and radiology staff (n=15). There were 67 errors of commission and 125 errors of omission. The primary cause was a planning problem in 78 cases and an execution problem in 114. CONCLUSIONS: Errors and adverse events related to obtaining a CT scan following blunt polytrauma are not uncommon and may impact significantly on the patient. Communication is essential to eliminate errors related to performing the wrong type of scan. The commonest errors relate to misinterpretation of the scan.


Assuntos
Erros Médicos/estatística & dados numéricos , Traumatismo Múltiplo/diagnóstico por imagem , Tomografia Computadorizada por Raios X/estatística & dados numéricos , Ferimentos não Penetrantes/diagnóstico por imagem , Adulto , Feminino , Humanos , Masculino , Estudos Retrospectivos , África do Sul , Tomografia Computadorizada por Raios X/efeitos adversos , Centros de Traumatologia
6.
Med Care ; 57(11): 913-920, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31609847

RESUMO

OBJECTIVE: There is limited knowledge about how general hospitals and Veterans Health Administration (VHA) hospitals fare relative to each other on a broad range of inpatient psychiatry-specific patient safety outcomes.This research compares data from 2 large-scale epidemiological studies of adverse events (AEs) and medical errors (MEs) in inpatient psychiatric units, one in VHA hospitals and the other in community-based general hospitals. METHOD: Retrospective medical record reviews assessed the prevalence of AEs and MEs in a sample of 4371 discharges from 14 community-based general hospitals (derived from 69,081 discharges at 85 hospitals) and a sample of 8005 discharges from 40 VHA hospitals (derived from 92,103 discharges at 105 medical centers). Rates of AEs and MEs across hospital systems were calculated, controlling for relevant patient and hospital characteristics. RESULTS: The overall rate of AEs and MEs in inpatient psychiatric units of VHA hospitals was 7.11 and 1.49 per 100 patient discharges; at community-based acute care hospitals, these rates were 13.48 and 3.01 per 100 patient discharges. The adjusted odds ratio of a patient experiencing an AE and a ME at community-based hospitals as compared with VHA hospitals was 2.11 and 2.08, respectively. CONCLUSION: Although chart reviews may not document the complete nature and outcomes of care, even after controlling for differences in patient and hospital characteristics, psychiatric inpatients at community-based hospitals were twice as likely to experience AEs or MEs as inpatients at VHA hospitals. While community-based hospitals may lag behind VHA hospitals, both hospital systems should continue to pursue evidence-based improvements in patient safety. Future research aimed at changing hospital practices should draw on established strategies for bridging the gap from research to practice in order to improve the quality of care for this vulnerable patient population.


Assuntos
Hospitais Comunitários/estatística & dados numéricos , Hospitais Gerais/estatística & dados numéricos , Hospitais de Veteranos/estatística & dados numéricos , Pacientes Internados/psicologia , Erros Médicos/estatística & dados numéricos , Unidade Hospitalar de Psiquiatria/estatística & dados numéricos , Adolescente , Adulto , Feminino , Humanos , Pacientes Internados/estatística & dados numéricos , Masculino , Erros Médicos/psicologia , Pessoa de Meia-Idade , Alta do Paciente/estatística & dados numéricos , Estudos Retrospectivos , Adulto Jovem
7.
Dis Colon Rectum ; 62(12): 1467-1476, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31567928

RESUMO

BACKGROUND: Laparoscopic total mesorectal excision is a challenging procedure requiring high-quality surgery for optimal outcomes. Patient, tumor, and pelvic factors are believed to determine difficulty, but previous studies were limited to postoperative data. OBJECTIVE: This study aimed to report factors predicting laparoscopic total mesorectal excision performance by using objective intraoperative assessment. DESIGN: Data from a multicenter laparoscopic total mesorectal excision randomized trial (ISRCTN59485808) were reviewed. SETTING: This study was conducted at 4 centers in the United Kingdom. PATIENTS AND INTERVENTION: Seventy-one patients underwent elective laparoscopic total mesorectal excision for rectal adenocarcinoma with curative intent: 53% were men, mean age was 69 years, body mass index was 27.7, tumor height was 8.5 cm, 24% underwent neoadjuvant therapy, and 25% had previous surgery. MAIN OUTCOME MEASURES: Surgical performance was assessed through the identification of intraoperative adverse events by using observational clinical human reliability analysis. Univariate analysis and multivariate binomial regression were performed to establish factors predicting the number of intraoperative errors, surgeon-reported case difficulty, and short-term clinical and histopathological outcomes. RESULTS: A total of 1331 intraoperative errors were identified from 365 hours of surgery (median, 18 per case; interquartile range, 16-22; and range, 9-49). No patient, tumor, or bony pelvimetry measurement correlated with total or pelvic error count, surgeon-reported case difficulty, cognitive load, operative data, specimen quality, number or severity of 30-day morbidity events and length of stay (all r not exceeding ±0.26, p > 0.05). Mesorectal area was associated with major intraoperative adverse events (OR, 1.09; 95%CI, 1.01-1.16; p = 0.015) and postoperative morbidity (OR, 1.1; 95% CI, 1.01-1.2; p = 0.033). Obese men were subjectively reported as harder cases (24 vs 36 mm, p = 0.042), but no detrimental effects on performance or outcomes were seen. LIMITATIONS: Our sample size is modest, risking type II errors and overfitting of the statistical models. CONCLUSION: Patient, tumor, and bony pelvic anatomical characteristics are not seen to influence laparoscopic total mesorectal excision operative difficulty. Mesorectal area is identified as a risk factor for intraoperative and postoperative morbidity. See Video Abstract at http://links.lww.com/DCR/B35. FACTORES QUE PREDICEN LA DIFICULTAD OPERATIVA DE LA ESCISIÓN MESORRECTAL TOTAL LAPAROSCÓPICA: La escisión mesorrectal total laparoscópica es un procedimiento desafiante. Para obtener resultados óptimos, se requiere cirugía de alta calidad. Se cree que, factores como el paciente, el tumor y la pelvis, determinan la dificultad, pero estudios previos solamente se han limitado a datos postoperatorios.Informar de los factores que predicen el resultado de la escisión mesorrectal total laparoscópica, mediante una evaluación intraoperatoria objetiva.Datos de un ensayo multicéntrico y randomizado de escisión mesorrectal total laparoscópica (ISRCTN59485808).Cuatro centros del Reino Unido.Un total de 71 pacientes fueron sometidos a escisión mesorrectal total laparoscópica electiva, para adenocarcinoma rectal con intención curativa. 53% hombres, edad media, índice de masa corporal y altura del tumor 69, 27.7 y 8.5 cm respectivamente, 24% terapia neoadyuvante y 25% cirugía previa.Rendimiento quirúrgico evaluado mediante la identificación de eventos intraoperatorios adversos, mediante el análisis clínico observacional de confiabilidad humana. Se realizaron análisis univariado y la regresión binomial multivariada para establecer factores que predicen el número de errores intraoperatorios, reportes del cirujano sobre la dificultad del caso y los resultados clínicos e histopatológicos a corto plazo.Se identificaron un total de 1,331 errores intraoperatorios en 365 horas de cirugía (media de 18 por caso, IQR 16-22, rango 9-49). Ningún paciente, tumor o medición de pelvimetría pélvica, se correlacionó con la cuenta de errores pélvicos o totales, reporte del cirujano sobre dificultad del caso, carga cognitiva, datos operativos, calidad de la muestra, número o gravedad de eventos de morbilidad de 30 días y duración de la estadía (todos r <± 0.26, p > 0.05). El área mesorrectal se asoció con eventos adversos intraoperatorios importantes (OR, 1.09; IC 95%, 1.01-1.16; p = 0.015) y morbilidad postoperatoria (OR, 1.1; IC 95%, 1.01-1.2; p = 0.033). Como información subjetiva, hombres obesos fueron casos más difíciles (24 mm frente a 36 mm, p = 0.042) pero no se observaron efectos perjudiciales sobre el rendimiento o los resultados.Nuestro tamaño de muestra es un modesto riesgo de errores de tipo II y el sobreajuste de los modelos estadísticos.No se observa que las características anatómicas del paciente, tumor y pelvis ósea influyan en la dificultad operatoria de la escisión mesorrectal laparoscópica total. El área mesorrectal se identifica como un factor de riesgo para la morbilidad intraoperatoria y postoperatoria. Vea el resumen del video en http://links.lww.com/DCR/B35.


Assuntos
Colectomia/métodos , Erros Médicos/estatística & dados numéricos , Obesidade/epidemiologia , Neoplasias Retais/cirurgia , Idoso , Procedimentos Cirúrgicos Eletivos , Feminino , Humanos , Laparoscopia , Terapia Neoadjuvante , Obesidade/complicações , Medição de Risco , Fatores de Risco , Resultado do Tratamento
8.
Medicine (Baltimore) ; 98(41): e17569, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31593143

RESUMO

Near misses and unsafe conditions have become more serious for patients in emergency departments (EDs). We aimed to search the near misses and unsafe conditions that occurred in an ED to improve patient safety.This was a retrospective analysis of a 10-year observational period from January 1, 2007 to December 31, 2016. We gained access to the adverse event notification forms (AENFs) sent to the hospital quality department from the ED. Patient age, sex, and date of presentation were recorded. The near misses and unsafe conditions were classified into 7 types: medication errors, falls, management errors, penetrative-sharp tool injuries, incidents due to institution security, incidents due to medical equipment, and forensic events. The outcome of these events was recorded.A total of 220 AENF were reported from 294,673 ED visits. The median age of the 166 patients was 60 (21-95) years. Of these, 57.1% of the patients were females and 47.9% were males. The most commonly reported events were medication errors (32.7%) and management errors (27.3%). The median age of falling patients was 67.5 years. The nurse-patient ratio between 2007 to 2011 and 2011 to 2016 were 1/10 and 1/7, respectively. We found that when this ratio increased, the adverse events results were less significant (P < .003).This was the 1st study investigating the adverse events in ED in Turkey. The reporting ratio of 0.07% for the total ED visits was too low. This showed that adverse events were under-reported.


Assuntos
Serviço Hospitalar de Emergência/normas , Erros de Medicação/estatística & dados numéricos , Segurança do Paciente/normas , Acidentes por Quedas/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Humanos , Masculino , Programas de Assistência Gerenciada/estatística & dados numéricos , Erros Médicos/classificação , Erros Médicos/estatística & dados numéricos , Erros de Medicação/classificação , Pessoa de Meia-Idade , Ferimentos Penetrantes Produzidos por Agulha/classificação , Segurança do Paciente/estatística & dados numéricos , Estudos Retrospectivos , Medidas de Segurança/classificação , Turquia/epidemiologia
9.
Acta Orthop ; 90(6): 596-601, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31612763

RESUMO

Background and purpose - Treatment outcomes of anterior cruciate ligament (ACL) injuries are generally good, but complications after ACL reconstruction (ACLR) can result in long-lasting problems. Patient injury claims usually fall on the more severe end of the complication spectrum. They are important to investigate because they may reveal the root causes of adverse events, which are often similar regardless of the complication's severity. Therefore, we analyzed ACL-related patient injuries in Finland, the reasons for these claims, causes of complications, and grounds for compensation.Patients and methods - We analyzed all claims filed at the Patient Insurance Centre (PIC) between 2005 and 2013 in which the suspected patient injury occurred between 2005 and 2010. This study also reviewed all original patient records and available imaging studies. General background data were obtained from the National Care Register for Social Welfare and Health Care (HILMO).Results - There were 248 patient injury claims, and 100 of these were compensated. Compensated claims were divided into 4 main categories: skill-based errors (n = 46), infections (n = 34), knowledge-based errors (n = 6), and others (n = 14). Of the compensated skill-based errors, 34 involved graft malposition, 26 of them involved the femoral-side tunnel. All compensated infections were deep surgical site infections (DSSI).Interpretation - This is the first nationwide study of patient injuries concerning ACLRs in Finland. The most common reasons for compensation were DSSI and malposition of the drill tunnel. Therefore, it would be possible to decrease the number of serious complications by concentrating on infection prevention and optimal surgical technique.


Assuntos
Reconstrução do Ligamento Cruzado Anterior/efeitos adversos , Erros Médicos/estatística & dados numéricos , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Compensação e Reparação , Feminino , Finlândia/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Sistema de Registros , Estudos Retrospectivos , Adulto Jovem
10.
BMC Health Serv Res ; 19(1): 677, 2019 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-31533699

RESUMO

BACKGROUND: The psychological and professional impact of adverse events on doctors and nurses is well-established, but limited data has emerged from low- and middle-income. This article reports the experiences of being involved in a patient safety event, incident reporting and organisational support available to assist health professionals in Viet Nam to learn and recover. METHOD: Doctors and nurses (1000) from all departments of a 1500-bed surgical and trauma hospital in Viet Nam were invited to take part in a cross-sectional survey. The survey explored respondents' involvement in adverse events and/or near miss, their emotional, behavioural and coping responses, experiences of organisational incident reporting, and the learning and/or other consequences of the event. Survey items also assessed the availability of organisational support including peer support and mentorship. RESULTS: Of the 497 respondents, 295 (59%) experienced an adverse event in which a patient was harmed, of which 86 (17%) resulted in serious patient harm. 397 (80%) of respondents experienced a near miss, with 140 of these (28%) having potential for serious harm. 386 (77%) reporting they had been affected professionally or personally in some way, with impacts to psychological health (416; 84%), physical health (388; 78%), job satisfaction (378; 76%) and confidence in their ability (276; 56%) commonly reported. Many respondents were unable to identify local improvements (373; 75%) or organisation-wide improvements following safety events (359; 72%) and 171 (34%) admitted that they had not reported an event to their organisation or manager that they should have. CONCLUSIONS: Health professionals in Viet Nam report impacts to psychological and physical health as a result of involvement in safety events that reflect those of health professionals internationally. Reports of limited organisational learning and improvement following safety events suggest that patient safety culture is underdeveloped in Viet Nam currently. In order to progress work on patient safety cultures and incident reporting in Viet Nam, health professionals will need to be convinced not only that they will not be exposed to punitive action, but that learning and positive changes will occur as a result of reporting safety events.


Assuntos
Erros Médicos/estatística & dados numéricos , Segurança do Paciente/estatística & dados numéricos , Gestão da Segurança/estatística & dados numéricos , Adaptação Psicológica , Adolescente , Adulto , Criança , Pré-Escolar , Aconselhamento , Estudos Transversais , Emoções , Feminino , Pessoal de Saúde/psicologia , Hospitais , Humanos , Lactente , Recém-Nascido , Aprendizagem , Masculino , Pessoa de Meia-Idade , Médicos/estatística & dados numéricos , Gestão de Riscos , Inquéritos e Questionários , Vietnã , Adulto Jovem
12.
South Med J ; 112(9): 491-496, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31485589

RESUMO

OBJECTIVES: The purpose of this study was to identify the incidence of anesthetic errors per discharges in the United States within these errors, the incidence of death. A secondary aim was to identify any association between the mortality and patient comorbidities. METHODS: A retrospective analysis of the hospitals in the United States using the Nationwide Inpatient Sample (NIS) database during 2007-2014 was performed. The study population consisted of patients who were recorded as inpatient discharges who experienced complications as a result of incorrect anesthetic administration resulting from either an overdose or inappropriate medication administration in the United States. RESULTS: Between 2007 and 2014, a total of 17,116 anesthetic errors were reported. There was a substantial decrease in the total number of these errors over time, from 2483 in 2007 to 1391 in 2014 (44% decrease). There were 131 reported deaths in this cohort (0.77% mortality rate), with 61 mortalities in teaching hospitals (0.86% mortality rate) and 57 in nonteaching hospitals (0.73% mortality rate). During the study period, deaths decreased from 21 in 2007 (0.85% mortality rate) to 11 in 2014 (0.79% mortality rate), corresponding with a 7.1% decrease in the mortality rate. Comorbidities associated with a significant increase in mortality from anesthetic substances included fluid and electrolyte disorders (odds ratio 8.82, 95% confidence interval 5.24-14.83, P < 0.001) and coagulopathies (odds ratio 5.26, 95% confidence interval 2.53-10.93, P < 0.001). CONCLUSIONS: Our study showed that although the incidence of anesthetic errors is small, they do still exist in our hospitals. Certain comorbidities appear to predispose patients to increased risk. The subsets of patients who appear to be at the greatest risk include those with preexisting electrolyte and fluid disorders and coagulopathies.


Assuntos
Anestesia/efeitos adversos , Anestésicos/farmacologia , Erros Médicos/estatística & dados numéricos , Erros de Medicação/estatística & dados numéricos , Adulto , Feminino , Humanos , Masculino , Estudos Retrospectivos , Taxa de Sobrevida/tendências , Estados Unidos/epidemiologia
13.
Int J Med Inform ; 130: 103938, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31442847

RESUMO

OBJECTIVE: To assess the role of speech recognition (SR) technology in clinicians' documentation workflows by examining use of, experience with and opinions about this technology. MATERIALS AND METHODS: We distributed a survey in 2016-2017 to 1731 clinician SR users at two large medical centers in Boston, Massachusetts and Aurora, Colorado. The survey asked about demographic and clinical characteristics, SR use and preferences, perceived accuracy, efficiency, and usability of SR, and overall satisfaction. Associations between outcomes (e.g., satisfaction) and factors (e.g., error prevalence) were measured using ordinal logistic regression. RESULTS: Most respondents (65.3%) had used their SR system for under one year. 75.5% of respondents estimated seeing 10 or fewer errors per dictation, but 19.6% estimated half or more of errors were clinically significant. Although 29.4% of respondents did not include SR among their preferred documentation methods, 78.8% were satisfied with SR, and 77.2% agreed that SR improves efficiency. Satisfaction was associated positively with efficiency and negatively with error prevalence and editing time. Respondents were interested in further training about using SR effectively but expressed concerns regarding software reliability, editing and workflow. DISCUSSION: Compared to other documentation methods (e.g., scribes, templates, typing, traditional dictation), SR has emerged as an effective solution, overcoming limitations inherent in other options and potentially improving efficiency while preserving documentation quality. CONCLUSION: While concerns about SR usability and accuracy persist, clinicians expressed positive opinions about its impact on workflow and efficiency. Faster and better approaches are needed for clinical documentation, and SR is likely to play an important role going forward.


Assuntos
Documentação/métodos , Registros Eletrônicos de Saúde/estatística & dados numéricos , Registros Eletrônicos de Saúde/normas , Pessoal de Saúde/estatística & dados numéricos , Erros Médicos/estatística & dados numéricos , Interface para o Reconhecimento da Fala/estatística & dados numéricos , Fala/fisiologia , Adulto , Idoso , Boston , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Percepção , Inquéritos e Questionários , Fluxo de Trabalho
14.
Bone Joint J ; 101-B(8): 960-969, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31362543

RESUMO

AIMS: The aim of this study was to give estimates of the incidence of component incompatibility in hip and knee arthroplasty and to test the effect of an online, real-time compatibility check. MATERIALS AND METHODS: Intraoperative barcode registration of arthroplasty implants was introduced in Denmark in 2013. We developed a compatibility database and, from May 2017, real-time compatibility checking was implemented and became part of the registration. We defined four classes of component incompatibility: A-I, A-II, B-I, and B-II, depending on an assessment of the level of risk to the patient (A/B), and on whether incompatibility was knowingly accepted (I/II). RESULTS: A total of 26 524 arthroplasties were analyzed. From 12 307 procedures that were undertaken before implementation of the compatibility check, 21 class A incompatibilities were identified (real- or high-risk combinations; 0.17%; 95% confidence interval (CI) 0.11 to 0.26). From 5692 hip and 6615 knee procedures prior to implementation of the compatibility check, we found rates of class A-I incompatibility (real- or high-risk combinations unknowingly inserted) of 0.14% (95% CI 0.06 to 0.28) and 0.17% (95% CI 0.08 to 0.30), respectively. From 14 217 procedures after the introduction of compatibility checking (7187 hips and 7030 knees), eight class A incompatibilities (0.06%; 95% CI 0.02 to 0.11) were identified. This difference was statistically significant (p = 0.008). CONCLUSION: Our data presents validated estimates of the baseline incidence of incompatibility events for hip and knee arthroplasty procedures and shows that a significant reduction in class A incompatibility events is possible using a web-based recording system. Cite this article: Bone Joint J 2019;101-B:960-969.


Assuntos
Artroplastia de Quadril/instrumentação , Artroplastia do Joelho/instrumentação , Prótese de Quadril/efeitos adversos , Prótese do Joelho/efeitos adversos , Erros Médicos/prevenção & controle , Desenho de Prótese/efeitos adversos , Falha de Prótese/etiologia , Estudos de Coortes , Sistemas de Computação , Dinamarca , Humanos , Erros Médicos/efeitos adversos , Erros Médicos/estatística & dados numéricos , Falha de Prótese/efeitos adversos , Sistema de Registros
15.
Cien Saude Colet ; 24(8): 2895-2908, 2019 Aug 05.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31389537

RESUMO

An integrative review was performed to identify and analyze national studies on barriers to patient safety incident reporting by health professionals within Brazilian health services. A search in the Virtual Health Library (BVS) Portal, PubMed and Web of Science was performed in January 2017 for papers published in the last ten years. One thousand and seven publications were identified and, following application of inclusion and exclusion criteria, eight papers were analyzed, five of which were qualitative and three quantitative. All research was conducted in hospitals, exclusively with nursing professionals, and 75% was conducted in Southeast Brazil. Most studies showed an under-reporting of incidents, and the main reasons were fear about reporting, reporting focused on more severe incidents, lack of knowledge about the subject or how to report and, registered nurse-centered reporting. While study of this theme is still incipient in Brazil, this review found important weaknesses in the process and barriers to incident reporting by professionals, revealing a need for encouraging their participation, eliminating or reducing such barriers with a view to strengthening patient safety.


Assuntos
Recursos Humanos de Enfermagem no Hospital/organização & administração , Segurança do Paciente , Gestão de Riscos/métodos , Brasil , Pessoal de Saúde/organização & administração , Humanos , Erros Médicos/estatística & dados numéricos
16.
Rev Esc Enferm USP ; 53: e03489, 2019 Aug 19.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31433019

RESUMO

OBJECTIVE: To identify work process-related causes associated with nursing errors reported in newspapers. METHOD: This was a documentary and qualitative study based on the work process theory and hermeneutic analysis that examined 112 news articles published between 2012 and 2016 in 21 high-circulation Brazilian newspapers, organized and codified using Atlas.ti software. RESULTS: The causes associated with the reported errors were associated with workforce (lack of professionals and training, turnover, work overload, lack of information, recklessness, negligence, and distraction); work instruments (similar labels or packages, storage, lack of product identification and information, and medical prescriptions); and the object of nursing work (overcrowding and specific characteristics of patient). CONCLUSION: Analysis of the possible causes of reported errors identified the negative outcomes of nursing work, while also identifying elements of the work process that influenced these results. The findings emphasize the importance of understanding these errors so they can be avoided and of reviewing nursing work conditions to guarantee quality and safety of care.


Assuntos
Erros Médicos/estatística & dados numéricos , Processo de Enfermagem/organização & administração , Enfermagem/organização & administração , Brasil , Hermenêutica , Humanos , Enfermagem/normas , Processo de Enfermagem/normas , Pesquisa Qualitativa
17.
Surgery ; 166(5): 835-843, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31353081

RESUMO

BACKGROUND: Critical errors increase postoperative morbidity and mortality. A trauma readiness index was used to evaluate critical errors in 4 trauma procedures. In comparison to practicing and expert surgeon benchmarks, we hypothesized that pretraining trauma readiness index including both vascular and nonvascular trauma surgical procedures can identify residents who will make critical errors. METHODS: In a prospective study, trained evaluators used a standardized script to evaluate performance of brachial, axillary, and femoral artery exposure and proximal control and lower-extremity fasciotomy on unpreserved cadavers. Forty residents were evaluated before and immediately after Advanced Surgical Skills for Exposure in Trauma training, and 38 were re-evaluated 14 months later. Residents were compared to 34 practicing surgeons evaluated once 30 months after training, and 10 experts. RESULTS: Resident trauma readiness index increased with training (P < .001), remained unchanged 14 month later and was higher, with lower variance than practicing surgeons (P < .05). Expert trauma readiness index was higher than residents (P < .004) and practicing surgeons (P < .001). Resident training decreased critical errors when evaluated immediately and 14 months after Advanced Surgical Skills for Exposure in Trauma training. Practicing surgeons had more critical errors and performance variability than residents or experts. Experts had 5 to 7 times better error recovery than practicing surgeons or residents. Trauma readiness index area under the receiver operating curve with Youden Index <0.60 or <6 decile in their cohort, predicts a surgeon will make a critical error. CONCLUSION: Low trauma readiness index was associated with critical errors occurring in all surgeon cohorts and can identify surgeons in need of remedial intervention.


Assuntos
Avaliação Educacional/estatística & dados numéricos , Internato e Residência/organização & administração , Erros Médicos/prevenção & controle , Ferimentos e Lesões/cirurgia , Artéria Axilar/lesões , Artéria Axilar/cirurgia , Benchmarking/métodos , Benchmarking/estatística & dados numéricos , Artéria Braquial/lesões , Artéria Braquial/cirurgia , Cadáver , Competência Clínica/estatística & dados numéricos , Avaliação Educacional/métodos , Fasciotomia/efeitos adversos , Fasciotomia/estatística & dados numéricos , Artéria Femoral/lesões , Artéria Femoral/cirurgia , Humanos , Internato e Residência/estatística & dados numéricos , Erros Médicos/estatística & dados numéricos , Estudos Prospectivos , Cirurgiões/educação , Cirurgiões/estatística & dados numéricos , Procedimentos Cirúrgicos Vasculares/efeitos adversos , Procedimentos Cirúrgicos Vasculares/educação , Procedimentos Cirúrgicos Vasculares/estatística & dados numéricos
18.
BMC Res Notes ; 12(1): 327, 2019 Jun 10.
Artigo em Inglês | MEDLINE | ID: mdl-31182161

RESUMO

OBJECTIVE: Healthcare professionals' empathy have been empirically demonstrated to decrease the risk of medical errors. Medical errors affect patient's outcomes and healthcare providers' well-being. Therefore, the purpose of this study was to determine the relationship between patients' perception of healthcare providers' empathy, their intention to adhere to treatment, and their perception of medical errors made. An anonymous survey was emailed to staff at a health center and an urban university in Miami, Florida, USA. RESULTS: A total of 181 participants were enrolled. Participants rating their healthcare provider as high in empathy had 80% lower odds of reporting errors (CI 0.04-0.6). The intention to follow-up with recommendations or return to the provider were not significantly associated with provider's empathy. Patients of high empathy providers were no more treatment adherent that those who rated their provider with low empathy but were less likely to perceive medical error. Providers' empathy significantly affected patients' perception of medical errors. Our results underscore that healthcare curricula need to address the link between empathy and perception of medical errors, including its potential legal implications.


Assuntos
Competência Clínica/estatística & dados numéricos , Empatia , Erros Médicos/estatística & dados numéricos , Relações Médico-Paciente , Médicos/psicologia , Adulto , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Erros Médicos/psicologia , Pessoa de Meia-Idade , Cooperação do Paciente/estatística & dados numéricos , Inquéritos e Questionários
19.
BMC Health Serv Res ; 19(1): 412, 2019 Jun 24.
Artigo em Inglês | MEDLINE | ID: mdl-31234858

RESUMO

BACKGROUND: To increase patient safety, so-called Critical Incident Reporting Systems (CIRS) were implemented. For Austria, no data are available on how CIRS is used within a healthcare facility. Therefore, the aim of this study was to present the development of CIRS within one of the biggest hospital providers in Austria. METHODS: In the province of Styria, CIRS was introduced in 2012 within KAGes (holder of public hospitals) in 22 regional hospitals and one tertiary university hospital. CIRS is available in all of these hospitals using the same software solution. For reporting a CIRS case an overall guideline exists. RESULTS: As of 2013, 2.504 CIRS cases were reported. Predominantly, CIRS-cases derived from surgical and associated disciplines (ranging from 35 to 45%). According to the list of hazards (also called "risk atlas"), errors in patient identification (ranging from 7 to 12%), errors in management of medicinal products (ranging from < 5 to 9%), errors in management of medical devices (ranging from < 5 to 10%) and errors in communication (ranging from < 5 to 6%) occurred most frequently. Most often, a CIRS case was reported due to individual error-related reasons (48%), followed by errors caused by organization, team factors, communication or documentation failures (34%). CONCLUSIONS: In summary, CIRS has been used for 5 years and 2.504 CIRS-cases were reported. There is a steady increase of reported CIRS cases per year. It became also obvious that disregarding guidelines or standards are a very common reason for reporting a CIRS case. CIRS can be regarded as a helpful supportive tool in clinical risk management and supports organizational learning and thereby collective knowledge management.


Assuntos
Hospitais Públicos/organização & administração , Gestão de Riscos/organização & administração , Gestão de Riscos/estatística & dados numéricos , Áustria , Comunicação , Humanos , Erros Médicos/estatística & dados numéricos , Segurança do Paciente
20.
Lakartidningen ; 1162019 Jun 11.
Artigo em Sueco | MEDLINE | ID: mdl-31192377

RESUMO

A retrospective review of medical records (2017-2018) at Linköping University Hospital compared hospital mortality for the 2-month period of summer vacations (group A) with two months of regular activity (group B). The mortality was 163 patients in group A and 216 in group B. Emergency admittance dominated (95%) in both groups. Comorbidity was found in 81%, and at admittance the risk for death during the hospital stay was estimated to more than 50% in three out of four patients. There was no difference between the groups regarding demography, hospital stay, or diagnosis. Due to a 30% reduction of hospital beds during the summer some patients were relocated to other specialties. No relocated patient died in group A but six in group B. Eight deaths were judged as probably preventable, but none definitely preventable. The similarity between the groups regarding mortality does not allow estimations of differences in adverse events in general. Low mortality among relocated patients is probably due to identification of high-risk patients not suitable for relocation.


Assuntos
Mortalidade Hospitalar , Estações do Ano , Abdome Agudo/mortalidade , Adulto , Idoso , Idoso de 80 Anos ou mais , Doenças Cardiovasculares/mortalidade , Comorbidade , Feminino , Hospitalização , Humanos , Tempo de Internação , Masculino , Erros Médicos/estatística & dados numéricos , Pessoa de Meia-Idade , Neoplasias/mortalidade , Doenças do Sistema Nervoso/mortalidade , Readmissão do Paciente , Estudos Retrospectivos , Suécia/epidemiologia , Adulto Jovem
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