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1.
Medicine (Baltimore) ; 98(48): e18168, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31770265

RESUMO

RATIONALE: Recent years have witnessed a marked improvement in the safety and accuracy of nerve blocks with the help of ultrasound and other visualization technologies. This study reports a challenging case of a severe complication during the ultrasound-guided stellate ganglion block. PATIENT CONCERNS: A 28-year-old male patient with refractory migraine complained episodic pulsatile pain with photophobia, haphalgesia of the scalp for 3 years. INTERVENTIONS: Ultrasound-guided stellate ganglion block with 4 ml of 1% lidocaine was administrated. OUTCOMES: A sudden loss of consciousness and tonic-clonic seizure was occurred after negative aspiration and test dose. Further sonographic examination revealed a variation in the left vertebral artery, which remained unrecognized during the needle insertion because of its sliding ability under the differential pressure applied by the probe. LESSONS: Inadvertent intra-arterial injection of a local anesthetic agent could be minimized under the ultrasound guidance with various protective strategies, including the determination of any prior variation, optimizing the block route, maintaining a constant probe pressure, and using saline for the test dosage. This case resulted in the implementation of new protocols of the ultrasound-guided stellate ganglion block in our department.


Assuntos
Bloqueio Nervoso Autônomo , Complicações Intraoperatórias , Lidocaína , Convulsões , Gânglio Estrelado , Inconsciência , Artéria Vertebral , Adulto , Anestésicos Locais/administração & dosagem , Anestésicos Locais/efeitos adversos , Bloqueio Nervoso Autônomo/efeitos adversos , Bloqueio Nervoso Autônomo/métodos , Humanos , Complicações Intraoperatórias/diagnóstico , Complicações Intraoperatórias/etiologia , Complicações Intraoperatórias/terapia , Lidocaína/administração & dosagem , Lidocaína/efeitos adversos , Masculino , Erros Médicos/prevenção & controle , Transtornos de Enxaqueca/cirurgia , Assistência ao Paciente/métodos , Convulsões/etiologia , Convulsões/terapia , Gânglio Estrelado/diagnóstico por imagem , Gânglio Estrelado/cirurgia , Resultado do Tratamento , Ultrassonografia de Intervenção/métodos , Inconsciência/etiologia , Inconsciência/terapia , Artéria Vertebral/anatomia & histologia , Artéria Vertebral/lesões
2.
Medicine (Baltimore) ; 98(40): e17459, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31577774

RESUMO

To determine the impact of the implementation of a hand-off bundle on medical errors at an inpatient unit of an academic community teaching hospital. Our secondary objective was to determine the research utility of the use of an all-electronic data collection system for medical errors.A retrospective review was conducted of 1290 admissions 6 months before and after implementation of an improved computerized hand-off tool and training bundle. The study took place at an academic community teaching hospital on a Family Medicine inpatient service caring for patients of all ages. The comparison focused on preventable and non-preventable adverse events.A significant decrease in medical errors was noted. Medical error rate dropped from 6.0 (95% CI, 4.2-8.3) to 2.2 (95% CI, 1.2-3.7) per 100 admissions (P < .001). Preventable medical errors dropped from 0.65 (95% CI, 0.18-1.67) to 0.15 (95% CI, 0.03-0.82) per 100 admissions (P = .194). Non-intercepted potential adverse events dropped from 1.30 (95% CI, 0.56-2.57) to 0.44 (95% CI, 0.09-1.30) per 100 admissions (P = .131). Intercepted potential adverse events dropped from 0.98 (95% CI 0.36-2.13) to 0.74 (95% CI 0.24-1.7) per 100 admissions (P = .766) and errors with little potential for harm dropped from 2.77 (95% CI 1.61-4.43) to 0.74 (95% CI 0.24-1.7) per 100 admissions (P = .009).Implementation of a standardized hand-off bundle was associated with a reduction in medical errors despite a low overall event rate. Further studies are warranted to determine the generalizability of this finding, to examine the overall epidemiology of medical errors and the reporting of such events within general medical teaching units.


Assuntos
Medicina de Família e Comunidade , Internato e Residência , Erros Médicos/prevenção & controle , Pacotes de Assistência ao Paciente , Transferência da Responsabilidade pelo Paciente/organização & administração , Centros Médicos Acadêmicos , Feminino , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Melhoria de Qualidade , Estudos Retrospectivos
4.
Cancer Radiother ; 23(6-7): 630-635, 2019 Oct.
Artigo em Francês | MEDLINE | ID: mdl-31447339

RESUMO

The use of stereotactic body radiotherapy (SBRT) has increased rapidly over the past decade. Optimal preservation of normal tissues is a major issue because of their high sensitivity to high doses per session. Extreme hypofractionation can convert random errors into systematic errors. Optimal preservation of organs at risk requires first of all a rigorous implementation of this technique according to published guidelines. The robustness of the imaging modalities used for planning, and training medical and paramedical staff are an integral part of these guidelines too. The choice of SBRT indications, dose fractionation, dose heterogeneity, ballistics, are also means of optimizing the protection of normal tissues. Non-coplanarity and tracking of moving targets allow dosimetric improvement in some clinical settings. Automatic planning could also improve normal tissue protection. Adaptive SBRT, with new image guided radiotherapy modalities such as MRI, could further reduce the risk of toxicity.


Assuntos
Órgãos em Risco/efeitos da radiação , Lesões por Radiação/prevenção & controle , Radiocirurgia/métodos , Radioterapia Guiada por Imagem/métodos , Fracionamento da Dose de Radiação , Humanos , Imagem por Ressonância Magnética Intervencionista/métodos , Erros Médicos/prevenção & controle , Hipofracionamento da Dose de Radiação , Radiocirurgia/educação , Dosagem Radioterapêutica , Planejamento da Radioterapia Assistida por Computador/normas
5.
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
6.
Stud Health Technol Inform ; 262: 284-287, 2019 Jul 04.
Artigo em Inglês | MEDLINE | ID: mdl-31349323

RESUMO

Structuring and processing natural language is a growing challenge in the medical field. Researchers are looking for new ways to extract knowledge to create databases and applications to help doctors treat patients and minimize medical errors. A very important part in treating a patient is to provide a fair and effective treatment for diseases. In this article we present a method of extracting important information from medical prospectuses, such as a drug-treated condition, a medicine name, a drug type, etc. To extract these entities, we use Stanford NER Tagger trained for prospectuses in Romanian language. The model was trained and tested with 3 types of medication. For each test, the accuracy of the extracted data was calculated. The extracted medical information is used to create databases with structured information that are useful for decision-support applications to check for or find suggestions for the best treatments.


Assuntos
Linguagem , Erros Médicos , Processamento de Linguagem Natural , Mineração de Dados , Humanos , Erros Médicos/prevenção & controle
7.
Nurse Educ ; 44(5): 261-264, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31305358

RESUMO

BACKGROUND: Patient safety efforts in practice have focused on creating a just culture where errors can be identified and reported, and system remedies created to prevent reoccurrence. The same is not true of nursing education where student experiences with error and the sequelae that follow focus on individual performance. PURPOSE: The purpose of this study was to adapt the Just Culture Assessment Tool (JCAT) used in practice settings into a valid and reliable instrument to evaluate just culture in academic settings. METHODS: A 27-item instrument was adapted for academia. Content validity was established. Reliability was determined in a pilot study with 133 prelicensure nursing students. RESULTS: The scale content validity index (CVI) was calculated at 1. The reliability of the instrument is strong (α = .75). CONCLUSIONS: The CVI and pilot study findings support the use of the JCAT for Nursing Education as a valid and reliable instrument to evaluate student perception of just culture in academia.


Assuntos
Bacharelado em Enfermagem/organização & administração , Erros Médicos/enfermagem , Cultura Organizacional , Estudantes de Enfermagem/psicologia , Inquéritos e Questionários , Feminino , Humanos , Masculino , Erros Médicos/prevenção & controle , Pesquisa em Educação de Enfermagem , Pesquisa em Avaliação de Enfermagem , Segurança do Paciente , Projetos Piloto , Reprodutibilidade dos Testes , Estudantes de Enfermagem/estatística & dados numéricos , Adulto Jovem
8.
Int J Surg ; 69: 19-22, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31310820

RESUMO

It is human nature to make mistakes, all people in all works make errors, but an amputation of the wrong leg or an inadvertently retained needle in the abdominal cavity are unanticipated incidents, that no physician in the world wants to experience. Such catastrophic events, except for the consequences on the patient's health and the physician's career, have severe financial implications on the healthcare system. Human nature, apart from making mistakes, is also able to find solutions to minimize adverse incidents. A systematic time-out in the operating room just before incision has been introduced the last two decades to help prevent wrong site surgeries and other surgical never events. Despite its effectiveness in increasing patient safety, compliance issues remain a major problem in its implementation and gaps in its daily use still occur. The current review presents patterns of wrong time-out procedures, emphasizes the problem of poor compliance and reviews the suggested strategies to increase compliance for safer operating rooms.


Assuntos
Lista de Checagem , Erros Médicos/prevenção & controle , Segurança do Paciente , Procedimentos Cirúrgicos Operatórios/normas , Humanos , Guias de Prática Clínica como Assunto , Organização Mundial da Saúde
9.
Am Surg ; 85(6): 663-670, 2019 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-31267909

RESUMO

Ineffective communication between surgical trainees and attending surgeons is a significant contributor to patient harm. The aim of this study was to evaluate a tool to improve resident-to-attending communication regarding changes in patient clinical status. Ten critical patient events were compiled into a list of triggers for direct attending surgeon notification at a single academic institution. Residents and faculty were surveyed to assess communication before and after implementation of the list. Institution of the triggers list was associated with a nonstatistically significant increase in resident-to-attending notification regarding 7 of 10 critical patient events. There was no reported change in frequency of calls associated with the list's implementation. Most residents felt that the list improved patient care and increased their comfort with calling attending surgeons. Comments were generally positive; however, both groups expressed concern that the list could negatively impact resident autonomy and supervision. Implementing a list of triggers for attending notification of critical patient events subjectively improved resident-to-attending communication in an environment with high baseline levels of communication.


Assuntos
Internato e Residência/organização & administração , Corpo Clínico Hospitalar/organização & administração , Equipe de Assistência ao Paciente/organização & administração , Melhoria de Qualidade , Inquéritos e Questionários , Centros Médicos Acadêmicos , Adulto , Educação de Pós-Graduação em Medicina/organização & administração , Feminino , Humanos , Comunicação Interdisciplinar , Relações Interprofissionais , Masculino , Erros Médicos/prevenção & controle , Pessoa de Meia-Idade , Ohio
10.
Rev Col Bras Cir ; 46(3): e20192197, 2019 Jul 10.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31291434

RESUMO

This article proposes the use of a safe surgical checklist in the teaching of the discipline of Ambulatory Surgery during medical graduation. It discusses its benefits and potential implementation and adherence difficulties. It underscores the importance of developing a patient safety culture and active learning methodologies to train students for greater commitment and accountability with the quality of care provided to the community in the academic outpatient clinic of the school hospital.


Assuntos
Procedimentos Cirúrgicos Ambulatórios/normas , Lista de Checagem/normas , Educação Médica/normas , Cuidados Pré-Operatórios/normas , Gestão da Segurança/normas , Procedimentos Cirúrgicos Ambulatórios/educação , Lista de Checagem/instrumentação , Educação Médica/métodos , Humanos , Erros Médicos/prevenção & controle , Segurança do Paciente , Cuidados Pré-Operatórios/educação , Gestão da Segurança/métodos , Materiais de Ensino
12.
Curr Opin Anaesthesiol ; 32(4): 504-510, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31157626

RESUMO

PURPOSE OF REVIEW: To review the findings of National Transportation Safety Board-related aviation near misses and catastrophes and apply these principles to the nonoperating room anesthesia (NORA) suite. RECENT FINDINGS: NORA is a specialty that has seen tremendous growth. In 2019, NORA contributes to a larger proportion of anesthesia practice than ever before. With this growth, the NORA anesthesiologist and team are challenged to provide safe, high-quality care for more patients, often with complex comorbidities, and are forced to utilize deeper levels of sedation and anesthesia than ever before. These added pressures create new avenues for human error and adverse outcomes. SUMMARY: Safety in modern anesthesia practice often draws comparison to the aviation industry. From distinct preoperational checklists, defined courses of action, safety monitoring and the process of guiding individuals through a journey, there are many similarities between the practice of anesthesia and flying an airplane. Consistent human performance is paramount to creating safe outcomes. Although human errors are inevitable in any complex process, the goal for both the pilot and physician is to ensure the safety of their passengers and patients, respectively. As the aviation industry has had proven success at managing human error with a dramatic improvement in safety, a deeper look at several key examples will allow for comparisons of how to implement these strategies to improve NORA safety.


Assuntos
Anestesia/efeitos adversos , Anestesiologia/organização & administração , Aviação/organização & administração , Segurança do Paciente , Qualidade da Assistência à Saúde , Acidentes Aeronáuticos/prevenção & controle , Acidentes Aeronáuticos/estatística & dados numéricos , Anestesiologistas/organização & administração , Lista de Checagem , Humanos , Colaboração Intersetorial , Erros Médicos/prevenção & controle , Equipe de Assistência ao Paciente/organização & administração , Estados Unidos
13.
Int J Radiat Oncol Biol Phys ; 105(2): 423-431, 2019 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-31158426

RESUMO

PURPOSE: To investigate a Bayesian network (BN)-based method to detect errors in external beam radiation therapy physician orders. METHODS AND MATERIALS: A total of 4431 external beam radiation therapy orders from 2008 to 2017 at the authors' institution were obtained from clinical treatment management systems and divided into 3 groups: single prescription, concurrent boost, and sequential boost. Multiple BNs were developed for each group to detect errors in new orders using joint posterior probabilities of the order parameters, given disease information. Each BN was trained with a group of orders using a Bayesian learning algorithm. A procedure was developed to select the optimal BN for each treatment site in each group and to determine site-specific parameters and error detection thresholds. Potential clinical errors, created both manually and automatically, were applied to test error detection performance. RESULTS: The average true-positive rate (TPR) and false-positive rate (FPR) of error detection were 95.72% and 1.99%, respectively, for the single-prescription cohort with 9 treatment sites. For the concurrent-boost cohort, the TPR and FPR were 92.94% and 14.53%, respectively. For the sequential-boost cohort, the TPR and FPR were 100% and 9.48%, respectively, for the prescribed dose values and 100% and 4.34%, respectively, for the remaining order parameters. For the patient simulation and imaging parameters for 9 treatment sites, the TPR and FPR were 100% and 4.96%, respectively. CONCLUSIONS: The probabilistic BN method was able to perform physician order error detection at a higher accuracy than previously reported in a variety of complex prescription instances, thus warranting further development in incorporating BNs into clinical error detection tools to assist manual physician order checks.


Assuntos
Teorema de Bayes , Erros Médicos/estatística & dados numéricos , Neoplasias/radioterapia , Radiologistas/estatística & dados numéricos , Algoritmos , Estudos de Coortes , Conjuntos de Dados como Assunto , Fracionamento da Dose de Radiação , Reações Falso-Negativas , Reações Falso-Positivas , Humanos , Erros Médicos/prevenção & controle , Neoplasias/patologia , Especificidade de Órgãos , Curva ROC , Dosagem Radioterapêutica , Planejamento da Radioterapia Assistida por Computador , Erros de Configuração em Radioterapia , Radioterapia Guiada por Imagem , Treinamento por Simulação , Tecnologia Radiológica
14.
Int J Med Inform ; 128: 62-70, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31160013

RESUMO

BACKGROUND: Hospital discharge summaries offer a potentially rich resource to enhance pharmacovigilance efforts to evaluate drug safety in real-world clinical practice. However, it is infeasible for experts to read through all discharge summaries to find cases of drug-adverse event (AE) relations. PURPOSE: The objective of this paper is to develop a natural language processing (NLP) framework to detect drug-AE relations from unstructured hospital discharge summaries. BASIC PROCEDURES: An NLP algorithm was designed using customized dictionaries of drugs, adverse event (AE) terms, and rules based on trigger phrases, negations, fuzzy logic and word distances to recognize drug, AE terms and to detect drug-AE relations. Furthermore, a customized annotation tool was developed to facilitate expert review of discharge summaries from a tertiary hospital in Singapore in 2011. MAIN FINDINGS: A total of 33 trial sets with 50 to 100 records per set were evaluated (1620 discharge summaries) by our algorithm and reviewed by pharmacovigilance experts. After every 6 trial sets, drug and AE dictionaries were updated, and rules were modified to improve the system. Excellent performance was achieved for drug and AE entity recognition with over 92% precision and recall. On the final 6 sets of discharge summaries (600 records), our algorithm achieved 75% precision and 59% recall for identification of valid drug-AE relations. PRINCIPAL CONCLUSIONS: Adverse drug reactions are a significant contributor to health care costs and utilization. Our algorithm is not restricted to particular drugs, drug classes or specific medical specialties, which is an important attribute for a national regulatory authority to carry out comprehensive safety monitoring of drug products. Drug and AE dictionaries may be updated periodically to ensure that the tool remains relevant for performing surveillance activities. The development of the algorithm, and the ease of reviewing and correcting the results of the algorithm as part of an iterative machine learning process, is an important step towards use of hospital discharge summaries for an active pharmacovigilance program.


Assuntos
Sistemas de Notificação de Reações Adversas a Medicamentos/estatística & dados numéricos , Algoritmos , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/diagnóstico , Registros Eletrônicos de Saúde/estatística & dados numéricos , Erros Médicos/prevenção & controle , Processamento de Linguagem Natural , Alta do Paciente/estatística & dados numéricos , Humanos , Aprendizado de Máquina , Singapura
16.
Pediatr Clin North Am ; 66(4): 751-773, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31230621

RESUMO

Communication errors during transitions of care are a leading source of adverse events for hospitalized patients. This article provides an overview of the role of communication errors in adverse events, describes the complexities of communication for hospitalized patients, and provides evidence regarding the positive effects of applying high-reliability principles to transitions of care and culture of safety. Elements of effective handoffs and a detailed approach for successful implementation of a handoff program are provided. The role of handoff communication in medical education at all levels, as well as for the interprofessional team, is discussed.


Assuntos
Comunicação Interdisciplinar , Transferência da Responsabilidade pelo Paciente/normas , Pediatria/normas , Medicina Baseada em Evidências , Humanos , Erros Médicos/prevenção & controle , Cultura Organizacional , Pacotes de Assistência ao Paciente/normas , Segurança do Paciente/normas , Melhoria de Qualidade
17.
Obstet Gynecol Clin North Am ; 46(2): 215-225, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31056124

RESUMO

Keeping patients safe while they receive medical care is essential. Yet current systems designed to ensure patient safety are not enough, because medical error is the third leading cause of preventable deaths in the United States. Clinicians can partner with the patient to enhance patient safety. Pulse Center for Patient Safety proposes patient- and family-driven processes designed to improve a patient's chances of avoiding harm. This article discusses highlights of the role of patient safety through a grassroots lens, summarizes the factors that influence the patient's role in patient safety and reviews recommendations on how clinicians can partner with patients.


Assuntos
Participação do Paciente , Segurança do Paciente , Adulto , Comunicação , Feminino , Ginecologia , Registros de Saúde Pessoal , Humanos , Imperícia/legislação & jurisprudência , Erros Médicos/legislação & jurisprudência , Erros Médicos/mortalidade , Erros Médicos/prevenção & controle , Obstetrícia , Defesa do Paciente , Educação de Pacientes como Assunto , Assistência Centrada no Paciente/métodos , Relações Médico-Paciente , Qualidade da Assistência à Saúde , Fatores de Risco , Estados Unidos
18.
Obstet Gynecol Clin North Am ; 46(2): 239-245, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31056126

RESUMO

Within health care, the Just Culture is model of workplace justice intended to create fairness for providers and create better outcome for patients. It is about creating a common language to evaluate provider conduct. A Just Culture helps create an open reporting culture. To create better patient safety outcomes, a Just Culture shifts the focus from errors and outcomes to system design and the facilitation of good behavioral choices.


Assuntos
Erros Médicos , Segurança do Paciente , Gestão da Segurança , Responsabilidade Social , Feminino , Ginecologia , Humanos , Imperícia , Erros Médicos/legislação & jurisprudência , Erros Médicos/prevenção & controle , Obstetrícia , Risco , Assunção de Riscos , Inquéritos e Questionários , Terminologia como Assunto , Resultado do Tratamento
19.
Obstet Gynecol Clin North Am ; 46(2): 257-267, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31056128

RESUMO

Research into the incidence of harm and death resulting from medical error has continued after the release of "To Err Is Human." Although debate of the incidence of harm from medical errors continues, patient safety experts agree that medical errors still occur at considerable and unacceptable rates. Continued attention and examination of medical errors are required. Patient Safety Organizations are a federal program that enables providers across the health care delivery system to analyze and learn from errors with the protection of privilege and confidentiality.


Assuntos
Organizações de Planejamento em Saúde , Segurança do Paciente , Gestão da Segurança/organização & administração , Confidencialidade , Feminino , Ginecologia , Pessoal de Saúde , Humanos , Erros Médicos/prevenção & controle , Erros Médicos/estatística & dados numéricos , Obstetrícia , Garantia da Qualidade dos Cuidados de Saúde/métodos , Gestão da Segurança/métodos
20.
Obstet Gynecol Clin North Am ; 46(2): 281-292, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31056130

RESUMO

Implementing change is difficult; few people want to wade into this area because of the challenge. However, it is highly rewarding and does not have to be complicated. Success requires a clear understanding of health care context, patient safety, and behavioral psychology. To achieve its goal, this article is divided into 3 parts: (1) the problem with engagement in health care, (2) patient safety in a new age, and (3) implementation.


Assuntos
Implementação de Plano de Saúde/métodos , Segurança do Paciente , Gestão da Segurança/métodos , Comportamento , Feminino , Ginecologia , Pessoal de Saúde , Humanos , Erros Médicos/prevenção & controle , Erros Médicos/psicologia , Obstetrícia , Equipe de Assistência ao Paciente , Gestão da Segurança/tendências , Engajamento no Trabalho
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