A 10-year cohort study of the burden and risk of in-hospital falls and fractures using routinely collected hospital data.
Qual Saf Health Care. 2010 Dec;19(6):e51
Authors: Brand CA, Sundararajan V
To document the burde…

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Impact of a standard medication chart on prescribing errors: a before-and-after audit.
Qual Saf Health Care. 2009 Dec;18(6):478-85
Authors: Coombes ID, Stowasser DA, Reid C, Mitchell CA
(1) To develop and implement a s…

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Large-scale deployment of the Global Trigger Tool across a large hospital system: refinements for the characterisation of adverse events to support patient safety learning opportunities.

Qual Saf Health Care. 2011 Jan;20(1):25-30

Authors: Good VS, Saldaña M, Gilder R, Nicewander D, Kennerly DA

Background The Institute for Healthcare Improvement encourages use of the Global Trigger Tool to objectively determine and monitor adverse events (AEs). Setting Baylor Health Care System (BHCS) is an integrated healthcare delivery system in North Texas. The Global Trigger Tool was applied to BHCS’s eight general acute care hospitals, two inpatient cardiovascular hospitals and two rehabilitation/long-term acute care hospitals. Strategy Data were collected from a monthly random sample of charts for each facility for patients discharged between 1 July 2006 and 30 June 2007 by external professional nurse auditors using an MS Access Tool developed for this initiative. In addition to the data elements recommended by Institute for Healthcare Improvement, BHCS developed fields to permit further characterisation of AEs to identify learning opportunities. A structured narrative description of each identified AE facilitated text mining to further characterise AEs. Initial findings Based on this sample, AE rates were found to be 68.1 per 1000 patient days, or 50.8 per 100 encounters, and 39.8% of admissions were found to have ?1 AE. Of all AEs identified, 61.2% were hospital-acquired, 10.1% of which were associated with a National Coordinating Council – Medical Error Reporting and Prevention harm score of “H or I” (near death or death). Future Direction To enhance learning opportunities and guide quality improvement, BHCS collected data-such as preventability and AE source-to characterise the nature of AEs. Data are provided regularly to hospital teams to direct quality initiatives, moving from a general focus on reducing AEs to more specific programmes based on patterns of harm and preventability.

PMID: 21228072 [PubMed - in process]

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How different are complications that affect the older adult inpatient?

Qual Saf Health Care. 2010 Dec;19(6):1-5

Authors: Rowell D, Nghiem HS, Jorm C, Jackson TJ

Objective The incidence and cost of complications occurring in older and younger inpatients were compared. Design Secondary analysis of hospital-recorded diagnosis and costs for multiday-stay inpatients in 68 public hospitals in two Australian states. Main outcome measures A complication is defined as a hospital-acquired diagnosis that required additional treatment. The Australian Classification of Hospital-Acquired Diagnoses system is used to identify these complications. Results Inpatients aged >70&emsp14;years have a 10.9% complication rate, which is not substantially different from the 10.89% complication rate found in patients aged <70&emsp14;years. Examination of the probability by single years, however, showed that the peak incidence associated with the neonatal period and childbirth is balanced by rates of up to 20% in patients >80&emsp14;years. Examining the adult patient population (40-70&emsp14;years), we found that while some common complications are not age specific (electrolyte disorders and cardiac arrhythmias), others (urinary tract and lower respiratory tract infections) are more common in the older adult inpatient. Conclusion For inpatients aged >70&emsp14;years, the risks of complications increase. The incidence of hospital-acquired diagnoses in older adults differs significantly from incidence rates found in younger cohorts. Urinary tract infection and alteration to mental state are more common in older adult inpatients. Surprisingly, these complexities do not result in additional costs when compared with costs for the same complications in younger adults. Greater awareness of these differing patterns will allow patient safety efforts for older patients to focus on complications with the highest incidence and cost.

PMID: 21127098 [PubMed - in process]

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Teamwork on inpatient medical units: assessing attitudes and barriers.

Qual Saf Health Care. 2010 Apr;19(2):117-21

Authors: O’Leary KJ, Ritter CD, Wheeler H, Szekendi MK, Brinton TS, Williams MV

BACKGROUND: Discrepant attitudes about teamwork among nurses and physicians exist in operating rooms and intensive care units. Little is known about teamwork attitudes on general medical services. OBJECTIVE: To assess ratings of teamwork by providers on inpatient medical units and barriers to collaboration. DESIGN AND PARTICIPANTS: Nurses, primary hospital physicians and medical subspeciality consultants on four general medical units were surveyed. MEASUREMENTS: Providers rated the quality of communication and collaboration experienced with their own and other disciplines. Providers also rated potential barriers to collaboration. Differences between providers in ratings of collaboration and barriers were tested using analysis of variance. RESULTS: Of 230 eligible providers, 159 (69%) completed the survey. Teamwork ratings of nurses were similarly high across provider types. Ratings of physicians differed considerably by provider type (p<or=0.001). Whereas the vast majority of physicians rated the quality of collaboration with nurses as high or very high, a minority of nurses rated collaboration with physicians as high or very high. Nurses perceived the biggest barriers to interdisciplinary communication to be difficulty identifying patients' providers and their roles. Primary hospital physicians rated not having physicians and nurses on a single telecommunication system as the biggest barrier. CONCLUSIONS: In a general medical inpatient setting, discrepancies among nurses and physicians existed in ratings of collaboration and barriers to teamwork. Whereas physicians rated the quality of teamwork with nurses favourably, nurses perceived teamwork as suboptimal.

PMID: 20351159 [PubMed - in process]

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Effects of shift length on quality of patient care and health provider outcomes: systematic review.

Qual Saf Health Care. 2009 Jun;18(3):181-8

Authors: Estabrooks CA, Cummings GG, Olivo SA, Squires JE, Giblin C, Simpson N

BACKGROUND: Healthcare providers work increasingly under a variety of shift work systems to cover the continuous care required by patients. However, the effects of shift work on patient and provider outcomes in healthcare settings has not been systematically evaluated. OBJECTIVE: To identify and analyse the available evidence on the effect of shift length (8-h vs 12-h shifts) on quality of patient care and healthcare provider outcomes. METHODS: Systematic searching of eight online databases, key governmental/organisational websites and academic journals with ancestry search of relevant articles (limited to articles published in English and Spanish). RESULTS: Of 562 articles that were retrieved from 20 446 titles identified through database and manual searches, 27 satisfied the inclusion criteria, of which 15 were rejected because of low methodological quality. The 12 final studies included cross-sectional/survey (7), before-after (3) and prospective cohort (2) designs. The main primary outcomes evaluated were: (1) quality of patient care and (2) healthcare provider outcomes. The results were equivocal. With respect to the effect of shift length on quality of patient care, two studies found that errors and near errors were associated with working longer shifts, and another study reported decreased patient complications and length of stay with longer shifts. Specific healthcare provider outcomes such as health complaints, well-being, drug and alcohol consumption, stress and job satisfaction were mostly evaluated by single studies and therefore there was insufficient evidence from which to draw conclusions. CONCLUSIONS: Methodological quality of the studies generally was low and results equivocal with insufficient evidence to determine the effects of shift length on quality of patient care and healthcare provider outcomes. Clearly, robust well-designed studies are needed to examine the effect of shift length on patient and healthcare provider outcomes.

PMID: 19467999 [PubMed - indexed for MEDLINE]

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Effect of a diabetes order set on glycaemic management and control in the hospital.

Qual Saf Health Care. 2008 Dec;17(6):464-8

Authors: Noschese M, Donihi AC, Koerbel G, Karslioglu E, Dinardo M, Curll M, Korytkowski MT

PROBLEM: Insulin can have favourable effects on patient outcomes when used appropriately; however, it is considered among the top five medications associated with errors in the hospital setting. SETTING: Tertiary care centre. METHODS : A diabetes order set with prescribing guidelines was developed by a multidisciplinary diabetes patient safety committee, and introduced on an inpatient unit (the order set unit) following educational sessions with doctors/nurses. To determine the safety and efficacy of the order set, all orders for diabetes medications on patients with 3 days of bedside blood glucose data were recorded and reviewed for types and appropriateness of orders and compared with those written on a unit not using the order set (control unit). An expert panel not involved in the project reviewed and determined appropriateness according to criteria that included evidence of insulin adjustments for hyperglycaemia, hypoglycaemia, or steroid therapy. Satisfaction with the order set among clinical personnel was elicited by a four-item questionnaire. RESULTS: There were more orders for scheduled basal/bolus insulin therapy (p = 0.008) and fewer orders for correctional insulin alone on the order set unit than the control unit. A trend toward more appropriate orders (91% vs 80%) was observed on the order set unit. A high degree of satisfaction for the diabetes order set was elicited from doctors, nurse practitioners, nurses and clerical staff using a four-item survey. CONCLUSIONS: A diabetes order set with prescribing guidelines can safely and effectively be implemented in hospitals. The success of this intervention is attributed to the contribution of nurses, pharmacists and prescribers in the design and implementation of the order set, the provider education accompanying order set implementation and the feedback following implementation.

PMID: 19064664 [PubMed - indexed for MEDLINE]

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Predicting patient complaints in hospital settings.

Qual Saf Health Care. 2008 Oct;17(5):346-50

Authors: Kline TJ, Willness C, Ghali WA

BACKGROUND: The prediction of patient complaints is not clearly understood. This is important in so far as patient complaints have been shown to correlate with other adverse outcomes of interest in acute care facilities. OBJECTIVES: To evaluate the complexity of the patient case and patient safety culture as predictors of patient complaints. DESIGN: A matched case-control analysis of data from patients filing complaints (cases) and matched patients who did not file complaints (controls) in 2005. Staff surveys were used to measure the Patient Safety Culture on individual units. SETTING: 45 inpatient acute care units from four general hospitals in a large metropolitan centre in western Canada. SAMPLE: 586 patients registering complaints in 2005. METHOD: The primary outcome was patient complaints (number and type). Predictors included unit-level measures of patient safety culture based on a survey and patient admission characteristics (including age, gender, treatment unit, primary diagnosis, case resource intensity). RESULTS: The probability of a patient complaint was positively associated with cases of higher complexity (beta = 0.145, p = 0.032; odds ratio = 1.16; CI 0.994 to 1.344). The culture of patient safety within hospital units was not related to the probability of complaints within a given unit. CONCLUSIONS: Patient complaints are associated with higher clinical complexity. However, the confidence interval around the odds ratio for this association just crosses 1.0 and is thus not “significant” in a traditional framework of dichotomously judging statistical significance at the 95% confidence level. The lack of association with a unit’s safety culture, meanwhile, implies that the non-modifiable clinical complexity factor is a more important determinant of patient complaints.

PMID: 18842973 [PubMed - indexed for MEDLINE]

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The incidence and nature of in-hospital adverse events: a systematic review.

Qual Saf Health Care. 2008 Jun;17(3):216-23

Authors: de Vries EN, Ramrattan MA, Smorenburg SM, Gouma DJ, Boermeester MA

INTRODUCTION: Adverse events in hospitals constitute a serious problem with grave consequences. Many studies have been conducted to gain an insight into this problem, but a general overview of the data is lacking. We performed a systematic review of the literature on in-hospital adverse events. METHODS: A formal search of Embase, Cochrane and Medline was performed. Studies were reviewed independently for methodology, inclusion and exclusion criteria and endpoints. Primary endpoints were incidence of in-hospital adverse events and percentage of preventability. Secondary endpoints were adverse event outcome and subdivision by provider of care, location and type of event. RESULTS: Eight studies including a total of 74 485 patient records were selected. The median overall incidence of in-hospital adverse events was 9.2%, with a median percentage of preventability of 43.5%. More than half (56.3%) of patients experienced no or minor disability, whereas 7.4% of events were lethal. Operation- (39.6%) and medication-related (15.1%) events constituted the majority. We present a summary of evidence-based interventions aimed at these categories of events. CONCLUSIONS: Adverse events during hospital admission affect nearly one out of 10 patients. A substantial part of these events are preventable. Since a large proportion of the in-hospital events are operation- or drug-related, interventions aimed at preventing these events have the potential to make a substantial difference.

PMID: 18519629 [PubMed - indexed for MEDLINE]

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