Journal of Patient Safety最新文献

{"title":"Assessing Between- and Within-Hospital Differences in Patient Safety Between Medicaid and Privately Insured Hospital Patients.","authors":"Anuj Gangopadhyaya","doi":"10.1097/PTS.0000000000001270","DOIUrl":"10.1097/PTS.0000000000001270","url":null,"abstract":"<p><strong>Objectives: </strong>The aims of the study are to investigate differences in rates of adverse safety events between nonelderly adult patients with Medicaid and those with private insurance and to assess whether differences are driven by differences in access to quality hospitals or differences in the quality of care delivered within hospitals.</p><p><strong>Data source: </strong>Inpatient records from 26 states in 2017 were collected from the Agency for Health Care Research and Quality's Hospital Cost and Utilization Project.</p><p><strong>Study design: </strong>This study measures differences in 11 patient safety indicators between patients with Medicaid coverage and patients with private insurance coverage. I use regression analysis to investigate differences in adverse safety events within hospitals. I further establish hospital-level quality based on overall rates of adverse safety events and use regression analysis to evaluate the difference in the probability of admission to high-quality hospitals.</p><p><strong>Data collection/extraction: </strong>This study uses hospital discharge data that is restricted to adults ages 19-64 with Medicaid or private coverage.</p><p><strong>Principal findings: </strong>Relative to privately insured patients, Medicaid patients had significantly higher rates of adverse safety events on 8 of 11 patient safety indicators, including on 6 of 7 surgery-related patient safety indicators. Medicaid patients experience respiratory failure and sepsis infections at rates that are 2.9 and 2.5 cases per 1000 greater than rates experienced by privately insured patients. After adjusting for demographic characteristics, patient diagnostic classifications and comorbidities, and geographic factors, 6 of 11 differences in patient safety indicators remained large and statistically significant. These differences were unchanged when further including hospital indicators, indicating that Medicaid and privately insured patients receive different quality of care within hospitals. There is little association between overall hospital quality and differences in the probability of admission between Medicaid and privately covered patients.</p><p><strong>Conclusions: </strong>Medicaid patients received lower quality of care, based on patient safety metrics, relative to privately insured patients within the same hospitals. Reducing payer disparities in adverse safety events requires reforming staffing and treatment patterns for Medicaid and privately insured patients within hospitals.</p><p><strong>Study date and location: </strong>Analysis for this study was conducted in 2023 at the Urban Institute and at Loyola University Chicago.</p>","PeriodicalId":48901,"journal":{"name":"Journal of Patient Safety","volume":" ","pages":"e135-e141"},"PeriodicalIF":1.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142074273","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adverse Events in Patients Transitioning From the Emergency Department to the Inpatient Setting.","authors":"Dennis Tsilimingras, Jeffrey Schnipper, Liying Zhang, Phillip Levy, Steven Korzeniewski, James Paxton","doi":"10.1097/PTS.0000000000001284","DOIUrl":"10.1097/PTS.0000000000001284","url":null,"abstract":"<p><strong>Objectives: </strong>The objective of this study was to determine the incidence and types of adverse events (AEs), including preventable and ameliorable AEs, in patients transitioning from the emergency department (ED) to the inpatient setting. A second objective was to examine the risk factors for patients with AEs.</p><p><strong>Methods: </strong>This was a prospective cohort study of patients at risk for AEs in 2 urban academic hospitals from August 2020 to January 2022. Eighty-one eligible patients who were being admitted to any internal medicine or hospitalist service were recruited from the ED of these hospitals by a trained nurse. The nurse conducted a structured interview during admission and referred possible AEs for adjudication. Two blinded trained physicians using a previously established methodology adjudicated AEs.</p><p><strong>Results: </strong>Over 22% of 81 patients experienced AEs from the ED to the inpatient setting. The most common AEs were adverse drug events (42%), followed by management (38%), and diagnostic errors (21%). Of these AEs, 75% were considered preventable. Patients who stayed in the ED longer were more likely to experience an AE (adjusted odds ratio = 1.99, 95% confidence interval = 1.19-3.32, P = 0.01).</p><p><strong>Conclusions: </strong>AEs were common for patients transitioning from the ED to the inpatient setting. Further research is needed to understand the underlying causes of AEs that occur when patients transition from the ED to the inpatient setting. Understanding the contribution of factors such as length of stay in the ED will significantly help efforts to develop targeted interventions to improve this crucial transition of care.</p>","PeriodicalId":48901,"journal":{"name":"Journal of Patient Safety","volume":" ","pages":"564-570"},"PeriodicalIF":1.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142330508","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Involving Patients and/or Their Next of Kin in Serious Adverse Event Investigations: A Qualitative Study on Hospital Perspectives.","authors":"Linda J Knap, Rachel I Dijkstra-Eijkemans, Roland D Friele, Johan Legemaate","doi":"10.1097/PTS.0000000000001282","DOIUrl":"10.1097/PTS.0000000000001282","url":null,"abstract":"<p><strong>Background: </strong>The involvement of patients or next of kin (P/N) after a serious adverse event (SAE) is evolving. Beyond providing mandatory information, there is growing recognition of the need to incorporate their interests. This study explores practical manifestations of P/N involvement and identifies significant considerations for hospitals.</p><p><strong>Methods: </strong>The data collection involved various qualitative research methods: 7 focus groups with 56 professionals from 37 hospitals, an interview with 2 representatives from the Dutch Association of Hospitals, and an interactive reflection seminar with over 60 participants from 34 hospitals. Before the focus groups, a brief questionnaire was sent out to survey participants' practices regarding into SAE investigations. After the study, another questionnaire was distributed to gather suggestions for future improvements and to identify their lessons learned. Thematic analysis was applied to the gathered data to identify key themes.</p><p><strong>Results: </strong>Hospitals are increasingly acknowledging the interests and perspectives of P/N, recognizing their potential contributions to organizational learning and improvement. P/N involvement following SAEs includes active participation in different stages of the investigation process, not just passive information dissemination. Important factors influencing involvement are the provision of (emotional) support, identification of needs, and transparency of the SAE investigation.</p><p><strong>Conclusions: </strong>This study enhances understanding of evolving practices surrounding P/N involvement in the context of SAEs in Dutch hospitals. The findings highlight the importance of promoting meaningful involvement, recognizing the significance of P/N experiences, and fostering a culture of transparency and collaboration. By examining the dynamics of involvement, this research aims to inform policy development and facilitate the implementation of patient-centered approaches to post-SAE care.</p>","PeriodicalId":48901,"journal":{"name":"Journal of Patient Safety","volume":" ","pages":"599-604"},"PeriodicalIF":1.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142478499","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Predictors of Patient Safety Culture in Hospital Setting: A Systematic Review.","authors":"Anja Vibe, Sara Haurum Rasmussen, Nikolaj Ohm Pranger Rasmussen, Doris Østergaard, Peter Dieckmann","doi":"10.1097/PTS.0000000000001285","DOIUrl":"10.1097/PTS.0000000000001285","url":null,"abstract":"<p><strong>Introduction: </strong>Patient safety (PS) is a global public health concern. It is estimated that 10% of patients experience preventable harm while hospitalized. Patient safety culture (PSC) has been recognized as essential to improving PS, drawing inspiration from other high-risk industries. In PS research, however, PSC poses conceptual challenges, with inconsistent terminology, a lack of definitions, and limited use of substantiating theory. Despite these challenges, PSC remains widely used in PS research and practice, as it is seen as a potential gateway to understanding sociotechnical complex aspects of the healthcare system and improving safe patient treatment and care.</p><p><strong>Objectives: </strong>This review explores the concept of PSC in a hospital setting. How PSC is used as an outcome, thus exploring the theoretical position underpinning PSC, which predictors impact PSC, and how these predictors are related to PSC.</p><p><strong>Method: </strong>Using a search of 3 electronic databases, 23 studies that met the inclusion criteria were selected for review.</p><p><strong>Results: </strong>The review identified 81 predictors of PSC. Study population, unit of analysis and method varied widely. PSC as an outcome was assessed based on one of 4 surveys. Thus, the underpinning position of the PSC construct is dominated by an organizational/managerial approach.</p><p><strong>Conclusions: </strong>The large number of predictors explored and the range in outcome measures, units of analysis, and methods make it hard to establish any causal relationship. We argue that studies closer to actual practices in the messy conditions of clinical practice are needed.</p>","PeriodicalId":48901,"journal":{"name":"Journal of Patient Safety","volume":" ","pages":"576-592"},"PeriodicalIF":1.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142478502","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring the Relationship Between Hospital Patient Safety Culture and Performance on Measures of Hospital-Acquired Conditions.","authors":"Pejmon Noghrehchi, Jennifer L Hefner, Hendrik Stegall, Daniel M Walker","doi":"10.1097/PTS.0000000000001281","DOIUrl":"10.1097/PTS.0000000000001281","url":null,"abstract":"<p><strong>Objective: </strong>The aim of the study is to examine the relationship between hospital perceptions of patient safety culture and the incidence of hospital-acquired conditions (HACs) included in Medicare's HAC Reduction Program utilizing updated and standardized metrics.</p><p><strong>Methods: </strong>The pooled cross-sectional study design utilized the 2018 and 2021 datasets from (1) the Agency for Healthcare Research and Quality's Hospital Survey on Patient Safety Culture (HSOPS), (2) the American Hospital Association's annual survey, and (3) the Center for Medicare and Medicaid's Hospital Compare dataset. The final analytic sample included 131 acute care, nonfederal, U.S. facilities. Multivariable linear regression models were used to compare the HSOPS domains of patient safety culture to CMS's HAC metrics.</p><p><strong>Results: </strong>Controlling for hospital structural and patient-mix characteristics, hospitals with higher staff-reported ratings of overall patient safety culture ('overall perceptions of patient safety' and 'patient safety grade') had significantly lower rates of HACs, including total HAC rate, catheter-associated urinary tract infections, and central line-associated blood stream infections (P's < 0.000-0.044). Higher HSOPS domain scores were variably associated with lower HAC rates, with consistently significant associations found for domains related to nonpunitive, open communication (P's < 0.05).</p><p><strong>Conclusions: </strong>Our relatively robust results suggest that while patient safety culture may not be the only strategy necessary to improve HAC rates, it needs to be aligned with other efforts to improve quality and safety. This underscores the importance of cultivating a culture of psychological safety that promotes open feedback and communication about errors.</p>","PeriodicalId":48901,"journal":{"name":"Journal of Patient Safety","volume":"20 8","pages":"549-555"},"PeriodicalIF":1.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142677550","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From Compliance to Collaboration: Learning From Transatlantic Frameworks for Healthcare Safety Improvement.","authors":"Olivia Lounsbury, Mark Sujan, Ken Catchpole","doi":"10.1097/PTS.0000000000001257","DOIUrl":"10.1097/PTS.0000000000001257","url":null,"abstract":"","PeriodicalId":48901,"journal":{"name":"Journal of Patient Safety","volume":" ","pages":"e118-e120"},"PeriodicalIF":1.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141894696","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient Safety and Perception of Quality in University Dental Hospitals: A French National Survey.","authors":"Pierre Hervy, Brigitte Keriven-Dessomme, Alexandra Cloitre, Béatrice Thivichon-Prince, Bérengère Phulpin, Anne-Gaëlle Chaux","doi":"10.1097/PTS.0000000000001272","DOIUrl":"10.1097/PTS.0000000000001272","url":null,"abstract":"<p><strong>Objectives: </strong>Patient safety is poorly developed in dentistry. The aim of this study was to evaluate the level of patient safety perception and quality culture in French university dental hospitals.</p><p><strong>Methods: </strong>A national survey was performed using a questionnaire that was sent electronically to dental students, teachers, senior professionals, and paramedics of the university dental clinics that volunteered to participate. The profile of the respondents, their involvement in quality teams, the occurrence of adverse events, and the organization of the department were explored.</p><p><strong>Results: </strong>Of the 17 university dental hospitals in France, 15 volunteered to participate, representing 681 respondents (65.9% students, 26.9% dentists, 3.7% paramedics, and 3.5% residents). Despite 58% of the respondents being aware of the procedure for declaring adverse events, only 28% of them had ever declared at least one. All professionals were aware of the high incidence of adverse events in their clinics. The perception of well-being and organization was low, especially for the items \"adequation between tasks and number of professionals\" and for \"task organization.\" The perception of \"team spirit and feeling of respect\" was good.</p><p><strong>Conclusions: </strong>The survey highlighted the need for courses and meetings on patient safety and quality, but also the good perception of dental care providers regarding patient safety. The lack of materials and of human resources emerged as a key point for improving patient safety in university dental hospitals. Nonetheless, communication was also perceived as very important and could be improved without incurring costs and through internal solutions.</p>","PeriodicalId":48901,"journal":{"name":"Journal of Patient Safety","volume":"20 8","pages":"e121-e127"},"PeriodicalIF":1.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142677554","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intraprocedural Fall of an Obese Patient During an Interventional Radiology Procedure.","authors":"Brian Liu, Shayan Sadiq, Helen Wang, Estele Odo de Barros, Zhuoxuan Li, Kevin Nguyen, Sujai Jaipalli, Molly Li, Robert P Liddell","doi":"10.1097/PTS.0000000000001261","DOIUrl":"10.1097/PTS.0000000000001261","url":null,"abstract":"","PeriodicalId":48901,"journal":{"name":"Journal of Patient Safety","volume":" ","pages":"e142-e143"},"PeriodicalIF":1.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141735371","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Characteristics and Outcomes of Patients With COVID-19 Treated in Mayo Clinic's Advanced Care at Home Program.","authors":"Rachel A Gothot, Michael J Maniaci, Margaret R Paulson, Igor Dumic, Amy A Haney, Zhuo Li, Karla C Maita, Brittane T Valles, Charles D Burger","doi":"10.1097/PTS.0000000000001286","DOIUrl":"10.1097/PTS.0000000000001286","url":null,"abstract":"<p><strong>Objectives: </strong>Mayo Clinic's hospital-at-home program, Advanced Care at Home (ACH), launched in 2020. While hospital-at-home literature reported safe and effective care for the general patient population and those with COVID, comparative outcomes between these two groups were unknown. The aim of this retrospective analysis was to compare the outcomes of COVID and non-COVID patients enrolled in ACH and evaluate if COVID patients can be safely treated in this setting.</p><p><strong>Methods: </strong>Demographics, clinical characteristics, and safety outcomes were retrospectively analyzed to compare COVID and non-COVID patients discharged from ACH between November 2020 and May 2022. Patient characteristics analyzed included severity of illness (SOI) and risk of mortality (ROM), calculated using All Patient Refined Diagnosis Related Groups (APR-DRG). Hospitalization-specific variables included length of stay (LOS), escalation of care, and 30-day readmission rates.</p><p><strong>Results: </strong>Of 1051 patients, 173 (16%) had COVID, and 878 (84%) were non-COVID patients. The average age in the COVID cohort was 66.6 (15.3) years, compared with 72.2 (14.0) in the non-COVID cohort. Extreme SOI was higher in the COVID group (43.3% versus 17.4%), as was extreme ROM (46.2% versus 16.2%), but LOS was shorter (5.7 versus 7 days). Escalation of care (7.5% in COVID cohort versus 8.4%) and 30-day readmission outcomes (9.2% for COVID patients versus 12.9%) were not statistically different between the groups.</p><p><strong>Conclusions: </strong>Despite higher SOI and ROM, COVID patients had shorter LOS with outcomes that were not statistically different from non-COVID patients. COVID patients can be safely and efficiently cared for in ACH.</p>","PeriodicalId":48901,"journal":{"name":"Journal of Patient Safety","volume":"20 8","pages":"605-611"},"PeriodicalIF":1.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142677541","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Second Victims in Mental Health Care.","authors":"Deborah Oyine Aluh, Jesus David Cortes","doi":"10.1097/PTS.0000000000001277","DOIUrl":"10.1097/PTS.0000000000001277","url":null,"abstract":"","PeriodicalId":48901,"journal":{"name":"Journal of Patient Safety","volume":"20 8","pages":"e144"},"PeriodicalIF":1.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142677561","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}