Risk Management and Healthcare Policy最新文献

{"title":"Managing Pin Tracts in Open Tibial Fractures: The Role of Medical Waste Rubber Bung.","authors":"Yi Hu, Yu Peng, Kaihu Li, Jun Zhang","doi":"10.2147/RMHP.S509406","DOIUrl":"https://doi.org/10.2147/RMHP.S509406","url":null,"abstract":"<p><strong>Objective: </strong>This study aims to assess the effect of using medical waste rubber bung (MWRB) for pin-tract management in patients with open tibial fractures treated with external fixators (EFs).</p><p><strong>Methods: </strong>A retrospective analysis of 91 patients with open tibial fractures admitted to our hospital over a three-year period was conducted to compare and statistically characterize overall PTI incidence, PTI rate across five different pin-tract locations, time (days) to the first occurrence of infection, and Checketts-Otterburn classification.</p><p><strong>Results: </strong>Among the enrolled 91 patients, 88 met the criteria. After excluding deaths and losses to follow-up, they were divided into two study groups, with no significant difference in overall PTI incidence. Group A exhibited a significantly lower rate of severe infection and prolonged time to initial infection compared to Group B (both <i>P</i> < 0.05). Group A also had a significantly lower rate of PTI at the tibial telangiectasia than Group B.</p><p><strong>Conclusion: </strong>The study underscores that compression in EF management is necessary to significantly reduce the incidence of severe PTIs, especially in the tibial metaphysis, and to delay the onset of initial infection among patients with open tibial fractures.</p>","PeriodicalId":56009,"journal":{"name":"Risk Management and Healthcare Policy","volume":"18 ","pages":"1455-1465"},"PeriodicalIF":2.7,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12048294/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144059228","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Using the Task-Oriented Quality Control Circle to Build the Central Sterile Supply Department Quality Control System for Foreign Objects Remaining in Sterile Packages.","authors":"Shunyu Yao, Liangying Yi, Ruixue Hu, Yanhua Chen, Wei Pan, Jinhui Zhang, Xiaochun Zhao","doi":"10.2147/RMHP.S514458","DOIUrl":"https://doi.org/10.2147/RMHP.S514458","url":null,"abstract":"<p><strong>Background: </strong>The occurrence of foreign objects in sterile packages may delay surgeries and affect the quality of medical treatment.</p><p><strong>Purpose: </strong>This study aimed to use the task-oriented quality control circle (QCC) to build the central sterile supply department (CSSD) quality control system for foreign objects remaining in sterile packages.</p><p><strong>Methods: </strong>A task-oriented QCC was created under the leadership of the CSSD within our hospital. The following were investigated by determining a topic and a task, setting targets, formulating strategies and determining optimal strategies: incidence of foreign objects remaining in sorted and folded textiles; incidence of foreign objects remaining in contaminated instrument packages; incidence of foreign objects remaining in clean textiles; incidence of complaints for foreign objects remaining in sterile packages; and satisfaction among the CSSD and operating room staff.</p><p><strong>Results: </strong>The incidence of foreign objects remaining in contaminated textiles decreased from 7.1% to 0.96%. The incidence of foreign objects remaining in contaminated instrument packages decreased from 0.27% to 0.04%. The incidence of foreign objects remaining in clean textiles decreased from 2.91% to 0.21%. The incidence of complaints received from operating room staff for foreign objects remaining in sterile packages decreased from 41.69% to 0. Satisfaction among the operating room and CSSD staff was improved from 53.7% to 100%.</p><p><strong>Conclusion: </strong>The task-oriented QCC could reduce the incidence of foreign objects remaining in sterile packages, thereby reducing the quality defect rates in instrument packaging.</p>","PeriodicalId":56009,"journal":{"name":"Risk Management and Healthcare Policy","volume":"18 ","pages":"1441-1454"},"PeriodicalIF":2.7,"publicationDate":"2025-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12046524/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144057487","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Survey Study of Oral Care Given by Nurses in Intensive Care Units.","authors":"Muhammet Burak Yavuz, Ekim Onur Orhan, Cemre Eksi, Mari Ainola, Katariina Nurmi, Kari K Eklund, Arzu Beklen","doi":"10.2147/RMHP.S513905","DOIUrl":"https://doi.org/10.2147/RMHP.S513905","url":null,"abstract":"<p><strong>Purpose: </strong>The study aims to analyze whether having a specialty certification (SC) among intensive care unit (ICU) nurses is associated with their knowledge, attitudes, and practices regarding oral care and related complications during hospitalization.</p><p><strong>Patients and methods: </strong>This cross-sectional study included 188 ICU nurses in Eskisehir, Turkey, between April and June 2021. A 20-item questionnaire was used to assess demographic data, knowledge, attitudes, and practices regarding oral care. Chi-square tests (p = 0.05) were used to analyze relationships.</p><p><strong>Results: </strong>A highly significant proportion of nurses having SC were satisfied with the level of oral hygiene instructions they had received, <i>X</i> ² = 12.29, d.f. = 1, n = 188, p < 0.001, and the factor of awareness of its benefits associated with SC education, <i>X</i> ² = 6.55, d.f. = 1, <i>p</i> = 0.010. Nurses who spend less time on oral hygiene performed less oral examinations, <i>X</i> ² = 16.73, d.f. = 4, p = 0.002, and there was an inverse relationship between the number of ICU patients per nurse and the time spent on oral care per patient, <i>X</i> ² = 33.24, d.f. = 8, p < 0.001. The majority of nurses carried out oral care for 2-5 minutes per patient daily (n = 72, 38.29%). SC nurses preferred manual toothbrush with toothpaste over foam stick or sodium carbonate, <i>X</i> ² = 4.16, d.f. = 1, p = 0.04. Regardless of the specialization, a highly significant relationship was observed between the duration of oral care and the experience of nurse in ICU, d.f. = 4, p < 0.001.</p><p><strong>Conclusion: </strong>Having SC significantly affects ICU nurses' ability and willingness to prioritize oral care to improve patients' oral hygiene.</p>","PeriodicalId":56009,"journal":{"name":"Risk Management and Healthcare Policy","volume":"18 ","pages":"1429-1440"},"PeriodicalIF":2.7,"publicationDate":"2025-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12042831/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144034367","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"CT-Detected Arterial Calcification and Ischemic Cardiovascular Risk Assessment in Patients with Upper Urinary Tract Calculi: A Case-Control Study.","authors":"Zhan Qu, Wenbo Yang, Shijun Liu, Mingqing Wang, An Zheng, Caipeng Qin, Yiqing Du, Xiaodong Zhu, Tao Xu","doi":"10.2147/RMHP.S510109","DOIUrl":"https://doi.org/10.2147/RMHP.S510109","url":null,"abstract":"<p><strong>Objective: </strong>Arterial calcification (AC) is frequently observed in computed tomography (CT) scans of patients with upper urinary tract calculi (UUTC). This study aimed to investigate the relationship between AC detected by CT in UUTC patients and the risk of ischemic cardiovascular diseases (ICVD).</p><p><strong>Methods: </strong>In this retrospective case-control study, clinical data of 596 patients were collected. Bone mineral density (BMD) of L1 vertebra and calcification of major/medium arteries were analyzed. Differences in clinical data, CT images and 10-year ICVD risk scores were compared between groups. Univariate analysis and multivariate logistic regression identified independent risk factors for AC in UUTC patients. A scoring system to assess concurrent AC risk in UUTC patients was developed and validated.</p><p><strong>Results: </strong>A total of 396 UUTC patients and 200 controls were included. AC prevalence was higher in UUTC group (71.7% vs 63.5%, <i>P</i> = 0.041), remained valid after controlling for specific confounding factors. UUTC patients exhibited lower BMD of L1 vertebra. Their 10-year ICVD risk scores were elevated (male: OR = 2.450, 95% CI = 1.262-4.758, <i>P</i> = 0.007; female: OR = 4.340, 95% CI = 2.203-8.550, <i>P</i> < 0.001). Multivariate analysis confirmed L1 vertebra BMD < 160 Hounsfield units (OR = 3.660, 95% CI = 2.107-6.358, <i>P</i> < 0.001) as an independent AC risk factor. The presence of AC was associated with a 13.7-fold increased odds of high-risk group classification (OR = 13.689, 95% CI = 8.021-23.346, <i>P</i> < 0.001).</p><p><strong>Conclusion: </strong>AC and the risk of ICVD are associated with UUTC. Our study establishes an innovative integration of UUTC with CT-based AC assessment and ICVD risk stratification, highlighting the need for cardiovascular surveillance in UUTC-affected individuals.</p>","PeriodicalId":56009,"journal":{"name":"Risk Management and Healthcare Policy","volume":"18 ","pages":"1419-1427"},"PeriodicalIF":2.7,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12039826/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143998135","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Current Status and Influencing Factors of Nursing Care Insufficiency in Intensive Care Units: A Cross-Sectional Study Focusing on Staff Shortages, Workload, and Care Omissions.","authors":"Yan Yang, Lihua Zhou, Lin Zhang, Miao Wang, Shaohua Hu","doi":"10.2147/RMHP.S494860","DOIUrl":"https://doi.org/10.2147/RMHP.S494860","url":null,"abstract":"<p><strong>Objective: </strong>This study aims to investigate the status of nursing care omissions in intensive care units (ICUs) in China and identify factors influencing these omissions.</p><p><strong>Methods: </strong>A cross-sectional study was conducted with 1162 ICU nurses from 30 hospitals across nine provinces in China. Data were collected using questionnaires on nursing care omissions, clinical leadership (nurses' ability to influence and coordinate care), and safety attitudes (perceptions of safety culture). Descriptive statistics, correlation analysis, and multiple linear regression were performed using SPSS.</p><p><strong>Results: </strong>The mean score for nursing care omissions is 57.38±21.27, clinical leadership is 59.13±15.30, and safety attitudes is 119.00±21.16. A negative correlation is observed between ICU nursing care omission scores and clinical leadership scores (r=-.212, p<0.001), and a negative correlation is observed between ICU nursing care omission scores and safety attitude scores (r=-.241, p<0.001). The multiple linear regression analysis indicates that the factors influencing nursing care omissions in the ICU includes nurses' age, position, personnel relationships, average monthly income, satisfaction with the ward teamwork, frequency of patient safety education, and clinical leadership and safety attitudes (p<0.05).</p><p><strong>Conclusion: </strong>This study found that nursing deficiency in ICU is significant, affecting patient safety, nurse burnout, and nursing quality. Key factors include nurse age, position, and so on. It is recommended to strengthen clinical leadership training, improve safety culture, and optimize staffing to reduce nursing omissions and improve patient outcomes. It calls on health policies to pay attention to ICU nursing deficiencies and formulate support measures to ensure patient safety and nurse health.</p>","PeriodicalId":56009,"journal":{"name":"Risk Management and Healthcare Policy","volume":"18 ","pages":"1407-1417"},"PeriodicalIF":2.7,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12036680/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144053569","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of the Awareness and Approaches of People Between the Ages of 19-60 in a Rural Area of Antalya Province About Blood Stem Cell Donation and Bone Marrow Donation.","authors":"Alparslan Merdin, Ümit Aydın","doi":"10.2147/RMHP.S514701","DOIUrl":"https://doi.org/10.2147/RMHP.S514701","url":null,"abstract":"<p><strong>Purpose: </strong>While hematopoietic stem cell transplantation is commonly associated with stem cell procedures in public discourse, \"stem cell\" remains a broad classification. More precise terminology such as \"blood stem cell transplantation\", \"bone marrow transplantation\", or \"bone marrow stem cell transplantation\" may better characterize hematopoietic stem cell procedures in both public and academic contexts. This study aimed to evaluate public comprehension of these specific terms and to assess awareness and attitudes toward stem cell donation, with particular focus on rural populations.</p><p><strong>Materials and methods: </strong>The study recruited 250 participants aged 19-60 years from rural Aksu District, Antalya Province. Individuals with a history of stem cell transplantation, those with a first-degree relative with a history of stem cell transplantation, and healthcare professionals were excluded from the study. The participants were asked 11 questions about their approach to stem cell donation and their thoughts on the subject.</p><p><strong>Results: </strong>Among the 250 participants, 51.6% (n=129) expressed willingness to become stem cell donors, whereas 48.4% (n=121) reported no willingness to be a donor. Interestingly, 95.6% (n=239) of the participants stated that they would like to know the identity of the person to whom they would be donating stem cells.</p><p><strong>Conclusion: </strong>This study underscores the need to revisit current anonymity regulations in stem cell transplantation, particularly when both donor and recipient express a desire for mutual identification. Updating regulatory protocols and codes to facilitate information exchange in such cases might be better. Moreover, if the recipient may require further donations from the same donor, the donor should be consulted pre-transplantation about their willingness to provide further support. Their preferences should also be considered in the treatment approach when necessary.</p>","PeriodicalId":56009,"journal":{"name":"Risk Management and Healthcare Policy","volume":"18 ","pages":"1397-1405"},"PeriodicalIF":2.7,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12065113/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144051165","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Christmas Break: Predictive Value of Holiday Avian Wishbone Traditions Among Frontline Healthcare Workers in a Prospective Trial.","authors":"Gideon Loevinsohn, Caitlin N Wizda, Tiffany R Glynn, Timothy B Erickson, Peter R Chai","doi":"10.2147/RMHP.S509590","DOIUrl":"https://doi.org/10.2147/RMHP.S509590","url":null,"abstract":"<p><strong>Objective: </strong>To assess the impact of winning a wishbone contest on the likelihood of subsequent goal attainment.</p><p><strong>Design: </strong>Prospective cohort study.</p><p><strong>Setting: </strong>A large urban academic emergency department in the United States.</p><p><strong>Participants: </strong>40 frontline emergency department clinicians including supervising and resident physicians and physician assistants. Participants were enrolled between December 8, 2023 and January 10, 2024 and followed for three months.</p><p><strong>Main outcome measures: </strong>The primary outcomes were feasibility of performing wishbone contests in the emergency department and attainment of a pre-specified wish by the end of the three-month follow-up period.</p><p><strong>Results: </strong>Forty participants who met eligibility criteria were enrolled in the study and 37 completed follow-up at three months. Half identified as female and professional roles (resident physician, attending physician and physician assistant) were equally distributed. Overall, 38% of wishes were realized at three month follow-up. There was no association between winning the wishbone competition and realizing the wish. Participants who perceived a greater degree of control over the outcome of their wish were more likely to have their wish realized (RR1.2, 95% CI 1.05-1.37).</p><p><strong>Conclusion: </strong>Frontline healthcare workers will engage in luckiness-boosting wishbone contests even in a busy emergency department environment. In our study, there was no association between winning the wishbone competition and goal or wish achievement. Participants who reported and perceived a greater degree of control over the outcome of their wish, however, were more likely to have their wish realized. Holiday cheer and wishful thinking traditions may indicate the feasibility of future work in extending positive thinking among frontline healthcare workers.</p>","PeriodicalId":56009,"journal":{"name":"Risk Management and Healthcare Policy","volume":"18 ","pages":"1387-1396"},"PeriodicalIF":2.7,"publicationDate":"2025-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12019686/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144053566","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence and Correlates of Mental Health Problems in Resident Physicians in Inner Mongolia Autonomous Region: A Cross-Sectional Study.","authors":"Yan Zhang, Li Zhang, Jianyu Que, Miao Jia, Xi Nan, Juanniu Zhang, Haifei Gao, Lixia Chen","doi":"10.2147/RMHP.S494326","DOIUrl":"https://doi.org/10.2147/RMHP.S494326","url":null,"abstract":"<p><strong>Objective: </strong>This study investigates the prevalence and contributory factors of mental health issues, including anxiety, depression, and insomnia, among resident physicians. Additionally, it endeavors to understand the complex characteristics of these issues across different demographic groups.</p><p><strong>Methods: </strong>Using an online cross-sectional design, the study engaged resident physicians in Inner Mongolia, China, through convenience sampling. Questionnaires collected data on sociodemographic background, training details, and symptoms of depression, anxiety, and insomnia, assessed using the Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), and Insomnia Severity Index (ISI). Conduct latent class analysis on psychological issues using Mplus software. Analyze the related influencing factors of different group characteristics using a multivariate logistic regression model.</p><p><strong>Results: </strong>The study comprised 2891 resident physicians, revealing that 20.3% experienced moderate to severe anxiety, 19.72% had moderate to severe depression, and 9.6% faced moderate to severe insomnia. Latent class analysis identified three distinct mental health groups: a high anxiety-depression-insomnia group, a low anxiety-depression-healthy sleep group, and a moderate anxiety-mild depression-variable insomnia group. Factors such as training stage, professional accomplishments, self-reported medical errors, self-esteem, perceived stress, and social support were significantly associated with mental health issues, as identified by multivariate logistic regression.</p><p><strong>Conclusion: </strong>The mental health problems among residents are prominent. By analyzing mental health status and influencing factors, residents can be categorized into different groups, allowing for more targeted interventions. These interventions may include stress management, communication skills training, crisis intervention, and the development of support systems, along with improvements to the work environment and a focus on humanistic care.</p>","PeriodicalId":56009,"journal":{"name":"Risk Management and Healthcare Policy","volume":"18 ","pages":"1377-1385"},"PeriodicalIF":2.7,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12015728/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144029104","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring the Correlation Between Patient Safety Culture and Adverse Medical Events Using Failure Mode and Effect Analysis (FMEA).","authors":"Yang Cui, Yu Wang, He Liu, Shaojie Xu, Xue Zhang","doi":"10.2147/RMHP.S502725","DOIUrl":"https://doi.org/10.2147/RMHP.S502725","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to explore the correlation between medical safety adverse events and patient safety culture through the lens of Failure Mode and Effect Analysis (FMEA).</p><p><strong>Methods: </strong>Sixty patients from a hospital were selected as the research subjects, alongside 440 medical staff members (including clinical, medical technology, and management personnel) who participated in the study. The general demographic characteristics of medical staff, patient safety culture, and adverse medical safety events were investigated. FMEA was employed to analyze the relationship between medical safety adverse events and patient safety culture, using the risk priority number (RPN) as a key metric.</p><p><strong>Results: </strong>A comparison of RPN values before and after FMEA intervention revealed that the RPN values of each failure mode significantly decreased post-intervention. Correlation analysis showed significant relationships between medication errors and several factors: \"incident reporting frequency\" (OR=0.706), \"manager expectations and actions to promote patient safety\" (OR=0.733), and \"management support for patient safety\" (OR=0.755). Pressure ulcers were significantly correlated with \"manager expectations and actions to promote patient safety\" (OR=0.729) and \"shift and transfer\" (OR=0.707). Falls were notably associated with \"interdepartmental cooperation\" (OR=0.735), \"feedback and communication about errors\" (OR=0.756), and \"shift and transfer\" (OR=0.660). Additionally, a strong correlation was identified between adverse events and \"management support for patient safety\" (OR=0.701).</p><p><strong>Conclusion: </strong>Utilizing FMEA to analyze the correlation between medical safety adverse events and patient safety culture is effective in identifying specific dimensions of these events related to safety culture. This enables the development of targeted interventions to mitigate adverse events and enhance patient safety.</p>","PeriodicalId":56009,"journal":{"name":"Risk Management and Healthcare Policy","volume":"18 ","pages":"1367-1376"},"PeriodicalIF":2.7,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12013626/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143993396","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating the Feasibility and Effectiveness of an Interdisciplinary Verbal De-Escalation and Implicit Bias Check Training for Agitation Management in the Emergency Department.","authors":"Jossie A Carreras Tartak, Giovanni Rodriguez, Madeline Schwid, Melissa A Meeker, Matthew D Thomas, Harold J Roy, Farah Z Dadabhoy, Melanie Molina, Anita Chary, Alice K Bukhman, Dana D Im, Elizabeth S Temin, Wendy L Macias-Konstantopoulos","doi":"10.2147/RMHP.S513026","DOIUrl":"https://doi.org/10.2147/RMHP.S513026","url":null,"abstract":"<p><strong>Purpose: </strong>Recent scholarship has revealed racial disparities in emergency department (ED) physical restraint use in agitation management. We implemented an interdisciplinary educational program that integrates discussions about the role of bias in physical restraint use with workplace violence (WPV) prevention strategies to increase awareness of implicit bias and comfort with verbal de-escalation among ED staff.</p><p><strong>Patients and methods: </strong>In partnership with hospital security at a large urban academic medical center, we developed a 1-hour online WPV prerequisite course followed by a 2-hour multi-modal, in-person training consisting of 40 minutes each of didactics, an interactive defensive skills workshop, and case-based simulations with structured debriefings. From September 2022 to June 2023, all patient-facing ED staff were invited to participate and received a $100 gift card for program completion. Participants rated their confidence and comfort in various aspects of agitation management on a 5-point Likert scale before and immediately after via pre- and post-training surveys. Wilcoxon matched-pairs tests were employed for analysis.</p><p><strong>Results: </strong>Of 91 participants, 72 (79%) completed the pre- and post-training surveys. Representing a wide range of ED role groups, 74% of participants were clinical staff and a majority had 0-5 years of experience (65%). Among all participants, there was a statistically significant improvement in confidence and comfort with the various aspects of agitation management across all 11 questions (p<0.001). A similar change was observed among the clinical staff (p<0.001), however, the degree of improvement observed among those with greater than 5 years of experience was less dramatic than among clinical staff with 0-5 years of experience.</p><p><strong>Conclusion: </strong>Interdisciplinary multi-modal training can improve confidence and comfort with verbal de-escalation and implicit bias checks in team-based agitation management. Additional research is needed to understand if such integrated training can also reduce physical restraint use, racial disparities in restraint use, and WPV events.</p>","PeriodicalId":56009,"journal":{"name":"Risk Management and Healthcare Policy","volume":"18 ","pages":"1355-1366"},"PeriodicalIF":2.7,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12012381/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144049753","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}