International journal for quality in health care : journal of the International Society for Quality in Health Care
-
Int J Qual Health Care · Dec 2014
Multicenter StudyInfluence of adverse drug events on morbidity and mortality in intensive care units: the JADE study.
To identify the influence of adverse drug events (ADEs) on morbidity and mortality in intensive care units (ICUs). ⋯ ADEs were common in ICUs and significantly associated with longer length of ICU stay but did not influence on mortality.
-
Int J Qual Health Care · Dec 2014
Systematic biases in group decision-making: implications for patient safety.
Key decisions in modern health care systems are often made by groups of people rather than lone individuals. However, group decision-making can be imperfect and result in organizational and clinical errors which may harm patients-a fact highlighted graphically in recent (and historical) health scandals and inquiries such as the recent report by Sir Robert Francis into the serious failures in patient care and safety at Mid Staffordshire Hospitals NHS Trust in the English NHS. In this article, we draw on theories from organization studies and decision science to explore the ways in which patient safety may be undermined or threatened in health care contexts as a result of four systematic biases arising from group decision-making: 'groupthink', 'social loafing', 'group polarization' and 'escalation of commitment'. For each group bias, we describe its antecedents, illustrate how it can impair group decisions with regard to patient safety, outline a range of possible remedial organizational strategies that can be used to attenuate the potential for adverse consequences and look forward at the emerging research agenda in this important but hitherto neglected area of patient safety research.
-
Int J Qual Health Care · Aug 2014
Failure mode and effects analysis applied to the maintenance and repair of anesthetic equipment in an austere medical environment.
Medical technology designed for Western settings frequently does not function adequately or as intended when placed in an austere clinical environment because of issues such as the instability of the electrical grid, environmental conditions, access to replacement parts, level of provider training and general absence of biomedical engineering support. The purpose of this study was to demonstrate the feasibility of applying failure mode and effects analysis as part of an implementation strategy for medical devices in austere medical settings. ⋯ This study demonstrates the feasibility of using the failure mode and effects analysis approach to improve implementation of technology in austere medical environments.
-
Int J Qual Health Care · Aug 2014
Randomized Controlled TrialFeasibility and evaluation of a pilot community health worker intervention to reduce hospital readmissions.
To pilot-test the feasibility and preliminary effect of a community health worker (CHW) intervention to reduce hospital readmissions. ⋯ Under performance-based payment systems, identifying cost-effective solutions for reducing hospital readmissions will be crucial to the economic survival of all hospitals, especially safety-net systems. This pilot study suggests that with appropriate supportive infrastructure, hospital-based CHWs may represent a feasible strategy for improving transitional care among vulnerable populations. An ongoing, randomized, controlled trial of a CHW intervention, developed according to the lessons of this pilot, will provide further insight into the utility of this approach to reducing readmissions.
-
Int J Qual Health Care · Aug 2014
Patient care transitions from the emergency department to the medicine ward: evaluation of a standardized electronic signout tool.
To evaluate the impact of a new electronic handoff tool for emergency department to medicine ward patient transfers over a 1-year period. ⋯ The eSignout was perceived as more efficient and preferred over the mandatory verbal signout process. Rates of reported adverse events were similar before and after the intervention. Our experience suggests electronic platforms with optional verbal communication can be used to standardize and improve the perceived efficiency of patient handoffs.