Qual Saf Health Care
-
Qual Saf Health Care · Feb 2008
Randomized Controlled Trial Comparative StudyPatient-actor perception of care: a comparison of obstetric emergency training using manikins and patient-actors.
To explore the effect of training on patient-actor perception of care during simulated obstetric emergencies. ⋯ All multiprofessional training improved patient-actor perception of care. Training using a patient-actor may be better at improving perception of safety and communication than training with a computerised manikin simulator.
-
Qual Saf Health Care · Feb 2008
Effective interventions and implementation strategies to reduce adverse drug events in the Veterans Affairs (VA) system.
Adverse drug events (ADEs) account for considerable patient morbidity and mortality as well as legal, operational and patient care costs. In Veterans Affairs (VA) hospitals in the USA, all serious adverse events and "potential" adverse events are reviewed using root cause analysis (RCA). This study characterised RCA reports associated with ADEs to determine what actions VA RCA teams took to reduce the number or severity of ADEs, and to evaluate which actions were effective in doing so. ⋯ Changes at the bedside and improvement in equipment and computers are effective at reducing ADEs. Well-organised tracking and support from leadership and staff were characteristics of facilities successful at improving outcomes. Training without action was associated with worse outcomes.
-
Qual Saf Health Care · Feb 2008
Comparative StudyComparing measures of patient safety for inpatient care provided to veterans within and outside the VA system in New York.
Previous studies have compared measures of patient safety for veterans using the VA system to the general population. Discrepancies in the results of those studies suggest that the choice of an appropriate comparison group is critical for accurate interpretation of results and for determining whether to take actions to address findings. We explored another method of providing consumer information by comparing the experiences of VA enrolled patients who received care in the VA to those who received care outside the VA system. ⋯ Using AHRQ's PSI software, male veterans in New York who obtain their inpatient care within the VA received care that was comparable with or somewhat better than those who obtained their inpatient care outside the VA. The experiences of older patients reflected those of younger patients. Given that our findings are much more similar to reported comparisons between the VA and Medicare than to comparisons between the VA and the general population, we conclude that, should system comparisons be made, choice of comparison groups will be critical to accurate interpretation of findings; however, prior to such interpretation, the validity of the PSIs must be determined within VA.
-
Qual Saf Health Care · Feb 2008
Intensive care unit nurses' perceptions of safety after a highly specific safety intervention.
It is unknown if successful changes in specific safety practices in the intensive care unit (ICU) generalize to broader concepts of patient safety by staff nurses. ⋯ ICU nurses who participated in a project to decrease hospital acquired infections did not generalize their experience to other aspects of patient safety or relate it to management's interest in patient safety. These findings are consistent with many adult learning theories, where self-initiated tasks, combined with immediate, but temporary problem-solving, are stronger learning forces than management-led activities with delayed feedback.
-
Qual Saf Health Care · Feb 2008
Adequacy of information transferred at resident sign-out (in-hospital handover of care): a prospective survey.
During sign-out (handover of care), information and responsibility about patients is transferred from one set of caregivers to another. Few residency training programmes formally teach resident physicians how to sign out or assess their ability to sign out, and little research has examined the sign-out process. ⋯ Although sign-out between resident physicians is a frequent activity, there are many times when important information is not transmitted. Analysis of these "missed opportunities" can be used to help develop an educational programme for resident physicians on how to sign out more effectively.