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Speaking up about traditional and professionalism-related patient safety threats: a national survey of interns and residents.
Martinez W, Lehmann LS, Thomas EJ, Etchegaray JM, Shelburne JT, Hickson GB, Brady DW, Schleyer AM, Best JA, May NB, Bell SK
(2017) BMJ Qual Saf 26: 869-880
MeSH Terms: Academic Medical Centers, Attitude of Health Personnel, Communication, Courage, Cross-Sectional Studies, Female, Humans, Internship and Residency, Male, Patient Safety, Professional Misconduct, Professionalism, Safety Management, United States
Show Abstract · Added May 26, 2017
BACKGROUND - Open communication between healthcare professionals about care concerns, also known as 'speaking up', is essential to patient safety.
OBJECTIVE - Compare interns' and residents' experiences, attitudes and factors associated with speaking up about traditional versus professionalism-related safety threats.
DESIGN - Anonymous, cross-sectional survey.
SETTING - Six US academic medical centres, 2013-2014.
PARTICIPANTS - 1800 medical and surgical interns and residents (47% responded).
MEASUREMENTS - Attitudes about, barriers and facilitators for, and self-reported experience with speaking up. Likelihood of speaking up and the potential for patient harm in two vignettes. Safety Attitude Questionnaire (SAQ) teamwork and safety scales; and Speaking Up Climate for Patient Safety (SUC-Safe) and Speaking Up Climate for Professionalism (SUC-Prof) scales.
RESULTS - Respondents more commonly observed unprofessional behaviour (75%, 628/837) than traditional safety threats (49%, 410/837); p<0.001, but reported speaking up about unprofessional behaviour less commonly (46%, 287/628 vs 71%, 291/410; p<0.001). Respondents more commonly reported fear of conflict as a barrier to speaking up about unprofessional behaviour compared with traditional safety threats (58%, 482/837 vs 42%, 348/837; p<0.001). Respondents were also less likely to speak up to an attending physician in the professionalism vignette than the traditional safety vignette, even when they perceived high potential patient harm (20%, 49/251 vs 71%, 179/251; p<0.001). Positive perceptions of SAQ teamwork climate and SUC-Safe were independently associated with speaking up in the traditional safety vignette (OR 1.90, 99% CI 1.36 to 2.66 and 1.46, 1.02 to 2.09, respectively), while only a positive perception of SUC-Prof was associated with speaking up in the professionalism vignette (1.76, 1.23 to 2.50).
CONCLUSIONS - Interns and residents commonly observed unprofessional behaviour yet were less likely to speak up about it compared with traditional safety threats even when they perceived high potential patient harm. Measuring SUC-Safe, and particularly SUC-Prof, may fill an existing gap in safety culture assessment.
Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.
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14 MeSH Terms
A Prospective Case-Control Study Comparing LithoVue, a Single-Use, Flexible Disposable Ureteroscope, with Flexible, Reusable Fiber-Optic Ureteroscopes.
Usawachintachit M, Isaacson DS, Taguchi K, Tzou DT, Hsi RS, Sherer BA, Stoller ML, Chi T
(2017) J Endourol 31: 468-475
MeSH Terms: Adult, Aged, Case-Control Studies, Equipment Design, Female, Fiber Optic Technology, Humans, Kidney Calculi, Male, Middle Aged, Operative Time, Patient Safety, Prospective Studies, Treatment Outcome, Ureteroscopes, Ureteroscopy, Urinary Bladder Neoplasms, Urinary Calculi, Urothelium
Show Abstract · Added March 15, 2017
OBJECTIVE - LithoVue™ is a novel, single-use, digital flexible ureteroscope that was released to the US market in January 2016. There are scant data regarding its performance in humans. Procedural outcomes comparing LithoVue with reusable ureteroscopes are presented in patients undergoing ureteroscopy for upper urinary tract pathology.
PATIENTS AND METHODS - Clinical outcomes between two groups of patients undergoing flexible ureteroscopy for upper urinary tract pathology were analyzed. The first group underwent surgery utilizing LithoVue, and the second group used reusable fiber-optic flexible ureteroscopes. Differences in procedural outcomes, operative times, and time spent in hospital were analyzed using two-tailed t-tests and chi-squared and Fisher's exact tests.
RESULTS - One hundred fifteen cases utilizing LithoVue and 65 cases utilizing reusable ureteroscopes were included in this study. Demographics, surgical indications, stone size, location, total stone burden, composition, procedural outcomes, and complications were comparable between groups. For all cases, LithoVue procedures lasted 54.1 ± 25.7 minutes compared with 64.5 ± 37.0 minutes for reusable scope procedures (p < 0.05) and for stone removal cases, 57.3 ± 25.1 vs 70.3 ± 36.9 minutes, respectively (p < 0.05). Scope failure occurred in 4.4% of LithoVue cases and 7.7% of reusable cases (p = 0.27).
CONCLUSIONS - LithoVue represents a feasible alternative to reusable ureteroscopes with a low rate of scope failure comparable with reusable ureteroscopes. Its use shortens procedure duration, a finding that warrants further investigation.
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19 MeSH Terms
Patients and families as teachers: a mixed methods assessment of a collaborative learning model for medical error disclosure and prevention.
Langer T, Martinez W, Browning DM, Varrin P, Sarnoff Lee B, Bell SK
(2016) BMJ Qual Saf 25: 615-25
MeSH Terms: Adult, Education, Family, Female, Humans, Interdisciplinary Placement, Male, Medical Errors, Middle Aged, Models, Educational, Patient Safety, Patients, Truth Disclosure
Show Abstract · Added May 26, 2017
BACKGROUND - Despite growing interest in engaging patients and families (P/F) in patient safety education, little is known about how P/F can best contribute. We assessed the feasibility and acceptability of a patient-teacher medical error disclosure and prevention training model.
METHODS - We developed an educational intervention bringing together interprofessional clinicians with P/F from hospital advisory councils to discuss error disclosure and prevention. Patient focus groups and orientation sessions informed curriculum and assessment design. A pre-post survey with qualitative and quantitative questions was used to assess P/F and clinician experiences and attitudes about collaborative safety education including participant hopes, fears, perceived value of learning experience and challenges. Responses to open-ended questions were coded according to principles of content analysis.
RESULTS - P/F and clinicians hoped to learn about each other's perspectives, communication skills and patient empowerment strategies. Before the intervention, both groups worried about power dynamics dampening effective interaction. Clinicians worried that P/F would learn about their fallibility, while P/F were concerned about clinicians' jargon and defensive posturing. Following workshops, clinicians valued patients' direct feedback, communication strategies for error disclosure and a 'real' learning experience. P/F appreciated clinicians' accountability, and insights into how medical errors affect clinicians. Half of participants found nothing challenging, the remainder clinicians cited emotions and enormity of 'culture change', while P/F commented on medical jargon and desire for more time. Patients and clinicians found the experience valuable. Recommendations about how to develop a patient-teacher programme in patient safety are provided.
CONCLUSIONS - An educational paradigm that includes patients as teachers and collaborative learners with clinicians in patient safety is feasible, valued by clinicians and P/F and promising for P/F-centred medical error disclosure and prevention training.
Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/
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13 MeSH Terms
Using Coworker Observations to Promote Accountability for Disrespectful and Unsafe Behaviors by Physicians and Advanced Practice Professionals.
Webb LE, Dmochowski RR, Moore IN, Pichert JW, Catron TF, Troyer M, Martinez W, Cooper WO, Hickson GB
(2016) Jt Comm J Qual Patient Saf 42: 149-64
MeSH Terms: Clinical Competence, Communication, Documentation, Humans, Inservice Training, Leadership, Medical Staff, Patient Care Team, Patient Safety, Personnel, Hospital
Show Abstract · Added May 13, 2016
BACKGROUND - Health care team members are well positioned to observe disrespectful and unsafe conduct-behaviors known to undermine team function. Based on experience in sharing patient complaints with physicians who subsequently achieved decreased complaints and malpractice risk, Vanderbilt University Medical Center developed and assessed the feasibility of the Co-Worker Observation Reporting System(SM) (CORS (SM)) for addressing coworkers' reported concerns.
METHODS - VUMC leaders used a "Project Bundle" readiness assessment, which entailed identification and development of key people, organizational supports, and systems. Methods involved gaining leadership buy-in, recruiting and training key individuals, aligning the project with organizational values and policies, promoting reporting, monitoring reports, and employing a tiered intervention process to address reported coworker concerns.
RESULTS - Peer messengers shared coworker reports with the physicians and advanced practice professionals associated with at least one report 84% of the time. Since CORS inception, 3% of the medical staff was associated with a pattern of CORS reports, and 71% of recipients of pattern-related interventions were not named in any subsequent reports in a one-year follow-up period.
CONCLUSIONS - Systematic monitoring of documented co-worker observations about unprofessional conduct and sharing that information with involved professionals are feasible. Feasibility requires organizationwide implementation; co-workers willing and able to share respectful, nonjudgmental, timely feedback designed initially to encourage self-reflection; and leadership committed to be more directive if needed. Follow-up surveillance indicates that the majority of professionals "self-regulate" after receiving CORS data.
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10 MeSH Terms
'Speaking up' about patient safety concerns and unprofessional behaviour among residents: validation of two scales.
Martinez W, Etchegaray JM, Thomas EJ, Hickson GB, Lehmann LS, Schleyer AM, Best JA, Shelburne JT, May NB, Bell SK
(2015) BMJ Qual Saf 24: 671-80
MeSH Terms: Academic Medical Centers, Adult, Attitude of Health Personnel, Factor Analysis, Statistical, Female, Humans, Internship and Residency, Male, Organizational Culture, Patient Safety, Physicians, Professional Misconduct, Psychometrics, Reproducibility of Results, Surveys and Questionnaires, United States
Show Abstract · Added May 13, 2016
OBJECTIVE - To develop and test the psychometric properties of two new survey scales aiming to measure the extent to which the clinical environment supports speaking up about (a) patient safety concerns and (b) unprofessional behaviour.
METHOD - Residents from six large US academic medical centres completed an anonymous, electronic survey containing questions regarding safety culture and speaking up about safety and professionalism concerns.
RESULTS - Confirmatory factor analysis supported two separate, one-factor speaking up climates (SUCs) among residents; one focused on patient safety concerns (SUC-Safe scale) and the other focused on unprofessional behaviour (SUC-Prof scale). Both scales had good internal consistency (Cronbach's α>0.70) and were unique from validated safety and teamwork climate measures (r<0.85 for all correlations), a measure of discriminant validity. The SUC-Safe and SUC-Prof scales were associated with participants' self-reported speaking up behaviour about safety and professionalism concerns (r=0.21, p<0.001 and r=0.22, p<0.001, respectively), a measure of concurrent validity, while teamwork and safety climate scales were not.
CONCLUSIONS - We created and provided evidence for the reliability and validity of two measures (SUC-Safe and SUC-Prof scales) associated with self-reported speaking up behaviour among residents. These two scales may fill an existing gap in residency and safety culture assessments by measuring the openness of communication about safety and professionalism concerns, two important aspects of safety culture that are under-represented in existing metrics.
Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
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16 MeSH Terms
Applying bar code medication administration to make a difference in adverse drug events with potential for harm: lessons learned.
FitzHenry F, Wells N, Doran J, Hughart K, Levy M, Doulis J
(2013) Comput Inform Nurs 31: 457-62
MeSH Terms: Drug Therapy, Drug-Related Side Effects and Adverse Reactions, Electronic Data Processing, Humans, Medication Errors, Patient Safety
Added March 7, 2014
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6 MeSH Terms
Enhancing patient safety and quality of care by improving the usability of electronic health record systems: recommendations from AMIA.
Middleton B, Bloomrosen M, Dente MA, Hashmat B, Koppel R, Overhage JM, Payne TH, Rosenbloom ST, Weaver C, Zhang J, American Medical Informatics Association
(2013) J Am Med Inform Assoc 20: e2-8
MeSH Terms: Commerce, Health Policy, Humans, Medical Errors, Medical Informatics, Medical Records Systems, Computerized, Patient Safety, Societies, Medical, United States, User-Computer Interface
Show Abstract · Added December 10, 2013
In response to mounting evidence that use of electronic medical record systems may cause unintended consequences, and even patient harm, the AMIA Board of Directors convened a Task Force on Usability to examine evidence from the literature and make recommendations. This task force was composed of representatives from both academic settings and vendors of electronic health record (EHR) systems. After a careful review of the literature and of vendor experiences with EHR design and implementation, the task force developed 10 recommendations in four areas: (1) human factors health information technology (IT) research, (2) health IT policy, (3) industry recommendations, and (4) recommendations for the clinician end-user of EHR software. These AMIA recommendations are intended to stimulate informed debate, provide a plan to increase understanding of the impact of usability on the effective use of health IT, and lead to safer and higher quality care with the adoption of useful and usable EHR systems.
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10 MeSH Terms
Response to "Doubt about the feasibility of preemptive genotyping".
Denny JC, Schildcrout JS, Pulley JM, Roden DM
(2013) Clin Pharmacol Ther 93: 234
MeSH Terms: Drug-Related Side Effects and Adverse Reactions, Female, Humans, Male, Patient Safety, Pharmacogenetics
Added May 27, 2014
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6 MeSH Terms
Critical and honest conversations: the evidence behind the "Choosing Wisely" campaign recommendations by the American Society of Nephrology.
Williams AW, Dwyer AC, Eddy AA, Fink JC, Jaber BL, Linas SL, Michael B, O'Hare AM, Schaefer HM, Shaffer RN, Trachtman H, Weiner DE, Falk AR, American Society of Nephrology Quality, and Patient Safety Task Force
(2012) Clin J Am Soc Nephrol 7: 1664-72
MeSH Terms: Anti-Inflammatory Agents, Non-Steroidal, Catheterization, Central Venous, Cost Savings, Cost-Benefit Analysis, Evidence-Based Medicine, Guideline Adherence, Health Care Costs, Health Promotion, Health Services Misuse, Hematinics, Humans, Mass Screening, Nephrology, Patient Safety, Physician-Patient Relations, Practice Guidelines as Topic, Professional-Family Relations, Program Development, Quality Indicators, Health Care, Renal Dialysis, Renal Insufficiency, Chronic, Societies, Medical, United States
Show Abstract · Added February 25, 2014
Estimates suggest that one third of United States health care spending results from overuse or misuse of tests, procedures, and therapies. The American Board of Internal Medicine Foundation, in partnership with Consumer Reports, initiated the "Choosing Wisely" campaign to identify areas in patient care and resource use most open to improvement. Nine subspecialty organizations joined the campaign; each organization identified five tests, procedures, or therapies that are overused, are misused, or could potentially lead to harm or unnecessary health care spending. Each of the American Society of Nephrology's (ASN's) 10 advisory groups submitted recommendations for inclusion. The ASN Quality and Patient Safety Task Force selected five recommendations based on relevance and importance to individuals with kidney disease.Recommendations selected were: (1) Do not perform routine cancer screening for dialysis patients with limited life expectancies without signs or symptoms; (2) do not administer erythropoiesis-stimulating agents to CKD patients with hemoglobin levels ≥10 g/dl without symptoms of anemia; (3) avoid nonsteroidal anti-inflammatory drugs in individuals with hypertension, heart failure, or CKD of all causes, including diabetes; (4) do not place peripherally inserted central catheters in stage 3-5 CKD patients without consulting nephrology; (5) do not initiate chronic dialysis without ensuring a shared decision-making process between patients, their families, and their physicians.These five recommendations and supporting evidence give providers information to facilitate prudent care decisions and empower patients to actively participate in critical, honest conversations about their care, potentially reducing unnecessary health care spending and preventing harm.
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23 MeSH Terms
Targeting mutant p53 in human tumors.
Lehmann BD, Pietenpol JA
(2012) J Clin Oncol 30: 3648-50
MeSH Terms: Antineoplastic Agents, Disease-Free Survival, Female, Humans, Male, Molecular Targeted Therapy, Mutation, Neoplasms, Patient Safety, Quinuclidines, Risk Assessment, Sensitivity and Specificity, Signal Transduction, Survival Analysis, Treatment Outcome, Tumor Suppressor Protein p53
Added September 3, 2013
1 Communities
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16 MeSH Terms