Committed to Safety: Ten Case Studies on Reducing Harm to Patients

Presents case studies of healthcare organizations, clinical teams, and learning collaborations to illustrate successful innovations for improving patient safety nationwide. Includes actions taken, results achieved, lessons learned, and recommendations

Evaluation of the Scrub Practitioners' List of Intraoperative Non-Technical Skills (SPLINTS) system

Peer reviewedPostprin

Keeping the Commitment: A Progress Report on Four Early Leaders in Patient Safety Improvement

Examines four healthcare systems' expansion of patient safety interventions over five years through the development of practical training methods, effective tools for minimizing errors, an emphasis on goal setting and accountability, and other approaches

Precise Proximal Femur Fracture Classification for Interactive Training and Surgical Planning

We demonstrate the feasibility of a fully automatic computer-aided diagnosis (CAD) tool, based on deep learning, that localizes and classifies proximal femur fractures on X-ray images according to the AO classification. The proposed framework aims to improve patient treatment planning and provide support for the training of trauma surgeon residents. A database of 1347 clinical radiographic studies was collected. Radiologists and trauma surgeons annotated all fractures with bounding boxes, and provided a classification according to the AO standard. The proposed CAD tool for the classification of radiographs into types "A", "B" and "not-fractured", reaches a F1-score of 87% and AUC of 0.95, when classifying fractures versus not-fractured cases it improves up to 94% and 0.98. Prior localization of the fracture results in an improvement with respect to full image classification. 100% of the predicted centers of the region of interest are contained in the manually provided bounding boxes. The system retrieves on average 9 relevant images (from the same class) out of 10 cases. Our CAD scheme localizes, detects and further classifies proximal femur fractures achieving results comparable to expert-level and state-of-the-art performance. Our auxiliary localization model was highly accurate predicting the region of interest in the radiograph. We further investigated several strategies of verification for its adoption into the daily clinical routine. A sensitivity analysis of the size of the ROI and image retrieval as a clinical use case were presented.Comment: Accepted at IPCAI 2020 and IJCAR

An investigation of biases in Patient Safety Indicator score distribution among hospital cohorts

Denman Research Forum- 2nd Place, Health Professions-ClinicalThe Centers for Medicare and Medicaid Services (CMS) have implemented a hospital reimbursement system that incentivizes payment proportional to the quality of care delivered and performance on certain metrics. One such metric is the Agency for Healthcare Research and Quality’s Patient Safety Indicator 90 (PSI-90). It is composed of eight individual indicators designed to flag adverse patient events that are potentially preventable, such as post-operative wound dehiscence and accidental lacerations. CMS publicly reports four of these individual PSI scores (6, 12, 14 and 15) in addition to the composite PSI-90. Previous studies question the PSIs’ validity beyond screening purposes and furthermore question the underlying administrative data’s ability to accurately and reliably flag such events. This study looks to analyze biases in PSI score distribution for hospitals depending on teaching status, differences in patient demographics and lastly, interactions between teaching status and patient demographic factors and their ability to account for differences in PSI rates. Significant differences were found between teaching and non-teaching hospitals for PSIs 6, 12, 15 and 90 (p<0.01). Inpatient volume and patient severity (p<0.01) were found to be significantly different between teaching status cohorts. Lastly, significant differences in PSI scores were found between patient severity quartiles for PSI 6, 15 and 90 (p<0.05) and between socio-economic quartiles for PSI 6, 12, 15 and 90 (p<0.05); but interaction between patient severity and teaching status was only significant for PSI 90 (p<0.05) and between socioeconomic and teaching statuses for PSI 6 (p<0.05). These results indicate current PSI score distributions may be biased against teaching hospitals for 4 out of 5 PSI measures. Further studies will involve assessing the adequacy of risk-adjustment methodology for PSI metrics. Until then, use of PSI metrics to determine federal reimbursement can lead to bias against teaching hospitals.A three-year embargo was granted for this item.Academic Major: Health Information Management and System

Teams and cardiac surgery

Motivation\ud Our study is designed to identify human factors that are a threat to the safety of children with heart disease.\ud \ud Research approach\ud After an initial observation period, we will apply a major safety intervention. We will then re-measure the occurrence and types of human factors in the operating room, and the incidence of adverse events, near misses and hospital death, to evaluate if there was a significant post-intervention reduction. \ud \ud Findings/design\ud We focus on challenges encountered during the training of the observers. Research Limitations\ud Because of the complexity of the OR, observations are necessarily subjective. \ud \ud Originality/Value\ud This work is original because of the systematic evaluation of a safety intevention and the training protocol for the observers.\ud \ud Take Away Message\ud Systematic and periodic assessment of observers is required when teamwork is observed in complex, dynamic settings

The Basic Surgical Skills course in sub-Saharan Africa: an observational study of effectiveness

Background: The Basic Surgical Skills (BSS) course is a common component of postgraduate surgical training programmes in sub-Saharan Africa, but was originally designed in a UK context, and its efficacy and relevance have not been formally assessed in Africa. Methods: An observational study was carried out during a BSS course delivered to early-stage surgical trainees from Rwanda and the Democratic Republic of the Congo. Technical skill in a basic wound closure task was assessed in a formal Objective Structured Assessment of Technical Skills (OSAT) before and after course completion. Participants completed a pre-course questionnaire documenting existing surgical experience and self-perceived confidence levels in surgical skills which were to be taught during the course. Participants repeated confidence ratings and completed course evaluation following course delivery. Results: A cohort of 17 participants had completed a pre-course median of 150 Caesarean sections as primary operator. Performance on the OSAT improved from a mean of 10.5/17 pre-course to 14.2/17 post-course (mean of paired differences 3.7, p &lt; 0.001). Improvements were seen in 15/17 components of wound closure. Pre-course, only 47% of candidates were forming hand-tied knots correctly and 38% were appropriately crossing hands with each throw, improving to 88 and 76%, respectively, following the course (p = 0.01 for both components). Confidence levels improved significantly in all technical skills taught, and the course was assessed as highly relevant by trainees. Conclusion: The Basic Surgical Skills course is effective in improving the basic surgical technique of surgical trainees from sub-Saharan Africa and their confidence in key technical skills

Geisinger Health System: Achieving the Potential of System Integration Through Innovation, Leadership, Measurement, and Incentives

Presents a case study of a physician-led nonprofit healthcare group exhibiting the attributes of an ideal healthcare delivery system as defined by the Fund. Describes how its ProvenCare model improved clinical outcomes with reduced resource utilization