Can Patient Safety Incident Reports Be Used to Compare Hospital Safety? Results from a Quantitative Analysis of the English National Reporting and Learning System Data.

BACKGROUND: The National Reporting and Learning System (NRLS) collects reports about patient safety incidents in England. Government regulators use NRLS data to assess the safety of hospitals. This study aims to examine whether annual hospital incident reporting rates can be used as a surrogate indicator of individual hospital safety. Secondly assesses which hospital characteristics are correlated with high incident reporting rates and whether a high reporting hospital is safer than those lower reporting hospitals. Finally, it assesses which health-care professionals report more incidents of patient harm, which report more near miss incidents and what hospital factors encourage reporting. These findings may suggest methods for increasing the utility of reporting systems. METHODS: This study used a mix methods approach for assessing NRLS data. The data were investigated using Pareto analysis and regression models to establish which patients are most vulnerable to reported harm. Hospital factors were correlated with institutional reporting rates over one year to examine what factors influenced reporting. Staff survey findings regarding hospital safety culture were correlated with reported rates of incidents causing harm; no harm and death to understand what barriers influence error disclosure. FINDINGS: 5,879,954 incident reports were collected from acute hospitals over the decade. 70.3% of incidents produced no harm to the patient and 0.9% were judged by the reporter to have caused severe harm or death. Obstetrics and Gynaecology reported the most no harm events [OR 1.61(95%CI: 1.12 to 2.27), p<0.01] and pharmacy was the hospital location where most near-misses were captured [OR 3.03(95%CI: 2.04 to 4.55), p<0.01]. Clinicians were significantly more likely to report death than other staff [OR 3.04(95%CI: 2.43 to 3.80) p<0.01]. A higher ratio of clinicians to beds correlated with reduced rate of harm reported [RR = -1.78(95%Cl: -3.33 to -0.23), p = 0.03]. Litigation claims per bed were significantly negatively associated with incident reports. Patient satisfaction and mortality outcomes were not significantly associated with reporting rates. Staff survey responses revealed that keeping reports confidential, keeping staff informed about incidents and giving feedback on safety initiatives increased reporting rates [r = 0.26 (p<0.01), r = 0.17 (p = 0.04), r = 0.23 (p = 0.01), r = 0.20 (p = 0.02)]. CONCLUSION: The NRLS is the largest patient safety reporting system in the world. This study did not demonstrate many hospital characteristics to significantly influence overall reporting rate. There were no association between size of hospital, number of staff, mortality outcomes or patient satisfaction outcomes and incident reporting rate. The study did show that hospitals where staff reported more incidents had reduced litigation claims and when clinician staffing is increased fewer incidents reporting patient harm are reported, whilst near misses remain the same. Certain specialties report more near misses than others, and doctors report more harm incidents than near misses. Staff survey results showed that open environments and reduced fear of punitive response increases incident reporting. We suggest that reporting rates should not be used to assess hospital safety. Different healthcare professionals focus on different types of safety incidents and focusing on these areas whilst creating a responsive, confidential learning environment will increase staff engagement with error disclosure

Adverse events in veterans affairs inpatient psychiatric units: Staff perspectives on contributing and protective factors.

OBJECTIVES: This study sought to identify risk factors and protective factors in hospital-based mental health settings in the Veterans Health Administration (VHA), with the goal of informing interventions to improve care of persons with serious mental illness. METHODS: Twenty key informants from a stratified sample of 7 VHA inpatient psychiatric units were interviewed to gain their insights on causes of patient safety events and the factors that constrain or facilitate patient safety efforts. RESULTS: Respondents identified threats to patient safety at the system-, provider-, and patient-levels. Protective factors that, when in place, made patient safety events less likely to occur included: promoting a culture of safety; advocating for patient-centeredness; and engaging administrators and organizational leadership to champion these changes. CONCLUSIONS: Findings highlight the impact of systems-level policies and procedures on safety in inpatient mental health care. Engaging all stakeholders, including patients, in patient safety efforts and establishing a culture of safety will help improve the quality of inpatient psychiatric care. Successful implementation of changes require the knowledge of local experts most closely involved in patient care, as well as support and buy-in from organizational leadership

Complex Care Management Program Overview

This report includes brief updates on various forms of complex care management including: Aetna - Medicare Advantage Embedded Case Management ProgramBrigham and Women's Hospital - Care Management ProgramIndependent Health - Care PartnersIntermountain Healthcare and Oregon Health and Science University - Care Management PlusJohns Hopkins University - Hospital at HomeMount Sinai Medical Center -- New York - Mount Sinai Visiting Doctors Program/ Chelsea-Village House Calls ProgramsPartners in Care Foundation - HomeMeds ProgramPrinceton HealthCare System - Partnerships for PIECEQuality Improvement for Complex Chronic Conditions - CarePartner ProgramSenior Services - Project Enhance/EnhanceWellnessSenior Whole Health - Complex Care Management ProgramSumma Health/Ohio Department of Aging - PASSPORT Medicaid Waiver ProgramSutter Health - Sutter Care Coordination ProgramUniversity of Washington School of Medicine - TEAMcar

CareOregon: Transforming the Role of a Medicaid Health Plan From Payer to Partner

Details Triple Aim pilot programs designed to offer patient-centered medical homes and multidisciplinary case management in an effort to improve population health, enhance patients' experience, and slow cost growth

Tracking Foodborne Pathogens from Farm to Table: Data Needs to Evaluate Control Options

Food safety policymakers and scientists came together at a conference in January 1995 to evaluate data available for analyzing control of foodborne microbial pathogens. This proceedings starts with data regarding human illnesses associated with foodborne pathogens and moves backwards in the food chain to examine pathogen data in the processing sector and at the farm level. Of special concern is the inability to link pathogen data throughout the food chain. Analytical tools to evaluate the impact of changing production and consumption practices on foodborne disease risks and their economic consequences are presented. The available data are examined to see how well they meet current analytical needs to support policy analysis. The policymaker roundtable highlights the tradeoffs involved in funding databases, the economic evaluation of USDA's Hazard Analysis Critical Control Point (HACCP) proposal and other food safety policy issues, and the necessity of a multidisciplinary approach toward improving food safety databases.food safety, cost benefit analysis, foodborne disease risk, foodborne pathogens, Hazard Analysis Critical Control Point (HACCP), probabilistic scenario analysis, fault-tree analysis, Food Consumption/Nutrition/Food Safety,

TeamSTEPPS Training and Vital Signs Chart to Improve Situational Monitoring for Clinical Deterioration

Failure to monitor early warning signs of patient deterioration can result in cardiopulmonary arrests and patient death. Implementation of team building programs emphasizing vital sign data, with consistent monitoring and trending have demonstrated positive outcomes in multiple health care environments. This project implemented TeamSTEPPS© education for 23 registered nurse (RN) residents in an acute care medical center. Specific aims included: (a) increased knowledge of team communication techniques; (b) improved attitudes towards vital sign monitoring, especially respiratory rate assessment; and (c) improved attitudes towards early rapid response system activation. The education program included support tools, behavioral-modeling, simulation exercises based on de-identified patient data and debriefing. Paired t-tests evaluated the impact of the intervention on total TeamSTEPPS Teamwork Attitudes Questionnaire (T-TAQ) and V-Scale scores. There were statistically significant increases in T-TAQ and V-Scale scores post intervention (1.78 p =.04 and 1.87 p = .04 respectively). Eta square calculation indicated a large effect size for T-TAQ and V-Scale measures. The TeamSTEPPS simulation-enhanced curriculum was successful in improving RN residents’ attitudes toward teamwork, and vital signs monitoring and surveillance practices

Rehabilitation Therapy in Older Acute Heart Failure Patients (REHAB-HF) trial: Design and rationale.

BACKGROUND: Acute decompensated heart failure (ADHF) is a leading cause of hospitalization in older persons in the United States. Reduced physical function and frailty are major determinants of adverse outcomes in older patients with hospitalized ADHF. However, these are not addressed by current heart failure (HF) management strategies and there has been little study of exercise training in older, frail HF patients with recent ADHF. HYPOTHESIS: Targeting physical frailty with a multi-domain structured physical rehabilitation intervention will improve physical function and reduce adverse outcomes among older patients experiencing a HF hospitalization. STUDY DESIGN: REHAB-HF is a multi-center clinical trial in which 360 patients ≥60 years hospitalized with ADHF will be randomized either to a novel 12-week multi-domain physical rehabilitation intervention or to attention control. The goal of the intervention is to improve balance, mobility, strength and endurance utilizing reproducible, targeted exercises administered by a multi-disciplinary team with specific milestones for progression. The primary study aim is to assess the efficacy of the REHAB-HF intervention on physical function measured by total Short Physical Performance Battery score. The secondary outcome is 6-month all-cause rehospitalization. Additional outcome measures include quality of life and costs. CONCLUSIONS: REHAB-HF is the first randomized trial of a physical function intervention in older patients with hospitalized ADHF designed to determine if addressing deficits in balance, mobility, strength and endurance improves physical function and reduces rehospitalizations. It will address key evidence gaps concerning the role of physical rehabilitation in the care of older patients, those with ADHF, frailty, and multiple comorbidities

Physiology-Aware Rural Ambulance Routing

In emergency patient transport from rural medical facility to center tertiary hospital, real-time monitoring of the patient in the ambulance by a physician expert at the tertiary center is crucial. While telemetry healthcare services using mobile networks may enable remote real-time monitoring of transported patients, physiologic measures and tracking are at least as important and requires the existence of high-fidelity communication coverage. However, the wireless networks along the roads especially in rural areas can range from 4G to low-speed 2G, some parts with communication breakage. From a patient care perspective, transport during critical illness can make route selection patient state dependent. Prompt decisions with the relative advantage of a longer more secure bandwidth route versus a shorter, more rapid transport route but with less secure bandwidth must be made. The trade-off between route selection and the quality of wireless communication is an important optimization problem which unfortunately has remained unaddressed by prior work. In this paper, we propose a novel physiology-aware route scheduling approach for emergency ambulance transport of rural patients with acute, high risk diseases in need of continuous remote monitoring. We mathematically model the problem into an NP-hard graph theory problem, and approximate a solution based on a trade-off between communication coverage and shortest path. We profile communication along two major routes in a large rural hospital settings in Illinois, and use the traces to manifest the concept. Further, we design our algorithms and run preliminary experiments for scalability analysis. We believe that our scheduling techniques can become a compelling aid that enables an always-connected remote monitoring system in emergency patient transfer scenarios aimed to prevent morbidity and mortality with early diagnosis treatment.Comment: 6 pages, The Fifth IEEE International Conference on Healthcare Informatics (ICHI 2017), Park City, Utah, 201

Patient-Centered Appointment Scheduling Using Agent-Based Simulation

Enhanced access and continuity are key components of patient-centered care. Existing studies show that several interventions such as providing same day appointments, walk-in services, after-hours care, and group appointments, have been used to redesign the healthcare systems for improved access to primary care. However, an intervention focusing on a single component of care delivery (i.e. improving access to acute care) might have a negative impact other components of the system (i.e. reduced continuity of care for chronic patients). Therefore, primary care clinics should consider implementing multiple interventions tailored for their patient population needs. We collected rapid ethnography and observations to better understand clinic workflow and key constraints. We then developed an agent-based simulation model that includes all access modalities (appointments, walk-ins, and after-hours access), incorporate resources and key constraints and determine the best appointment scheduling method that improves access and continuity of care. This paper demonstrates the value of simulation models to test a variety of alternative strategies to improve access to care through scheduling