The Handoff Culture: Can we change how an ICU to floor transfer works?

Handoffs between providers have increased following the implementation of the 2011 Accreditation Council for Graduate Medical Education (ACGME) work hour restrictions. Properly structured and timed handoffs are essential to patient safety.1 Despite this, studies have shown that errors in code status, medication allergies, and important updates to the problem list are common, all of which can lead to adverse outcomes to patients.2 At Thomas Jefferson University Hospital (TJUH) the 2016 Safety Culture Survey revealed that across all specialties, 37% of residents felt that things “fall through the cracks” when transferring patients from one unit to another. Our interdepartmental Housestaff Quality and Safety Leadership Council (HQSLC) sought to evaluate and modify the TJUH ICU to floor handoff process. Through engaging our diverse membership, we realized that the ICU to floor handoff process at TJUH lacks standardization. The following areas demonstrated a high degree of variation, and were seen as targets for improvement: ● Timing of handoff: Some departments give the handoff at the time of transfer order, and others at bed assignment. ● Incorporation of best practices: Both verbal and written handoffs should be performed with time for follow up questions by the receiving team ● Closed loop communication: Both sending and receiving teams should clearly communicate the plan of care, and the receiving team should clearly indicate when they have taken over primary responsibility. Poster presented at: House Staff Quality and Safety Leadership Council conference at Thomas Jefferson University.https://jdc.jefferson.edu/patientsafetyposters/1073/thumbnail.jp

The 2014 American State Litter Scorecard FINAL: USA's Dirtiest & Cleanest States Includes Statistics and Charts

A NEW State Litter "Scorecard" is released for the 2014 American Society for Public Administration (ASPA) Conference. Every three years, the Scorecard approximates each state's overall public spaces environmental quality through tried-and-true, hard-to-publicly obtain objective and subjective measures, resulting in a total overall jurisdictional score. Readers gain a realistic "picture" of "what's going on" within one or all of the 50 states. Illegal littering and dumping, found frequently on or near transportation paths, creates danger to public safety and health, with 800+ Americans dying each year by vehicle collisions with unmoved roadway debris. Because policy makers, public administrators and citizens are ever more involved in effectuating "green" outcomes, satisfactory public spaces waste removals are vital. Since 2008, major publications (the Boston Globe; TRAVEL+LEISURE; National Cooperative Highway Research Program's "Reducing Litter on Roadsides" Journal) have referred to the Scorecard, an ever valuable, trusted standard for improving debris/litter abatement in states and localities

The 2014 American State Litter Scorecard FINAL: USA's Dirtiest & Cleanest States Includes Statistics and Charts

A NEW State Litter "Scorecard" is released for the 2014 American Society for Public Administration (ASPA) Conference. Every three years, the Scorecard approximates each state's overall public spaces environmental quality through tried-and-true, hard-to-publicly obtain objective and subjective measures, resulting in a total overall jurisdictional score. Readers gain a realistic "picture" of "what's going on" within one or all of the 50 states. Illegal littering and dumping, found frequently on or near transportation paths, creates danger to public safety and health, with 800+ Americans dying each year by vehicle collisions with unmoved roadway debris. Because policy makers, public administrators and citizens are ever more involved in effectuating "green" outcomes, satisfactory public spaces waste removals are vital. Since 2008, major publications (the Boston Globe; TRAVEL+LEISURE; National Cooperative Highway Research Program's "Reducing Litter on Roadsides" Journal) have referred to the Scorecard, an ever valuable, trusted standard for improving debris/litter abatement in states and localities

Tackling Ageing Continence through Theory, Tools & Technology

Originally presented at ‘Aging and Society: An Interdisciplinary Conference’, University of California, Berkeley (2011), this article was double-blind peer reviewed, receiving scores of 96% and 73%. It outlines the interdisciplinary research of the cross-Research-Council-funded New Dynamics of Ageing Tackling Ageing Continence through Theory Tools & Technology (TACT3) project (2008–12), which brought together designers, social scientists, bio-engineers, chemists and care-management services to understand the challenges faced by an ageing population in the management of continence. Bichard’s Work Package, ‘Challenging Environmental Barriers to Continence’, explored the need for public toilet provision as essential for quality of life, health and well-being. It developed a life-course methodology that considered ageing from birth through to advanced age (0–101 years), and involved inclusive design research with members of the public and providers of facilities to assess public expectations and provider limitations in service provision. As co-investigator on TACT3, this research built on Bichard’s previous work for the VivaCity2020 consortium (Bichard REF Output 2). Whereas the VivaCity2020 work focused on architectural barriers in toilet provision, the TACT3 project examined the problem in service provision, and how, through inclusive design research, service-design solutions might be explored and implemented. Bichard’s contribution to the TACT3 project produced The Great British Public Toilet Map (http://greatbritishpublictoiletmap.rca.ac.uk/), a public participation website that provides information and locations of public toilets, encouraging members of the public to contact relevant local authorities that have not released information in the format of Open Data. Secondary analysis of TACT3 data for references to issues of personal safety and community initiative in toilet provision was used for the ESRC-funded Robust Accessible Toilets (RATs) project (2011) and produced Publicly Accessible Toilets: An Inclusive Design Guide (2011). Related published conference papers include those in ‘Cumulus 2010’ (China) and ‘Include 2011’ (UK)

The Swiss cheese model of safety incidents: are there holes in the metaphor?

BACKGROUND: Reason's Swiss cheese model has become the dominant paradigm for analysing medical errors and patient safety incidents. The aim of this study was to determine if the components of the model are understood in the same way by quality and safety professionals. METHODS: Survey of a volunteer sample of persons who claimed familiarity with the model, recruited at a conference on quality in health care, and on the internet through quality-related websites. The questionnaire proposed several interpretations of components of the Swiss cheese model: a) slice of cheese, b) hole, c) arrow, d) active error, e) how to make the system safer. Eleven interpretations were compatible with this author's interpretation of the model, 12 were not. RESULTS: Eighty five respondents stated that they were very or quite familiar with the model. They gave on average 15.3 (SD 2.3, range 10 to 21) "correct" answers out of 23 (66.5%) – significantly more than 11.5 "correct" answers that would expected by chance (p < 0.001). Respondents gave on average 2.4 "correct" answers regarding the slice of cheese (out of 4), 2.7 "correct" answers about holes (out of 5), 2.8 "correct" answers about the arrow (out of 4), 3.3 "correct" answers about the active error (out of 5), and 4.1 "correct" answers about improving safety (out of 5). CONCLUSION: The interpretations of specific features of the Swiss cheese model varied considerably among quality and safety professionals. Reaching consensus about concepts of patient safety requires further work

Proposal of a clinical care pathway for quality and safe management of headache patients: a consensus study report

Background Headache is one of the most prevalent and disabling conditions. Its optimal management requires a coordinated and comprehensive response by health systems, but there is still a wide variability that compromises the quality and safety of the care process. Purpose To establish the basis for designing a care pathway for headache patients through identifying key subpathways in the care process and setting out quality and clinical safety standards that contribute to providing comprehensive, adequate and safe healthcare. Method A qualitative research study based on the consensus conference technique. Eleven professionals from the Spanish National Health System participated, seven of them with clinical experience in headache and four specialists in healthcare management and quality. First, identification of the key subpathways in the care process for headache, barriers/limitations for optimal quality of care, and quality and safety standards applied in each subpathway. Second, two consecutive consensus rounds were carried out to assess the content of the subpathway level descriptors, until the expert agreement was reached. Third, findings were assessed by 17 external healthcare professionals to determine their understanding, adequacy and usefulness. Results Seven key subpathways were identified: (1) primary care, (2) emergency department, (3) neurology department, (4) specialised headache unit, (5) hospitalisation, (6) outpatients and (7) governance and management. Sixty-seventh barriers were identified, the most frequent being related to diagnostic errors (36,1%), resource deficiency (25%), treatment errors (19,4%), lack of health literacy (13,9%) and inadequate communications with care transitions (5,6%). Fifty-nine quality and 31 safety standards were defined. They were related to evaluation (23.3%), patient safety (21.1%), comprehensive care (12.2%), treatment (12.2%), clinical practice guidelines (7.8%), counselling (6.7%), training (4.4%) and patient satisfaction (3.3%). Conclusions This proposal incorporates a set of indicators and standards, which can be used to define a pathway for headache patients and determine the levels of quality

Improving Sustainability in Organic and Low Input Food Production Systems. Proceedings of the 3rd International Congress of the European Integrated Project Quality Low Input Food (QLIF). University of Hohenheim, Germany, March 20 – 23, 2007

These proceedings document the results of the congress 'Improving Sustainability in Organic and Low Input Food Production Systems' which took place on March 20–23, 2007, at the University of Hohenheim in Germany. This congress was the 3rd in a series organized as part of the EU funded Integrated Project 'Quality Low Input Food' QLIF . The congress was convened in parallel with the 9th Scientific Conference on Organic Agriculture in German-speaking countries, entitled 'Between tradition and globalization', hosted by the University of Hohenheim. The QLIF project aims to improve quality, ensure safety and reduce cost along the organic and low input food supply chains through research, dissemination and training activities. Its subprojects cover all aspects of organic and low input food and farming: Consumer studies, quality, crop & livestock production, processing and supply chains, environmental and socioeconomic aspects

DeepGauge: Multi-Granularity Testing Criteria for Deep Learning Systems

Deep learning (DL) defines a new data-driven programming paradigm that constructs the internal system logic of a crafted neuron network through a set of training data. We have seen wide adoption of DL in many safety-critical scenarios. However, a plethora of studies have shown that the state-of-the-art DL systems suffer from various vulnerabilities which can lead to severe consequences when applied to real-world applications. Currently, the testing adequacy of a DL system is usually measured by the accuracy of test data. Considering the limitation of accessible high quality test data, good accuracy performance on test data can hardly provide confidence to the testing adequacy and generality of DL systems. Unlike traditional software systems that have clear and controllable logic and functionality, the lack of interpretability in a DL system makes system analysis and defect detection difficult, which could potentially hinder its real-world deployment. In this paper, we propose DeepGauge, a set of multi-granularity testing criteria for DL systems, which aims at rendering a multi-faceted portrayal of the testbed. The in-depth evaluation of our proposed testing criteria is demonstrated on two well-known datasets, five DL systems, and with four state-of-the-art adversarial attack techniques against DL. The potential usefulness of DeepGauge sheds light on the construction of more generic and robust DL systems.Comment: The 33rd IEEE/ACM International Conference on Automated Software Engineering (ASE 2018