100 research outputs found
High-reliability in healthcare : nurse-reported patient safety climate and its relationship with patient outcomes in Swiss acute care hospitals
Get PDFHealthcare
is
a
high-‐risk
industry.
Worldwide,
healthcare
systems
struggle
daily
to
keep
pa-‐
tients
safe
and
protect
them
from
harm.
Still,
every
day,
countless
errors
occur.
Most
are
minor
and
pass
unnoticed;
however,
a
significant
proportion
result
in
adverse
events
such
as
pressure
ulcers,
patient
falls,
or
healthcare-‐associated
infections,
with
consequences
for
patients
ranging
from
dis-‐
comfort
to
mortality
[6-‐10].
Today,
a
close
focus
on
patient
safety,
i.e.,
“the
continuous
identification,
analysis
and
management
of
patient-‐related
risks
and
incidents
in
order
to
make
patient
care
safer
and
to
minimize
harm
to
patients”
[11,
p.
9],
is
a
key
component
of
high-‐quality
care
[12,
13].
Con-‐
versely,
as
in
other
high-‐risk
industries,
such
as
aviation
or
nuclear
power,
adverse
events
should
be
viewed
not
as
failures
of
individual
healthcare
professionals
but
as
symptoms
of
system
vulnerability
[14-‐16].
And,
as
experience
in
those
industries
has
shown,
the
majority
of
"human
error"
in
healthcare
originates
not
with
poorly
performing
individuals,
such
as
nurses,
physicians,
or
other
providers,
but
with
faulty
systems
/
processes
such
as
stressful
environments,
heavy
workloads
or
inadequate
communication
[17,
18].
To
overcome
such
systemic
defects,
a
growing
number
of
international
experts
agree
that
a
well-‐developed
“culture
of
safety”
is
fundamental
to
understanding
patient
safety
mechanisms
and
preventing
adverse
events
[13,
19].
Other
high-‐risk
industries
regularly
evaluate
and
improve
their
safety
cultures
via
workforce
surveys
designed
to
assess
and
monitor
safety
climate
(i.e.,
the
per-‐
ceived
safety
culture
of
a
particular
group
at
a
particular
time)
[20].
Since
the
1999
publication
of
To
Err
is
Human
[21],
safety
culture
and
climate
have
attracted
increasing
interest
in
healthcare,
leading
to
major
advances
in
patient
safety
climate
research,
particularly
regarding
instrument
development
and
psychometric
evaluation
[22-‐24].
To
date,
though,
few
studies
have
investigated
the
relationship
between
patient
safety
climate,
adverse
event
incidence
and
patient
outcomes
[24-‐29].
SUMMARY
-‐
10
-‐
Overall,
this
dissertation's
aim
is
to
describe
the
results
of
4
studies
designed
first
to
test
nurse-‐reported
patient
safety
climates
in
Swiss
acute-‐care
hospitals,
then
to
analyze
for
relationships
with
possible
contributing
factors
(e.g.,
characteristics
of
Swiss
acute
care
hospitals)
and
conse-‐
quences
(e.g.,
patient
outcomes).
Three
of
these
studies
used
survey
data
originally
collected
for
the
Swiss
RN4CAST
(Nurse
Forecasting:
Human
Resources
Planning
in
Nursing)
study,
including
data
from
1,633
nurses
and
997
patients
on
132
general
medical,
surgical
and
mixed
medical/surgical
units
in
35
Swiss
acute
care
hospitals.
The
dissertation
is
organized
in
7
chapters:
Chapter
1
introduces
the
problematic
issue
of
patient
safety
and
adverse
events,
as
well
as
of
human
contributions
to
error.
Emphasis
is
placed
on
the
importance
of
understanding
human
fac-‐
tors,
including
organizational
safety-‐related
behaviors
/
perceptions,
i.e.,
organizational
safety
cul-‐
ture
/
climate,
regarding
understanding
and
minimizing
human
errors
and
their
underlying
system
defects.
An
overview
is
provided
of
the
state
of
safety
climate
research
in
healthcare,
and
the
concep-‐
tual
framework
of
this
dissertation
project
is
presented.
In
the
final
part
of
the
introduction,
gaps
in
the
scientific
literature
are
summarized,
along
with
this
dissertation's
contribution
to
narrowing
those
gaps.
Chapter
2
describes
the
aims
of
this
dissertation,
including
the
translation
and
first
psy-‐
chometric
testing
of
the
German,
French
and
Italian
versions
of
the
Safety
Organizing
Scale.
Findings
addressed
in
four
component
studies
are
reported
(Chapter
3
to
Chapter
6).
Chapter
3
presents
the
results
of
a
German
study
describing
the
translation
process
according
to
the
adapted
Brislin
translation
model
for
cross-‐cultural
research
[30].
In
addition,
based
on
content
validity
rating
and
calculations
of
content
validity
indices
at
the
item
and
scale
levels,
the
content
valid-‐
ity
testing
results
for
the
German
version
of
the
Safety
Organizing
Scale
(SOS)
are
described.
Chapter
4
presents
our
initial
evidence
regarding
the
validity
and
reliability
of
the
German-‐,
French-‐
and
Italian-‐language
versions
of
the
SOS.
For
each
translation,
psychometric
evaluation
re-‐
vealed
evidence
based
on
content
(scale-‐content
validity
index
>
0.89),
response
patterns
(e.g.,
aver-‐
age
of
missing
values
across
all
items
=
0.80%),
internal
structure
(e.g.,
comparative
fit
indices
>
0.90,
root
mean
square
error
of
approximation
<
0.08)
and
reliability
(Cronbach’s
alpha
>
0.79).
We
differ-‐
entiated
the
SOS
regarding
one
related
concept
(implicit
rationing
of
nursing
care).
At
the
individual
level,
higher
SOS
scores
correlated
with
supportive
leadership
and
fewer
nurse-‐reported
medication
errors,
but
not
with
nurse-‐reported
patient
falls.
The
results
suggest
that
the
SOS
offers
a
valuable
measurement
of
engagement
in
safety
practices
that
might
influence
patient
outcomes,
including
adverse
events.
Further
analysis
using
more
reliable
outcome
measures
(e.g.,
mortality
rates)
will
be
necessary
to
confirm
concurrent
validity.
SUMMARY
-‐
11
-‐
Chapter
5
reports
on
our
study
describing
nurse
reports
of
patient
safety
climate
and
nurses’
engagement
in
safety
behaviors
in
Swiss
acute
care
hospitals,
exploring
relationships
between
unit
type,
hospital
type,
language
region,
and
nurse-‐reported
patient
safety
climate.
Of
the
120
units
in-‐
cluded
in
the
analysis,
only
on
33
(27.5%)
did
at
least
60%
of
the
nurses
rate
their
patient
safety
cli-‐
mates
positively.
The
majority
of
participating
nurses
(51.2-‐63.4%,
n=1,564)
reported
that
they
were
“consistently
engaged”
in
only
three
of
the
nine
measured
patient
safety
behaviors.
Our
multilevel
regression
analyses
revealed
both
significant
inter-‐unit
and
inter-‐hospital
variability.
Of
our
three
variables
of
interest
(hospital
type,
unit
type
and
language
region)
only
language
region
was
consist-‐
ently
related
to
nurse-‐reported
patient
safety
climate.
Nurses
in
the
German-‐speaking
region
rated
their
patient
safety
climates
more
positively
than
those
in
the
French-‐
and
Italian-‐speaking
language
regions.
This
study's
findings
suggest
a
need
to
improve
individual
and
team
skills
related
to
proac-‐
tively
and
preemptively
discussing
and
analyzing
possible
unexpected
events,
detecting
and
learning
from
errors,
and
thinking
critically
about
everyday
work
activities/processes.
Chapter
6
presents
the
results
of
our
explorative
study
of
the
associations
between
nurse-‐
reported
patient
safety
climate,
nurse-‐related
organizational
variables
and
selected
patient
outcomes.
In
none
of
our
regression
models
was
patient
safety
climate
a
significant
predictor
for
medication
er-‐
rors,
patient
falls,
pressure
ulcers,
bloodstream
infections,
urinary
tract
infection,
pneumonia,
or
pa-‐
tient
satisfaction.
However,
from
the
nurse-‐related
organizational
variables,
implicit
rationing
of
nurs-‐
ing
care
emerged
as
a
robust
predictor
for
patient
outcomes.
After
controlling
for
major
organizational
variables
and
hierarchical
data
structure,
higher
levels
of
implicit
rationing
of
nursing
care
resulted
in
a
significant
decrease
in
the
odds
of
patient
satisfaction
(OR
=
0.276,
95%CI
=
0.113
to
0.675)
and
a
sig-‐
nificant
increase
in
the
odds
of
nurse
reported
medication
errors
(OR
=
2.513,
95%CI
=
1.118
to
5.653),
bloodstream
infections
(OR
=
3.011,
95%CI
=
1.429
to
6.347),
and
pneumonia
(OR
=
2.672,
95%CI
=
1.117
to
6.395).
Overall,
our
findings
did
not
confirm
our
hypotheses
that
PSC
is
related
to
improved
patient
outcomes.
Given
the
current
state
of
research
on
patient
safety
climate,
then,
the
direct
impact
of
PSC
improvements
on
patient
outcomes
in
general
medical
/
surgical
acute-‐care
settings
should
not
be
overestimated.
As
a
structural
component
of
the
work
environment,
PSC
might
influence
the
care
process
(by
calling
attention
to
rationing
of
nursing
care)
and
thus
have
only
an
indirect
effect
on
pa-‐
tient
outcomes.
Testing
this
possibility
will
require
further
analyses.
Finally,
in
Chapter
7,
major
findings
of
the
individual
studies
are
synthesized
and
discussed,
and
methodological
strengths
and
limitations
of
this
dissertation
are
discussed.
Furthermore,
impli-‐
cations
for
further
research
and
clinical
practice
are
suggested.
The
findings
of
this
dissertation
add
to
the
existing
literature
the
first
evidence
regarding
validity
and
reliability
of
the
German,
French
and
Italian
versions
of,
the
Safety
Organizing
Scale,
a
patient
safety
climate
measurement
instrument.
Our
findings
did
not
confirm
the
underlying
theoretical
assumption
that
higher
safety
climate
levels
are
related
to
improved
patient
safety
and
quality.
Although
these
findings
suggest
the
need
to
im-‐
SUMMARY
-‐
12
-‐
prove
of
patient
safety
climate
on
general
medical,
surgical
and
mixed
medical/surgical
units
in
Swiss
hospitals,
it
remains
unclear
whether
improving
nurses’
engagement
in
safety
behaviors
will
lead
to
improved
patient
safety
outcomes
(e.g.,
reduced
occurrence
of
adverse
events).
This
disserta-‐
tion
will
contribute
to
the
further
development
of
safety
culture
and
climate
theory
and
raises
meth-‐
odological
issues
that
will
require
consideration
in
future
studies
Comparing Charlson and Elixhauser comorbidity indices with different weightings to predict in-hospital mortality: an analysis of national inpatient data
Get PDFUnderstanding how comorbidity measures contribute to patient mortality is essential both to describe patient health status and to adjust for risks and potential confounding. The Charlson and Elixhauser comorbidity indices are well-established for risk adjustment and mortality prediction. Still, a different set of comorbidity weights might improve the prediction of in-hospital mortality. The present study, therefore, aimed to derive a set of new Swiss Elixhauser comorbidity weightings, to validate and compare them against those of the Charlson and Elixhauser-based van Walraven weights in an adult in-patient population-based cohort of general hospitals.; Retrospective analysis was conducted with routine data of 102 Swiss general hospitals (2012-2017) for 6.09 million inpatient cases. To derive the Swiss weightings for the Elixhauser comorbidity index, we randomly halved the inpatient data and validated the results of part 1 alongside the established weighting systems in part 2, to predict in-hospital mortality. Charlson and van Walraven weights were applied to Charlson and Elixhauser comorbidity indices. Derivation and validation of weightings were conducted with generalized additive models adjusted for age, gender and hospital types.; Overall, the Elixhauser indices, c-statistic with Swiss weights (0.867, 95% CI, 0.865-0.868) and van Walraven's weights (0.863, 95% CI, 0.862-0.864) had substantial advantage over Charlson's weights (0.850, 95% CI, 0.849-0.851) and in the derivation and validation groups. The net reclassification improvement of new Swiss weights improved the predictive performance by 1.6% on the Elixhauser-van Walraven and 4.9% on the Charlson weights.; All weightings confirmed previous results with the national dataset. The new Swiss weightings model improved slightly the prediction of in-hospital mortality in Swiss hospitals. The newly derive weights support patient population-based analysis of in-hospital mortality and seek country or specific cohort-based weightings
Validity and reliability on three European language versions of the Safety Organizing Scale
Get PDFBackground The Safety Organizing Scale (SOS) offers a reliable snapshot of nurses' engagement in unit-level safety behaviors in hospitals. As no comparable questionnaire exists in German, French and Italian, we explored the psychometric properties of SOS translations into each of those languages. Design and Methods The psychometric properties of the nine-item SOS were tested according to American Educational Research Association guidelines. Subjects and Setting Between October 2009 and June 2010, 1633 registered medical and/or surgical nurses in 35 Swiss hospitals completed translated SOS questionnaires. Results For each translation, psychometric evaluation revealed evidence based on content (scale-content validity index >0.89), response patterns (e.g. average of missing values across all items = 0.80%), internal structure (e.g. comparative fit indices >0.90, root mean square error of approximation 0.79). We differentiated the scale regarding one related concept (implicit rationing of nursing care). Higher SOS scores correlated with supportive leadership and lower nurse-reported medication errors, but not with nurse-reported patient falls. Conclusions The SOS offers a valuable measurement of engagement in safety practices that might influence patient outcomes. Initial evidence regarding the validity and reliability of the translated versions supports their use in German, French and Italian. Concurrent validity will require confirmation via further analysis using more reliable outcome measures (e.g. mortality rates). The translated versions' predictive validity needs to be established in prospective studie
How hospital leaders contribute to patient safety through the development of trust
Get PDFThe aim of this study was to explore the associations between hospital management support for patient safety, registered nurses' trust in hospital management, and their overall perception of patient safety, considering aspects of safety communication as possible mediating variables.; Limited research exists regarding how key elements of a patient safety culture, that is, leadership, safety communication, and trust, are interrelated.; This study used cross-sectional nurse survey data from 1,633 registered nurses working in 35 acute care hospitals participating in the Swiss arm of the RN4CAST (Nurse Forecasting in Europe) study.; A path analysis revealed that the indirect associations between "management support for patient safety" and "overall perception of patient safety" were more prominent than the direct association.; Our findings confirm that safety communication plays a partially mediating role between "management support for patient safety" and nursing professionals' assessments of patient safety. This suggests that hospital leader-unit exchanges might improve patient safety
Validity and reliability on three European language versions of the Safety Organizing Scale
Get PDFBackground: The Safety Organizing Scale (SOS) offers a reliable snapshot of nurses' engagement in unit-level safety behaviors in hospitals. As no comparable questionnaire exists in German, French and Italian, we explored the psychometric properties of SOS translations into each of those languages.
Design and Methods: The psychometric properties of the nine-item SOS were tested according to American Educational Research Association guidelines.
Subjects and Setting: Between October 2009 and June 2010, 1633 registered medical and/or surgical nurses in 35 Swiss hospitals completed translated SOS questionnaires.
Results: For each translation, psychometric evaluation revealed evidence based on content (scale-content validity index >0.89), response patterns (e.g. average of missing values across all items = 0.80%), internal structure (e.g. comparative fit indices >0.90, root mean square error of approximation 0.79). We differentiated the scale regarding one related concept (implicit rationing of nursing care). Higher SOS scores correlated with supportive leadership and lower nurse-reported medication errors, but not with nurse-reported patient falls.
Conclusions: The SOS offers a valuable measurement of engagement in safety practices that might influence patient outcomes. Initial evidence regarding the validity and reliability of the translated versions supports their use in German, French and Italian. Concurrent validity will require confirmation via further analysis using more reliable outcome measures (e.g. mortality rates). The translated versions' predictive validity needs to be established in prospective studies
Strengthening tRansparent reporting of reseArch on uNfinished nursing CARE: The RANCARE guideline
Get PDFUnfinished, rationed, missed, or otherwise undone nursing care is a phenomenon observed across health-care settings worldwide. Irrespective of differing terminology, it has repeatedly been linked to adverse outcomes for both patients and nursing staff. With growing numbers of publications on the topic, scholars have acknowledged persistent barriers to meaningful comparison across studies, settings, and health-care systems. The aim of this study was thus to develop a guideline to strengthen transparent reporting in research on unfinished nursing care. An international four-person steering group led a consensus process including a two-round online Delphi survey and a workshop with 38 international experts. The study was embedded in the tRansparent reporting of reseArch on uNfinished nursing CARE (RANCARE) COST Action. Participation was voluntary. The resulting 40-item RANCARE guideline provides recommendations for transparent and comprehensive reporting on unfinished nursing care regarding conceptualization, measurement, contextual information, and data analyses. By increasing the transparency and comprehensiveness in reporting of studies on unfinished nursing care, the RANCARE guideline supports efficient use of the research results, for example, allowing researchers and nurses to take purposeful actions, with the goal of improving the safety and quality of health-care services
The effect of time-varying capacity utilization on 14-day in-hospital mortality: a retrospective longitudinal study in Swiss general hospitals
Get PDFHigh bed-occupancy (capacity utilization) rates are commonly thought to increase in-hospital mortality; however, little evidence supports a causal relationship between the two. This observational study aimed to assess three time-varying covariates-capacity utilization, patient turnover and clinical complexity level- and to estimate causal effect of time-varying high capacity utilization on 14 day in-hospital mortality.; This retrospective population-based analysis was based on routine administrative data (n = 1,152,506 inpatient cases) of 102 Swiss general hospitals. Considering the longitudinal nature of the problem from available literature and expert knowledge, we represented the underlying data generating mechanism as a directed acyclic graph. To adjust for patient turnover and patient clinical complexity levels as time-varying confounders, we fitted a marginal structure model (MSM) that used inverse probability of treatment weights (IPTWs) for high and low capacity utilization. We also adjusted for patient age and sex, weekdays-vs-weekend, comorbidity weight, and hospital type.; For each participating hospital, our analyses evaluated the ≥85th percentile as a threshold for high capacity utilization for the higher risk of mortality. The mean bed-occupancy threshold was 83.1% (SD 8.6) across hospitals and ranged from 42.1 to 95.9% between hospitals. For each additional day of exposure to high capacity utilization, our MSM incorporating IPTWs showed a 2% increase in the odds of 14-day in-hospital mortality (OR 1.02, 95% CI: 1.01 to 1.03).; Exposure to high capacity utilization increases the mortality risk of inpatients. Accurate monitoring of capacity utilization and flexible human resource planning are key strategies for hospitals to lower the exposure to high capacity utilization
Awareness and use of home remedies in Italy's alps: a population-based cross-sectional telephone survey
Get PDFBelief in complementary and alternative medicine practices is related to reduced preparedness for vaccination. This study aimed to assess home remedy awareness and use in South Tyrol, where vaccination rates in the coronavirus pandemic were lowest in Italy and differed between German- and Italian-speaking inhabitants.; A population-based survey was conducted in 2014 and analyzed using descriptive statistics, multiple logistic regression, and latent class analysis.; Of the representative sample of 504 survey respondents, 357 (70.8%) participants (43.0% male; primary language German, 76.5%) reported to use home remedies. Most commonly reported home remedies were teas (48.2%), plants (21.0%), and compresses (19.5%). Participants from rural regions were less likely (odds ratio 0.35, 95% confidence interval 0.19-0.67), while female (2.62, 1.69-4.10) and German-speaking participants (5.52, 2.91-9.88) were more likely to use home remedies. Latent classes of home remedies were "alcoholic home remedies" (21.4%) and "non-alcohol-containing home remedies" (78.6%). Compared to the "non-alcohol-containing home remedies" class, members of the "alcoholic home remedies" class were more likely to live in an urban region, to be male and German speakers.; In addition to residence and sex, language group membership associates with awareness and use of home remedies. Home remedies likely contribute to socio-cultural differences between the language groups in the Italian Alps. If the observed associations explain the lower vaccination rates in South Tyrol among German speakers requires further study
Trends and variability of implicit rationing of care across time and shifts in an acute care hospital : a longitudinal study
Get PDFThe proposed study was funded for 2 years (2018‐2020) by the Medical Practice Plan, Faculty of Medicine, American University of Beirut, Lebanon.Background Implicit rationing of nursing care is associated with work environment factors. Yet a deeper understanding of trends and variability is needed. Aims To explore the trends and variability of rationing of care per shift between individual nurses, services over time, and its relationship with work environment factors. Methods Longitudinal study including 1,329 responses from 90 nurses. Intraclass correlation coefficients (ICC) were computed to examine variability of rationing per shift between individual nurses, services, and data collection time; generalized linear mixed models were used to explore the relationship with work environment factors. Results Percentage of rationing of nursing activities exceeded 10% during day and night shifts. Significant variability in rationing items was observed between nurses, with ICCs ranging between 0.20 and 0.59 in day shifts, and between 0.35 and 0.85 in night shifts. Rationing of care was positively associated with nurses’ self‐perceived workload in both shifts, but not with patient‐to‐nurse ratios. Conclusion Most variability in rationing over time was explained by the individual.PostprintPeer reviewe
Variation in detected adverse events using trigger tools: A systematic review and meta-analysis
Get PDFAdverse event (AE) detection is a major patient safety priority. However, despite extensive research on AEs, reported incidence rates vary widely.; This study aimed: (1) to synthesize available evidence on AE incidence in acute care inpatient settings using Trigger Tool methodology; and (2) to explore whether study characteristics and study quality explain variations in reported AE incidence.; Systematic review and meta-analysis.; To identify relevant studies, we queried PubMed, EMBASE, CINAHL, Cochrane Library and three journals in the patient safety field (last update search 25.05.2022). Eligible publications fulfilled the following criteria: adult inpatient samples; acute care hospital settings; Trigger Tool methodology; focus on specialty of internal medicine, surgery or oncology; published in English, French, German, Italian or Spanish. Systematic reviews and studies addressing adverse drug events or exclusively deceased patients were excluded. Risk of bias was assessed using an adapted version of the Quality Assessment Tool for Diagnostic Accuracy Studies 2. Our main outcome of interest was AEs per 100 admissions. We assessed nine study characteristics plus study quality as potential sources of variation using random regression models. We received no funding and did not register this review.; Screening 6,685 publications yielded 54 eligible studies covering 194,470 admissions. The cumulative AE incidence was 30.0 per 100 admissions (95% CI 23.9-37.5; I2 = 99.7%) and between study heterogeneity was high with a prediction interval of 5.4-164.7. Overall studies' risk of bias and applicability-related concerns were rated as low. Eight out of nine methodological study characteristics did explain some variation of reported AE rates, such as patient age and type of hospital. Also, study quality did explain variation.; Estimates of AE studies using trigger tool methodology vary while explaining variation is seriously hampered by the low standards of reporting such as the timeframe of AE detection. Specific reporting guidelines for studies using retrospective medical record review methodology are necessary to strengthen the current evidence base and to help explain between study variation
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