A national study of patient safety culture in hospitals in Bulgaria

Background. Patient safety culture (PSC) is an essential component of the care quality. An important contribution to the evaluation of hospital culture and the enhancement of PSC is the HSOPSC questionnaire elaborated by the Agency for Healthcare Research and Quality (AHRQ). Objective of the study. To assess the patient safety culture among hospital staff using the Bulgarian version of Hospital Survey on Patient Safety Culture (B-HSOPSC) and explore the areas of deficiencies and opportunities for improvement regarding this issue. Material and Methods. A national cross-sectional survey was conducted using a special developed Web-based platform. The questionnaire for assessment of HSOPSC includes 42 questions, organized in 12 domains. To the Bulgarian version of B-HSOPSC two new items were added. In total, 545 healthcare professionals from hospitals were enrolled. Data were exported to SPSS 17.0 and analyzed with descriptive statistics. Results. In general, results show positive assessments of patient safety culture, regardless of few of exceptions. The dimensions “Handoffs and transitions” and „Supervisor/manager expectations and actions promoting safety “showed the highest mean values, respectively 3.76±0.79 and 3.64±0.79, whereas the “Staffing” and “Non-punitive response to error” have received the lowest mean values, respectively 2.79±0.60 and 2.99±0.89. Conclusion. For the first time in Bulgaria the level of hospital patient safety was measured. Special attention should be paid to the staff turnover in hospital, as well as the introduction of a patient safety reporting system in our country

The EUROPEP questionnaire for patient’s evaluation of general practice care: Bulgarian experience

Aim To validate the Bulgarian EUROPEP-questionnaire and its implementation to measure patient evaluation of general practice care in Bulgarian population. Methods A multicenter cross-sectional study was conducted at twenty five primary care practices from South-Central Region of Bulgaria. A total of 1000 adult patients aged over 18 years and visiting the practice for more than a year were approached consecutively to take part in the study. The internal consistency and test-retest reliability of the EUROPEP questionnaire were evaluated. To confirm the construct validity of the questionniare, еxplanatory factor analysis was performed. Results Cronbach’alpha for “clinical behaviour” is 0.95 and for “organisation of care” 0.81. Factor analysis identifed two factors, which accounted for 77.0% of the total variation in these items. On average, 58.7% of respondents rated the level of care received as excellent. The waiting time in the waiting room was the item most poorly rated (33.8%). The item “keeping patients’ records and data confidential” was the most highly rated (88.8%). Patients were less satisfied with “providing quick services for urgent health problems” (78.5% excellent or good) and “getting an appropriate for them appointment” (76.2% excellent or good). Conclusion Two scales with satisfactory psychometric properties were established in the Bulgarian version of the EUROPEP-questionnaire. The study identified areas requiring improvement in general practice, such as reduction in waiting times and obtaining patient’s convenience appointment

Linguistic Validation and Cultural Adaptation of Bulgarian Version of Hospital Survey on Patient Safety Culture (HSOPSC)

BACKGROUND: Patient safety (PS) is one of the essential elements of health care quality and a priority of healthcare systems in most countries. Thus the creation of validated instruments and the implementation of systems that measure patient safety are considered to be of great importance worldwide.AIM: The present paper aims to illustrate the process of linguistic validation, cross-cultural verification and adaptation of the Bulgarian version of the Hospital Survey on Patient Safety Culture (B-HSOPSC) and its test-retest reliability.METHODS: The study design is cross-sectional. The HSOPSC questionnaire consists of 42 questions, grouped in 12 different subscales that measure patient safety culture. Internal con­sistency was assessed using Cronbach’s alpha. The Wilcoxon signed-rank test and the split-half method were used; the Spear­man-Brown coefficient was calculated.RESULTS: The overall Cronbach’s alpha for B-HSOPSC is 0.918. Subscales 7 Staffing and 12 Overall perceptions of safety had the lowest coefficients. The high reliability of the instrument was confirmed by the Split-half method (0.97) and ICC-coefficient (0.95).  The lowest values of Spearmen-Broun coefficients were found in items A13 and A14.CONCLUSION: The study offers an analysis of the results of the linguistic validation of the B-HSOPSC and its test-retest reliability. The psychometric characteristics of the questions revealed good validity and reliability, except two questions. In the future, the instrument will be administered to the target population in the main study so that the psychometric properties of the instrument can be verified

Academic Staff Satisfaction with their Work: A Cross-Sectional Study in a Medical University

BACKGROUND: Employees' work satisfaction, combined with democratic management, are important predictors of future productivity in any organisation. AIM: The aim of this study is to investigate job satisfaction in academic staff as well as the associated working environment factors, using an original self-administered questionnaire. METHODS: A cross-sectional survey was conducted using an original standardised questionnaire. It involved 370 academic staff members at one of the five medical universities in Bulgaria. The questionnaire consists of 17 items (including occupational hazards, management style, conflict solving and demographic characteristics) rated on a 5-point Likert scale. RESULTS: The results revealed that the majority of academic staff (71.7%) works in a risky environment. Employees indicate that “mental strainâ€, “work with chemical agents and dust†and “work with biological hazards†are the most common risk factors. Democratic leadership and cooperation are most commonly applied management styles. CONCLUSION: The instrument for the measurement of job satisfaction revealed high values of psychometric characteristics for reliability and validity. The study found a high level of satisfaction of academics with their working conditions. It is necessary to conduct similar studies periodically to detect more precisely the decrease in academic staff work satisfaction and take timely and adequate measures to improve it

The Role of Vaspin in the Development of Metabolic and Glucose Tolerance Disorders and Atherosclerosis

In recent years, most research efforts have been focused on studying insulin-sensitizing adipokines. One of the most recently discovered adipokines is vaspin, a visceral adipose tissue-derived serine protease inhibitor. Vaspin levels have been found significantly increased in mice with obesity and insulin resistance. It has been assumed that vaspin serves as an insulin sensitizer with anti-inflammatory effects and might act as a compensatory mechanism in response to decreased insulin sensitivity. Most studies in humans have shown a positive correlation between vaspin gene expression and serum levels, and metabolic syndrome parameters. Vaspin gene expression is influenced by age and gender, and the administration of insulin sensitizers enhances it in mice, whereas the use of metformin decreases serum vaspin levels in humans, probably due to different regulatory mechanisms. Presumably vaspin plays local and endocrine role in the development of initial and advanced atherosclerosis in obese subjects and might be used as a predictor of coronary and cerebrovascular disease. It is believed that vaspin could be regarded as a new link between obesity and related metabolic disorders, including glucose intolerance. The entire understanding of vaspin intimate mechanism of action might enable the development of novel etiology-based treatment strategies, targeting metabolic and glucose tolerance disorders

The Survey of Health Care Managers’ Attitude towards the Implementation of Information and Communication System for the Registration of Medical Errors

The aim of the study has been to examine attitudeand motivation of managers of Health Care Establishments forthe implementation of information and communication systemfor the registration and reporting of medical errors.A sociological method: anonymous inquiry sent by e-mail or bypost has been used to register the initial information. More thanhalf of the health care managers (59.6% (62)) are willing toimplement an information system for the registration of medicalerrors in their respective health care establishment

The Survey of Health Care Managers’ Attitude towards the Implementation of Information and Communication System for the Registration of Medical Errors

The aim of the study has been to examine attitude and motivation of managers of Health Care Establishments for the implementation of information and communication system for the registration and reporting of medical errors. A sociological method: anonymous inquiry sent by e-mail or by post has been used to register the initial information. More than half of the health care managers (59.6% (62)) are willing to implement an information system for the registration of medical errors in their respective health care establishments

Perception of patient safety culture among hospital staff

A patient safety culture (PSC) is a complex phenomenon, representing an essential part of the organizational culture and refers to the shared values, conceptions and beliefs which contribute to the formation and encouragement of safe behavioural models in a health organization. With this study, the authors wanted to delineate the attitude of hospital staff in Bulgaria regarding PSC and to document to whether attitudes differ between physicians and other healthcare professionals (HCPs)

Predictors of a severe course and mortality in patients with COVID-19–associated pneumonia

Introduction: Severe and critical forms of SARS-CoV-2 pneumonia are associated with high morbidity and mortality. Numerous research studies have been conducted around the world to investigate various variables (demographic, clinical, laboratory, etc.) in an attempt to understand the relationships between them and the course and outcome of patients with COVID-19 infection and pneumonia. Aim: To outline predictors of a severe or critical course and fatal outcome in patients with COVID-19–associated pneumonia. Materials and methods: The current study was conducted from August 2021 to April 2022 in the COVID-19 ward of the Clinics of Pulmonology and Phthisiology at St George University Hospital in Plovdiv. It included 146 patients with PCR-confirmed COVID-19 and with anamnestic, laboratory, and imaging evidence of pneumonia. The patients were divided into three groups based on the severity of infection: moderate, severe, and critical. Demographic, clinical, laboratory, and imaging studies were performed for all patients. The data was exported to IBM SPSS v. 23 statistical software and analyzed with descriptive statistics, parametric and non-parametric methods. The relationships between the above-mentioned indicators and the severe or critical course and fatal outcome of the COVID-19 infection were outlined. A regression model was applied if the tested variables had a statistically significant correlation with the lethal outcomes. Results: The age and sex of the patients appeared to be the most important demographic factors: the mean age of the patients who were discharged was 57 years, whereas the mean age of the deceased patients was 71 years. However, there was no statistically significant difference between the mortality rates of the age group under 65 and the age group over 65. Regarding sex, 30.8% of men and 25.5% of women had a fatal outcome, the difference failing to reach statistical significance (p=0.159). Among the clinical signs at admission, shortness of breath and mental status changes were related to a more severe course of the disease and increased mortality: statistically significant difference was found depending on the absence or presence of dyspnea (p=0.039). Of the patients without dyspnea, 90.9% were discharged, unlike 79.1% of the patients who had it, which makes a mortality rate of 29% for the latter group. There was also a statistically significant difference in the outcome depending on the presence of mental status changes – 45.5% of patients without mental status changes were discharged, whereas only 12% of those with mental status changes were discharged (p=0.011). Elevated D-dimers also seemed to affect the outcome – 82.2% of deceased patients had D-dimer levels of >0.5. In terms of illness severity, the disease had a moderate course in 46 (65.2%) patients without raised D-dimers, and a severe course in 75 (72.2%) patients who had elevated D-dimer levels, and a critical course in 22 (76%) patients. There was a statistically significant difference between the pO2 values and disease severity – the probability of a severe and critical course in those with pO2<60 mmHg was 77.2% (p=0.002). Presence of alveolar infiltrates seen in chest x-ray (CXR) or CT studies also led to a severe or critical course (p=0.000). The regression model showed that the three independent variables, shortness of breath, confusion at admission, and pO2 level <60, were found to be statistically significant based on the Wald criterion (p<0.000). Conclusions: The results of the study indicated that older age, shortness of breath, and altered mental state at admission are predictors of severe or critical course and lethal outcome in patients with COVID-19 pneumonia. Regarding the laboratory tests, the elevated D-dimers and pO2 levels <60 also indicate high risk and lethal outcomes