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

Pilot3 D5.1 - Verification and validation plan

This deliverable provides the methodological framework which will enable the execution of the verification and validation activities. The actions defined within framework plan will support the incremental development of the prototype based on the principle of Agile paradigm. The verification defines all activities that will ensure the thorough test of different prototype versions, while validation will assess the functioning hypotheses addressing the operational benefits of the tool. The validation campaign will be done primarily through the interaction with the internal and external experts to capture their feedback. The deliverable presents the five-level hierarchy approach on the definition of experiments (scenario and case studies) that ensures the flexibility and tractability in their selection through different versions of prototype development. The deliverable also details the organisation and schedule of the internal and external meetings, workshops and dedicated activities along with the specification of the questionnaires, flow-type diagrams and other instruments which aims to facilitate the validation assessments

Constrained invariant mass distributions in cascade decays. The shape of the "mqllm_{qll}-threshold" and similar distributions

Considering the cascade decay $D\to c C \to c b B \to c b a A$ in which $D,C,B,A$ are massive particles and $c,b,a$ are massless particles, we determine for the first time the shape of the distribution of the invariant mass of the three massless particles $m_{abc}$ for the sub-set of decays in which the invariant mass $m_{ab}$ of the last two particles in the chain is (optionally) constrained to lie inside an arbitrary interval, $m_{ab} \in [ m_{ab}^\text{cut min}, m_{ab}^\text{cut max}]$. An example of an experimentally important distribution of this kind is the ``$m_{qll}$ threshold'' -- which is the distribution of the combined invariant mass of the visible standard model particles radiated from the hypothesised decay of a squark to the lightest neutralino via successive two body decay,: \squark \to q \ntlinoTwo \to q l \slepton \to q l l \ntlinoOne , in which the experimenter requires additionally that $m_{ll}$ be greater than ${m_{ll}^{max}}/\sqrt{2}$. The location of the ``foot'' of this distribution is often used to constrain sparticle mass scales. The new results presented here permit the location of this foot to be better understood as the shape of the distribution is derived. The effects of varying the position of the $m_{ll}$ cut(s) may now be seen more easily.Comment: 12 pages, 3 figure

Strongly-Coupled Quarks and Colorful Black Holes

We use the AdS/CFT correspondence to study the behavior of strongly-coupled quarks in a black hole background. The supergravity background consists of a six-dimensional Schwarzschild-black string AdS soliton, for which the bulk horizon extends from the AdS boundary down to an infra-red floor. By going to higher energy scales, the regime of validity of the classical supergravity background can be extended closer to the singularity than might be expected from the four-dimensional perspective. Small black holes potentially created by the Large Hadron Collider could typically carry color charges inherited from their parton progenitors. The dynamics of quarks near such a black hole depends on the curved spacetime geometry as well as the strong interaction with the color-charged black hole. We study the resulting behavior of quarks and compute the rate at which a quark rotating around the black hole loses energy. We also investigate how the interaction between a quark and an antiquark is altered by the presence of the black hole, which results in a screening length.Comment: Proceedings of the DPF-2011 Conference, 8 pages, 5 figures, added reference

Enhanced ULF radiation observed by DEMETER two months around the strong 2010 Haiti earthquake

In this paper we study the energy of ULF electromagnetic waves that have been recorded by the satellite DEMETER, during its passing over Haiti before and after a destructive earthquake. This earthquake occurred on 12/1/2010, at geographic Latitude 18.46o and Longitude 287.47o, with Magnitude 7.0 R. Specifically, we are focusing on the variations of energy of Ez-electric field component concerning a time period of 100 days before and 50 days after the strong earthquake. In order to study these variations, we developed a novel method that can be divided in two stages: first we filter the signal keeping only the very low frequencies and afterwards we eliminate its trend using techniques of Singular Spectrum Analysis, combined with a third-degree polynomial filter. As it is shown, a significant increase in energy is observed for the time interval of 30 days before the strong earthquake. This result clearly indicates that the change in the energy of ULF electromagnetic waves could be related to strong precursory earthquake phenomena. Moreover, changes in energy were also observed 25 days after the strong earthquake associated with strong aftershock activity. Finally, we present results concerning the comparison in changes in Energy during night and day passes of the satellite over Haiti, which showed differences in the mean energy values, but similar results as far as the rate of energy change is concerned.Comment: 16 pages, 7 figures, submitted to NHES

Changes in urethral resistance in the presence of detrusor activity

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The role of minimal access valve surgery in the elderly. A meta-analysis of observational studies

Background Minimal access valve surgery, both mitral and aortic, may be related to improvement in specific post-operative outcomes, therefore may be beneficial for the subgroup of the elderly referred for valve surgery. Methods A systematic literature review identified several different studies, of which 6 fulfilled criteria for meta-analysis. Outcomes for a total of 1347 patients (675 conventional standard sternotomy and 672 minimally invasive valve surgery) were assessed with a meta-analysis using random effects modeling. Heterogeneity, subgroup analysis with quality scoring were also assessed. The primary endpoint was early mortality. Secondary endpoints included intra and post-operative outcomes. Results In the context of elderly patients, minimal access valve surgery conferred comparable early mortality to standard sternotomy (odd ratio (OR) 0.79, CI [0.40,1.56], p\ua0=\ua00.50) with no heterogeneity (p\ua0=\ua00.13); it was also associated with reduced mechanical intubation time (OR 0.48, CI [0.30,0.78], p\ua0=\ua00.003) and reduced post-operative length of stay (weighted mean difference (WMD)\ua0 122.91, CI [ 123.09,\ua0 122.74] p\ua0<\ua00.00001), however both cardio-pulmonary bypass time and cross clamp time were longer (WMD 24.29, CI [22.97, 25.61] p\ua0<\ua00.00001 and WMD 8.61, CI [7.61, 9.61], p\ua0<\ua00.00001, respectively); subgroup analysis demonstrated statistically significant reduced post-operative length of stay for both minimally invasive aortic and mitral surgery (WMD\ua0 122.84, CI [ 123.07,\ua0 122.60] p\ua0<\ua00.00001 and WMD\ua0 122.98, CI [ 123.25,\ua0 122.71] p\ua0<\ua00.00001 respectively). Conclusions Despite a prolonged cardiopulmonary bypass and cross clamp time, minimally invasive valve surgery is a safe alternative to standard sternotomy in the elderly, with similar early mortality, and improvements in intubation time as well as length of stay