Safety Risk Registers: Challenges and Guidance

A risk database, or risk register, is a central tool for organisations to use to monitor and reduce risks, both those identified during initial safety assessments and those emerging during operations (Whipple and Pitblado, 2010). The risk register should contain all analysed risks and should prioritise the areas that require managerial attention. When populated with information on each risk, including risk ranking, the risk register can be analysed to present the risk profile for different aspects of the organisation (Filippin and Dreher, 2004). When reviewed and updated over time, it can also be analysed to present trends within the risk profile and focus management attention on the highest risk activities or facilities (Whipple and Pitblado, 2010). In order to successfully develop a risk registry that provides an accurate level of risk within a process, there is a requirement for real time data on risk to be input into a risk registry. Despite their place at the heart of safety management, there is relatively little guidance and research on how to construct, maintain and use a risk register. The challenges and ideas in this paper were developed during the initial phase of a case study to develop a single central risk register for an energy generation company. The case study used workshops with key stakeholders from the company to work through the issues faced in developing a single integrated risk register. Challenges faced ranged from ensuring employees contributing to the risk register had a basic understanding of risk concepts, through identification and scope of hazards to be included, to data collection and automatic population of the risk register. The challenges encountered during this project are believed to be those that many companies face, and therefore the resolutions proposed and adopted for this case study will be presented here as guidance for the implementation and management of risk registries in safety management systems

What capabilities are required for facilitators to support student pharmacists effectively during experiential learning (EL) in Scotland? : Part 1

Experiential Learning (EL) is a requirement of the General Pharmaceutical Council’s Standards for the Initial Education and Training of Pharmacists. Essential to the growth of high-quality EL is the development of the facilitators who supervise the student pharmacists in practice. This research aimed to identify the capabilities required by facilitators to support a student pharmacist effectively during EL. A two-phase mixed methods process was undertaken to reach agreement on the capability descriptors required by EL facilitators. A literature review followed by a modified Delphi process was used to determine consensus on the identified draft capability descriptors. All feedback gained from the Delphi was analysed and used to shape the development of the descriptors. A panel of 48 stakeholders were recruited to take part in the Delphi Process. Response rates for the two Delphi rounds were high (Round 1 – 46 (95.8%), Round 2 – 41 (85.4%)) Following the Delphi the initial list of descriptors was reduced to 92 descriptors across eight overall domains. Through this research, a high level of consensus was reached for the range of descriptors within the framework which can ensure relevant, efficient education and training for EL facilitators to develop quality EL in pharmacy environments

Computing Optimal Equilibria and Mechanisms via Learning in Zero-Sum Extensive-Form Games

We introduce a new approach for computing optimal equilibria via learning in games. It applies to extensive-form settings with any number of players, including mechanism design, information design, and solution concepts such as correlated, communication, and certification equilibria. We observe that optimal equilibria are minimax equilibrium strategies of a player in an extensive-form zero-sum game. This reformulation allows to apply techniques for learning in zero-sum games, yielding the first learning dynamics that converge to optimal equilibria, not only in empirical averages, but also in iterates. We demonstrate the practical scalability and flexibility of our approach by attaining state-of-the-art performance in benchmark tabular games, and by computing an optimal mechanism for a sequential auction design problem using deep reinforcement learning

Steering No-Regret Learners to Optimal Equilibria

We consider the problem of steering no-regret-learning agents to play desirable equilibria in extensive-form games via nonnegative payments. We show that steering is impossible if the total budget (across iterations) is finite. However, with average, realized payments converging to zero, we show that steering is possible. In the full-feedback setting, that is, when players' full strategies are observed at each timestep, it is possible with constant per-iteration payments. In the bandit-feedback setting, that is, when only trajectories through the game tree are observable, steering is impossible with constant per-iteration payments but possible if we allow the maximum per-iteration payment to grow with time, while maintaining the property that average, realized payments vanish. We supplement our theoretical positive results with experiments highlighting the efficacy of steering in large, extensive-form games, and show how our framework relates to optimal mechanism design and information design

Outcomes and Pattern of Care for Spinal Myxopapillary Ependymoma in the Modern Era-A Population-Based Observational Study

(1) Background: Myxopapillary ependymoma (MPE) is a rare tumor of the spine, typically slow-growing and low-grade. Optimal management strategies remain unclear due to limited evidence given the low incidence of the disease. (2) Methods: We analyzed data from 1197 patients with spinal MPE from the Surveillance, Epidemiology, and End Results (SEER) database (2000-2020). Patient demographics, treatment modalities, and survival outcomes were examined using statistical analyses. (3) Results: Most patients were White (89.9%) with a median age at diagnosis of 42 years. Surgical resection was performed in 95% of cases. The estimated 10-year overall survival was 91.4%. Younger age (hazard ratio (HR) = 1.09, p \u3c 0.001) and receipt of surgery (HR = 0.43, p = 0.007) were associated with improved survival. Surprisingly, male sex was associated with worse survival (HR = 1.86, p = 0.008) and a younger age at diagnosis compared to females. (4) Conclusions: This study, the largest of its kind, underscores the importance of surgical resection in managing spinal MPE. The unexpected association between male sex and worse survival warrants further investigation into potential sex-specific pathophysiological factors influencing prognosis. Despite limitations, our findings contribute valuable insights for guiding clinical management strategies for spinal MPE

Professional care workforce: a rapid review of evidence supporting methods of recruitment, retention, safety, and education

Background: Across the care economy there are major shortages in the health and care workforce, as well as high rates of attrition and ill-defined career pathways. The aim of this study was to evaluate current evidence regarding methods to improve care worker recruitment, retention, safety, and education, for the professional care workforce. Methods: A rapid review of comparative interventions designed to recruit, retain, educate and care for the professional workforce in the following sectors: disability, aged care, health, mental health, family and youth services, and early childhood education and care was conducted. Embase and MEDLINE databases were searched, and studies published between January 2015 and November 2022 were included. We used the Quality Assessment tool for Quantitative Studies and the PEDro tools to evaluate study quality. Results: 5594 articles were initially screened and after applying the inclusion and exclusion criteria, 30 studies were included in the rapid review. Studies most frequently reported on the professional nursing, medical and allied health workforces. Some studies focused on the single domain of care worker education (n = 11) while most focused on multiple domains that combined education with recruitment strategies, retention strategies or a focus on worker safety. Study quality was comparatively low with a median PEDro score of 5/10, and 77% received a weak rating on the Quality Assessment tool for Quantitative Studies. Four new workforce strategies emerged; early career rural recruitment supports rural retention; workload management is essential for workforce well-being; learning must be contextually relevant; and there is a need to differentiate recruitment, retention, and education strategies for different professional health and care workforce categories as needs vary. Conclusions: Given the critical importance of recruiting and retaining a strong health and care workforce, there is an immediate need to develop a cohesive strategy to address workforce shortfalls. This paper presents initial evidence on different interventions to address this need, and to inform care workforce recruitment and retention. Rapid Review registration PROSPERO 2022 CRD42022371721 Available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD4202237172

Elective cancer surgery in COVID-19-free surgical pathways during the SARS-CoV-2 pandemic: An international, multicenter, comparative cohort study

PURPOSE As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19–free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19–free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19–free surgical pathways. Patients who underwent surgery within COVID-19–free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19–free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score–matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19–free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION Within available resources, dedicated COVID-19–free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

Elective Cancer Surgery in COVID-19-Free Surgical Pathways During the SARS-CoV-2 Pandemic: An International, Multicenter, Comparative Cohort Study.

PURPOSE: As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19-free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS: This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19-free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS: Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19-free surgical pathways. Patients who underwent surgery within COVID-19-free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19-free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score-matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19-free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION: Within available resources, dedicated COVID-19-free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Safety Risk Registers: Challenges and Guidance

A risk database, or risk register, is a central tool for organisations to use to monitor and reduce risks, both those identified during initial safety assessments and those emerging during operations (Whipple and Pitblado, 2010). The risk register should contain all analysed risks and should prioritise the areas that require managerial attention. When populated with information on each risk, including risk ranking, the risk register can be analysed to present the risk profile for different aspects of the organisation (Filippin and Dreher, 2004). When reviewed and updated over time, it can also be analysed to present trends within the risk profile and focus management attention on the highest risk activities or facilities (Whipple and Pitblado, 2010). In order to successfully develop a risk registry that provides an accurate level of risk within a process, there is a requirement for real time data on risk to be input into a risk registry. Despite their place at the heart of safety management, there is relatively little guidance and research on how to construct, maintain and use a risk register. The challenges and ideas in this paper were developed during the initial phase of a case study to develop a single central risk register for an energy generation company. The case study used workshops with key stakeholders from the company to work through the issues faced in developing a single integrated risk register. Challenges faced ranged from ensuring employees contributing to the risk register had a basic understanding of risk concepts, through identification and scope of hazards to be included, to data collection and automatic population of the risk register. The challenges encountered during this project are believed to be those that many companies face, and therefore the resolutions proposed and adopted for this case study will be presented here as guidance for the implementation and management of risk registries in safety management systems