Health and social care-associated harm amongst vulnerable children in primary care: mixed methods analysis of national safety reports.

PURPOSE: Patient safety failures are recognised as a global threat to public health, yet remain a leading cause of death internationally. Vulnerable children are inversely more in need of high-quality primary health and social-care but little is known about the quality of care received. Using national patient safety data, this study aimed to characterise primary care-related safety incidents among vulnerable children. METHODS: This was a cross-sectional mixed methods study of a national database of patient safety incident reports occurring in primary care settings. Free-text incident reports were coded to describe incident types, contributory factors, harm severity and incident outcomes. Subsequent thematic analyses of a purposive sample of reports was undertaken to understand factors underpinning problem areas. RESULTS: Of 1183 reports identified, 572 (48%) described harm to vulnerable children. Sociodemographic analysis showed that included children had child protection-related (517, 44%); social (353, 30%); psychological (189, 16%) or physical (124, 11%) vulnerabilities. Priority safety issues included: poor recognition of needs and subsequent provision of adequate care; insufficient provider access to accurate information about vulnerable children, and delayed referrals between providers. CONCLUSION: This is the first national study using incident report data to explore unsafe care amongst vulnerable children. Several system failures affecting vulnerable children are highlighted, many of which pose internationally recognised challenges to providers aiming to deliver safe care to this at-risk cohort. We encourage healthcare organisations globally to build on our findings and explore the safety and reliability of their healthcare systems, in order to sustainably mitigate harm to vulnerable children

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

Vulnerable children and their care quality issues: a descriptive analysis of a national database [Abstract]

Background Globally, two in five children are deemed vulnerable by virtue of their physical, psychological and social characteristics. These children are at increased risk of sub-optimal care and disproportionate levels of iatrogenic harm. There remains a paucity of literature describing initiatives for practice improvement for these children. Objectives Identify safety reports describing vulnerable children in the England and Wales National Reporting and Learning System (NRLS). Characterise reports in terms of what happened and reported causative issues, in order to identify key change concepts (drivers) and related interventions (change ideas) for improvement. Methods An operational definition of ‘vulnerability in children’, including key domains and related keywords (Appendix 1, 2), was empirically informed by a scoping review of the published and grey literature. Relevant reports were descriptively analysed. The free text of the four most frequent incident types (Pareto principle) was discussed by a multi-disciplinary team to identify key concepts for improvement. Results 2,015 reports were identified involving vulnerable children. The problem areas identified primarily resulted from a fragmentation of care services. This included inefficient transfer of information between primary care services; failure to operationalise care plans in practice; and inconsistent access to healthcare services. Reported causes are outlined in an Ishikawa diagram (figure 1) and summarized in the related driver diagram (figure 2) to mitigate problem areas. Conclusions Analysis of patient safety incident reports assisted in the pragmatic identification of key concepts for healthcare professionals to begin more informed discussions about improving the care delivered to vulnerable childre

The use of normothermic liver preservation in combined liver and lung transplantation: A single-center experience

Combined liver and lung transplantation (CLLT) is indicated in patients with both end-stage liver and lung disease. Ex-situ normothermic machine perfusion (NMP) has been previously used for extended normothermic lung preservation in CLLT. We aim to describe our single-center experience using ex-situ NMP for extended normothermic liver preservation in CLLT. Four CLLTs were performed from 2019 to 2020 with the lung transplanted first for all patients. Median ex-situ pump time for the liver was 413 min (IQR 400-424). Over a median follow-up of 15 months (IQR 14-19), all patients were alive and doing well. Normothermic extended liver preservation is a safe method to allow prolonged cold ischemia using normothermic perfusion of the liver during CLLT

Combined liver and lung transplantation with extended normothermic liver preservation using TransmedicsOrgan Care System (OCS)™ liver: A single center experience

Combined liver-lung transplantation (CLLT) is indicated in patients who cannot survive single-organ transplantation alone. Ex-situ normothermic machine perfusion (NMP) has been used to increase the pool of suboptimal donors and has been previously used for extended normothermic lung preservation in CLLT. We aim to describe our single-center experience using the \u27Transmedics Organ Care System (OCS) ™ liver for extended normothermic liver preservation in CLLT. Results [Values shown as mean (standard deviation)]: Four CLLTs were performed from 2015 to 2020 including 3 male and 1 female recipients, age 50 (±13.7) years (Table 1). Indications for lung transplantation: (1) cystic fibrosis (CF), (1) severe bronchiectasis, and (2) interstitial pulmonary fibrosis. Indications for liver transplantation: (1) biliary cirrhosis secondary to CF, (1) autoimmune hepatitis, (1) alcoholic cirrhosis, and (1) cryptogenic cirrhosis. The lung was transplanted first for all patients. Recipient characteristics at transplant: Mean forced expiratory volume in 1 second (FEV1) was 51% (±22), and Model for End- Stage Liver Disease was 12 (±3.7). The livers were donated after brain death with donor age of 34 (±9.4) years and cold ischemia time 566 (±38) minutes. Ex-vivo pump time for the livers was 411 (±38) minutes (Table 2). Mean hospital stay was 34 days (±18). Over a median follow-up of 201 days, all patients were alive and doing well, while 50% had biopsy-proven acute cellular rejection of the liver. Conclusion: Normothermic extended liver preservation is a safe method to prolong perfusion time and preserve the liver during combined organ transplantation

EFSUMB Clinical Practice Guidelines for Point-of-Care Ultrasound:Part One (Common Heart and Pulmonary Applications) SHORT VERSION

Aims To evaluate the evidence and produce a summary and recommendations for the most common heart and lung applications of point-of-care ultrasound (PoCUS). Methods We reviewed 10 clinical domains/questions related to common heart and lung applications of PoCUS. Following review of the evidence, a summary and recommendation were produced, including assignment of levels of evidence (LoE) and grading of the recommendation, assessment, development, and evaluation (GRADE). 38 international experts, the expert review group (ERG), were invited to review the evidence presented for each question. A level of agreement of over 75 % was required to progress to the next section. The ERG then reviewed and indicated their level of agreement regarding the summary and recommendation for each question (using a 5-point Likert scale), which was approved if a level of agreement of greater than 75 % was reached. A level of agreement was defined as a summary of “strongly agree” and “agree” on the Likert scale responses. Findings and Recommendations One question achieved a strong consensus for an assigned LoE of 3 and a weak GRADE recommendation (question 1). The remaining 9 questions achieved broad agreement with one assigned an LoE of 4 and weak GRADE recommendation (question 2), three achieving an LoE of 3 with a weak GRADE recommendation (questions 3–5), three achieved an LoE of 3 with a strong GRADE recommendation (questions 6–8), and the remaining two were assigned an LoE of 2 with a strong GRADE recommendation (questions 9 and 10). Conclusion These consensus-derived recommendations should aid clinical practice and highlight areas of further research for PoCUS in acute settings