Estonian adverse events study for multimorbid patients using Estonian Trigger Tool (MUPETT-MUltimorbid Patients-Estonian Trigger Tool). Development of Estonian trigger tool for multimorbid patients. A study protocol for mixed-methods study

It is widely recognized that providing healthcare may produce harm to the patient. Different approaches have been developed to measure the burden of adverse events (AEs) to plan and measure the effects of interventions. One of the most widely used instruments is the Trigger Tool, which has previously been modified to be used on various settings and translated into many languages. Multimorbidity complicates care and may increase the number of AEs patients experience. Currently there is no instrument designed to measure AEs in multimorbid patients. In Estonia, there is currently no validated instrument to measure the burden of AEs. The aim of this study will be evaluating the characteristics and ocurrence of AEs in multimorbid patients in hospitalised internal medicine patients of Estonia, and describes the development of a trigger tool for this purpose. We will search for the evidence on measuring AEs in the population of multimorbid patients focusing on trigger tools, and synthesize the data. Data collection of the triggers from the literature will be followed by translating triggers from English to Estonian. An expert multidisciplinary panel will select the suitable triggers for this population. Trigger tool will be pre-tested to assess agreement among professionals and usability of the tool. Validation will be done using 90 medical records. A cross-sectional study in internal medicine departments of two Estonian tertiary care hospitals will be performed to identify the frequency and characteristics of AEs in 960 medical records. We will also provide preventability potential and influencing factors. Results will be disseminated to healthcare providers and stakeholders at national and international conferences, and as a doctoral medical thesis

"It's like two worlds apart": an analysis of vulnerable patient handover practices at discharge from hospital.

BACKGROUND: Handover practices at hospital discharge are relatively under-researched, particularly as regards the specific risks and additional requirements for handovers involving vulnerable patients with limited language, cognitive and social resources. OBJECTIVE: To explore handover practices at discharge and to focus on the patients' role in handovers and on the potential additional risks for vulnerable patients. METHODS: We conducted qualitative interviews with patients, hospital professionals and primary care professionals in two hospitals and their associated primary care centres in Catalonia, Spain. RESULTS: We identified handover practices at discharge that potentially put patients at risk. Patients did not feel empowered in the handover but were expected to transfer information between care providers. Professionals identified lack of medication reconciliation at discharge, loss of discharge information, and absence of plans for follow-up care in the community as quality and safety problems for discharge handovers. These occurred for all patients, but appeared to be more frequent and have a greater negative effect in patients with limited language comprehension and/or lack of family and social support systems. CONCLUSIONS: Discharge handovers are often haphazard. Healthcare professionals do not consider current handover practices safe, with patients expected to transfer information without being empowered to understand and act on it. This can lead to misinformation, omission or duplication of tests or interventions and, potentially, patient harm. Vulnerable patients may be at greater risk given their limited language, cognitive and social resources. Patient safety at discharge could benefit from strategies to enhance patient education and promote empowerment

CLAS App ML

This is a multi-language (ML) update of the CLAS App original design by Bridget Maher from the School of Medicine at University College Cork, Ireland. The current version has an improve counting mechanism and has been translated from English to Spanish, Catalan and German languages within the European project PATIENT (www.patient-project.eu). The CLAS App ML aims to train good written communication skills as they are essential to the practice of medicine and avoidance of medical error. The hospital discharge letter is probably the most important of all written communications between hospital and General Practitioner (Family Doctors). However, discharge letters vary greatly in quality, structure, cohesion, and ‘readability’. Most discharge letters are written by junior doctors and frequently omit important information. The School of Medicine at University College Cork developed a comprehensive check-list i-phone application to improve the quality of hospital discharge letters. The CLAS scale lists the key elements of a discharge letter - reason for admission, investigations, results, diagnosis, problem list, medications, management plan, name and contact details of doctor writing the letter etc. There are 4 pages of items, divided into various sections. Either a section heading or an individual item can be ticked. Most items score 1, but some items of particular importance, such as medication, score higher. Total CLAS score is 50. At the end, the user is shown his total score and can swipe to see a list of unchecked items. By using the CLAS application as a point-of-practice reference tool, doctors and medical students can improve their letter-writing skills, decrease the risk of medical error and improve patient safety. With the new version CLAS App ML we aim to provide a standard within Europe for the structure of hospital discharge letter. Therefore, the App has been translated to 3 new languages.This work has been partly funded by the Patient Project (with support from the European Commission. 527620-LLP-1-2012-1-NLERASMUS-FEXI, http://patient-project.eu/

"Adiós Bacteriemias": a multi-country quality improvement collaborative project to reduce the incidence of CLABSI in Latin American ICUs

Quality Problem: The incidence of central line-associated bloodstream infections (CLABSI) in Latin America has been estimated at 4.9 episodes per 1000 central line (CL) days, compared to a pooled incidence of 0.9 in the United States. CLABSI usually result from not adhering to standardized health procedures and can be prevented using evidence-based practices. Initial Assessment: The first phase of the ?Adiós Bacteriemias? Collaborative was implemented in 39 intensive care units (ICUs) from Latin America from September 2012 to September 2013 with a 56% overall reduction in the incidence of CLABSI. Choice of Solution: Bundles of care for the processes of insertion and maintenance of CLs have proven to be effective in the reduction of CLABSI across different settings. Implementation: Building on the results of the first phase, we implemented a second phase of the ?Adiós Bacteriemias? Collaborative between June 2014-July 2015. We adapted the Breakthrough Series (BTS) Collaborative model to guide the adoption of bundles of care for CLABSI prevention through virtual learning sessions and continuous feedback. Evaluation: Eighty-three ICUs from five Latin American countries actively reported process and outcome measures. The overall reduction in the CLABSI incidence rate was 22% (incidence rate 0.78; 95% CI 0.65, 0.95), from 2.58 episodes per 1000 CL days at baseline to 2.02 episodes per 1000 CL days (P < 0.01) during the intervention period. Lessons Learned: Adiós Bacteriemias was effective in reducing the incidence of CLABSI and improving the adherence to good practices for CL insertion and maintenance processes in participating ICUs in Latin America.Fil: Arrieta, Jafet. Harvard University. Harvard School of Public Health; Estados UnidosFil: Orrego, Carola. Fundacion Avedis Donabedian; EspañaFil: Macchiavello, Dolores. Instituto Alexander Fleming; ArgentinaFil: Mora, Nuria. Fundacion Avedis Donabedian; EspañaFil: Delgado, Pedro. Harvard University. Harvard School of Public Health; Estados UnidosFil: Giuffré, Carolina. Hospital Británico de Buenos Aires; ArgentinaFil: Garcia Elorrio, Ezequiel. Hospital Alemán; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Rodriguez, Viviana. Hospital Alemán; Argentin