Development of an evidence-based framework of factors contributing to patient safety incidents in hospital settings: a systematic review

Objective The aim of this systematic review was to develop a ‘contributory factors framework’ from a synthesis of empirical work which summarises factors contributing to patient safety incidents in hospital settings. Design A mixed-methods systematic review of the literature was conducted. Data sources Electronic databases (Medline, PsycInfo, ISI Web of knowledge, CINAHL and EMBASE), article reference lists, patient safety websites, registered study databases and author contacts. Eligibility criteria Studies were included that reported data from primary research in secondary care aiming to identify the contributory factors to error or threats to patient safety. Results 1502 potential articles were identified. 95 papers (representing 83 studies) which met the inclusion criteria were included, and 1676 contributory factors extracted. Initial coding of contributory factors by two independent reviewers resulted in 20 domains (eg, team factors, supervision and leadership). Each contributory factor was then coded by two reviewers to one of these 20 domains. The majority of studies identified active failures (errors and violations) as factors contributing to patient safety incidents. Individual factors, communication, and equipment and supplies were the other most frequently reported factors within the existing evidence base. Conclusions This review has culminated in an empirically based framework of the factors contributing to patient safety incidents. This framework has the potential to be applied across hospital settings to improve the identification and prevention of factors that cause harm to patients

Measuring the built environment in studies of child health – a meta-narrative review of associations

Although the built environment (BE) is important for children’s health there is little consensus about which features are most important due to differences in measurement and outcomes across disciplines. This meta-narrative re-view was undertaken by a multi-disciplinary team of researchers to summarise ways in which BE are measured, and how these link to children’s health. A structured search of four databases across the relevant disciplines retrieved 108 relevant references. The health-related outcomes most commonly addressed were active travel, physical activ-ity and play, and obesity. Many studies used objective (GIS and street audits) or standardised subjective (per-ceived), measurements of the built environment. However, there was a wide variety, and sometimes inconsistency, in their use. There were clear associations between the BE and health. Objective physical activity and self-reported active travel were positively associated with higher street connectivity or walkability measures; while self-reported physical activity and play had the strongest association with reduced street connectivity, indicated by quieter, one-way streets. Future research should implement consistent BE measures to ensure key features are explored. A systems approach will be particularly relevant for addressing place-based health inequalities, given potential un-intended health consequences of making changes to the built environment

Differences in public's perception of air quality and acceptability of a clean air zone : A mixed-methods cross sectional study

Background: Air pollution is a major cause of morbidity and mortality. Clean Air Zones (CAZs) which restrict the entry of polluting vehicles in targeted areas have been identified as potentially effective in improving health and reducing air pollution; however, their implementation can be controversial. Methods: A cross-sectional survey was completed by 1949 respondents who lived or worked in Bradford, a multi-cultural deprived city in England, between April and December 2021. Of these, 1137 were recruited from the longitudinal Born in Bradford (BiB) family cohort (families with children born in the city during 2007–2011) and 812 were from the general public. Bradford is the seventh largest metropolitan district in England and Wales with a population of over half a million mainly white British and Pakistani origin. The BiB families cohort and the general public respondents were used for descriptive analysis of perception of air quality and acceptability of CAZ, then the relationship between participants responses with demographic characteristics were investigated using the BiB families cohort. Outcomes included perceptions of air quality and acceptability of the CAZ supplemented by free-text questions. Thematic analysis was used to code free-text data. Descriptive analyses were performed on the entire sample. Latent class analysis was used to characterise participants was performed in the BiB dataset for whom detailed existing socio-demographic data were available. Results: The majority of participants (67%) considered improving air quality in Bradford as extremely important; 70% supported implementation of the CAZ. Three latent classes were identified within the BiB sample: deprived white British families (25%), more affluent white British families (32%) and deprived Pakistani-origin families (43%). Deprived white British (OR = 0.54, 95% CI: 0.34 to 0.84) and more affluent white British families (OR = 0.53, 95% CI: 0.36 to 0.79) were less likely to say the air quality was good/excellent when compared with deprived Pakistani-origin families. Affluent White British families were more likely to support the CAZ compared with deprived white British families (OR = 2.24; 95% CI: 1.55. to 3.25) and deprived Pakistani-origin families (OR = 2.06, 95% CI: 1.50 to 2.85). Qualitative analysis suggested that a perceived lack of cohesion in the policy and concerns about financial impacts drove negative attitudes. Conclusion: Families in Bradford were generally supportive of the planned CAZ and efforts to reduce pollution; however, support was weaker in more deprived communities. Pakistani-origin communities living in deprived areas perceived air quality as better than other groups. Tailored approaches to communicate about the proposed benefits of policies such as CAZ prior to implementation may be an important way to increase acceptability amongst vulnerable groups

Associations between park features, park satisfaction and park use in a multi-ethnic deprived urban area

Parks are increasingly understood to be key community resources for public health, particularly for ethnic minority and low socioeconomic groups. At the same time, research suggests parks are underutilised by these groups. In order to design effective interventions to promote health, the determinants of park use for these groups must be understood.This study examines the associations between park features, park satisfaction and park use in a deprived and ethnically diverse sample in Bradford, UK. 652 women from the Born in Bradford cohort completed a survey on park satisfaction and park use. Using a standardised direct observation tool, 44 parks in the area were audited for present park features. Features assessed were: access, recreational facilities, amenities, natural features, significant natural features, non-natural features, incivilities and usability. Size and proximity to the park were also calculated. Multilevel linear regressions were performed to understand associations between park features and (1) park satisfaction and (2) park use. Interactions between park features, ethnicity and socioeconomic status were explored, and park satisfaction was tested as a mediator in the relationship between park features and park use.More amenities and greater usability were associated with increased park satisfaction, while more incivilities were negatively related to park satisfaction. Incivilities, access and proximity were also negatively associated with park use. Ethnicity and socioeconomic status had no moderating role, and there was no evidence for park satisfaction as a mediator between park features and park use.Results suggest diverse park features are associated with park satisfaction and park use, but this did not vary by ethnicity or socioeconomic status. The reduction of incivilities should be prioritised where the aim is to encourage park satisfaction and park use

PDT in the Thoracic Cavity: Spectroscopic Methods and Fluence Modeling for Treatment Planning

PDT for the thoracic cavity provides a promising cancer treatment modality, but improvements in treatment planning, particularly in PDT dosimetry, can be made to improve uniformity of light delivery. When a cavity of arbitrary geometry is illuminated, the fluence increases due to multiple-scattered photons, referred to as the Integrating Sphere Effect (ISE). Current pleural PDT treatment protocol at the University of Pennsylvania monitors light fluence (hereafter simply fluence, measured in W/cm2) via seven isotropic detectors sutured at different locations in thoracic cavity of a patient. This protocol monitors light at discrete locations, but does not provide a measurement of fluence for the thoracic cavity as a whole. Current calculation of light fluence includes direct light only and thus does not account for the unique optical properties of each tissue type present, which in turn affects the accuracy of the calculated light distribution in the surrounding tissue and, in turn, the overall cell death and treatment efficacy. Treatment planning for pleural PDT can be improved, in part, by considering the contribution of scattered light, which is affected by the two factors of geometry and in vivo optical properties. We expanded the work by Willem Star in regards to the ISE in a spherical cavity. A series of Monte Carlo (MC) simulations were run for semi-infinite planar, spherical, and ellipsoidal geometries for a range of optical properties. The results of these simulations are compared to theory and numerical solutions for fluence in the cavity and at the cavity-medium boundary. The development via MC simulations offers a general method of calculating the required light fluence specialized to each patient, based on the treatment surface area. The scattered fluence calculation is dependent on in vivo optical properties (μa and μs\u27) of the tissues treated. Diffuse reflectance and fluorescence spectroscopy methods are used to determine the optical properties and oxygenation (reflectance measurements) and drug concentration (fluorescence measurements) of different tissues in vivo, before and after treatment, in patients enrolled the Phase I HPPH study ongoing at the University of Pennsylvania. This work aims to provide the building blocks essential to pleural PDT treatment planning by more accurately calculating the required fluence using a model that accounts for the effects of treatment geometry and optical properties measured in vivo

Explaining variable effects of an adaptable implementation package to promote evidence-based practice in primary care : a longitudinal process evaluation

This study is funded by the National Institute for Health Research (NIHR) [Programme Grants for Applied Research (Grant Reference Number RP-PG-1209-10040)] (https://www.nihr.ac.uk/).Background Implementing evidence-based recommendations is challenging in UK primary care, especially given system pressures and multiple guideline recommendations competing for attention. Implementation packages that can be adapted and hence applied to target multiple guideline recommendations could offer efficiencies for recommendations with common barriers to achievement. We developed and evaluated a package of evidence-based interventions (audit and feedback, educational outreach and reminders) incorporating behaviour change techniques to target common barriers, in two pragmatic trials for four “high impact” indicators: risky prescribing; diabetes control; blood pressure control; and anticoagulation in atrial fibrillation. We observed a significant, cost-effective reduction in risky prescribing but there was insufficient evidence of effect on the other outcomes. We explored the impact of the implementation package on both social processes (Normalisation Process Theory; NPT) and hypothesised determinants of behaviour (Theoretical Domains Framework; TDF). Methods We conducted a prospective multi-method process evaluation. Observational, administrative and interview data collection and analyses in eight primary care practices were guided by NPT and TDF. Survey data from trial and process evaluation practices explored fidelity. Results We observed three main patterns of variation in how practices responded to the implementation package. First, in integration and achievement, the package “worked” when it was considered distinctive and feasible. Timely feedback directed at specific behaviours enabled continuous goal setting, action and review, which reinforced motivation and collective action. Second, impacts on team-based determinants were limited, particularly when the complexity of clinical actions impeded progress. Third, there were delivery delays and unintended consequences. Delays in scheduling outreach further reduced ownership and time for improvement. Repeated stagnant or declining feedback that did not reflect effort undermined engagement. Conclusions Variable integration within practice routines and organisation of care, variable impacts on behavioural determinants, and delays in delivery and unintended consequences help explain the partial success of an adaptable package in primary care.Publisher PDFPeer reviewe

The patient reporting and action for a safe environment (PRASE) intervention: a feasibility study

Background: There is growing interest in the role of patients in improving patient safety. One such role is providing feedback on the safety of their care. Here we describe the development and feasibility testing of an intervention that collects patient feedback on patient safety, brings together staff to consider this feedback and to plan improvement strategies. We address two research questions: i) to explore the feasibility of the process of systematically collecting feedback from patients about the safety of care as part of the PRASE intervention; and, ii) to explore the feasibility and acceptability of the PRASE intervention for staff, and to understand more about how staff use the patient feedback for service improvement. Method: We conducted a feasibility study using a wait-list controlled design across six wards within an acute teaching hospital. Intervention wards were asked to participate in two cycles of the PRASE (Patient Reporting & Action for a Safe Environment) intervention across a six-month period. Participants were patients on participating wards. To explore the acceptability of the intervention for staff, observations of action planning meetings, interviews with a lead person for the intervention on each ward and recorded researcher reflections were analysed thematically and synthesised. Results: Recruitment of patients using computer tablets at their bedside was straightforward, with the majority of patients willing and able to provide feedback. Randomisation of the intervention was acceptable to staff, with no evidence of differential response rates between intervention and control groups. In general, ward staff were positive about the use of patient feedback for service improvement and were able to use the feedback as a basis for action planning, although engagement with the process was variable. Gathering a multidisciplinary team together for action planning was found to be challenging, and implementing action plans was sometimes hindered by the need to co-ordinate action across multiple services. Discussion: The PRASE intervention was found to be acceptable to staff and patients. However, before proceeding to a full cluster randomised controlled trial, the intervention requires adaptation to account for the difficulties in implementing action plans within three months, the need for a facilitator to support the action planning meetings, and the provision of training and senior management support for participating ward teams. Conclusions: The PRASE intervention represents a promising method for the systematic collection of patient feedback about the safety of hospital care

Maternal psychological distress in primary care and association with child behavioural outcomes at age three

Observational studies indicate children whose mothers have poor mental health are at increased risk of socio-emotional behavioural difficulties, but it is unknown whether these outcomes vary by the mothers’ mental health recognition and treatment status. To examine this question, we analysed linked longitudinal primary care and research data from 1078 women enrolled in the Born in Bradford cohort. A latent class analysis of treatment status and self-reported distress broadly categorised women as (a) not having a common mental disorder (CMD) that persisted through pregnancy and the first 2 years after delivery (N = 756, 70.1 %), (b) treated for CMD (N = 67, 6.2 %), or (c) untreated (N = 255, 23.7 %). Compared to children of mothers without CMD, 3-year-old children with mothers classified as having untreated CMD had higher standardised factor scores on the Strengths and Difficulties Questionnaire (d = 0.32), as did children with mothers classified as having treated CMD (d = 0.27). Results were only slightly attenuated in adjusted analyses. Children of mothers with CMD may be at risk for socio-emotional and behavioural difficulties. The development of effective treatments for CMD needs to be balanced by greater attempts to identify and treat women. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1007/s00787-015-0777-2) contains supplementary material, which is available to authorized users