Physicians� perspectives on causes of health care errors and preventive strategies: A study in a developing country

Background: To prevent health care errors, the main causes and preventive strategies should be identified. The purpose of this study was to identify the causes and preventive strategies of health care errors from the perspectives of physicians. Methods: We surveyed 250 randomly selected physicians in five teaching hospitals in Tehran, Iran, in 2015. We used a questionnaire with 29 questions regarding causes and 17 ones regarding the preventive strategies. The participants were asked to answer the questions based on Likert�s five-point score (1=very low to 5= very high). The data was analyzed using descriptive (frequency, and mean scores) and inferential statistics in SPSS. Results: Managerial factors (3.6±0.7), personal factors of providers (3.5±0.6), factors related to the patients (3.4±0.71), and the factors pertinent to laboratory and pharmacy (3.2±0.8) were the main causes respectively. The most important preventive strategies were improvement of academic education, better taking past medical history, implementing electronic prescription and increasing healthcare budget. Conclusion: Heavy workloads, long work shifts, failure to do thorough examination and to collect detailed history information, providers� fatigue, patients� reluctance to follow orders or to give their complete information, failure to give detailed instruction to patients about the medications, lack or insufficient monitoring and supervising systems, and lack of enough budget were some of the most important causes of errors. Using IT to access patients� information, improving patients� adherence, reducing workload, developing efficient methods for collecting patients� information, dedicating adequate budget for improvement programs are recommended. © 2018, Iranian Journal of Public Health. All rights reserved

Physicians� perspectives on causes of health care errors and preventive strategies: A study in a developing country

Background: To prevent health care errors, the main causes and preventive strategies should be identified. The purpose of this study was to identify the causes and preventive strategies of health care errors from the perspectives of physicians. Methods: We surveyed 250 randomly selected physicians in five teaching hospitals in Tehran, Iran, in 2015. We used a questionnaire with 29 questions regarding causes and 17 ones regarding the preventive strategies. The participants were asked to answer the questions based on Likert’s five-point score (1=very low to 5= very high). The data was analyzed using descriptive (frequency, and mean scores) and inferential statistics in SPSS. Results: Managerial factors (3.6±0.7), personal factors of providers (3.5±0.6), factors related to the patients (3.4±0.71), and the factors pertinent to laboratory and pharmacy (3.2±0.8) were the main causes respectively. The most important preventive strategies were improvement of academic education, better taking past medical history, implementing electronic prescription and increasing healthcare budget. Conclusion: Heavy workloads, long work shifts, failure to do thorough examination and to collect detailed history information, providers’ fatigue, patients’ reluctance to follow orders or to give their complete information, failure to give detailed instruction to patients about the medications, lack or insufficient monitoring and supervising systems, and lack of enough budget were some of the most important causes of errors. Using IT to access patients’ information, improving patients’ adherence, reducing workload, developing efficient methods for collecting patients’ information, dedicating adequate budget for improvement programs are recommended. Keywords: Medical error, Healthcare error, Patient safety, Physician

Physicians� perspectives on causes of health care errors and preventive strategies: A study in a developing country

Background: To prevent health care errors, the main causes and preventive strategies should be identified. The purpose of this study was to identify the causes and preventive strategies of health care errors from the perspectives of physicians. Methods: We surveyed 250 randomly selected physicians in five teaching hospitals in Tehran, Iran, in 2015. We used a questionnaire with 29 questions regarding causes and 17 ones regarding the preventive strategies. The participants were asked to answer the questions based on Likert�s five-point score (1=very low to 5= very high). The data was analyzed using descriptive (frequency, and mean scores) and inferential statistics in SPSS. Results: Managerial factors (3.6±0.7), personal factors of providers (3.5±0.6), factors related to the patients (3.4±0.71), and the factors pertinent to laboratory and pharmacy (3.2±0.8) were the main causes respectively. The most important preventive strategies were improvement of academic education, better taking past medical history, implementing electronic prescription and increasing healthcare budget. Conclusion: Heavy workloads, long work shifts, failure to do thorough examination and to collect detailed history information, providers� fatigue, patients� reluctance to follow orders or to give their complete information, failure to give detailed instruction to patients about the medications, lack or insufficient monitoring and supervising systems, and lack of enough budget were some of the most important causes of errors. Using IT to access patients� information, improving patients� adherence, reducing workload, developing efficient methods for collecting patients� information, dedicating adequate budget for improvement programs are recommended. © 2018, Iranian Journal of Public Health. All rights reserved

Technical requirements framework of hospital information systems: Design and evaluation

Background: Implementing the health information system (HIS) is more complex and costly than implementing other information systems. The present study was conducted to design and evaluate technical requirements for the HIS. Methods: The present study was conducted in 2016 by determining technical requirements for the HIS using the Delphi technique and then evaluating this system using a checklist based on the approved requirements. Results: The first part of the study designed a 73-item final list of technical requirements for the HIS in four domains, i.e. communication service, system architecture, security service and system response time. The evaluation results obtained in the second part showed that communication service was met in 63.8 of the HIS programs, system architecture in 65.5, security service in 72.4 and system response time in 76.3. Conclusions: A technical evaluation tool was designed and used to select and evaluate the HIS. The evaluation results suggested the study HIS was poorer in terms of communication service and system architecture than in the other two dimensions. © 2020 The Author(s)

Perceived Quality of Informed Refusal Process: A Cross-Sectional Study from Iranian Patients' Perspectives

Patients have the right to refuse their treatment; however, this refusal should be informed. We evaluated the quality of the informed refusal process in Iranian hospitals from patients' viewpoints. To this end, we developed a questionnaire that covered four key aspects of the informed refusal process including; information disclosure, voluntariness, comprehension, and provider-patient relationship. A total of 284 patients who refused their treatment from 12 teaching hospitals in the Isfahan Province, Iran, were recruited and surveyed to produce a convenience sample. Patients' perceptions about the informed refusal process were scored and the mean scores of the four components were calculated. The findings showed that the practice of information disclosure (9.6±6.4 out of 22 points) was perceived to be moderate, however, comprehension (2.3±1.4 out of 4 points), voluntariness (8.7±1.5 out of 12 points) and provider-patient relationship (10.2±5.2 out of 16 points) were perceived to be relatively good. We found that patients, who refused their care before any treatment had commenced, reported a lower quality of information disclosure and voluntariness. Patients informed by nurses and those who had not had a previous related admission, reported lower scores for comprehension and relationship. In conclusion, the process of obtaining informed refusal was relatively satisfactory except for levels of information disclosure. To improve current practices, Iranian patients need to be better informed about; different treatment options, consequences of treatment refusal, costs of not continuing treatment and follow-ups after refusal. Developing more informative refusal forms is needed. © 2015 John Wiley & Sons Ltd

Task-specific usability requirements of electronic medical records systems: Lessons learned from a national survey of end-users

Background: There are various approaches to evaluating the usability of electronic medical record (EMR) systems. User perspectives are an integral part of evaluation. Usability evaluations efficiently and effectively contribute to user-centered design and supports tasks and increase user satisfaction. This study determined the main usability requirements for EMRs by means of an end-user survey. Method: A mixed-method strategy was conducted in three phases. A qualitative approach was employed to collect and formulate EMR usability requirements using the focus group method and the modified Delphi technique. Classic Delphi technique was used to evaluate the proposed requirements among 380 end-users in Iran. Results: The final list of EMR usability requirements was verified and included 163 requirements divided into nine groups. The highest rates of end-user agreement relate to EMR visual clarity (3.65 ± 0.61), fault tolerance (3.58 ± 0.56), and suitability for learning (3.55 ± 0.54). The lowest end-user agreement was for auditory presentation (3.18 ± 0.69). Conclusion: The highest and lowest agreement among end-users was for visual clarity and auditory presentation by EMRs, respectively. This suggests that user priorities in determination of EMR usability and their understanding of the importance of the types of individual tasks and context characteristics differ

Nursing Information Systems Requirements: A Milestone for Patient Outcome and Patient Safety Improvement

Considering the integral role of understanding users� requirements in information system success, this research aimed to determine functional requirements of nursing information systems through a national survey. Delphi technique method was applied to conduct this study through three phases: focus group method modified Delphi technique and classic Delphi technique. A cross-sectional study was conducted to evaluate the proposed requirements within 15 general hospitals in Iran. Forty-three of 76 approved requirements were clinical, and 33 were administrative ones. Nurses� mean agreements for clinical requirements were higher than those of administrative requirements; minimum and maximum means of clinical requirements were 3.3 and 3.88, respectively. Minimum and maximum means of administrative requirements were 3.1 and 3.47, respectively. Research findings indicated that those information system requirements that support nurses in doing tasks including direct care, medicine prescription, patient treatment management, and patient safety have been the target of special attention. As nurses� requirements deal directly with patient outcome and patient safety, nursing information systems requirements should not only address automation but also nurses� tasks and work processes based on work analysis. Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved

Designing and evaluating functional laboratory information system requirements integrated to hospital information systems

Rationale, aims, and objectives: Laboratory information sub-systems play an important role in diagnosis and treatment of patients. This study aimed to determine functional requirements of users and assess the existence of these requirements in the laboratory information system. Method: This descriptive cross-sectional study was conducted in 2016 in two phases. The first phase was done through three stages. First, based on an unsystematic review of related literature, an outline of functional laboratory information system requirements was identified. In the second stage, these requirements were identified in group meetings in the form of a semi-structured questionnaire and given to experts. Then, modified Delphi technique was used to reach agreement on each item. Then, based on experts' comments, the final version of the questionnaire was presented including 61 closed-ended items using Likert scale and an open-ended item. It was surveyed by 50 experts using Delphi technique. Responses were scored, and the requirements whose mean final score was 3 and above were finally confirmed. In the second phase, based on the confirmed requirements, a checklist comprising 68 requirements was prepared and adopted hospital information systems were evaluated through researcher observation. Data were analysed using descriptive statistics. Results: The final list of functional laboratory information system requirements was prepared with 68 items. The results of the evaluation revealed that confirmed requirements existed in 58.8 of hospital information systems. Conclusion: Laboratory information system requirements were designed with 68 items. Evaluation results showed that the systems were moderate in terms of compliance with the requirements. © 2018 John Wiley & Sons, Ltd

Investigating the satisfaction level of physicians in regards to implementing medical Picture Archiving and Communication System (PACS)

Background: User satisfaction with PACS is considered as one of the important criteria for assessing success in using PACS. The objective of this study was to determine the level of user satisfaction with PACS and to compare its functional features with traditional film-based systems. Methods: This study was conducted in 2017. Residents at three large university hospitals in Kerman filled-out a self-administered questionnaire consisting of three parts: demographic information of participants, user satisfaction with PACS, comparing features of the two digital and traditional imaging systems. The validity of this questionnaire was approved by five medical informatics, radiology, and health information management specialists and its reliability was confirmed by Cronbach's alpha (86). Data were analyzed using descriptive statistics and the Spearman, Mann Whitney U and Kruskal-Wallis statistical tests. Results: The mean of the participants' ages was 31.4 (±4.4) years and 59 of the participants were females. The mean of physicians' satisfaction with PACS' had no significant relationship with their age (P = 0.611), experience of using PACS (P = 0.301), specialty (P = 0.093), and percent of interpretation of images with PACS (P = 0.762). It had a significant relationship with the participants' computer skills (P = 0.022). Conclusions: The mean of physicians' satisfaction with PACS was at a moderate to a high level, yet there are still problems in the successful implementation of these systems and establishing interoperability between them. PACS has not fully met all the demands of physicians and has not achieved its predetermined objectives, such as all-access from different locations. © 2020 The Author(s)

The relationship between user interface problems of an admission, discharge and transfer module and usability features: A usability testing method

Background: The admission, discharge and transfer (ADT) module is used in the hospital information system (HIS) for the purposes of managing appointments, patient admission, daily control of hospital beds, planning surgery procedures, keeping up-to-date on patient discharges, and registering patient transfers within or outside the hospital. The present study aimed to evaluate the usability of ADT module of a HIS through usability testing and assess the relationship between the number of user interface problems and usability features (i.e. effectiveness, efficiency, and satisfaction). Methods: This descriptive analytical study was conducted in Shahid Beheshti hospital in Kashan, Iran, in 2017. The participating users were eight students in their last semester of a Bachelor of Health Information Technology Sciences degree. First, the users were introduced to the module functions in a two-hour session; ten days later, the users were asked to perform scenarios designed based on seven tasks and take notes of the problems encountered in performing each task after it was over. Effectiveness was measured based on the rate of completing the tasks, efficiency based on the time taken to perform each task, and satisfaction based on the users' answers to a satisfaction questionnaire. The relationship between these three usability features and the number of problems noted was assessed using Spearman's test in SPSS version 16. Results: Thirteen unique usability problems were identified from the perspective of the users. Effectiveness was rated as 58.9, efficiency as 53.3, and mean user satisfaction as 53.4 ± 10.6. The number of problems in each task had significant relationships to the effectiveness (P = 0.009) and efficiency (P = 0.016) scores. User satisfaction also had a significant relationship with the effectiveness (P = 0.043) but not with the efficiency (P = 0.230) scores. Conclusions: In the view of the potential users, a HIS, used in more than 200 hospitals in a developing country, has several usability problems in its ADT module and its effectiveness, efficiency, and user satisfaction were not acceptable. The number of usability problems in the HIS user interface affected the effectiveness, efficiency and user satisfaction of the system. © 2019 The Author(s)