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WORLD HOSPITAL DIRECTORY
Health Care Management Medical International Journal for Quality in Health Care - current issue
<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Background</div>Increasing the use of independent providers has been proposed as a solution to the long waiting times at public hospitals generated by the postpandemic backlog for elective care. However, the profit-maximizing aims of some independent providers may risk cost-cutting behaviours and reduced care quality. Empirical evidence on the extent to which these concerns are borne out in practice is sparse. We aim to examine the quality of acute hospital care provided by the public and independent hospital sectors in England and explore the drivers of variation in quality.<div class="boxTitle">Methods</div>We construct a unique dataset collating publicly available Care Quality Commission (CQC) quality ratings of independent and public acute hospitals as of December 2022 and 2020. We link these to regional deprivation indices, population estimates, average household disposable incomes, and referral to treatment (RTT) data. We first categorize providers into National Health Service (NHS) and independent hospitals to analyse the association of ownership with quality ratings. To analyse ownership further, we then subcategorize independent hospitals further and consider whether the organization provides NHS-commissioned care. Thus, hospitals were categorized into seven mutually exclusive categories: NHS provider, commissioned charity, commissioned brand, commissioned independent other, noncommissioned charity, noncommissioned brand, and noncommissioned independent other. We use linear and ordered logistic regression models to assess the association of ownership with quality ratings. In supplementary analysis, we examine consistency over time by comparing the effects on 2022 ratings and 2020 ratings.<div class="boxTitle">Results</div>Of the 283 NHS hospitals, 47.3% (<span style="font-style:italic;">N</span> = 134) was rated ‘Good’ and 41.0% (<span style="font-style:italic;">N</span> = 116) was rated as ‘Requires Improvement’. Of the 453 independent hospitals, 82.3% (<span style="font-style:italic;">N</span> = 373) was rated ‘Good’ and 9.5% (<span style="font-style:italic;">N</span> = 43) was rated as ‘Requires Improvement’. On average, independent hospitals had 0.205 (Standard Error [SE] = 0.0581) higher category quality ratings than NHS providers. All types of NHS-commissioned independent sector hospitals had higher average quality ratings than NHS hospitals, as did noncommissioned branded hospitals. Quality ratings were negatively related to the number of different services provided, suggesting that specialization is associated with higher quality.<div class="boxTitle">Conclusion</div>We find higher quality ratings for independent providers providing NHS-funded care, branded providers, and providers with a narrower range of services. We find no evidence to suggest that outsourced patients will experience lower quality care, although cream-skimming could still be detrimental for NHS services if they are left with a more complex case mix. Overall, our results taken together suggest that the increasing number of NHS patients treated in the independent sector does not experience a worse quality of care, especially if providers specialize in a limited number of services.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Background</div>Medication safety remains a global concern, with governments and organizations striving to mitigate preventable patient harm across healthcare systems. Look-alike, sound-alike medication incidents and the safety culture are widely acknowledged as a contributor to medication errors, particularly within the high-risk perioperative environment. The Medication Safety Culture Indicator Matrix (MedSCIM) is a novel tool developed by the Canadian Institute for Safe Medication Practices to assess the maturity of the medication safety culture. This study aims to delineate look-alike sound-alike (LASA) medication incidents reported in the pharmacy and perioperative settings of an Australian hospital and assess the maturity of the medication safety culture.<div class="boxTitle">Methods</div>The study setting is within a large regional hospital in Australia, servicing both adult and paediatric populations. Medication incidents from 1 April 2018 to 1 April 2023 were retrospectively gathered from the Clinical Incident Management System, Riskman®. Data and statistical analyses were carried out using Microsoft Excel®. The necessary approvals were secured from the Heath Service Human Research and Ethics Committee.<div class="boxTitle">Results</div>During the 5-year period, a total of 246 (4.1%) of the 6002 medication incidents within the health service were identified as meeting the inclusion criteria. Of the 246 medication incidents, 63.0% were identified from the Pharmacy Department, while 22.0% and 15.0% were from the Post Anaesthetic Care Unit and Anaesthetics Department, respectively. The most frequently reported incident classification in both the Anaesthetics Department and Post Anaesthetic Care Unit was ‘incorrect dose’, followed by ‘incorrect medication’. Throughout the 5-year period, 46 (18.7%) of the 246 medication incidents were attributed to look-alike, sound-alike sources of error, predominantly identified in the Pharmacy Department (73.9%), followed by the Anaesthetics Department (17.4%) and the Post Anaesthetic Care Unit (8.7%). High-risk medications were most frequently reported to the Anaesthetics Department. Packaging (packaging alone, naming and packaging, and syringe swaps) was determined to be a contributing factor in 30 (65.2%) of the 46 LASA medication incidents. MedSCIM assessment revealed a reactive medication safety culture. Additionally, the medication incident report documentation was found to be mostly complete or semi-complete.<div class="boxTitle">Conclusion</div>Our analysis delineated medication incidents occurring across the entire medication management cycle and identified incidents related to LASA medications as a contributor to medication incidents across these clinical settings. This novel medication safety culture tool assessment highlighted opportunities for improvement with clinical incident documentation.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Background</div>Despite the importance of hospital accreditation, its sustainability is jeopardized. This is due to the disparity between the rapid changes in the health sector and the accreditation standards that remain unchanged. This study aims to examine what improvements are important in enhancing the sustainability of the hospital accreditation model in Saudi Arabia.<div class="boxTitle">Methods</div>All quality managers in accredited Saudi Arabian hospitals were invited to participate in a cross‐sectional questionnaire-based study in July–August 2022. A structured questionnaire was developed, tested, piloted, and factorially validated using exploratory factor analysis. On a 5-point Likert scale, respondents were asked to rate the importance of recommended changes that are proposed to enhance the sustainability of accreditation policies, standards development, evaluation methods, and the evaluation team. The importance of the recommendations, according to the respondents, was described using the relative importance index, while multivariate linear regression was used to analyse the association with independent variables.<div class="boxTitle">Results</div>A total of 158 valid questionnaires (64% response rate) were included in the analysis. On average, participants had 6.9 (SD 2.1) years of experience in quality management. The overall mean importance attached to improving standards development, accreditation policies, evaluation team, and evaluation methods were 3.55, 3.43, 3.41, and 3.21, on a 5-point scale, respectively. Shifting the focus of accreditation standards from structure and compliance to outcomes and improvement (mean importance = 4.47), updating standards periodically to reflect current best practices and research (mean importance = 4.41), and integrating consumer perspectives in all aspects of accreditation (mean importance = 4.37) were the most important perceived recommendations. Multivariate regression analysis yielded that managers with more years of experience had significantly higher mean scores on the importance of improving accreditation policies (β = 0.120, <span style="font-style:italic;">P </span>= .037), standards development (β = 0.246, <span style="font-style:italic;">P </span>< .001), evaluation methods (β = 0.268, <span style="font-style:italic;">P </span>< .001), and the evaluation team (β = 0.369, <span style="font-style:italic;">P</span> < .001).<div class="boxTitle">Conclusions</div>Improving accreditation policies, standards development, evaluation methods, and the evaluation team are important in enhancing the sustainability of hospital accreditation programmes. This study offers insights to assist policymakers and other stakeholders in redesigning traditional accreditation models to make them more sustainable and that can supplement other performance improvement tools in improving the quality of healthcare services.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Background</div>Interprofessional team-based care has been known to aid in better patient-focused care and outcomes. However, the same concept in the space of bone marrow transplant (BMT) especially in this part of the world is currently elusive. This single-center experience from a BMT unit of India depicts the effectiveness of interdisciplinary care.<div class="boxTitle">Methods</div>An interdisciplinary team was built, and experts from different medical and allied specialties were onboarded along with establishment of state-of-the-art laboratories. Conceptualization of an integrative approach and development of HemeTEAM India began in 2020, and implementation in 2021. The evaluation of outcomes was performed on 31 December 2020 and on 31 July 2024 to compare the differences in outcomes after implementation of HemeTEAM India<div class="boxTitle">Results</div>A total of 550 transplants were conducted before 2021. From 2021 to 2024, 500 more transplants were done. The day 100 mortality, hospital acquired infection rate, and antibiotic stewardship reduced by ∼70% after 2021. The uptake of genomics-based testing increased to 95%, with genetically informed treatment in 65%. The average length of hospital stay reduced from 21 to 19 days and intensive care unit stay from 7 to 3 days. The net profit increased from 12% to 16%, with a cost benefit of ∼$10 000 to the patient.<div class="boxTitle">Conclusion</div>This is a single-center experience, depicting the effect of an integrative team base approach in a BMT unit providing holistic interdisciplinary care in India. This is the largest and the first of its kind hematology team in the country and South East Asia, where all aspects for a hematology/transplant patient are available in a single consultation</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Background</div>The COVID-19 pandemic significantly affected global healthcare systems, revealing their resilience to crises. Despite this, national-level research on its impact across key healthcare domains—such as acute and chronic disease management, cancer screening and care, mental health, and palliative care—is scarce. This study examines the pandemic’s impact on contacts, quality of care, and social disparity in these healthcare domains to guide better preparedness for future health emergencies.<div class="boxTitle">Methods</div>The study utilized data from the Danish National Clinical Quality Registries, covering January 2015 to June 2022, to create a nationwide cohort for comparing healthcare metrics across the pandemic’s phases and the prepandemic period. Healthcare contacts were assessed through descriptive analyses, while the quality of care and social disparities were analysed using multivariable regression models, providing estimated prevalence ratios and 95% confidence intervals.<div class="boxTitle">Results</div>The first wave of the COVID-19 pandemic in Denmark led to community and healthcare lockdowns, which were associated with fewer hospital contacts and reduced participation in national cancer screening programs. However, a gradual recovery towards prepandemic levels was found, with the exceptions of chronic obstructive pulmonary disease contacts and colorectal cancer incidence. Overall, the quality of care across various healthcare domains in Denmark remained largely unchanged or improved slightly during the pandemic. However, social disparities in contacts were increased across all examined healthcare domains, with patients who were immigrants, living alone, had limited educational level or low income experiencing reduced contact compared to the prepandemic period.<div class="boxTitle">Conclusions</div>Overall, the Danish healthcare system appeared to be resilient and largely unaffected throughout the pandemic, and the quality of care in several healthcare domains remained high. Nevertheless, the increasing social disparities in healthcare contacts during the pandemic demands attention. In preparing for future health crises, it is important to address and mitigate potential social inequalities, focusing on achieving equity in healthcare.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Introduction</div>Enhancing patient safety and minimizing medical errors are crucial in healthcare. While root cause analysis (RCA) is commonly used to investigate adverse events, its lack of human factor integration limits its effectiveness. The Human Factors Analysis and Classification System (HFACS), adapted from aviation to healthcare, systematically identifies human and organizational factors. However, the integration of HFACS into RCA and the impact of HFACS-RCA implementation remain underexplored. Therefore, this study aims to provide a practical case of HFACS integration into RCA and explore the effects of HFACS-RCA implementation.<div class="boxTitle">Methods</div>This study integrates HFACS into the RCA process at a medical center in Taiwan, examining an incident involving unsterilized instruments distributed from the Central Sterile Supply Room (CSR) to the Intensive Care Unit (ICU). This study employed a before-and-after study design to examine the impact of the HFACS-RCA intervention. The primary outcome measures were the changes in scores across the eight dimensions of the Taiwan Patient Safety Culture Survey (TPSC) before and after the intervention.<div class="boxTitle">Results</div>A 1-year follow-up of the CSR case showed no similar incidents. HFACS-RCA significantly improved TPSC scores in unit safety climate (<span style="font-style:italic;">P </span>= .05), feelings toward management (<span style="font-style:italic;">P </span>= .05), and job satisfaction (<span style="font-style:italic;">P </span>= 0.05), while the other dimensions showed no significant changes.<div class="boxTitle">Conclusion</div>HFACS-RCA application offers a comprehensive framework for identifying and mitigating factors contributing to medical errors, improving patient safety, and setting a precedent for future healthcare safety management research and practice.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Background</div>Various health screenings are conducted in South Korea, including state-supported national health screenings, privately funded comprehensive health screenings, and employment-related or industry-specific screenings. Given the various risks of patient safety incidents during the health screening process and the lack of studies of incidents in this environment, this study aimed to analyse the types and characteristics of reported patient safety incidents during health screenings, the distribution of harm, and the impact of the incident types on harm.<div class="boxTitle">Methods</div>We analysed patient safety incidents reported to the Korean Institute for Healthcare Accreditation (2017–22) using the World Health Organization’s framework for patient safety. We performed frequency analysis, chi-square tests, and binomial logistic regression analysis to identify the types and characteristics of reported patient safety incidents, the differences in the distribution of harm, and the impact of patient safety incident types on harm during health screenings.<div class="boxTitle">Results</div>A total of 213 cases were included in the analysis. Over half of the patient safety incidents during health screenings resulted in harm to the patient, and examination-related incidents were the most frequent type of incident. Furthermore, reported patient safety incidents were more likely to occur during regular working hours, in the examination room, in hospitals with over 500 beds, and amongst patients in their 50s, with no significant differences in sex distribution. Significant differences were observed in the distribution of harm according to incident types (<span style="font-style:italic;">P</span> <.001) and patient age (<span style="font-style:italic;">P</span> =.023). Controlling for patient and incident characteristics, the incident type was a determinant of harm. Amongst the incident types, medication/drug administration [adjusted odds ratio (aOR) = 29.730, 95% confidence interval (CI) = 6.081, 145.368], anaesthesia/sedation/treatments and procedures (aOR = 5.121, 95% CI = 1.002, 26.178), falls (aOR = 4.903, 95% CI = 2.022, 11.890), infections/injuries (aOR = 11.898, 95% CI = 1.082, 130.839), and other types of incidents (aOR = 8.719, 95% CI = 2.602, 29.212) increased the probability of harm compared to examination-related incidents.<div class="boxTitle">Conclusion</div>This study underscores the critical need to manage high-risk patient safety incidents and implement systemic harm reduction strategies during health screenings. Encouraging the reporting of incidents, including near misses, alongside developing targeted interventions, is essential for enhancing patient safety. Future research should leverage larger datasets, consistent classification systems, and standardized data collection to generalize findings and advance prevention strategies, thereby improving the quality and safety of health screening services.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Background</div>Stroke is globally one of the leading causes of mortality and disability. Adhering to evidence-based guidelines and protocols can improve the quality of care for ischaemic stroke patients. We aimed to compare the availability and content of specific protocols versus adherence to these key interventions in clinical daily practice among Flemish hospitals. We selected five key interventions for managing ischaemic stroke patients. These key interventions encompassed the measurement of body temperature, glycaemia monitoring, screening of swallowing function according to the Fever, Sugar, and Swallowing protocol (FeSS protocol), depression screening, and activities of daily living (ADL) screening (FeSS<sup>+</sup> key interventions).<div class="boxTitle">Methods</div>A systematic quantitative and qualitative approach was designed to analyse specific protocols from 24 hospitals. A predefined data extraction matrix for the five FeSS<sup>+</sup> key interventions was utilized for data collection. Using this matrix, protocols were scored according to the completeness of content, regarding the FeSS<sup>+</sup> interventions. These scores were used to calculate a total protocol content score, i.e. a total score for the five FeSS<sup>+</sup> interventions and an individual score for each key intervention separately, ranging between 0 and 1, per hospital. A score of 0 indicates absence of the FeSS<sup>+</sup> interventions in the protocols, while a score of 1 signifies complete coverage of these interventions. In addition, we assessed the correlation between the availability and content of these protocols in relation to the adherence to interventions documented for 30 patients per hospital.<div class="boxTitle">Results</div>The mean total protocol content score was 0.40 ± 0.20, ranging from 0.64 ± 0.25 for glycaemia management to 0.1 ± 0.28 for ADL screening. With regard to the individual FeSS<sup>+</sup> key interventions, we identified a correlation between protocol characteristics and adherence for glycaemia (<span style="font-style:italic;">r</span><sub>s</sub> = 0.42, <span style="font-style:italic;">P</span> = .04), depression screening (<span style="font-style:italic;">r</span><sub>s</sub> = 0.43, <span style="font-style:italic;">P</span> = .04), and ADL screening (<span style="font-style:italic;">r</span><sub>s</sub> = 0.44, <span style="font-style:italic;">P</span> = 0.03). Total FeSS<sup>+</sup>-protocol content also correlated with adherence (<span style="font-style:italic;">r</span> = 0.6140, <span style="font-style:italic;">P</span> = .0014).<div class="boxTitle">Conclusion</div>Protocol characteristics for the FeSS<sup>+</sup> key interventions were variable and rather limited, especially for ADL and depression screening. The identified relationship between the content of protocols and adherence to interventions underscores the value of defining these activities in hospital documentation to improve stroke care.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Background</div>Medications are a major cause of harm to patients in hospitals, and several studies have found that they cause approximately 20% of injuries that occur in medical institutions. It was found that the rate of adverse drug events (ADEs) in pediatric hospitalizations ranges from 11 to 40 events per 100 hospitalizations and 1% of cases caused death.<div class="boxTitle">Objectives</div>This is a comparative and retrospective study. The overarching objective is to adapt the Pediatric Trigger Tool (PTT) of the “Child Health Corporation of America” to pediatric wards in Israel, with the intention of using it to assess the rate of adverse events that occur during medication given in pediatric wards. The study characterized ADEs and examined the ability of the PTT to identify ADEs in relation to those that were voluntarily reported by the staff.<div class="boxTitle">Method</div>This study included internal and surgical pediatric wards at an academic pediatric medical center. The PTT was validated on medical record data from 700 hospitalizations between the years 2015 and 2017. The study also determined, among other things: the stage of drug administration at which the events occurred, the percentage of all events that could have been prevented, the degrees of damage the ADE caused and more.<div class="boxTitle">Results</div>The Positive Predictive Value of the customized tool stands at 16.91%. The study found 108 ADEs in 78 hospitalizations. The ADE rate per 100 hospitalizations was 15.4, the ADE rate per 1000 drug doses was 3.9, and the ADE rate per 1000 hospitalization days was 22.8, of which 18.5% were preventable. The category of drugs that led to the highest number of ADEs was painkillers. Those ADEs led to a large number of adverse clinical effects: constipation, hypokalemia, vomiting, and rash. The most common reason for coming to the hospital was suspicion or treatment of a hematologic disease, followed by hospitalization due to a burn. The customized tool found 10.8 times more ADEs than those reported voluntarily-subjectively by the clinical staff.<div class="boxTitle">Conclusions</div>The study found that, properly adapted, the PTT tool can be used to detect ADEs in internal and surgical pediatric wards.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Background</div>Medication administration in busy emergency departments (EDs) presents significant challenges due to the high-pressure environment and complexity of processes. Medication administration errors (MAEs) are a critical concern as they can severely impact patient safety and increase healthcare costs. Understanding the prevalence and underlying factors contributing to intravenous MAEs is essential for enhancing patient care and improving hospital services. This study aims to explore and measure the frequency of intravenous MAEs in EDs and identify factors contributing to these errors during their preparation and administration.<div class="boxTitle">Methods</div>This prospective study utilized the direct observation technique where the preparation and administration of 222 intravenous medications were observed in the EDs of two hospitals in Malaysia. Information on medication preparation, administration, and other procedures was recorded. Error rates were calculated, and multivariable logistic regression was conducted to identify factors contributing to intravenous MAEs.<div class="boxTitle">Results</div>MAEs were detected in 83.3% (185/222) of the observed medications affecting 86.7% (124/143) patients. Among these, a total of 240 MAEs were identified, with the most common being wrong rate of administration (55.8%), wrong preparation technique (20.8%), and omission error (11.7%). Alimentary tract and metabolism medications accounted for the highest proportion of MAEs (52.0%), followed by anti-infective medications (21.7%) and nervous system medications (15.4%). Excluding wrong time errors reduced the error rate to 80.2% (178/222). Nonverbal orders and inadequate or absence of labelling were significantly associated with MAEs, while factors such as the complexity of preparations, working shift, experience, and high-alert medications showed no significant associations.<div class="boxTitle">Conclusion</div>The study highlighted a high prevalence of intravenous MAEs in EDs. Nonverbal orders and inadequacy in labelling of medications were significant contributing factors to MAEs in the ED. Implementing an admixture labelling policy, comprehensive training programmes, strict enforcement of existing guidelines and protocols through regular audits, establishing nonpunitive error reporting system, and technological solutions where financially feasible are crucial for mitigating these errors to promote patient safety.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Background</div>Routine clinical debriefings (RCDs) have been shown to improve communication, team reflexivity, and safety in clinical settings. When combined with incident reports (IRs), RCDs offer a potential tool for enhancing quality improvement frameworks. This study aimed to identify and compare healthcare safety-related information captured through RCDs and IRs in a Belgian emergency department operating across two distinct facilities.<div class="boxTitle">Methods</div>This study employed a quasi-mixed-method design with a monostrand conversion approach. Information was collected from 90 RCDs and 263 IRs. Data were analyzed using two frameworks: the World Health Organization’s Incident Report Classification Grid and the Debriefing and Organizational Lessons Learned Grid.<div class="boxTitle">Results</div>The findings revealed significant differences in the types of information captured by RCDs and IRs. RCDs predominantly highlighted teamwork, internal organization, and procedural issues, while IRs focused more on care processes, patient concerns, and patient flow. These complementary insights demonstrate the value of integrating RCDs and IRs to create a comprehensive understanding of patient and clinician safety.<div class="boxTitle">Conclusions</div>This study highlights the complementary nature of RCDs and IRs in addressing healthcare safety. RCDs foster team reflexivity and promote open discussions about systemic challenges, directly improving team cohesion, resilience, and learning. Combining RCDs and IRs provides actionable insights for enhancing safety and driving organizational improvements.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div>Hospitals require continuous process optimization to ensure uninterrupted care. This study investigates the integration of Real-Time Locating Systems (RTLS) with logistics and dispatch management in a metropolitan hospital. The system, which tracks circulating beds and medical equipment, improves resource allocation, reduces inefficiencies, and enhances task distribution using wearable devices and big data analytics. Results showed a 20.9% reduction in delivery time, 86.8% faster equipment search, and 91.2% staff satisfaction with zero adverse event recurrence. The findings underscore RTLS’s potential to enhance medical quality, efficiency, and patient safety through digital technology adoption.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div><strong>Background</strong>: Despite an epidemic of end-stage kidney disease in the Australian Aboriginal and Torres Strait Islander population, disparities in access to kidney transplantation persist. The journey to a successful kidney transplant is long, with an initial suitability assessment required before waitlist-specific activities begin. In an Aboriginal Community Controlled renal service, we aimed to:(i) design and implement a continuous quality improvement (CQI) approach to transplant suitability assessment,(ii) provide transplant suitability assessments for all patients of the service,(iii) describe what temporary contraindications to kidney transplantation should be the focus of health service improvements,(iv) explore participant experiences with the suitability assessment process, and(v) use our findings to inform pre- and post-transplant model of care development within Kimberley Renal Services.<strong>Methods</strong>: Mixed methods design with file review. Transplant suitability assessment results with descriptive analysis and semi-structured interview with thematic analysis.<strong>Results</strong>: Of completed assessments, 20/66 (30%) had no contraindications and were cleared for workup with median time on dialysis prior to assessment of 2.9 years, 42/66 (64%) had temporary contraindications, and 4/66 (6%) had permanent contraindications. Eighty-five temporary contraindications were identified in 46 individuals: 17/46 had both medical and nonmedical contraindications, 5/46 had medical contraindications only, and 24/46 had nonmedical contraindications only. The most common temporary contraindications were smoking (23/46), treatment adherence (17/46), and high body mass index (11/46). Patients wanted more information on the transplant process, and interviewers noted the importance of providing information in an appropriate way. Patients wanted more support to address modifiable health risk factors to improve their chances of future transplantation.<strong>Conclusions</strong>: In the first stages of our CQI approach to improving access to kidney transplants for Kimberley Aboriginal people, we achieved substantial catch-up in suitability assessments and a comprehensive summary of factors impacting successful waitlisting. Our results are consistent with, and build upon other work in this space, highlighting the importance of involving Aboriginal staff and patients in education and support for prospective recipients.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Background</div>Hospitals face mounting pressure to reduce unplanned utilization amid rising healthcare demands from an aging population. The Case management for At-Risk patients in the Emergency Department (CARED) program is among the first ED transitional care strategies to focus on both frail older adults and emergency department (ED) re-attenders to reduce acute hospital utilization. This study aims to evaluate the effectiveness of the CARED program in reducing hospital (re)admissions and ED re-attendances within 30- and 60 days post-discharge.<div class="boxTitle">Methods</div>A retrospective, propensity-matched study was conducted from April 2022 to July 2023 in the ED of Ng Teng Fong General Hospital in Singapore. The CARED program identifies and enrols at-risk patients, i.e. frail older adults and patients who re-attend the ED within 30 days of hospital discharge, for a geriatric assessment. This is followed by multidisciplinary team care, discharge planning and right siting of care from the ED to community-based services by ED case managers. The primary outcomes were hospital (re)admissions and ED re-attendances within 30- and 60 days post-discharge. Secondary outcomes were cost avoidance and bed occupancy days from reduced acute hospital usage.<div class="boxTitle">Results</div>Nearest-neighbour 1:1 propensity score matching matched 1615 intervention group to 1615 control group. Baseline characteristics of the intervention and control groups did not differ significantly. Difference-in-differences (DID) analyses showed significantly lower 30-day (3.96%; 95% CI 2.71–5.23%) and 60-day (6.69%; 95% CI 5.47–7.91%) hospital admissions, as well as 30-day (4.89%; 95% CI 3.83–5.95%) and 60-day (6.50%; 95% CI 5.28–7.72%) ED re-attendances in the intervention group compared to the control group. Additionally, the reduced admission and ED re-attendance rates resulted in 30-day and 60-day inpatient admission costs avoidance [$1 553 548.96 (69.86%); 95% CI $1 525 827.76 to $1 581 270.15; <span style="font-style:italic;">P</span> = .006; and $1 400 047.07 (32.56%); 95% CI $1 365 484.79 to $1434 609.37; <span style="font-style:italic;">P</span> = .048, respectively], ED attendance costs avoidance [$25 849.92 (23.70%); 95% CI $25 091.93 to $26 607.89; <span style="font-style:italic;">P</span> = .096; and $37 538.39 (18.09%); 95% CI $36 470.27 to $38 606.53; <span style="font-style:italic;">P</span> = .086, respectively] and bed occupancy days saved (1212 days; 95% CI 1191.80 days to 1232.20 days; <span style="font-style:italic;">P</span> = .003; and 1267 days; 95% CI 1242.58 days to 1291.42 days; <span style="font-style:italic;">P</span> = .011, respectively)<div class="boxTitle">Conclusion</div>CARED program effectively reduced unplanned hospital use within 30- and 60 days post-ED discharge for at-risk patients. It also significantly lowered inpatient admission and ED attendance costs and hospital bed occupancy days, highlighting its potential to improve patient outcomes and reduce healthcare expenses.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Background</div>Healthcare systems worldwide experience shortages of healthcare professionals. Retention of physicians is becoming an increasing problem. The psychological safety among physicians affects not only performance but also their emotional well-being and job satisfaction. This study aims to evaluate early career physicians’ perception of psychological safety and its influence on job satisfaction and intention to leave.<div class="boxTitle">Methods</div>In a cross-sectional study, early career physicians, currently in fellowship programs in Germany were invited to fill in an electronic survey. The instrument consisted of demographic variables and sections from validated and well-established questionnaires. Psychological safety was evaluated on three levels—in relation to the team leader, team as a whole, and peers. Also, job satisfaction was assessed with standardized measures, and participants were asked if they were considering leaving their current employer. Participants were recruited via a nationwide learning platform—an online educational portal for medical students and early career physicians. Data analyses included descriptive, correlation analysis, and regression analyses to determine univariate and multivariate associations with job satisfaction and intention to leave.<div class="boxTitle">Results</div>The study sample consisted of 432 early career physicians. Most were fulltime employed (85.6%), female (78.2%), and in first 3 years of their postgraduate education (77.5%). A total of 47.2% indicated intention to leave their current employment. On a Likert-10 agreement scale, with high scores indicating greater psychological safety, the mean scores for leader-related, team-related, and peer-related psychological safety were 6.01 [95% confidence interval = 5.81–6.21), 7.30 (7.11–7.49), and 7.95 (7.78–8.12), respectively. In correlation analysis, all dimensions of psychological safety showed significant associations with job satisfaction and the intention to leave. In the multiple regression analyses, female gender (B = −0.10; <span style="font-style:italic;">P</span> = .04) and age group (B = −0.08; <span style="font-style:italic;">P</span> < .01) were associated with lower job satisfaction. High leader and team-related psychological safety were significantly associated with higher job satisfaction (B = 0.18, <span style="font-style:italic;">P</span> < .01; B = 0.10, <span style="font-style:italic;">P</span> < .01), and negatively related to intention to leave (OR = 0.53, <span style="font-style:italic;">P</span> < 0.01; OR = 0.77, <span style="font-style:italic;">P</span> < .01).<div class="boxTitle">Conclusion</div>This survey enhances our understanding of the nuances of psychological safety among early career physicians. In Germany, they reported low-to-medium levels of psychological safety related to the leader and low job satisfaction. Almost every second participant indicated intention to leave the organization. Leader-related psychological safety had highest effect on job satisfaction and intention to leave. Our findings corroborate the eminent role of leadership, workplace, and safety culture for job satisfaction and retention of early career physicians, what consequently affects quality and safety of healthcare.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div>Lithuania ratified the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD) in 2010 and started deinstitutionalization in 2014. This reform covers segregated social care institutions where persons with mental health conditions, psychosocial, and/or intellectual disabilities live. It aims to move away from institutional care and towards community-based services. Mental healthcare services are also a part of the complex picture, undergoing its own reform since 2022. This study aims to assess the human rights conditions and standards of care in Lithuanian psychiatric and social care facilities in the context of deinstitutionalization. Data collection assessments were conducted in psychiatric hospitals and psychiatric units in general hospitals, segregated social care homes, and community-based group living homes. Independent experts collected data through documentation review, observation, and semistructured interviews with service users and staff. The study followed the World Health Organization’s QualityRights Toolkit methodology. In all assessed facilities, regardless of their type, the human rights of service users are often undermined, especially the right to exercise legal capacity, personal liberty and security, freedom from seclusion and restraints, and the right to live independently and be included in the community. The study reveals shortcomings in the implementation of the UNCRPD and Lithuania’s attempts at deinstitutionalization. It points to key practical gaps and areas, including the vital need for better collaboration between the social and mental healthcare systems. The Lithuanian government needs to address these issues to make reforms more effective, safeguard human rights, and ensure the quality of mental health and social care services.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Background</div>In Taiwan, as the population ages, palliative care services (PCS) have expanded significantly to include comprehensive benefit plans for critically ill individuals, supported by reimbursements from the National Health Insurance program. However, incorporating palliative care into the medical management of these patients presents several challenges. We aim to evaluate the effects of palliative care interventions on medical resources in end-of-life scenarios, to promote earlier palliative care access and provide high-quality healthcare services for patients.<div class="boxTitle">Methods</div>A total of 2202 patients were included in this study. Primary diagnosis and referral for PCS were assessed using ICD-10 and HNI code. All study subjects were divided into three groups: patients who did not receive PCS (no-PCS), patients who received PCS before their final hospital admission (PCS-before), and patients who received PCS after their final admission (PCS-after). We evaluated (i) the effects of PCS on eight medical resource utilization outcomes within the 30 days preceding death and (ii) the effects of early intervention on two major diseases.<div class="boxTitle">Results</div>Initiating PCS before a patient’s last hospital admission was associated with less aggressive medical interventions in the 30 days before death, including reduced length of intensive care unit (ICU) [odds ratio (OR) = 0.25], and rates of endotracheal intubation (OR = 0.12), respiratory ventilator support (OR = 0.20), cardiopulmonary resuscitation (OR = 0.18), and blood transfusion (OR = 0.65). Among patients with cancer and lung diseases, those who received PCS prior to their final hospitalization of over 14 days experienced reduced hospitalization duration (OR = 0.52 and 0.24, respectively). Patients with lung disease also had significantly lower odds of ICU stays (OR = 0.44) and respiratory ventilation (OR = 0.33).<div class="boxTitle">Conclusion</div>The timing of palliative care intervention critically impacts on duration of hospitalization and ICU stay and the need for intubation procedures or cardiopulmonary resuscitation. The findings can help the government and medical providers in developing comprehensive palliative care policies and programs to improve care quality and patient rights.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div>Patients continue to suffer from preventable harm and uneven quality outcomes. Reliable clinical outcomes depend on the quality of robust administrative systems and reliable support processes. Critically ill patient handoffs from the operating room (OR) to the intensive care unit (ICU) are known to be high-risk events. We describe a novel perspective on how risk factors associated with the process of patient handoff communication between the OR and the ICU can lead to flawed communication, degraded team awareness, medical errors, and increased patient harm. Data were collected from two semi-structured focus groups using a five-step risk management approach at a tertiary hospital in São Paulo, Brazil. We conducted a failure modes and effects analysis (FMEA) with multidisciplinary healthcare providers consisting of attending physicians, anesthesiologists, nurses, and physiotherapists involved in patient handoffs. We analyzed the results using a similitude analysis to evaluate the effectiveness of implementing this novel risk management approach. We identified the handoffs risks associated with patients, staff, institution, and potential financial risks. The FMEA identified 12 process failures and 36 causes that generated 12 consequences and pointed to robust needed preventive measures to mitigate handoff risks. The clinical teams reported that this approach allowed them to see the process more completely as a whole not only in their narrow silos, thus understanding the enablers and difficulties of the other team members and how this understanding can shed light on their mental models, actions, and the process reliability. Teams identified key steps in the OR to ICU handoff process that are prone to the highest hazards to patients, the hospital, and staff, and are currently targeted for process improvement. Evidence-driven recommendations intended for reducing the risks associated with patient handoffs are presented. Implementing a dynamic risk management, interdisciplinary approach was used to redesign the OR to ICU patient handoff approach around the patient’s and clinician’s needs. The risk management program helped healthcare providers identify handoff steps, highlighting risky handoff process failures, making it possible to identify actionable failures, consequences, and define preventative action plans for mitigating the risks to improve the quality and safety of patient handoffs.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Background</div>Safety culture development is essential for patient safety in healthcare institution. Perceptions of patient safety and cultural changes are reflected in patient safety reports; however, they were rarely investigated. The aim of this study was to investigate the perception of physicians and to explore the development of safety culture using quantitative content analysis for patient safety reports.<div class="boxTitle">Methods</div>A retrospective analysis of free descriptions of harmful patient safety reports submitted by physicians was performed. Natural language processing and text analysis were conducted using the “KH Coder.” A co-occurrence analysis was performed in each period to identify and analyze the safety concepts. The study period was grouped into three for comparison.<div class="boxTitle">Results</div>The patient safety reports from physicians were collected between April 2004 and March 2020. Of these, 3351 reports were harmful: 839 reports were included in period 1, 1016 reports in period 2, and 1496 reports in period 3. Natural language processing identified 316 307 words in the free descriptions of 3351 reports. We identified seven concepts from the cluster in co-occurrence analysis as follows: “explanation of adverse event to patients and families,” “central venous catheter,” “intraoperative procedure and injury,” “minimally invasive surgery,” “life-threatening events,” “blood loss,” and “medical emergency team and critical care.” These seven concepts showed significant differences among the three periods, except for “blood loss.” The “explanation of adverse event to patients and families” decreased in proportion from 11.3% to 8.8% (<span style="font-style:italic;">P</span> < .05). The “central venous catheter” decreased from 17.3% to 11.3% (<span style="font-style:italic;">P</span> < .01). Meanwhile, “minimally invasive surgeries” and “intraoperative procedures” increased from 3.9% to 12.9% (<span style="font-style:italic;">P</span> < .01) and from 10.8% to 14.6% (<span style="font-style:italic;">P</span> < .05), respectively. Focusing on patients’ events, “life-threatening events” decreased from 13.0% to 8.1% (<span style="font-style:italic;">P</span> < .01); however, “medical emergency teams and critical care” increased from 3.3% to 10.6% (<span style="font-style:italic;">P</span> < .01).<div class="boxTitle">Conclusion</div>Free description in patient safety reports is useful for evaluating the safety culture. Co-occurrence analysis revealed multiple concepts of physicians’ perceptions. Quantitative content analysis revealed changes in perceptions and attitudes, and a disclosure policy of adverse events and the priority of patient care appeared with the development of safety culture.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Background</div>To determine methods of FOBT de-implementation in acute care practice while summarizing the reasons and contraindications for inappropriate FOBT in acute care settings. Fecal occult blood testing is valuable for colorectal cancer screening in ambulatory settings but is not valuable for diagnostics in acute care with consistent indications for discontinuation as a tradition-based practice.<div class="boxTitle">Methods</div>We included all English language prospective and retrospective evaluation studies of FOBT use in acute care settings with or without de-implementation interventions and published as original research articles in peer-reviewed journals. A meta-analysis of FOBT positivity was conducted using a random effects model. Quality was assessed using Critical Appraisals Skills Programme criteria.<div class="boxTitle">Results</div>Of 2471 abstract/titles screened, 157 full-text articles were reviewed, and 22 articles met inclusion criteria of measuring prevalence or de-implementation of FOBT use in acute care settings. All 22 studies evaluated either FOBT use or de-implementation. Twenty articles reported FOBT positivity, with some illustrating that FOBT results were inconsequential to subsequent endoscopy decisions (<span style="font-style:italic;">n</span> = 7, 32%). The included studies represent a publication date range spanning 32 years, with limited documentation of de-implementation strategies. Four published studies described system-level disinvestment to administratively eliminate access to inpatient FOBT orders.<div class="boxTitle">Conclusion</div>Overall, all studies endorse that the use of FOBTs in acute care settings results in increased workload and/or cost without diagnostic benefit. Critical appraisal of low-value tradition-based practices such as FOBT use in acute care settings are essential for deploying deliberate and effective de-implementation strategies.</span>
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