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1 High reliability organizations and their organizational culture (Reproduced with permission from Berg [ 23 ])
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Keywords Patient safety • quality • patient care • high reliability organizations • culture of safety • team work • outcomes • health reform
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Abstract Background Hospitals and healthcare institutions should be observant of the ever-changing environment and be adaptive to learning practices. By adopting the steps and other components of organizational learning, healthcare institutions can convert themselves into learning organizations and ultimately strengthen the overall healthcare syste...
Citations
... This meant that the target group for the study was greatly involved as it formed the majority of the respondents. Barach, Jacobs, Lipshultz & Laussen, 2015) stresses the importance of analysing the age of the respondents because it helps the researcher to attach the respondents to their views because age is an important aspect in data analysis. ISSN 2250-3153 This publication is licensed under Creative Commons Attribution CC BY. https://dx.doi.org/10.29322/IJSRP.14.02.2024.p14626 ...
... Patients were divided into two groups with Mortality Category 1-3 and 4-5, and comparisons were performed. We grouped the Mortality category into low-risk group (1-3) and high-risk group (4,5) based on the previous studies that reported significant difference in mortality between two groups (6, 7). ...
Background
The rate of the prenatal diagnosis of congenital heart disease is increasing along with advances in fetal echocardiography techniques. Here, we aimed to investigate the trend of the use of fetal echocardiography over time and to compare the medical costs of congenital heart disease treatment according to whether fetal echocardiography was performed.
Methods
We reviewed our hospital’s database, and patients who underwent the first surgery for congenital heart disease within 30 days of birth during 2005–2007, 2011–2013, and 2017–2019 were included. The severity of congenital heart disease diagnosed in each case was evaluated according to The Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery Congenital Heart Surgery Mortality Scores (STS-EACTS Mortality Scores) and Mortality Categories (STAT Mortality Categories).
Results
In total, 375 patients were analyzed, and fetal echocardiography use increased significantly after the 2010s compared with in 2005–2007 (19.1% vs. 39%, p = 0.032 in Mortality Category 1–3; 15.5% vs. 69.5%, p = 0.000 in Mortality Category 4–5). Additionally, the mean STS-EACTS Mortality Score was higher in prenatally diagnosed patients than in postnatally diagnosed patients (2.287 vs. 1.787, p = 0.001). In the recent period, there was no significant difference in hospitalization durations and medical costs according to whether or not fetal echocardiography was performed.
Conclusions
This single center study showed the use of fetal echocardiography is increasing. Further, prenatal diagnosis with fetal echocardiography causing no differences in medical costs in recent years. Therefore, we suggest that fetal echocardiography can be applied more widely without increasing the economic burden.
... Despite clearly established links among emotions, regulation strategies, and consequential risk perceptions, as well as recent work highlighting the urgent need to investigate affective factors [15][16][17][18][19] that can influence clinical information processing and decision making in the emergency department [20][21][22], the role of emotions is often neglected in patient safety research [23][24][25]. The current study focused on a key aspect of clinical information processing within an important emergency provider population: risk perceptions among nurses. ...
Background
As the COVID-19 pandemic began, frontline nurses experienced many emotions as they faced risks relevant to both patients (e.g., making errors resulting in patient harm) and themselves (e.g., becoming infected with COVID-19). Although emotions are often neglected in the patient safety literature, research in affective science suggests that emotions may significantly impact nurses’ perceptions of risk, which can have downstream consequences. Further, the use of chronic emotion regulation strategies that are known to differ in adaptability and effectiveness (i.e., emotional suppression, reappraisal) can impact risk perceptions.
Objective
To investigate the relationship between nurses’ emotional experiences in response to the pandemic and their estimates of how likely they would be to experience adverse outcomes related to both patients and themselves within the next six months. Additionally, we investigated the extent to which the use of suppression and reappraisal processes to manage emotions are associated with these risk perceptions.
Design
Cross-sectional survey.
Setting
Online survey distributed via email to emergency nurses at eight hospitals in the northeastern United States during fall 2020.
Participants
132 emergency nurses (Mage = 37.05; 81.1% Female; 89.4% White).
Methods
Nurses reported the extent to which they experienced a variety of positive (e.g., hope, optimism) and negative (e.g., fear, sadness) emotions in response to the COVID-19 pandemic, and reported their perceptions of risk to both patients and themselves. Nurses also completed the Emotion Regulation Questionnaire, a measure of chronic tendencies to engage in emotional suppression and reappraisal. Immediately prior to providing data for this study, nurses completed an unrelated decision-making study.
Results
Nurses’ negative emotions in response to COVID-19 were associated with greater perceptions of both patient safety risks (b = 0.31, p < .001) and personal risks (b = 0.34, p < .001). The relationships between positive emotions and risk perceptions were not statistically significant (all p values > .66). Greater chronic tendencies to suppress emotions uniquely predicted greater perceptions of patient safety risks (b = 2.91, p = .036) and personal risks (b = 2.87, p = .040) among nurses; however, no statistically significant relationships with reappraisal emerged (all p values > .16).
Conclusions
Understanding factors that influence perceptions of risk are important, given that these perceptions can motivate behaviours that may adversely impact patient safety. Such an understanding is essential to inform the development of interventions to mitigate threats to patient safety that emerge from nurses’ negative emotional experiences and their use of different emotion regulation strategies.
Tweetable abstract
Covid-related negative emotions and emotional suppression are associated with greater patient and personal risk perceptions among emergency nurses @lindamisbell @Nathan_Huff_1
... In 2014, approximately 1,885 kidneys were discarded in the United States [18]. There should be refining criteria to match marginal donors to recipients instead of discarding ECD kidneys. ...
Dual Kidney Transplantation (DKT) has been developed to improve outcomes from transplantation based on extended criteria of donors (ECD) and demonstrated excellent short-term outcomes. We performed DKT at Samsung Medical Center in March 2021. The donor was a 74-year-old male with no history of known underlying diseases but died from traumatic subarachnoid hemorrhage. The recipient was a 72-year-old male who had been undergoing nephrological observation for 4 years prior to the kidney transplant. The patient had been on hemodialysis since July 2017 and had been suffering from type 2 diabetes since 2003. On non-contrast computed tomography, diffuse calcific atherosclerosis was observed in the abdominal aorta and left iliac artery. As a result, ipsilateral DKT was performed. Because of this diffuse calcific atherosclerosis, we planned ipsilateral DKT on the right side. Postoperative healing was uneventful without complications. In conclusion, DKT is an option for improving survival in the ECD pool, and ipsilateral DKT can be helpful option for preventing organ discard in ECDs.
... For children with presumed acute-onset viral disease, detecting active myocardial involvement is critical because its symptoms can be wrongly attributed to respiratory or infectious complications, delaying appropriate therapy [98,99]. We found that nearly 10% of children presenting to the emergency department of a major children's hospital with presumptive viral febrile illnesses had active myocardial injury, characterized with dead and dying cardiomyocytes, and about 2% had serum concentrations of cardiac troponin T similar to those found in adults with acute myocardial infarctions. ...
... Keeping in view similar surgical complications risk and similar incidence of delayed graft function and rejection with reasonable survival benefit DKT is considered as one of the viable option. In 2014 around 2,885 (17%) kidneys were discarded in USA [45]. Discard rate in Europe though 7.5% (304 donors) is still high [3]. ...
Kidney transplantation (KT) is one of the treatment options for patients with chronic kidney disease. The number of patients waiting for kidney transplantation is growing day by day. Various strategies have been put in place to expand the donor pool. Extended criteria donors are now accepted more frequently. Increasing number of elderly donors with age > 60 years, history of diabetes or hypertension, and clinical proteinuria are accepted as donor. Dual kidney transplantation (DKT) is also more frequently done and experience with this technique is slowly building up. DKT not only helps to reduce the number of patients on waiting list but also limits unnecessary discard of viable organs. Surgical complications of DKT are comparable to single kidney transplantation (SKT). Patient and graft survivals are also promising. This review article provides a summary of evidence available in the literature.
... In Israel, as in the UK, (National Health Service, UK, 2014), amniocentesis is fully funded above the age of 35, which women take as an indication that the test is mandatory or at least highly recommended; AMA women who know that their screening results are normal choose nonetheless to undergo amniocentesis and cite their age as a determining factor (Grinshpun-Cohen et al., 2015). Therefore, for a clinician to recommend against the test to an AMA woman is a non-trivial and potentially controversial decision (Blumenthal-Barby & Krieger, 2014;Croskerry, 2015). The second important factor influencing whether physicians made a different recommendation for a younger vs. older woman was concern over liability in potential litigation if they did not recommend amniocentesis. ...
Funding policy and medico-legal climate are part of physicians' reality and might permeate clinical decisions. This study evaluates the influence of maternal age and government funding on obstetrician/gynecologist recommendation for invasive prenatal testing (i.e. amniocentesis) for Down syndrome (DS), and its association with the physician's assessment of the risk of liability for medical malpractice unless they recommend amniocentesis. Israeli physicians (N = 171) completed a questionnaire and provided amniocentesis recommendations for women at 18 weeks gestation with normal preliminary screening results, identical except aged 28 and 37. Amniocentesis recommendations were reversed for the younger ('yes' regardless of testing results: 6.4%; 'no' regardless of testing results: 31.6%) versus older woman ('yes' regardless of testing results: 40.9%; 'no' regardless of testing results: 7.0%; χ(2) = 71.55, p < .01). About half of the physicians endorsed different recommendations per scenario; of these, 65.6% recommended amniocentesis regardless of testing results for the 37-year-old woman. Physicians routinely performing amniocentesis and those advocating for amniocentesis for all women ≥ age 35 were approximately twice as likely to vary their recommendations per scenario. Physicians who perceived risk of liability for malpractice as large were nearly one-and-a-half times more likely to vary recommendations. The results indicate physicians' recommendations are influenced by maternal age, though age is already incorporated in prenatal DS risk evaluations. The physician's assessment of the risk that they will be sued unless they recommend amniocentesis may contribute to this spurious influence.
... The art and science of outcome analysis of paediatric and congenital cardiac care continue to evolve [1,2]. Ranucci et al. [3] are to be congratulated for their manuscript titled: 'Re-tuning mortality risk prediction in pediatric cardiac surgery: the additional role of early postoperative metabolic and respiratory profile', which reports the results of a study designed to investigate whether early postoperative parameters may be used to improve the prediction of risk associated with paediatric cardiac surgery. ...
... To perform meaningful multiinstitutional analyses of outcomes, any database should incorporate the following seven essential elements [15][16][17]: (1) use of a common language and nomenclature; (2) an established uniform core dataset for collection of information; (3) incorporation of a mechanism to evaluate and account for case complexity; (4) availability of a mechanism to assure and verify the completeness and accuracy of the data collected; (5) collaboration between medical and surgical subspecialties; (6) standardization of protocols for lifelong follow-up; and (7) incorporation of strategies for quality assessment and quality improvement. The STS CHSD has made important advances in six of these elements; however, STS CHSD has not yet developed strategies for longitudinal follow-up beyond discharge from the hospital and 30 days after surgery. ...
... (2) studying the relationship between volume (both programmatic volume and surgeon volume) and outcome using the enhanced 2014 STS CHSD Mortality Risk Model. Strategies for assessing outcomes of pediatric and congenital cardiac surgery continue to evolve [15][16][17]. Efforts are under way to expand the range of outcomes analyzed, with future emphasis on morbidity (including complications and postoperative length of stay) [42], long-term outcomes, and costs [43][44][45][46], which, combined with risk-adjusted clinical outcomes, will begin to address the important endpoint of value [47]. An article and an accompanying editorial, published in the January issue of World Journal for Pediatric and Congenital Heart Surgery, emphasize and explain to surgeons and their data managers the critical importance of accurate and complete submission of data about risk factors to facilitate meaningful calculation of the O/E mortality ratio on which the publicly reported star rating is based [48,49]. ...
The Society of Thoracic Surgeons Congenital Heart Surgery Database is the largest congenital and pediatric cardiac surgical clinical data registry in the world. It is the platform for all activities of The Society of Thoracic Surgeons related to the analysis of outcomes and the improvement of quality in this subspecialty. This article summarizes current aggregate national outcomes in congenital and pediatric cardiac surgery and reviews related activities in the areas of quality measurement, performance improvement, and transparency. The reported data about aggregate national outcomes are exemplified by an analysis of 10 benchmark operations performed from January 2011 to December 2014 and documenting overall discharge mortality (interquartile range among programs with more than 9 cases): off-bypass coarctation, 1.0% (0.0% to 0.9%); ventricular septal defect repair, 0.7% (0.0% to 1.1%); tetralogy of Fallot repair, 1.0% (0.0% to 1.7%); complete atrioventricular canal repair, 3.2% (0.0% to 6.5%); arterial switch operation, 2.7% (0.0% to 5.6%); arterial switch operation plus ventricular septal defect, 5.3% (0.0% to 6.7%); Glenn/hemiFontan, 2.1% (0.0% to 3.8%); Fontan operation, 1.4% (0.0% to 2.4%); truncus arteriosus repair, 9.6% (0.0 % to 11.8%); and Norwood procedure, 15.6% (10.0% to 21.4%).
... Outcomes after cardiac surgery are now being reported transparently and publicly. [4][5][6][7][8] The rationale for such transpar ency is multifactorial. Public reporting of the outcomes of pediatric and congenital cardiac care is our professional responsibility. ...
Background
The pediatric cardiac intensive care environment is challenging and unpredictable due to the heterogeneous patient population. Leadership within this complex environment is critical for optimal outcomes.
Methods
The 10th International Meeting of the Pediatric Cardiac Intensive Care Society provided a forum for leaders to share their own practice and experience that concluded with take-home messages regarding quality, safety, clinical effectiveness, stewardship, and leadership.
Results
Presentations defined vital aspects for successful outcomes and highlighted ongoing challenges.
Conclusions
Accomplishing exceptional outcomes requires a blend of clinical expertise, leadership, communication skills with briefing and debriefing, meaningful use of data, and transparency among peers and toward patients and their families.
