Challenges and Opportunities in Patient Safety

Special Issue:

Challenges and Opportunities in Patient Safety

Ifeoluwa Mary Falade, MD
Mersey and West Lancashire Teaching Hospitals, United Kingdom.

Gideon Kwame Siaw Gyampoh, MBChB
Eastern Regional Hospital, Koforidua, Ghana

Emmanuel Onyekachi Akpamgbo, MBBS
Abia State University College of Medicine, Abia State, Nigeria

Oragui C. Chika, MD
Stanford University School of Medicine, Pala Alto, California, USA

Okiemute Rita Obodo, MD
Windsor University School of Medicine, Cayon, St Kitts and Nevis

Okelue E. Okobi, MD
Larkin Community Hospital, Miami, FL, USA

John Chika Aguguo, MD
University of Nigeria, Nsukka, Nigeria

Victor Ugochukwu Chukwu, MBBS
College of Medicine, Abia State University, Uturu, Abia State, Nigeria.

Abstract

Ensuring patient safety and enhancing quality of care are paramount objectives in healthcare, pivotal for minimizing errors and optimizing care outcomes. This review synthesizes diverse strategies aimed at improving patient safety and quality across various healthcare sectors. Key initiatives highlighted include specialized training programs for ICU handovers, leadership practices in radiology, and enhancing interprofessional communication to bolster medication safety. The review underscores the positive impact of these strategies on fostering a culture of safety among hospital staff, drawing insights from nationwide safety protocols and simulation-based training in oncology. Furthermore, the review discusses advancements such as machine learning applications in pre-hospital care, standardized prescription protocols, and cultural safety initiatives tailored for Indigenous populations, all significantly improving healthcare outcomes. Additional critical areas encompass structured case management, frameworks for pandemic management, virtual interprofessional education initiatives, incident reporting enhancements in surgical settings, and interventions addressing verbal mistreatment in mental health settings. These efforts highlight the importance of interdisciplinary collaboration, evidence-based practices, and continuous improvement in optimizing patient outcomes and healthcare delivery.

In conclusion, the review emphasizes the effectiveness of diverse strategies and interventions in enhancing patient safety and quality improvement across healthcare settings. These main safety strategies include targeted training programs like the “Room of Improvement” simulation, which enhances error detection during ICU handovers. Standardized practices and effective communication across healthcare facilities ensure consistent quality care. Virtual interprofessional education improves teamwork and discharge processes. Early integration of quality improvement and patient safety education in health curricula equips students with essential skills. Zero-harm programs and simulation-based training also significantly enhance patient safety and readiness to manage complex situations.

Each approach plays a crucial role in mitigating risks and cultivating a robust safety culture, from targeted training and leadership practices to innovative technologies. Embracing proactive measures, interdisciplinary teamwork, and ongoing learning is essential for achieving safer and more effective healthcare delivery globally, underscoring the need for integrated strategies to enhance patient care amidst evolving challenges.

Humberto Lugo Vicente
Section of Pediatric Surgery, Department of Surgery, UPR School of Medicine, San Juan, Puerto Rico.

Derick Rodriguez Reyes
UPR UPR School of Medicine, San Juan, Puerto Rico.

Juan C. Bonilla
UPR UPR School of Medicine, San Juan, Puerto Rico.

Abstract

Laparoscopic surgery has brought about a significant transformation in modern surgical practices, offering numerous advantages such as reduced postoperative discomfort and quicker recovery times. However, the initial step of accessing the abdominal cavity presents inherent challenges, especially in patients with previous cesarean sections, whose abdominal anatomy may be altered by adhesions or scar tissue. Among the techniques used to establish pneumoperitoneum, the Veress needle method is commonly employed, yet its safety in females with prior cesarean sections requires careful consideration. This paper provides a thorough examination of safety outcomes, strategies for managing complications, and the long-term implications of Veress needle insertion in females with prior cesarean sections undergoing laparoscopic surgery. It delves into the evolution of laparoscopic surgery, emphasizing the need for a nuanced understanding of the challenges posed by altered abdominal anatomy. Drawing from diverse literature, including peer-reviewed articles and clinical studies, the paper explores the intricacies of preoperative assessment, highlighting the importance of comprehensive patient evaluation to identify potential risk factors and inform surgical planning. Furthermore, it investigates refinements in surgical techniques, examining novel approaches and safety measures proposed to mitigate the risks associated with Veress needle insertion in this specific patient population. From innovative methods for measuring the depth of the anterior abdominal wall to alternative entry sites and techniques, such as the open (Hasson) technique or left upper quadrant (Palmer’s point) entry, the paper elucidates the multifaceted strategiesemployed to enhance safety and efficacy. Additionally, it addresses acute safety concerns and long-term complications, advocating for ongoing monitoring and follow- up care. Identifying research gaps, the paper calls for further investigation to refine safety protocols and improve patient outcomes, ultimately aiming to enhance patient well-being in this specific patient cohort.

Yahia M LodiAdam BowenAria SoltaniVarun ReddyHanish PolavarapuAdam CloudRohan Arora
 

Abstract

Background: Cerebral Aneurysms (CA) including dissecting pseudoaneurysms are treated endovascularly through a trans-radial or trans-femoral approach. When these options are not available, a trans-carotid approach via Direct Carotid Artery Cutdown (DCAC) may be used as the last option. However, the safety and feasibility of DCAC is not well studied or defined in these contexts. Our objective is to present our four unique patients who were treated by the DCAC approach for their cerebral aneurysm and/or internal carotid artery dissecting pseudoaneurysm using flow diversion.

Method: This is a report of a case series and retrospective review.

Results: Patient 1; A 75-year-old woman with known left internal carotid artery (ICA) petrocavernous aneurysm that enlarged from 6 mm to 10 mm resulting in double vision and headaches. Trans-femoral approach failed due to the tortuosity in the common carotid artery (CCA). A multidisciplinary team was formed; A vascular surgeon began the surgery followed by FD by a neuroendovascular surgeon. A 6 French sheath was placed on the right common carotid artery via DCAC then brought to right ICA by vascular surgeon, and a neuroendovascular surgeon confirmed the placement with digital subtraction angiography (DSA). The DSA confirmed a large 10 x 8 x 5mm broad-based aneurysm. Flow diversion was performed with pipeline flex measuring 5 x 30mm. Patient was discharged home and achieved baseline modified Rankin Scale (mRS )1 which sustained in 5 years with aneurysm obliteration. Patient 2; A 65- year-old woman with multiple symptomatic left ICA-Para-ophthalmic artery aneurysm measuring 9 mm. Both femoral and radial arteries were occluded and underwent DCAC and flow diversion with pipeline flex of 4×30 mm using the similar technique described above. Patient discharged home in 48 hours with National Institute of Health Stroke Scale (NIHSS) of 0 and achieved her baseline mRS. However, this patient refused to have any further follow-up studies done. Patient 3; A 67-year-old man with aortic arch endograph with stent graft after previous aortic dissection and diagnosed with bilateral internal carotid artery dissecting pseudoaneurysm (ICADP) by computed topographic angiography (CTA). The right ICADP measured 19 x 15 x 20 mm, was multilevel, extending from skull base to the internal carotid artery (ICA) origin. The left ICADP was 16 x 9 x 22 mm with inflow-zone stenosis. The DSA was attempted but failed due to the aortic stent. The right ICADPA was repaired first using Surpass streamline (Stryker Neurovascular, Irving, CA) device measuring 4 x 50 mm x2 and 5 x 40 mm covering the entire dissecting artery. Patient was discharged home in 48 hours. Three months after the first procedure, using similar technique the left ICADPA was treated with a 5 x 50 mm Surpass evolve flow diverter. Patient achieved mRS 0. In 24-months follow up CTA demonstrated complete resolution of left ICDAP, but occlusion of the right ICA without impairing his mRS 0. Patient 4; a 76-year-old-woman with tinnitus, headaches and dizziness; DSA demonstrated RICA dissecting large 16 x 8 mm pseudoaneurysm. Trans-femoral approach failed and underwent DCAC, and flow diversion with a single surpass evolve flow diverter 4.5 x3 0 mm. Patient was discharged with NIHSS 0 and achieved her baseline mRs 0.

F J García-Miguel, MD, PhD, DESAIC
DESAIC Chief of Department, Complejo Hospitalario Segovia, Spain

S L Valencia Castillo, MD, PhD.
Specialist Haematologist, Complejo Hospitalario Segovia, Spain.

Abstract

Although anaesthetic and surgical procedures should be individualised for every patient, in practice many preoperative protocols and routines are used generally. The “Helsinki Declaration on Patient Safety in Anaesthesiology” establishes that the safety and quality of the perioperative care received by patients is the responsibility of anaesthesiologists. This declaration has been accepted by all the European Societies of Anaesthesiology and stipulates that all institutions providing perioperative anaesthesia care to patients should design protocols to guide perioperative patient management.


 


The present article aims to provide an evidenced-based review of preoperative assessment and preparation and to propose a protocol that can be adapted to the needs of each hospital and be incorporated into their routine practice. Emphasis is placed on the importance of correct preoperative evaluation in reducing morbidity and mortality in the surgical patient. This task can be aided by the use of preoperative questionnaires and the rational use of preoperative tests, which will also reduce unnecessary costs. Finally, the most widely accepted recommendations on preoperative fasting is discussed. The anaesthesiologist’s legal responsibility, and patients’ views in the preoperative process are also considered. A thorough clinical preoperative evaluation of the patient is more important than routine preoperative tests, which should be requested only when justified by clinical indications. Moreover, this practice eliminates unnecessary cost without compromising the safety and quality of care.

Nicolas Martin

David King Sam Hyde Shirin Shahrbaf Bilal El-Dhuwaib Sam Gate Abdulrahman Elmougy

Abstract

Specialist consultations are routine in medical and oral healthcare provision. These take place as an ‘in-person’ event in the secondary care centres. The primary outcome of the specialist consultation is to provide the dentist and the patient with a specialist assessment, diagnosis, prognosis and a proposed care plan.

This in-person procedure remains the gold-standard as it is a considered safe and effective. It presents a number of shortcomings: (1) The referring clinician is not actively involved in the decision-making process. (2) The patient must travel to the secondary care centre for the consultation, creating inequalities of care provision. (3) The patient travel has a carbon footprint. (4) The setting of the referral centre can be unfamiliar and intimidating to the patient.  (5) The outbreak of COVID-19 highlighted the need for alternative system to address this need.

This clinical study assessed the feasibility and effectiveness of undertaking remote clinical consultations in restorative dentistry between a patient and dentist co-located in a clinical primary care dental practice and a specialist consultant in a remote secondary care centre.

Method: A remote clinical consultation in restorative dentistry was conducted that enabled full engagement between the remote consultant and the patient/General Dental Practitioner (GDP) in the dental surgery.  A comprehensive bespoke high-speed secure internet connected hardware and software platform was used.

Each participant completed a semi-structured interview and a validated questionnaire covering four domains: Patient safety, communication between different parties, formulation of a treatment plan, and effectiveness of the technology.

Results: Effective and safe clinical consultations were carried out in all the cases, regardless of gender, age and presenting complaint.  Neither the process nor the outcomes were inferior to an in-person consultation.

Conclusion: This pilot in-practice clinical effectiveness study identified that Remote Clinical Consultations (RCCs), as conducted in this study, are effective for the delivery of specialist consultations in restorative dentistry. They are not inferior to an in-person consultation.  Secondary outcomes:  Three-way discussion was very positive; high levels of acceptability from the patients and the referring GDPs; an alternative to patient travel, reducing travel inconvenience, cost and the environmental burden from the associated carbon dioxide emissions.

Nguyen Van Son
Department of Neurosurgery, Phu Tho Provincial General Hospital, Phu Tho, Vietnam

Nguyen Quang Chung
Quality Management Department, Phu Tho Provincial General Hospital, Phu Tho, Vietnam

Pham Ngoc Vin
Quality Management Department, Phu Tho Provincial General Hospital, Phu Tho, Vietnam

Do Thuy Tien
Quality Management Department, Phu Tho Provincial General Hospital, Phu Tho, Vietnam

Dang Thu Ha
Quality Management Department, Phu Tho Provincial General Hospital, Phu Tho, Vietnam

Nguyen Thi Lan Huong
Department of Nutrition and Dietetics, Phu Tho Provincial General Hospital, Phu Tho, Vietnam

Nguyen Trong Hung

Abstract

Background: The patient experience includes all interactions between the patient and the health care system, including the treatment plan, doctors, nurses, and hospital staff. Patient experience is one of the three important pillars of hospital quality including: patient safety, clinical effectiveness, and patient experience. A positive patient experience is an important goal to be focused on. The aim of this study was to have an overview of the experience and satisfaction of hospital inpatients, thereby offering solutions to improve service quality at the hospital.

Methods: A cross-sectional descriptive study on 115 patients being treated at the Oncology Center to evaluate the experience of patients undergoing inpatient treatment at the Oncology Center, Phu Tho Provincial General Hospital in 2021.

Results: Research results showed that the rate of good feedback about the treatment experience of the doctor, the care of the Nursing, the response of the medical staff to the patient’s request, experience themselves during treatment, experience when receiving drugs, experience of hospital environment and experience when leaving hospital were 95.65%, 97.39%, 87.83%, 100%, 93.91%, 86.96%, 94.78%, respectively. The overall score for the Oncology center was 9.43 points. The study found 3 factors that have a statistically significant relationship: the patient’s education level was related to the assessment of the hospital environment (OR=2.955; 95%CI=1). ,22-7.15; P=0.014), the number of days in the hospital stay of inpatients was related to the experience assessment of the hospital environment (OR=2.43; 95%CI = 1.00 -5.87; P=0.045) and inpatient mental health were related to the overall hospital rating (OR=2.1; 95%CI = 1.00-4.40; P=0.05).   Conclusion: Satisfaction about the experience of hospital inpatients has given us the key to come up with optimal solutions to contribute to improving service quality at the hospital. Promote the advantages and improve the problems that make patients unsatisfied.

Adam Bowen
Upstate Medical University, Binghamton & NYUHS-Hospitals, Binghamton, NY

Aria Soltani
Upstate Medical University, Binghamton & NYUHS-Hospitals, Binghamton, NY

Adam Cloud
Upstate Medical University, Binghamton & NYUHS-Hospitals, Binghamton, NY

Hanish Polavarapu
Upstate Medical University, Binghamton & NYUHS-Hospitals, Binghamton, NY

Yahia Lodi
Upstate Medical University, Binghamton & NYUHS-Hospitals, Binghamton, NY

Abstract

Background: Surpass streamline flow diversion is performed by transfemoral, transradial or both approaches. Safety and feasibility of direct carotid artery cutdown and is not known. Objective is to report Surpass streamline flow diversion via direct carotid artery utdown for a patient with bilateral internal carotid artery dissecting pseudoaneurysm. Method: Case report. Outcome was measured using modified ranking scale (mRS). Results: Sixty-seven-year-old man with history of repaired aortic arch dissecting aneurysm using aortic stent, developed worsening headaches and dizziness and diagnosed with bilateral internal carotid artery dissecting pseudoaneurysm on a computed tomographic angiography; right internal carotid artery dissecting pseudoaneurysm measured 19x15x20 mm and left was 16x9x22 mm. Digital subtraction angiogram was attempted but failed.  A direct carotid artery cutdown followed by surpass streamline flow diversion was performed in a staged fashion. A 6-french sheath was placed from right common carotid artery to right internal carotid artery by a vascular surgeon and was confined with digital subtraction angiography. An intermediate catheter was navigated to the internal carotid artery beyond the internal carotid artery dissecting pseudoaneurysm and surpass streamline flow diversion was achieved with 3 devices; 4×50 mm x2 and 5×40 mm. Carotid artery cutdown site was sutured by vascular surgeon. Patient was extubated and discharged home in 48 hours with NIHSS 0 and mRS1 at his baseline. The left internal carotid artery dissecting pseudoaneurysm was repaired after 3 month using similar technique as described above with two 5×50 mm flow diverters. For the second procedure, angioplasties were required for better appositions of flow diverters. Patient was discharged home in 24 hours. Patient’s symptoms resolved and resumed baseline activities. Prescribed to continued 325 mg aspirin and 75 mg clopidogrel for six months followed by 162 mg aspirin and 75 mg of clopidogrel. Patient maintained mRS 0 in follow-up visits but refused to have a computed tomographic angiography, which finally performed in 24 months, demonstrates complete obligations of the left internal carotid artery dissecting pseudoaneurysm but occlusion of right internal carotid artery with robust collaterals from left internal carotid artery through collaterals. Patient admits premature discontinuation of antiplatelets when he learned about his computed tomographic angiography results. Conclusion: This is the first report of treatment of bilateral internal carotid artery dissecting pseudoaneurysm repaired by direct carotid artery cutdown approach. This is also the first report of a patient with an aortic arch stent, who developed bilateral internal carotid artery dissecting pseudoaneurysm and direct carotid artery cutdown required for treatment. Additionally, antiplatelets must be continued to prevent device occlusion.

L Ding
Department of Radiation Oncology, UMass Memorial Health Care, Worcester Ma. 01655 USA;  Department of Radiation Oncology, UMass Chan Medical School, Worcester Ma. 01655 USA

S Sioshansi
Department of Radiation Oncology, UMass Memorial Health Care, Worcester Ma. 01655 USA;  Department of Radiation Oncology, UMass Chan Medical School, Worcester Ma. 01655 USA

Y Geng
Department of Radiation Oncology, UMass Memorial Health Care, Worcester Ma. 01655 USA

L McIntosh
Department of Radiology, UMass Memorial Health Care, Worcester, Ma. 01655 USA; Department of Radiology, UMass Chan Medical School, Worcester, Ma. 01655 USA

E Ruppell
Department of Radiology, UMass Memorial Health Care, Worcester, Ma. 01655 USA; Department of Radiology, UMass Chan Medical School, Worcester, Ma. 01655 USA

R Licho
Department of Radiology, UMass Memorial Health Care, Worcester, Ma. 01655 USA; Department of Radiology, UMass Chan Medical School, Worcester, Ma. 01655 USA

Y Kim
Department of Radiology, UMass Memorial Health Care, Worcester, Ma. 01655 USA; Department of Radiology, UMass Chan Medical School, Worcester, Ma. 01655 USA

A Goldstein
Department of Radiology, UMass Memorial Health Care, Worcester, Ma. 01655 USA; Department of Radiology, UMass Chan Medical School, Worcester, Ma. 01655 USA

K Mittal
Department of Medicine, UMass Memorial Health Care, Worcester, Ma. 01655 USA; Department of Medicine, UMass Chan Medical School, Worcester, Ma. 01655 USA

M Wang
Department of Medicine, UMass Memorial Health Care, Worcester, Ma. 01655 USA; Department of Medicine, UMass Chan Medical School, Worcester, Ma. 01655 USA

S Mehta
Department of Medicine, UMass Memorial Health Care, Worcester, Ma. 01655 USA; Department of Medicine, UMass Chan Medical School, Worcester, Ma. 01655 USA

K Foley
Department of Medicine, UMass Memorial Health Care, Worcester, Ma. 01655 USA; Department of Medicine, UMass Chan Medical School, Worcester, Ma. 01655 USA

K Smith
Department of Radiation Oncology, UMass Chan Medical School, Worcester Ma. 01655 USA

M Bishop-Jodoin
Department of Radiation Oncology, UMDepartment of Radiation Oncology, UMass Chan Medical School, Worcester Ma. 01655 USA

TJ FitzGerald
Department of Radiation Oncology, UMass Memorial Health Care, Worcester Ma. 01655 USA ; Department of Radiation Oncology, UMass Chan Medical School, Worcester Ma. 01655 USA

Abstract

This paper is a follow-up report concerning a patient treated with Yttrium-90 to a hepatocellular carcinoma. The radiation therapy dose distribution was published as a case report in 2022, https://doi.org/10.18103/mra.v10i11.3379. The hepatic target volume for directed therapy abutted the right kidney and this report provides clinical follow up information on the patient relative to renal function on unintentional radiation renal dose. Yttrium-90 therapy has become an important therapy component for patient care directed to multiple malignancies with emphasis on treating lesions in close proximity to the hepatic parenchyma. The targets are treated with an intra-arterial approach with a goal of applying target directed radiation therapy. Historically, prior to the development of voxel-based dose volume computation software, dose to target was prescribed as activity of isotope delivered with a qualitative assessment of isotope delivery based on images obtained from single positron emission computer tomography. As a qualitative image, single positron emission computer tomography served as an image reference and qualitative surrogate for representing radiation dose. Today, commercial software is available to fuse single positron emission computer tomography images into radiation oncology planning images and calculate dose to volume in a manner similar to how radiation oncology physics dosimetry teams calculate radiation dose to target volume for external therapy and brachytherapy with image guidance. In this particular case, we demonstrated that the proximity of the right kidney to the target resulted in unintentional radiation dose to renal parenchyma evaluated using voxel-based dosimetry. In this report, we review progressive decrease in renal function with blood urea nitrogen/creatinine of 45 and 2.75 respectively with continued normal liver function. Although potentially multi-factorial in origin, the decrease in renal function is at a time point consistent with radiation injury. In this paper we review radiation oncology dose volume constraints for renal tolerance and strategies for patient care moving forward. The goal is to provide additional knowledge of this issue and provide an additional knowledge layer for patient safety with emphasis on improving patient outcomes.

Sudarshan Munigangaiah, FRCSI
Department of spinal disorders, Alder Hey Children’s Hospital, Liverpool, UK

Gareth R Davies-Jones, MRCS
Department of Spinal Disorders, Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, UK.

Abstract

Across the 193 member states of the World Health Organization (WHO) an estimated 234 million operations were conducted worldwide in 2008 (1 per every 25 human beings on the planet). These numbers have continued to increase to 312.9 million by 2016. Surgical errors involving the wrong site, wrong procedure or wrong patient occur at a rate of 1 in 112,000. This equates to 2,000 estimated ‘never events’ every year with a significant associated physical and psychological burden on patients and surgeons and financial and reputational burden on health organisations involved in litigation for such errors. The WHO Surgical Safety Checklist (WHOSSC), produced in 2009 is now synonymous with safety in the operating theatre. This checklist imposes a process of scrutiny at the key steps of the patients journey through theatre. The key details scrutinised have been shown to improve patient outcomes and theatre efficiency. Several studies have looked at adapted checklists specific to different specialties and it is becoming clearer that whilst the overall benefit of the original checklist is undeniable, in some speciality areas a more deliberate and nuanced application of the checklist to address specific problems could be of value. As a specialism, spinal surgery differs from others with a significant risk of a perioperative complication leading to harm and morbidity, permanent disability or even death. Iatrogenic spinal cord injury requires high-level resources and prolonged, sometimes lifelong rehabilitation. Other complications include cerebrospinal fluid leak, blood loss, new neurologic deficit, hardware failure, proximal junctional failure, pseudarthrosis, and surgical site infection. Wrong level spinal surgery (WLSS) is a complication specific to spinal surgery and studies have reported WLSS effecting 50-68% of spinal surgeons at some point in their career. The risks of these complications can be mitigated by factors, some of which are included in the WHOSSC and others with are lacking. This scoping review looks at how surgical checklists; both the original and modified versions have and could be used to address the surgical safety challenges specific to spinal surgery.

Dekel Taliaz
Taliaz Ltd.

Rivka R. Lilian, Roy Schurr, Lihi Levin

Abstract

Decision-making in the field of psychiatry, including diagnosis, is highly complex and is hindered by use of a dichotomous categorical classification system that is ill-suited to mental disorders which are multi-factorial behavioral conditions. In addition, traditional use of results from randomized controlled trials to guide medical device regulation in the field of psychiatry is also problematic, as marked heterogeneity exists within psychiatric patient groups, which precludes results from these trials being projected onto the general patient population. In the past 20 years, clinical decision support software (CDSS) has been found to improve decision-making abilities, but the traditional regulatory approach based on the categorical classification system and randomized controlled trials does not allow the necessary flexibility for CDSS-based decision-making in psychiatry. In this article, we will use Major Depressive Disorder as an example and will discuss regulatory considerations for CDSS, including artificial intelligence, in psychiatry. We will also provide an adjusted life-cycle framework for CDSS in psychiatry, given that the particular complexity of psychiatric disorders demands new and innovative decision support tools. We suggest that any new software would need to perform at least as well as the standard-of-care, which in psychiatry is an unfortunate trial-and-error process. This would be demonstrated during the pre-market validation stage using clinical data from back-end testing of the CDSS. We propose that pre-market evidence of CDSS efficacy should be based on parameters that are used to measure the software success rate, with evidence of safety including demonstration of the low risk of CDSS due to human involvement in the decision-making process. In the post-market stage, CDSS would be used by doctors to generate real-world data that would allow ongoing evaluation and improvement of the algorithms. Furthermore, CDSS would collect data beyond the initial intended-use patient population, allowing the CDSS to learn about related indications. These data would inform the pre-market phase, during which the CDSS could be updated with an expanded patient population. We anticipate that such changes would support effective use of CDSS in psychiatry and improved patient care, which is particularly important given the trial-and-process that comprises the current standard-of-care in the field.

Florence R Lecraw, MD
Adjunct Professor, Andrew Young School of Policy Studies, Georgia State University, Atlanta, Georgia, USA

Abstract

The Communication and Optimal Resolution (CANDOR) program, a patient safety, medicolegal, and healthcare professional wellness program, has been implemented or in the process of being implemented in over 800 US hospitals. The program was designed to help patients suffering from unexpected adverse outcomes and healthcare professionals whose patients experience injury while under their care. The CANDOR program’s basic premise emphasizes honesty in medical error situations. It aims to prevent the recurrence of medical errors. Studies have found that, compared to the common US practice known as “Deny, Delay, and Defend,” using CANDOR not only benefits current and future patients but can improve the well-being of healthcare professionals. This paper therefore aimed to describe CANDOR and evidence regarding its effects on patients and the healthcare professional’s well-being at hospitals that implemented it in comparison to their previous practice of “Deny, Delay, and Defend.” This paper describes methods used by CANDOR teams, which include physicians, attorneys, patient advocates, and health policy leaders, in their successful endeavor to persuade hospital leaders to implement it, in essence to change the hospital’s culture from a culture of opaqueness regarding medical errors and their consequences to a culture embracing transparency. This paper also describes obstacles the teams faced in their endeavor to implement CANDOR at their institution and how they surmounted the obstacles.

Vako Ilda
Healthcare Management, Hellenic Open University, Greece; Evaggelismos General Hospital, Greece.

Eirini Patsaki
Department of Physiotherapy, University of West Attica, Greece

Alexandros Kouvarakos
Evaggelismos General Hospital, Greece

Vaios Grammatis
Healthcare Management, Hellenic Open University, Greece

Ioannis Kouroutzis
Healthcare Management, Hellenic Open University, Greece; Nursing Department, University of Thessaly, Greece

Theodora Paisia Apostolidi
Medicine University of Sofia, Bulgaria

Vasiliki Roka
Healthcare Management, Hellenic Open University, Greece

Anastasia Kotanidou
Evaggelismos General Hospital, Greece

Pavlos Sarafis
Healthcare Management, Hellenic Open University, Greece; University of Thessaly, Greece

Maria Malliarou
Healthcare Management, Hellenic Open University, Greece; Nursing Department, University of Thessaly, Greece

Abstract

Healthcare professionals during the pandemic in the Greek public healthcare system have experienced increased psychological distress, fear and a greater intention to quit their jobs. This study analyzes the factors of moral distress and moral resilience of healthcare professionals employed during the second wave of the pandemic. The target group was the healthcare professionals (HP = 169) who served in the Evaggelismos General Hospital Covid-clinics and -ICU for 2022 and data were collected through life protocols.

Healthcare professionals believe that when faced with moral challenges, they are able to discern them and think clearly. They are especially stressed when they care for more patients than they can safely handle when they are involved in care that causes unnecessary suffering or does not adequately relieve pain or symptoms, and when they notice that patient care is getting worse. Also stressful are the situations, leading to the creation of possible moral distress, when they witness a violation of a standard of practice or moral code. Factors that lead or may lead healthcare professionals to moral distress are nursing safety, unnecessary and deteriorating patient care, and violation of medical confidentiality, violation of standards of practice or moral codes.

The score on the MMD-HP scale indicates low-to-moderate levels of moral distress. Based on the RMRS scale the moral resilience of healthcare professionals is characterized by moderate-to-high with the highest scores per statement seen when patient care is getting worse and feel pressured to ignore situations where patients have not been given adequate information. The healthcare professionals report that they have either left or have considered leaving their position in a clinic due to moral distress, although they are not currently thinking of leaving their position. The factors that increase the frequency of moral distress and decrease their moral resilience are feeling powerless anxiety, nursing/treatment errors, aggressive treatment, caring for more patients than they can handle, substandard patient care, and hierarchical teams.

Yair Edden
Chief Clinical Outcomes Officer, Sheba Medical Center Tel Hashomer, Ramat Gan, Israel

Elena Ben-Shachar
Senior charge nurse, Patient safety and quality of care unit, division of medicine, Sheba Medical Center Tel Hashomer, Ramat Gan, Israel

Amit Gutkind
Director, Patient safety and quality of care unit, division of medicine, Sheba Medical Center Tel Hashomer, Ramat Gan, Israel

Nadav Ben Yosef
Head of Strategic Planning, Sheba Medical Center Tel Hashomer, Ramat Gan, Israel

Yuval Levy
Chief Medical Officer, Sheba Medical Center Tel Hashomer, Ramat Gan, Israel

Abstract

“Clinical outcomes” has become a popular phrase among clinicians, hospital managers, government regulators, health insurers, policy makers and healthcare economy specialists. Compared to other sectors, the health care industry has a different approach to quality measurement since classic tools and basic principles such as economic profitability or human resources necessity in many occasions do not apply.  Among other reasons, this is due to the complexities related to characterizing various aspects surrounding care and the fact that high-quality care is not always correlated with desired outcomes.  Therefore, measures recommended by traditional methods sometimes simply cannot be implemented. Since the “end product” of the healthcare pipeline can be multifaceted and frequently hard to define, the most logical solution would be to measure it by clinical outcomes.

In this paper, we will review the literature on this issue and describe the process of extracting the data and defining which indices will be measures at Sheba Medical Center in order to evaluate clinical outcomes.

Abha Agrawal, MD, FACP, FACHE
Chief Medical Officer, Humboldt Park Health, Chicago IL USA

Abstract

Equitable care has been recognized as one of the six core components of quality for over two decades, yet scant attention has been paid to understand and address healthcare disparities in the US. There is long-standing evidence of substantial health disparities and poor health outcomes along race, ethnicity and income levels in the US. The COVID-19 pandemic both exacerbated and exposed these inequities and catalyzed a national imperative to achieve equitable healthcare. The objective of this article is to provide a case study of a resource-challenged safety net hospital’s journey to advance health equity in Chicago. Humboldt Park Health (HPH) is a 200-bed independent community teaching hospital located on the West side of Chicago serving a multiracial, multilingual and socioeconomically disadvantaged population. Our journey started with the formation of a multidisciplinary health equity committee in 2021, reporting to the Board of Trustees, that was charged with formulating a strategy, developing an evidence-based framework and priorities for action, and implementing the action plan. We addressed four groups of stakeholders: our patients, our people, our organization, and our community. Our actions to advance equity have included (a) collection of patients’ demographic data such as race, ethnicity, language, sexual orientation, and gender identity; (b) assessment of social determinants of health (SDOH) along with connecting patients with social services; (c) the development of health disparities dashboards for various ambulatory preventive measures for stratification of quality data along race, ethnicity and language; (d) focus on LGBTQ+ community’s access to well-informed and sensitivity-trained behavioral health service providers, and (e) organization-wide training to embed the concepts of diversity, equity and inclusivity in the fabric of the organization. Other initiatives include the building of a community wellness center and a 100-unit affordable housing complex in the community. Digital health equity is an important domain that is being addressed by the launch of a patient portal to empower patients by providing them access to their information, and remote patient monitoring solutions. The next phase of our work involves evaluation studies to understand the impact of our interventions on health disparities and outcomes in our community.

Jijo Paul, Ph.D., M.Phil., E.MBA, M.S.
Varian, a Siemens Healthineers company Advanced Oncology Services (AOS) 3100 Hansen Way, Palo Alto, CA 94304, United States Sutter Health/ Ridley-Tree Cancer Center Department of Radiation Oncology, 540 W Pueblo St, Santa Barbara, CA 93105, United States

Abstract

Objective: United States healthcare systems faced enormous pressure from the Coronavirus disease 2019 (COVID-19) crisis, and such scenarios may arise again at any time in the future, so an appropriate crisis action plan should be ready to face them effectively. This study explores the significance of crisis management in healthcare organizations and explains some of the foremost institutional best practices to preserve their reputations in the community. Moreover, the study aimed to detail various strategies targeted for effective crisis management in healthcare organizations to overcome the issues caused by the pandemic.

Methods: A literature survey was conducted using a comprehensive search in PubMed, Research Gate, Scopus, and Google Scholar databases. The gathered articles underwent double screening processes, and the eligible articles were included in this study to formulate this review. Broad search terms were used to find relevant literature articles, including the COVID-19 pandemic, healthcare, crisis, business strategies, and patient safety.

Results: Major healthcare systems in the United States had a proper crisis management plan to continue departmental clinical operations while upholding basic principles. The healthcare organizations acknowledged the crisis, approached it responsibly, and overcame it by reformulating appropriate crisis management plans. Clear communication, delegation, and sustainability were the basic principles held by the institutions in managing crises and serving communities. Crisis team leaders developed intranet pages for fast communication and conducted electronic discussion boards and virtual town hall meetings. They were Responsible, Accountable, Consulted, and Informed (RACI) approaches to manage the crisis by focusing on society, people, and sustainability.

Conclusion: A time-sensitive crisis management plan is critical for every institution’s reputation and survival since they face unexpected issues, threats, risks, and crises from time to time. The best strategies/ practices for effective crisis management may include bold decisions, well-outlined policies, planning, informing stakeholders in time, and taking rapid action to avoid a disaster. Organizations must establish suitable crisis management teams, well-structured strategic plans, communication channels, implementation procedures, and evaluation methods to overcome a crisis. 

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