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Background There has been a proliferation of health professions training programmes focused on quality and patient safety, but little information regarding the outcomes of these programmes. The purpose of this study was to examine the impact of an interprofessional quality and patient safety curriculum on career outcomes of interprofessional healthcare learners for the Veterans Affairs Patient Safety Fellowship.Method We conducted a survey-based assessment of 117 alumni of the Interprofessional Fellowship in Patient Safety assessing their satisfaction with the training program and career impacts.Results 84 of 117 alumni were located and participated in the assessment. Fellows entered the training programme from a wide range of educational experiences, but most were in their early career at entry. Satisfaction with the training programme was high, with 42% (n=35) of alumni reporting being extremely satisfied with their fellowship experience. Programme alumni reported being either extremely or very knowledgeable about quality and patient safety (77%, n=65). Fellows reported considerable engagement with the academic field of patient safety and quality, with 63% (n=53) having published at least one manuscript about the topic and 75% (n=63) reporting a role teaching patient safety and quality improvement. Fellows’ employments post training were quite varied, although positions focused on health profession education were most common.Conclusions The Interprofessional Fellowship in Patient Safety is an early successful example of an interprofessional training programme that resulted in satisfied alumni who reported good knowledge and abilities in the topic of patient safety. Career pathways were varied, but a focus on health professions education post fellowship was prominent.
Objective: Hypoglycemia is a common complication of inpatient care for patients with diabetes. We sought to determine recent trends and demographic disparities in the rate of inpatient hypoglycemia. Research Design and Methods: We used data from the Veterans Affairs (VA) health care system to identify all patients with type 2 diabetes hospitalized from 2016-2022. We determined rates of inpatient hypoglycemia (< 70 mg/dl) and discharge diagnosis coding for hypoglycemia. We determined differences in rates of hypoglycemia by age, gender and race/ethnicity, adjusting for other patient diagnoses, laboratory values, vital signs and insulin use. Results: Among 512,261 patients hospitalized with diabetes, 6.8% (34,918) had an episode of hypoglycemia (< 70 mg/dl). This rate decreased by 17% from 2016-2022 (7.4% to 6.3%) while the rate of discharge diagnosis among those with hypoglycemia increased. After adjustment for other patient characteristics, the youngest and oldest patients, and those hospitalized in earlier years (vs. 2022) had significantly higher rates of hypoglycemia. Black (adjusted odds ratio -aOR, 1.42 95% CI 1.36-1.49) or Hispanic patients (aOR 1.26 95% CI 1.17-1.35) had a greater risk of hypoglycemia compared with non-Hispanic White patients and women had borderline less hypoglycemia than men (aOR 0.95, 95% CI 0.89-1.00) Conclusion: Inpatient hypoglycemia in the VA Health System has been declining though there are race, age and gender differences that remain unexplained. Recognition of hypoglycemia, defined as a discharge diagnosis, is increasing.
In critical care, the specific, structured approach to patient care known as a "time-limited trial" has been promoted in the literature to help patients, surrogate decision makers, and clinicians navigate consequential decisions about life-sustaining therapy in the face of uncertainty. Despite promotion of the timelimited trial approach, a lack of consensus about its definition and essential elements prevents optimal clinical use and rigorous evaluation of its impact. The objectives of this American Thoracic Society Workshop Committee were to establish a consensus definition of a time-limited trial in critical care, identify the essential elements for conducting a time-limited trial, and prioritize directions for future work. We achieved these objectives through a structured search of the literature, a modified Delphi process with 100 interdisciplinary and interprofessional stakeholders, and iterative committee discussions. We conclude that a time-limited trial for patients with critical illness is a collaborative plan among clinicians and a patient and/or their surrogate decision makers to use life-sustaining therapy for a defined duration, after which the patient's response to therapy informs the decision to continue care directed toward recovery, transition to care focused exclusively on comfort, or extend the trial's duration. The plan's 16 essential elements follow four sequential phases: consider, plan, support, and reassess. We acknowledge considerable gaps in evidence about the impact of time-limited trials and highlight a concern that if inadequately implemented, time-limited trials may perpetuate unintended harm. Future work is needed to better implement this defined, specific approach to care in practice through a person-centered equity lens and to evaluate its impact on patients, surrogates, and clinicians.
ObjectiveTo evaluate nationwide implementation of a Guidebook designed to standardize safety practices across VA-delivered and VA-purchased care (i.e., Community Care) and identify lessons learned and strategies to improve them.Data Sources and Study SettingQualitative data collected from key informants at 18 geographically diverse VA facilities across 17 Veterans Integrated Services Networks (VISNs).Study DesignWe conducted semi-structured interviews from 2019 to 2022 with VISN Patient Safety Officers (PSOs) and VA facility patient safety and quality managers (PSMs and QMs) and VA Facility Community Care (CC) staff to assess lessons learned by examining organizational contextual factors affecting Guidebook implementation based on the Consolidated Framework for Implementation Research (CFIR).Data Collection/Extraction MethodsInterviews were conducted virtually with 45 facility staff and 10 VISN PSOs. Using directed content analysis, we identified CFIR factors affecting implementation. These factors were mapped to the Expert Recommendations for Implementing Change (ERIC) strategy compilation to identify lessons learned that could be useful to our operational partners in improving implementation processes. We met frequently with our partners to discuss findings and plan next steps.Principal FindingsSix CFIR constructs were identified as both facilitators and barriers to Guidebook implementation: (1) planning for implementation; (2) engaging key knowledge holders; (3) available resources; (4) networks and communications; (5) culture; and (6) external policies. The two CFIR constructs that were only barriers included: (1) cosmopolitanism and (2) executing implementation.ConclusionsOur findings suggest several important lessons: (1) engage all collaborators involved in implementation; (2) ensure end-users have opportunities to provide feedback; (3) describe collaborators' purpose and roles/responsibilities clearly at the start; (4) communicate information widely and repeatedly; and (5) identify how multiple high priorities can be synergistic. This evaluation will help our partners and key VA leadership to determine next steps and future strategies for improving Guidebook implementation through collaboration with VA staff.
The coronavirus disease 2019 (COVID-19) epidemic has exposed vulnerabilities within the U.S. healthcare system and globally. This study reviewed COVID-related high-harm patient safety events in the Veterans Health Administration to further our knowledge of the effects of the COVID-19 pandemic on patient safety. Methods A retrospective descriptive analysis of patient safety events related to COVID-19 was performed on data that were submitted in the Joint Patient Safety Event Reporting System and Root Cause Analysis databases to the VHA National Center for Patient Safety from March 2020 to February 2021. Events were coded for type of event, location, and cause of event. Results Delays in care and staff/patients exposed to COVID-19 were the most common types of patient safety events, followed by COVID-19–positive patients eloping, laboratory processing errors, and one wrong procedure. The most frequently cited locations where events took place were emergency departments, medical units, community living centers, and intensive care units. Confusion over procedures, care not provided because of COVID-19, and failure to identify COVID-positive patient before they exposed others to COVID were the most common causes for patient safety events. Discussion Our results are similar to other studies of patient safety during the first year of the COVID-19 pandemic. Based on these results, we recommend the following: (1) focus on patient safety culture, leadership, and governance; (2) proactively develop competency checklists, cognitive aids, and other tools for healthcare staff who are working in new or unfamiliar clinical settings; (3) augment or enhance communication efforts with patient safety huddles or briefings at all levels within a healthcare organization to proactively uncover risk and mitigate fear by explaining changes in policies and procedures; and (4) maximize the use of quality and patient safety experts who are knowledgeable in system and human factor theories as well as change management to assist in redesigning clinical workflows and processes.
