OBJECTIVES:The use of physical restraints is a common practice in acute-care hospitals. Nonetheless, physical restraints are associated with adverse patient outcomes and ethical dilemmas. Currently, a comprehensive evidence-based instrument that can guide nurses through the complex decision-making process concerning the use of physical restraints is lacking. This study aimed to develop and validate the Physical Restraint Decision-Making Assessment Instrument to support and standardize nurses' decision-making regarding the use of physical restraints in acute-care settings. METHODS:Instrument items were developed through a systematic review of the existing literature and interviews with stakeholder focus groups. A 2-round Delphi technique involving 5 multidisciplinary experts was used to establish content validity, which was assessed using the content validity index (CVI) and modified kappa coefficient (k*). Subsequently, 10 clinical teaching nurses evaluated face validity using the face validity index (FVI). Finally, 3 nurses independently assessed 30 patients to determine inter-rater reliability, with agreement measured using Fleiss' kappa. RESULTS:The Delphi process refined an initial set of 36 items into a final 31-item instrument. This tool showed excellent content validity (scale-level CVI [S-CVI/Ave] of 0.99 for relevance and 0.99 for clarity) and satisfactory face validity (scale-level FVI [S-FVI/Ave] of 0.90). The inter-rater reliability was almost perfect, with Fleiss' kappa value of 0.822 (P<0.001). CONCLUSIONS:The instrument demonstrates strong psychometric properties and shows promise as a structured tool to support and standardize the complex decision-making process for applying physical restraints. Clinical effectiveness and impact on restraint rates and patient outcomes require confirmation through the planned randomized controlled trial before routine implementation is recommended.
OBJECTIVES:This study aimed to systematically assess the changes physicians identify as needed in their EMRs to better support safe clinical practice. METHODS:Data were obtained from a national survey on EMR usability and patient safety conducted among Swiss physicians in 2024. Responses to the open-ended question "What should change in 'MySystem' to better support you in working safely?" were categorized inductively. When a respondent mentioned more than 1 change, these were split into separate statements. Inter-rater reliability was assessed in 2 rounds (subcategory κ=0.63, major category κ=0.70). Differences between physician subgroups were examined using a design-based F-adjusted test to account for clustering. RESULTS:A total of 1479 statements from 809 physicians were categorized into 9 major categories and 24 subcategories. Improvements in usability were the most frequently expressed need (33.4%), followed by better workflow integration (12.4%) and integration of emerging features and technologies (12.2%). Significant differences were observed in the comments between hospital and medical practice physicians [F(7.82, 6321.44)=5.92, P<0.001], between residents and higher hierarchy physicians [F(7.83, 4760.09)=5.05, P<0.001], and between 4 major hospital EMR systems [F(21.58, 9410.64)=6.34, P<0.001]. CONCLUSIONS:This study provides a systematic assessment of physicians' self-expressed EMR change needs in relation to patient safety. These needs differed substantially across EMR systems, work settings, and medical roles. Our findings indicate that changes are needed at 2 levels: direct modifications to EMR systems and changes to implementation and training practices. Systematically incorporating frontline clinician perspectives into EMR design, development, and implementation is essential to advancing patient safety.
OBJECTIVES:The COVID-19 pandemic challenged hospitals. Yet, little is known about the extent of COVID-19's impact on patient safety. We assessed change in Patient Safety Indicators (PSIs), which identify potentially preventable adverse events, before and after the onset of COVID-19 and when a hospital had a high proportion of COVID-19 admissions. METHODS:Using Medicare Provider Analysis and Review data, our sample included 51,960,029 non-COVID-19 admissions eligible for inclusion in at least 1 PSI. This included 23,262,714 patients and a total of 294,871 PSI events. We fit risk-adjusted trends from 2018 to 2022 using interrupted time series models of PSIs before and after the onset of COVID-19. We also tested for the difference of a hospital having a high proportion of COVID-19 admissions. PSIs were categorized into provider-resource, surgical/team-resource, or hospital-resource-dependent events. RESULTS:Ten (of 14) PSIs were worse after the onset of COVID-19 and had substantial increases in event rates, ranging from 14.6% (postoperative sepsis) to 51.9% (central venous catheter-related bloodstream infections). Also, when a hospital had a high proportion of COVID-19 admissions, 8 PSIs significantly worsened and had substantial increases in event rates, ranging from 5.9% (postoperative pulmonary embolism/deep venous thrombosis) to 15.8% (postoperative sepsis). CONCLUSION:The COVID-19 pandemic placed immense, prolonged strain on hospitals, resulting in a worsening of inpatient patient safety events. Increased rates of safety events occurred whether events were provider-resource, surgical/team-resource, or hospital-resource-dependent. These findings are a call for hospitals to return to placing heightened emphasis on reducing preventable harm and minimizing hospital complications and adverse events.
OBJECTIVES:Although clinical engineers (CEs) play essential roles in medical device safety management, analyses of CE-related safety events remain limited. This nationwide study characterizes CE-involved incidents and adverse events and identifies priority areas for improvement. METHODS:From 162,837 Japan Council for Quality Health Care patient safety reports (2010-2024), CE-related reports were retrieved by keyword searches across all columns and deduplicated by ID. Incidents were defined as events with no, minor, or unknown patient impact, whereas adverse events involved death, residual disability, or unexpected treatment beyond what had been anticipated. Two reviewers independently screened free-text descriptions to confirm CE involvement, and any discrepancies were resolved by a third reviewer. The final data set comprised 1845 CE-involved reports: 1484 incidents and 361 adverse events. Descriptive statistics and text mining were applied. RESULTS:Cases were reported on weekdays in dialysis rooms, operating rooms, and intensive care units. Male patients were affected in 65.8% of incidents and 59.8% of adverse events; patients aged 70 to 79 years were most affected. Incidents most often involved CEs with 0 to 4 years' experience (35.2%); adverse events, those with 5 to 9 years' experience (29.1%). Co-occurrence network analysis identified clusters centered on multidisciplinary collaboration and device operation (case descriptions), verification and device setup (contributing factors), and verification and inspection (improvement measures). CONCLUSIONS:Reported CE-related events most frequently involved elderly male patients and early-career CEs, with recurring vulnerabilities in device setup, connection, and verification. Rather than relying on human vigilance, prevention requires workflow standardization, technology-assisted verification, and supervision of junior staff.
Objectives: Patient safety in primary health care remains understudied compared with hospital settings, with particularly scarce comparative evidence on incident profiles across outpatient and telehealth modalities. This study addresses these gaps by characterizing safety signals and reporting dynamics in a Brazilian supplementary health program. Methods: This observational, retrospective study analyzed incident notifications from an institutional reporting system (January 2019 to October 2024), adhering to EQUATOR and STROBE guidelines. Incidents were classified using the World Health Organization International Classification for Patient Safety. Distributions of incident types, harm severity, reporter categories, and adverse events between outpatient and telehealth settings were compared using the χ 2 or Fisher exact tests, with associations quantified through univariable logistic regression as odds ratios (OR) and 95% confidence intervals (CI). Results: Among 3,287 incidents, telehealth reports were dominated by infrastructure (46.0%) and behavioral (36.0%) issues, while outpatient reports emphasized clinical processes/procedures (25.7%) and medication events (17.8%; P <0.001). Telehealth reports were more concentrated in risk circumstances and less often classified as near misses, incidents without harm, mild adverse events, or adverse events, with no significant difference in moderate or severe adverse events. Nurses submitted significantly more telehealth than outpatient reports (85.1% vs. 38.3%; P <0.001). Conclusion: Telehealth and outpatient primary care have distinct safety profiles shaped by differences in incident type, report behavior, and care context. A one-size-fits-all approach is inadequate —while institutional interventions can quickly shift reporting culture, lasting improvement requires modality-specific strategies. Policymakers should adopt tailored safety frameworks for both virtual and outpatient care to translate reporting gains into real harm reduction.
Objectives: Timely clinical communication is a core safety function in acute care, yet response latency remains poorly measured. This study treats it as a stratified safety indicator and introduces a dual-phase model distinguishing verbal triage (T₀verbal) from physical intervention (T₀physical). Methods: A mixed-methods observational design evaluated nurse call response latency across 3 anonymised hospitals: Hospital A (public, no-voice), Hospital B (private, no-voice), and Hospital C (private, voice-enabled). Voice-enabled systems provide 2-way audio between the patient and the nurse before arrival. A total of 16,000 call events across 9 departments were stratified by shift and acuity (NEWS2). Semistructured interviews contextualised patterns within the SEIPS 2.0 framework. Escalation was defined as a response time exceeding 180 seconds. Results: Median response times were 29 seconds (voice-enabled), 130 seconds (private nonvoice), and 256 seconds (public nonvoice). The 90th-percentile response times were 60, 381, and 416 seconds, respectively. Escalation rates were 0.0%, 19.6%, and 70.3%. Ward night shift escalation in hospital A reached 76.0%. For patients with NEWS2 ≥7, medians were 28 seconds (voice-enabled) versus 80 to 88 seconds (nonvoice). Qualitative themes identified alarm fatigue, nonvalue-added locomotion, and coordination friction. Conclusions: Response latency, including tail latency, shift-stratified escalation, and the Surveillance Gap in nonvoice environments, may function as a leading indicator for safety monitoring. Voice-enabled communication may support workflow during low-staffing hours by narrowing the verbal-to-physical intervention interval and reducing nonvalue-added nursing locomotion. Findings are associative; institution type and communication modality were not fully separable.
OBJECTIVE:Adult studies show that persons marginalized by race/ethnicity, preferred language, and public insurance experience higher rates of hospital harm. This study examined the association between patient race/ethnicity, preferred language, insurance type, and safety events among hospitalized pediatric patients. METHODS:This retrospective observational study analyzed safety event reports from 2 tertiary children's hospitals (2020-2022). Patients ≤18 years admitted to neonatal intensive care, pediatric intensive care, and inpatient units were included. Demographics were obtained from the electronic health record, and safety events from the voluntary reporting system. Patients were matched by age, sex, and unit to reduce confounding. Descriptive statistics and multivariable logistic regression were used to assess the independent effect of demographic factors on the occurrence of safety events. RESULTS:Among 4112 unique patients, 370 (9%) experienced a reported safety event. Medication errors comprised 76% of events. After matching, there were no statistically significant differences in the likelihood of experiencing a safety event by race/ethnicity or primary language. However, patients with public insurance had higher odds of experiencing a safety event than those with private insurance (OR=1.51; 95% CI: 1.04-2.20). CONCLUSION:Public insurance type remains a significant factor in a patient's likelihood of experiencing a safety event during hospitalization. While previous studies have identified race/ethnicity and primary language as contributing factors, we observed no such associations in our analysis. Further research is warranted to explore the underlying structural drivers of this health inequity.
Objectives: Handoffs of patient care are opportunities for promoting efficiency and safety. With the shift from paper to digital records, we examine changes in provider perceptions of efficiency, errors, and confidence on a labor and delivery service at an urban, academic hospital. Methods: An anonymous survey was sent during the use of a paper and digital handoff board. Descriptive statistics and χ 2 analyses were used to compare provider perceptions. Results: Survey responders were primarily resident (50.0%-54.8%) and attending (35.5%-50.0%) physicians, as well as one certified nurse-midwife. Responders’ training levels did not differ significantly [χ 2 (2)=2.61, P =0.27]. Time spent updating the board did not differ significantly [χ 2 (4)=3.50, P =0.48], although there were fewer delays in initiating the handoff [χ 2 (3)=27.03, P <0.001] when using a digital board. Providers reported fewer errors [χ 2 (5)=18.26, P <0.01], and perception of patient safety was greater with the digital board [χ 2 (4)=10.07, P <0.05]. Providers reported higher scores on the standardization of patient presentation [χ 2 (4)=17.95, P =0.001] and greater ease of updating the records [χ 2 (4)=20.75, P <0.001] with the digital board. Conclusions: Compared with provider perceptions of using a paper board, providers reported improved scores in efficiency, errors, safety, and standardization of patient presentation when using a digital board. Our findings document the benefit of transitioning to digital tools to facilitate handoffs, especially in a fast-paced labor and delivery setting.
Serious reportable and sentinel events are preventable events that cause death or serious injuries to patients. Such events within the field of psychiatry include abscondment, inpatient suicide, unexpected deaths, sexual assaults, and serious physical assaults. This review aimed to examine the contributing risk factors and preventive strategies of serious reportable or sentinel events. PRISMA for scoping reviews and the updated Arksey and O'Malley methodological framework for conducting scoping reviews guided the methodology of the review. Databases (CINAHL, Embase, PsycINFO, PubMed, ScienceDirect, and Scopus) were searched. Twenty-nine articles were included. The articles explored (1) inpatient suicide [n=18 (62.07%)]; (2) general adverse events [n=5 (17.24%)]; (3) serious assaults [n=2 (6.90%)]; (4) abscondment [n=2 (6.90%)]; and (5) inpatient sexual events [n=2 (6.90%)]. Preventive strategies were as follows: (1) suicide (means restriction, allocation of high‑risk patients to higher‑dependency wards, safe prescribing, psychiatrist review of high-risk patients around the clock); (2) unexpected death (routine medical review, prompt activation of the code blue team); and (3) sexual incidents (segregation of genders). Consistent preventive strategies common to all adverse events, including establishment and continual review of guidelines, optimal staffing, and training, a secured ward with surveillance and no blind spots, rigorous observation, individualized risk assessments, and supportive counseling to patients. Consistent factors were associated with varying serious reportable or sentinel events. These factors were associated with patient and ward profiles, management, staffing, training, observation, risk assessments, and treatment. Bolstering factors related to the prevention of these events can enhance patient safety and the provision of quality care for psychiatric inpatients.
OBJECTIVES:The recent pilot simulation study by Greenberg and colleagues introduced a proof-of-concept audio-visual support system for anesthesiology professional management of perioperative patient deterioration. The results demonstrated that real-time decision support for providers may enhance diagnostic accuracy/efficiency. In collaboration with Greenberg and colleagues, the authors from Massachusetts General Brigham (MGB) similarly developed a realistic operating room simulation environment at Massachusetts General Hospital (MGH) Learning Center. Here, the ability of anesthesiology trainees to accurately diagnose and treat using audio-visual cues was measured. METHODS:This study is a prospective, randomized controlled pilot trial adapted from a recent study further investigating the impact of audio-visual decision support on anesthesiology resident and student nurse anesthetist diagnostic accuracy and efficiency. This study took place entirely at Massachusetts General Hospital Center for Simulation and Innovation. Twenty-one anesthesiology trainees were randomized into 2 groups: (1) standard of care (control) versus (2) audio-visual cue group (experimental). The experimental group received audio-visual cues such as a choice of possible diagnoses from an experienced anesthesiologist and subsequent recommended interventions from the Stanford emergency manual and based on changes in the simulated patient's vitals. Each participant underwent 3 experimental simulations where patient deterioration occurs. These included: anaphylaxis, amniotic fluid embolism (AFE), and pulseless electrical activity (PEA) arrest during a pediatric dental case. Key time points and accuracy of diagnoses and treatment steps were recorded. RESULTS:The simulation scenario recordings for 10 anesthesiology residents and 11 student nurse anesthetists of various training years were investigated. For the anaphylaxis scenario, there was a statistically significant increase in the number of participants who correctly executed intervention 1 in the intervention group compared with the control group (P=0.0015). For the AFE scenario, there was a statistically significant increase in the median time to intervention 1 for SRNAs in the intervention group compared with the control group (P=0.01). However, there was a statistically significant decrease in the median time to intervention 1 for residents in the intervention group compared with the control group (P=0.01). For the pediatric dental scenario, there was a statistically significant increase in the number of participants in the intervention group versus the control group who made the correct diagnosis 2 (P=0.005). In addition, there was a statistically significant increase in the number of participants in the intervention group versus the control group who made the correct diagnosis 3 (P=0.023). CONCLUSIONS:The results indicate that real-time audio and visual cues in a simulated operative environment may improve time to diagnosis and treatment. This effect has now been investigated across the training spectrum from resident trainees to attendings. On the basis of observations from these simulations, this mode of simulation can be an effective educational tool for simulation-based learning exercises. In education or real-time practice, additional dedicated research and development of decision support technology could be beneficial in improving safety during periprocedural care by guiding best training practices.
Adverse drug events (ADEs) are unintended harm resulting from appropriate or inappropriate medication use. Many ADE-related emergency department visits are repeat events that occur after re-exposure to a medication that previously caused harm. Identifying risks and risk factors for repeat ADEs could inform clinical decision-making. We conducted a systematic review of literature on repeat ADEs published over a 20-year period. We applied a predefined search strategy in MEDLINE, Embase, and Scopus and extracted data on risk factors (e.g., age, sex, drug type, re-exposure type) and ADE outcomes. We conducted a meta-analysis if 2 or more studies reported on the same drug class, re-exposure type, ADE outcome, and follow-up period. We screened 13,452 articles and included 55. Most studies reported on re-exposures to the same drug (n=44), with few reporting on exposures to new drugs (n=5). The most studied drug classes were antineoplastics (n=20), anticoagulants (n=10), and antibiotics (n=5). The proportion of Repeat ADEs varied widely across studies from <1 to 88%. We were only able to pool data from studies on re-exposure to anticoagulants and found that 10% (95% confidence interval: 4%-19%) rebled within 90 days. Repeat ADE risks varied by drug class, reflecting different patient populations, medications and indicating conditions. Inconsistent reporting prevented quantification of risk factors. Pooled repeat ADE incidence, where available, can inform shared decision-making by providing estimates of ADE risk in the context of re-exposures to treat underlying conditions. Repeat ADEs remain an understudied area, highlighting the need for further research given their clinical significance.
OBJECTIVES:Patient safety culture (PSC) is a critical organizational determinant of health care quality and workforce well-being; however, its longitudinal relationship with emotional exhaustion across clinical contexts remains unclear. This study investigated how PSC dimensions influenced 5-year patterns of emotional exhaustion among internal medicine and surgical health care professionals in a high-pressure teaching hospital. METHODS:A repeated cross-sectional design was used using data collected annually from 2020 to 2024 at a regional teaching hospital in Taiwan. The Chinese version of the Safety Attitudes Questionnaire (CSAQ) was administered, yielding 939 valid responses from internal medicine and surgical staff. Stepwise multiple linear regression analyses were conducted for each year to identify department-specific predictors and examine temporal variations in PSC influences on emotional exhaustion. RESULTS:Predictors of emotional exhaustion varied over time and between departments. During the early study period, organizational support factors-particularly job satisfaction and perceptions of management-were the strongest negative predictors. As the COVID-19 pandemic stabilized, stress recognition emerged as a consistent protective factor across multiple years. In surgical departments, teamwork climate showed a positive association with emotional exhaustion in certain periods, suggesting that intensive collaboration demands may increase emotional strain. Furthermore, discrepancies between perceived managerial support and actual working conditions indicated potential resource misalignment, especially within internal medicine settings. CONCLUSIONS:The relationship between PSC and emotional exhaustion is dynamic and context-dependent. These findings underscore the importance of phase-specific psychological support, improved alignment between task demands and organizational resources, and department-tailored interventions to enhance workforce well-being and support safer, higher-quality health care delivery.
OBJECTIVES:Anesthesia induction is a key risk factor for intraoperative hypotension due to the cardiovascular system's suppression of induction anesthetics, and intraoperative hypotension significantly affects mortality linked to traumatic brain injury (TBI). Topical airway anesthesia could optimize intubation conditions with less induction anesthetic. This study aimed to determine whether topical airway anesthesia for tracheal intubation can prevent intraoperative hypotension by reducing the need for induction anesthetics in TBI patients. METHODS:A total of 120 patients with severe TBI who underwent craniectomy without preoperative intubation were randomized into the standard anesthesia (C) group or the topical airway anesthesia for intubation (T) group. The patients in the C group received standard anesthesia induction, and those in the T group received topical airway anesthesia without standard induction anesthetics. Intraoperative systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR) were recorded at the designated time points. In-hospital mortality, ICU morbidity, ICU stay duration, and neurological outcomes at discharge and 6 months postoperatively were evaluated. Postoperative injury to the heart, kidney, and liver was assessed. RESULTS:A total of 52 patients in the C group and 51 in the T group completed the trial. After intubation, the SBP and DBP in the T group were significantly greater than in the C group (P<0.05). The in-hospital mortality and ICU morbidity rates in the T group were lower than in the C group (P<0.05). The T group also had lower postoperative injury rates to the heart, kidney, and liver in was lower (P<0.05). While neurological recovery at discharge was improved in the T group, the difference was not statistically significant (P>0.05), except for the number of moderate and severe comas (P<0.05). The neurological score at 6 months postoperatively was increased in the T group (P<0.05). CONCLUSIONS:Topical airway anesthesia for tracheal intubation was associated with higher intraoperative blood pressure, lower in-hospital mortality and ICU morbidity rates, and improved neurological outcomes in patients with severe TBI. These findings suggest that reducing induction anesthetics through topical airway anesthesia may be a promising strategy for managing anesthesia in TBI patients, though confirmation in larger multicenter trials is warranted.
OBJECTIVES:To evaluate the association of a templated interhospital transfer (IHT) note on transfer appropriateness and clinical outcomes. METHODS:We conducted a retrospective, single-center study of 100 IHTs to the Department of Medicine services between May and June 2023. The exposure was the type of documentation at the time of transfer, categorized as templated note, nontemplated note, or no note. The primary outcome was appropriateness of transfer, determined by 2 independent adjudicators using a standardized framework developed as part of the POINT Study. Documentation type by clinical specialty and reason for transfer were assessed, with statistical analyses of clinical outcomes limited to those with an incidence >5% (ie, escalation/downgrade in level of care within 24 h of transfer and 30 d mortality). RESULTS:Among 100 transfers, 81 (81%) were deemed appropriate and 19 (19%) were deemed inappropriate. Documentation was present in 59%, including templated (35%) and nontemplated notes (24%). IHTs without documentation had the highest appropriateness rate (87.8%, 36/41), compared with templated notes (29/35, 82.9%; P=0.15) and nontemplated notes (66.7%, 16/24; P=0.042). Downgrades were more common in inappropriate transfers with nontemplated notes (50.0%, 4/8) than in appropriate transfers with templated notes (10.3%, 3/29; P=0.012). CONCLUSIONS:Structured IHT documentation was inconsistently used and did not predict the appropriateness of transfer. Transfers without documentation were most often appropriate, suggesting straightforward cases may not require formal notes. In contrast, nontemplated notes in inappropriate transfers showed high downgrade rates, implying that unstructured documentation may inflate perceived acuity. Further evaluation of documentation strategies is needed to support appropriate transfer decision-making.
OBJECTIVES:Medical errors are a leading cause of preventable harm worldwide and disproportionately affect women and racial minorities. However, evidence regarding racial disparities in medical errors among women remains inconsistent, and it is unclear whether disparities reflect differences in overall error rates or differences in specific types of errors. This study aimed to quantify racial disparities in medical errors among Black and White women receiving medical care. METHODS:A systematic review and meta-analysis was conducted following PRISMA guidelines. EMBASE, PubMed, Google Scholar, ScienceDirect, and Web of Science were searched for peer-reviewed studies examining racial disparities in medical errors among women. Random-effects meta-analyses were performed in RStudio to calculate pooled odds ratios (ORs) and 95% CIs. RESULTS:Thirteen studies involving 3,608,296 women were included in the systematic review, and 11 studies were included in the meta-analysis. Overall, Black women had higher odds of experiencing medical errors compared with White women; however, the association was not statistically significant (OR=1.18, 95% CI: 0.68-2.06). Subgroup analyses demonstrated that patient safety events were significantly more common among Black women (OR=1.19, 95% CI: 1.02-1.39), whereas diagnostic and human errors showed no significant racial differences. Further analysis revealed a significant difference between underdiagnosis in Black women and overdiagnosis in White women. CONCLUSIONS:Although overall medical error rates did not differ significantly between Black and White women, Black women were more likely to experience underdiagnosis and patient safety events, whereas overdiagnosis was more frequently observed among White women.
BACKGROUND:To evaluate the impact of the NLSE program on perioperative nurse capabilities, nurse and patient satisfaction, nursing practices, and patient safety, and to explore experiences related to leadership, workflow, safety culture, and standardization in 3 Ethiopian hospitals. METHODS:A prospective quasi-experimental pre/postintervention mixed-methods study design was conducted from December 2023 to August 2024 at 3 major Ethiopian hospitals. The NLSE intervention comprised tailored training, mentorship, and nurse-led quality improvement initiatives. Quantitative data were collected from 9 fellows, 3 facility mentors, 112 perioperative nurses (65 at baseline, 47 postintervention), and 257 surgical patients using validated Likert-scale questionnaires. Statistical analyses, including paired t tests, χ 2 tests, and ordinal logistic regression, were performed using SPSS Version 27. Qualitative data from 18 key informant in-depth interviews were analyzed thematically using ATLAS.ti. RESULTS:Nurse fellows demonstrated significant improvements in self-reported capabilities (knowledge, skills, and confidence) on quality improvement (QI), evidence-based practice, patient safety, and clinical leadership (mean difference: 0.2-0.8; P <0.001). Patient satisfaction scores also increased, with courtesy, comfort, privacy, and a quiet environment as significant predictors. Nurse satisfaction improved in areas such as motivation, recognition, and support. Qualitative findings supported these results, highlighting enhanced teamwork, communication, and patient safety culture. CONCLUSIONS:The NLSE program significantly enhanced perioperative nurse capabilities, nurse and patient satisfaction, and patient safety practices. These findings support the adoption of multimodal, nurse-led interventions to strengthen perioperative care and outcomes in low-resource settings. We highly recommend scaling up the NLSE program framework in such environments.
BACKGROUND:Centralized monitoring units (CMUs) can enhance electrocardiographic (ECG)/physiologic monitoring, yet variability in technician training and communication can undermine patient safety and reduce CMU efficiency. This review synthesizes evidence on the competencies, workflows, and technological supports needed to optimize ECG/physiologic monitoring technician performance within CMUs. METHODS:A narrative review of published studies, professional guidelines, and human factors research was conducted to evaluate technician responsibilities, training standards, alarm management practices, and CMU operational models. A standardized competency framework was proposed based on data obtained from included studies. RESULTS:There is a lack of consistency in technician rhythm interpretation skills, alarm validation accuracy, and communication pathways. Evidence supports American Heart Association (AHA)-aligned foundational training, simulation-based alarm scenario practice, and structured escalation protocols. Operational factors-including patient load, alarm burden, and cognitive workload-substantially influence safety performance. Emerging technologies such as AI decision support and enhanced visualization tools may reduce nonactionable alarms and improve detection of clinically meaningful events. Performance metrics spanning patient safety, operational reliability, and workforce outcomes provide a framework to evaluate CMU effectiveness. CONCLUSIONS:ECG/physiologic monitoring technicians are central to effective CMU operation, yet the absence of national training standards contributes to variability in performance and potential patient harm, including preventable patient safety risks such as delayed arrhythmia recognition, alarm fatigue, and communication breakdowns. Implementing a competency-based, standardized training curriculum can improve alarm accuracy, enhance early detection of patient deterioration, and strengthen CMU reliability. Ongoing education and workload-aware operational design remain essential to sustain high-quality centralized monitoring.
OBJECTIVES:Open and transparent disclosure between health care professionals and patients and/or their families after an adverse event is an important feature of high-quality patient care. Within many countries, disclosure is a legal requirement. Previous research has been well documented within the specialties of surgery and internal medicine, but literature on disclosure within maternity settings is sparse. This study aimed to explore the experiences and views of UK maternity healthcare professionals regarding the disclosure of adverse events. METHODS:Semi-structured interviews were conducted and analyzed using reflexive thematic analysis. Maternity health care professionals (8 midwives and 10 obstetricians), from UK maternity services within the National Health Service (NHS), took part in the study. RESULTS:Both midwives and obstetricians strongly emphasized the importance of honesty and transparency during disclosure. However, the following barriers were identified, which made the disclosure process challenging: uncertainty about the type of incident that occurred, uncertainty about current disclosure practices, concerns about the investigation process and legal risks, and a lack of support and training regarding disclosure. Five main themes were identified, which described midwives' and obstetricians' views and experiences of disclosure: 'Easing the burden,' 'Role of uncertainty,' 'Fear of vulnerability,' 'Personalization or professionalization,' and 'Need for further support.' CONCLUSIONS:Disclosure is an emotionally demanding task for health care professionals. There is a need for support and guidance during the disclosure process, in understanding legal and regulatory processes, and in approaching disclosure when there is uncertainty about whether an adverse event or complication has occurred.
OBJECTIVES:Patients' admission to different specialty wards (the so-called "outliers") due to a hospital bed shortage may significantly reduce the quality and safety of clinical care. However, data on clinical outcomes are limited, heterogeneous, and mainly retrospective. For this reason, we performed a prospective controlled study, the Survival and Safety Issues for Medical Outliers (SISIFO) study. METHODS:We conducted the SISIFO study, a prospective, multicenter, controlled study to primarily evaluate clinical and safety outcomes in outliers from October 2018 to March 2020. RESULTS:Thirty-seven Italian Internal Medicine Units enrolled 2056 medically ill patients, 988 outliers, and 1068 controls. Overall, the median length of hospital stay was 10 days [interquartile range (IQR) 7-15]. The median stay in the different specialty wards was 2 days (IQR 2-4). The in-hospital mortality of outliers was significantly higher than that of controls (OR=2.1, 95% CI: 1.3-3.3) at multivariate analysis. Among outliers, modified early warning score (MEWS) >3, reduced mobility, and dysphagia at baseline were significantly associated with a higher risk of in-hospital death. No significant differences between "outliers" and controls were observed for secondary outcomes, including postdischarge 90-day mortality and readmission rate, requests for diagnostic tests, or specialist consultations. In-hospital adverse events presented some noteworthy findings. CONCLUSIONS:Our study suggests a significant increase in in-hospital mortality associated with admission to different specialty wards. Future studies should investigate the specific reasons for this finding.
OBJECTIVES:Recent randomized controlled trials (RCTs) challenge the routine practice of keeping patients NPO ("nil per os") after midnight before diagnostic cardiac catheterization. Shorter fasting durations improve patient experience without increasing risks; however, systematic uptake into routine practice remains limited. At a high-volume cardiac care centre, patients were still being required to fast from midnight, despite emerging evidence. To assess the feasibility of shifting long‑standing practice patterns, we established a >70% adherence target for uptake of a shortened fasting protocol. METHODS:A structured quality improvement initiative using sequential Plan-Do-Study-Act (PDSA) cycles modified pre-procedural fasting protocols to permit a light meal up to 2 hours before cardiac catheterization and clear fluids until the procedure (i.e., intervention). Patient experience surveys were administered to intervention and control groups in 2 PDSA cycles, followed by a post-implementation intervention group. The primary outcome was adherence to shortened fasting protocols (>70% target). Secondary outcomes included patient comfort, satisfaction, safety events, and sustained uptake. RESULTS:Cycle 1 included 97 outpatients (37 control, 60 intervention), cycle 2 included 84 inpatients (40 control, 44 intervention), and 45 patients were in the post-implementation group. Target adherence was met (77% in cycle 1, 82% in cycle 2, and 79% at post-implementation). Patients in the intervention groups reported lower hunger (cycle 1 outpatients) and lower nausea (cycle 2 inpatients), while satisfaction scores remained consistently high across all groups. No aspiration, intubation, or escalation to higher-level care was observed. CONCLUSIONS:Shortening fasting requirements to 2 hours before cardiac catheterization was feasible to implement in a high‑volume cardiac centre.
