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22. Patient safety, resident well-being and continuity of care with different resident duty schedules in the intensive care unit: a randomized trial

Author

Parshuram, Christopher S., C.K.B., Andre, Ferguson, Niall D., Baker, G. Ross, Etchells, Edward E., Flintoft, Virginia, Granton, John, Lingard, Lorelei, Kirpalani, Haresh, Mehta, Sangeeta, Moldofsky, Harvey, Scales, Damon C., Stewart, Thomas E., Willan, Andrew R., and Friedrich, Jan O.

Subjects
Medical appointments and schedules -- Usage -- Research, Patients -- Care and treatment, Company business management, Health
Abstract

Background: Shorter resident duty periods are increasingly mandated to improve patient safety and physician well-being. However, increases in continuity-related errors may counteract the purported benefits of reducing fatigue. We evaluated the effects of 3 resident schedules in the intensive care unit (ICU) on patient safety, resident well-being and continuity of care. Methods: Residents in 2 university-affiliated ICUs were randomly assigned (in 2-month rotation-blocks from January to June 2009) to in-house overnight schedules of 24, 16 or 12 hours. The primary patient outcome was adverse events. The primary resident outcome was sleepiness, measured by the 7-point Stanford Sleepiness Scale. Secondary outcomes were patient deaths, preventable adverse events, and residents' physical symptoms and burnout. Continuity of care and perceptions of ICU staff were also assessed. Results: We evaluated 47 (96%) of 49 residents, all 971 admissions, 5894 patient-days and 452 staff surveys. We found no effect of schedule (24-, 16- or 12-h shifts) on adverse events (81.3, 76.3 and 78.2 events per 1000 patient-days, respectively; p = 0.7) or on residents' sleepiness in the daytime (mean rating 2.33, 2.61 and 2.30, respectively; p = 0.3) or at night (mean rating 3.06, 2.73 and 2.42, respectively; p = 0.2). Seven of 8 preventable adverse events occurred with the 12-hour schedule (p = 0.1). Mortality rates were similar for the 3 schedules. Residents' somatic symptoms were more severe and more frequent with the 24-hour schedule (p = 0.04); however, burnout was similar across the groups. ICU staff rated residents' knowledge and decision-making worst with the 16-hour schedule. Interpretation: Our findings do not support the purported advantages of shorter duty schedules. They also highlight the trade-offs between residents' symptoms and multiple secondary measures of patient safety. Further delineation of this emerging signal is required before widespread system change. Trial registration: ClinicalTrials.gov, no. NCT00679809., Physician fatigue is common, is associated with worse physician well-being and more medical errors than for well-rested clinicians, and may compromise patient safety. (1-3) Shorter duty hours are purported to [...]

Published
2015
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29. The sensitivity of adverse event cost estimates to diagnostic coding error

Author

Wardle, Gavin, Wodchis, Walter P., Laporte, Audrey, Anderson, Geoffrey M., and Baker, G. Ross

Subjects
Medical care, Cost of -- Analysis, Clinical coding -- Quality management, Medical errors -- Analysis, Business, Health care industry
Abstract

Objective. To examine the impact of diagnostic coding error on estimates of hospital costs attributable to adverse events. Data Sources. Original and reabstracted medical records of 9,670 complex medical and surgical admissions at 11 hospital corporations in Ontario from 2002 to 2004. Patient specific costs, not including physician payments, were retrieved from the Ontario Case Costing Initiative database. Study Design. Adverse events were identified among the original and reabstracted records using ICD 10-CA (Canadian adaptation of ICD 10) codes flagged as postadmission complications. Propensity score matching and multivariate regression analysis were used to estimate the cost of the adverse events and to determine the sensitivity of cost estimates to diagnostic coding error. Principal Findings. Estimates of the cost of the adverse events ranged from $16,008 (metabolic derangement) to $30,176 (upper gastrointestinal bleeding). Coding errors caused the total cost attributable to the adverse events to be underestimated by 16 percent. The impact of coding error on adverse event cost estimates was highly variable at the organizational level. Conclusions, Estimates of adverse event costs are highly sensitive to coding error. Adverse event costs may be significantly underestimated if the likelihood of error is ignored. Key Words. Medical errors, patient safety, hospital costs, propensity matching, A growing branch of research in the patient safety arena is the estimation of the economic cost of adverse events. Prior examinations have consistently reported alarmingly high estimates of the [...]

Published
2012
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35. Canadian adverse events study

Author

Zed, Peter J., Slavik, Richard S., McGregor, Maurice, Croskerry, Pat, Campbell, Sam, Delaney, J.A. Chris, Palko, Mark, Brennan, Andrei S.P., Desapriya, Ediriweera B.R., Norton, Peter G., Flintoft, Virginia, and Baker, G. Ross

Abstract

Ross Baker and associates, in their study of adverse events (AEs) in Canadian hospitals, (1) used a method that has been used in other countries to characterize this problem, but [...]

Published
2004

36. The effects of quality improvement practices on team effectiveness: a mediational model

Author

Lemieux-Charles, Louise, Murray, Michael, Baker, G. Ross, Barnsley, Jan, Tasa, Kevin, and Ibrahim, Salahadin A.

Subjects
Quality control -- Models, Work groups -- Quality management, Health care industry -- Quality management, Organizational effectiveness -- Case studies, Business, Human resources and labor relations, Psychology and mental health, Social sciences
Abstract

The importance of quality improvement to health care work team effectiveness was studied. The influence of that quality improvement was assessed differently by the work team members and their managers.

Published
2002

37. Applying the principles of adaptive leadership to person‐centred care for people with complex care needs: Considerations for care providers, patients, caregivers and organizations.

Author

Kuluski, Kerry, Reid, Robert J., and Baker, G. Ross

Subjects
CAREGIVERS, HEALTH facilities, SOCIAL support, LEADERSHIP, ATTITUDE (Psychology), PATIENT-centered care, MEDICAL care, PATIENTS, MEDICAL personnel, TREATMENT effectiveness, MEDICAL needs assessment, HEALTH self-care
Abstract

Background: Health systems in many countries see person‐centred care as a critical component of high‐quality care but many struggle to operationalize it in practice. We argue that models such as adaptive leadership can be a critical lever to support person‐centred care, particularly for people who have multiple complex care needs. Objective: To reflect on two concepts: person‐centred care and adaptive leadership and share how adaptive leadership can advance person‐centred care at the front‐line care delivery level and the organizational level. Findings: The defining feature of adaptive leadership is the separation of technical solutions (ie applying existing knowledge and techniques to problems) from adaptive solutions (ie requiring shifts in how people work together, not just what they do). Addressing adaptive challenges requires identifying key assumptions that may limit motivations for change and the behaviours influenced by these assumptions. Thus, effective care for patients, particularly those with multiple complex care needs, often entails helping care providers and patients to examine their relationships and behaviours not just identifying technical solutions. Addressing adaptive challenges also requires a supportive and enabling organizational context. We provide illustrative examples of how adaptive leadership principles can be applied at both the front line of care and the organization level in advancing person‐centred care delivery. Conclusions: Advancing person‐centred care at both the clinical and organizational levels requires a growth mindset, a willingness to try (and fail) and try again, comfort in being uncomfortable and a commitment to figure things out, in partnership, in iterative ways. Patients, caregivers, care providers and organizational leaders all need to be adaptive leaders in this endeavour. [ABSTRACT FROM AUTHOR]

Published
2021
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42. Consumers of natural health products: natural-born pharmacovigilantes?

Author

Austin Zubin, Barnes Joanne, Boon Heather, Walji Rishma, Welsh Sandy, and Baker G Ross

Subjects
Other systems of medicine, RZ201-999
Abstract

Abstract Background Natural health products (NHPs), such as herbal medicines and vitamins, are widely available over-the-counter and are often purchased by consumers without advice from a healthcare provider. This study examined how consumers respond when they believe they have experienced NHP-related adverse drug reactions (ADRs) in order to determine how to improve current safety monitoring strategies. Methods Qualitative semi-structured interviews were conducted with twelve consumers who had experienced a self-identified NHP-related ADR. Key emergent themes were identified and coded using content analysis techniques. Results Consumers were generally not comfortable enough with their conventional health care providers to discuss their NHP-related ADRs. Consumers reported being more comfortable discussing NHP-related ADRs with personnel from health food stores, friends or family with whom they had developed trusted relationships. No one reported their suspected ADR to Health Canada and most did not know this was possible. Conclusion Consumers generally did not report their suspected NHP-related ADRs to healthcare providers or to Health Canada. Passive reporting systems for collecting information on NHP-related ADRs cannot be effective if consumers who experience NHP-related ADRs do not report their experiences. Healthcare providers, health food store personnel, manufacturers and other stakeholders also need to take responsibility for reporting ADRs in order to improve current pharmacovigilance of NHPs.

Published
2010
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47. Managerial strategies for integrated care: Health care provider engagement in the iCOACH project

Author

Shaw, James, primary, Baker, G. Ross, additional, Gutberg, Jennifer, additional, Barnsley, Jan, additional, Steele Gray, Carolyn, additional, Breton, Mylaine, additional, Belzile, Louise, additional, Guillette, Maxime, additional, Embuldeniya, Gayathri, additional, McKillop, Ann, additional, Wodchis, Walter, additional, Sheridan, Nicolette, additional, Parsons, John, additional, and Kenealy, Tim, additional

Published
2017
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48. Explanation and elaboration of the SQUIRE (Standards for Quality Improvement Reporting Excellence) Guidelines, V.2.0 : Examples of SQUIRE elements in the healthcare improvement literature

Author

Goodman, Daisy, Ogrinc, Greg, Davies, Louise, Baker, G. Ross, Barnsteiner, Jane, Gali, Kari, Hilden, Joanne, Horwitz, Leora, Kaplan, Heather C., Leis, Jerome, Matulis, John C., Michie, Susan, Miltner, Rebecca, Neily, Julia, Nelson, William A., Niedner, Matthew, Oliver, Brant, Rutman, Lori, Thomson, Richard, and Thor, Johan

Subjects
Hälso- och sjukvårdsorganisation, hälsopolitik och hälsoekonomi, Health services research, Implementation science, Quality improvement methodologies, Statistical process control, Health Care Service and Management, Health Policy and Services and Health Economy, Quality improvement
Abstract

Since its publication in 2008, SQUIRE (Standards for Quality Improvement Reporting Excellence) has contributed to the completeness and transparency of reporting of quality improvement work, providing guidance to authors and reviewers of reports on healthcare improvement work. In the interim, enormous growth has occurred in understanding factors that influence the success, and failure, of healthcare improvement efforts. Progress has been particularly strong in three areas: the understanding of the theoretical basis for improvement work; the impact of contextual factors on outcomes; and the development of methodologies for studying improvement work. Consequently, there is now a need to revise the original publication guidelines. To reflect the breadth of knowledge and experience in the field, we solicited input from a wide variety of authors, editors and improvement professionals during the guideline revision process. This Explanation and Elaboration document (E&E) is a companion to the revised SQUIRE guidelines, SQUIRE 2.0. The product of collaboration by an international and interprofessional group of authors, this document provides examples from the published literature, and an explanation of how each reflects the intent of a specific item in SQUIRE. The purpose of the guidelines is to assist authors in writing clearly, precisely and completely about systematic efforts to improve the quality, safety and value of healthcare services. Authors can explore the SQUIRE statement, this E&E and related documents in detail at http://www.squire-statement.org.

Published
2016

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