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Applying a grounded theory approach, we investigate how professionals cope with making errors that unintentionally harm others. We purposively sampled medical clinicians to study this phenomenon, as these professionals understand themselves as "enablers of patient health." When unintentionally harming others, clinicians experienced initial feelings of guilt. Triggered by the error experience, these professionals engaged in a cognitive sensemaking process, aiming to determine the root causes of the error and evaluate their level of responsibility. In this process, clinicians considered aspects of themselves and their social environment (i.e., supervisors, organization, colleagues, and clients) as either sensemaking assets or liabilities. The self and others became sensemaking assets when helping to alleviate initial feelings of guilt, and sensemaking liabilities when aggravating them. Depending on the outcome of their sensemaking process, clinicians engaged in control-focused or escape-focused identity work. This identity work, in turn, influenced the thriving or deterioration of their future professional identity. [ABSTRACT FROM AUTHOR]

BACKGROUND: Incident reporting is widely used in hospitals to improve patient safety, but current reporting systems do not function optimally. The utility of incident reports is limited because hospital staff may not know what to report, may fear retaliation, and may doubt whether administrators will review reports and respond effectively. METHODS: This is a clustered randomized controlled trial of the Safety Action Feedback and Engagement (SAFE) Loop, an intervention designed to transform hospital incident reporting systems into effective tools for improving patient safety. The SAFE Loop has six key attributes: obtaining nurses input about which safety problems to prioritize on their unit; focusing on learning about selected high-priority events; training nurses to write more informative event reports; prompting nurses to report high-priority events; integrating information about events from multiple sources; and providing feedback to nurses on findings and mitigation plans. The study will focus on medication errors and randomize 20 nursing units at a large academic/community hospital in Los Angeles. Outcomes include: (1) incident reporting practices (rates of high-priority reports, contributing factors described in reports), (2) nurses attitudes toward incident reporting, and (3) rates of high-priority events. Quantitative analyses will compare changes in outcomes pre- and post-implementation between the intervention and control nursing units, and qualitative analyses will explore nurses experiences with implementation. CONCLUSION: If effective, SAFE Loop will have several benefits: increasing nurses engagement with reporting, producing more informative reports, enabling safety leaders to understand problems, designing system-based solutions more effectively, and lowering rates of high-priority patient safety events.

Background: Diagnostic errors lead to patient harm; however, most research has been conducted in nonsurgical disciplines. We sought to characterize diagnostic error in the pre-, intra-, and postoperative surgical phases, describe their contributing factors, and quantify their impact related to patient harm. Methods: We performed a retrospective analysis of closed medico-legal cases and complaints using a database representing more than 95% of all Canadian physicians. We included cases if they involved a legal action or complaint that closed between 2014 and 2018 and involved a diagnostic error assigned by peer expert review to a surgeon. Results: We identified 387 surgical cases that involved a diagnostic error. The surgical specialties most often associated with diagnostic error were general surgery (n = 151, 39.0%), gynecology (n = 71, 18.3%), and orthopedic surgery (n = 48, 12.4%), but most surgical specialties were represented. Errors occurred more often in the postoperative phase (n = 171, 44.2%) than in the pre- (n = 127, 32.8%) or intra-operative (n = 120, 31.0%) phases of surgical care. More than 80% of the contributing factors for diagnostic errors were related to providers, with clinical decision-making being the principal contributing factor. Half of the contributing factors were related to the health care team (n = 194, 50.1%), the most common of which was communication breakdown. More than half of patients involved in a surgical diagnostic error experienced at least moderate harm, with 1 in 7 cases resulting in death. Conclusion: In our cohort, diagnostic errors occurred in most surgical disciplines and across all surgical phases of care; contributing factors were commonly attributed to provider clinical decision-making and communication breakdown. Surgical patient safety efforts should include diagnostic errors with a focus on understanding and reducing errors in surgical clinical decision-making and improving communication. Contexte : Les erreurs de diagnostic causent des préjudices à la patientèle; par contre, la majeure partie de la recherche a porté sur d'autres disciplines que la chirurgie. Nous avons voulu caractériser les erreurs de diagnostic susceptibles de survenir lors des périodes pré-, per-, et postopératoires, en décrire les facteurs contributifs, et mesurer leur impact sur le plan des préjudices causés à la patientèle. Méthodes : À partir d'une base de données représentant plus de 95% de tous les médecins canadiens, nous avons procédé à une analyse rétrospective des dossiers et des plaintes de nature médico-légale réglés. Nous avons inclus tous les dossiers ayant donné lieu à une poursuite judiciaire ou à une plainte officielle qui ont été réglés entre 2014 et 2018 et qui, après expertise, mettaient en cause une erreur de diagnostic imputée à un chirurgien ou une chirurgienne. Résultats : Nous avons recensé 387 cas chirurgicaux associés à une erreur de diagnostic. Les spécialités chirurgicales les plus souvent impliquées dans une erreur diagnostique étaient la chirurgie générale (n = 151, 39,0%), la gynécologie (n = 71, 18,3%), et la chirurgie orthopédique (n = 48, 12,4%), mais la plupart des spécialités chirurgicales étaient représentées. Les erreurs se sont produites plus fréquemment durant la période postopératoire (n = 171, 44,2%) que durant les périodes pré- (n = 127, 32,8%) ou peropératoires (n = 120, 31,0%). Plus de 80% des facteurs contributifs impliquaient le personnel soignant, la prise de décision clinique en étant le principal. La moitié des facteurs contributifs avaient à voir avec l'équipe soignante (n = 194, 50,1%), et le plus fréquent concernait un quelconque bris de communication. Plus de la moitié des cas ayant fait l'objet d'une erreur de diagnostic ont subi des préjudices au moins modérés, et 1 fois sur 7, l'issue en a été fatale. Conclusion : Dans notre cohorte, les erreurs de diagnostic ont touché la plupart des disciplines chirurgicales et toutes les périodes opératoires; les facteurs contributifs ont souvent été liés à la prise de décision clinique et à un bris de communication. Les efforts déployés pour assurer la sécurité de la patientèle devraient aussi tenir compte des erreurs de diagnostic et mettre l'accent sur l'analyse et la prévention des erreurs associées à la prise de décision clinique et sur l'amélioration de la communication., The diagnostic process is a foundational element of every medical specialty, both surgical and nonsurgical. In any clinical practice, the diagnostic process involves information gathering (via history taking, physical examination, [...]

Background: Transitions of patient care from the inpatient to outpatient setting is a high‐risk time often resulting in medical errors and adverse events. Transitions of care programmes have been demonstrated to reduce negative outcomes. Several professional societies have highlighted care transitions as a central pillar of patient care and therefore a crucial aspect of health professional education; however, little data exist on medical student education in this area. Approach: The Transitions of Care Curriculum was developed and delivered to all Harvard Medical School Core I Internal Medicine Clerkship students at Beth Israel Deaconess Medical Center, Boston, MA between January 2017 and March 2019, where 12–14 students participated each quarter and included didactic teaching followed by experiential learning. Student data were collected via postclerkship survey. Patient data were collected via chart review. Student self‐reported comfort level with transitions in care skills and medical errors were analysed. Evaluation: All student measures related to comfort with transitions in care skills demonstrated statistically significant improvement after curriculum participation(p < 0.001). Of the patients with a completed postdischarge note, students identified ≥1 postdischarge related issue in 33 of 70 patients, with multiple issues identified in many of these patients. Seventy‐six total issues were identified. Implications: The Transitions of Care Curriculum demonstrated promising student and patient outcomes, suggesting that students can successfully learn and advance clinical skills while having a positive impact on a highly needed and important aspect of patient care by reducing postdischarge errors and adverse events. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject: Most health professionals working in psychiatric care will experience adverse events (AE) such as service user suicide or violence, during their careerNorway lacks measures to capture potential iatrogenic injuries, such as risk assessment measures, to evaluate patient records for AEs in both inpatient and outpatient psychiatric clinics in hospitals What the paper adds to existing knowledge: We have described an approach to the validation of a research tool between different national contexts; a process that went beyond language translationWe have incorporated the understanding of health professionals and service users; to bring together the lifeworld of the patient with the professional definition of AEs, triggers and risk areas of AEs in a psychiatric context. The service users' experiences resulted in modifications to the tool. What are the implications for nurses: Applying the 'Global Trigger Tool—Psychiatry' in Norway and Sweden can help mental health nurses to prevent iatrogenic harm and reduce the occurrence of AEs through the identification of potential triggers.Implementing 'Global Trigger Tool—Psychiatry' might help mental health nurses to improve patient safety in Norway and Sweden. Introduction: There is little consensus on cross‐cultural and cross‐national adaptation of research instruments. Aim/Question: To translate and validate a Swedish research tool (GTT‐P) to detect iatrogenic adverse events in psychiatric health care by involving service users and health professionals in the process. Method: The GTT‐P, designed to identify events in patient records that were triggers for adverse events, was translated to Norwegian using a cross‐cultural adaptation approach. This involved two focus groups with clinical staff, one of which involved service users, and a joint discussion at a Dialogue Conference to generate consensus on the definition of the triggers of potential adverse events identifiable in patient records. Results: We highlight both the differences and commonalities in defining the nature of risks, the adverse events and the triggers of such events. The Dialogue Conference resulted in three modifications of the tool, based on service users' experiences. Service user involvement and co‐production was essential for both the translation and adaptation of the research instrument. Discussion: We have described an approach to the validation of a research tool between different national contexts; a process that went beyond language translation. This approach enables a more nuanced understanding of potential risks within a psychiatric context as it engages differences in the care delivery. Applying the GTT‐P in hospital‐based psychiatric care might help to identify processes that need to be changed in order to promote patient safety and a safer work environment for mental health nurses. Implications for practice: When translating and validating the GTT‐P from Swedish to Norwegian, we have considered the knowledge and experiences of both service users and health professionals. The application of the GTT‐P can promote greater patient safety in hospital settings. [ABSTRACT FROM AUTHOR]

Introduction: Ethylenediaminetetraacetic acid (EDTA)‐dependent platelet aggregation (PA) can cause medical errors. Currently, there is no reliable method for completely solving this problem. This study aims to solve this problem that has plagued clinical practice for many years by using oscillation method. Methods: Sixty‐one EDTA‐PA samples were collected, divided, and disaggregated using the oscillation method at various times and speeds. The samples were analyzed using routine blood tests and blood smears. Results: Platelet counts (PLT) were increased significantly after oscillation. PLT in the 3000 rpm for 0.5 min group was significantly higher than that in the 500 rpm for 0.5 min group (p < 0. 01). After 3000 rpm oscillation, the PLT gradually increased with time, while compared with the 10‐min group, the PLT in the 13‐min group showed no significant differences. The effective disaggregation rates in the EDTA‐PA samples using the oscillation method and sodium citrate anticoagulant were 96.72% and 65.57%, respectively. There were no significant changes in white blood cell (WBC) or red blood cell (RBC) counts or morphology after the use of the oscillation method. Conclusion: The oscillation method effectively depolymerized EDTA‐PA without adverse effects on WBC and RBC. The implementation of this technique promises to resolve the issue of EDTA‐PA. [ABSTRACT FROM AUTHOR]

While reflective supervision and trauma-informed care are often implemented separately within early care and education (ECE) settings, there is meaningful intersection between these two approaches that may support ongoing efforts to support young children who have experienced trauma. The current study presents secondary analysis of qualitative data from three focus groups with 11 ECE supervisors who attended a reflective supervision training, paired with reflective consultation. ECE supervisors who engaged in a reflective supervision training noted shifts in experience and practice that intersect with Substance Abuse and Mental Health Services Administration (SAMHSA's) six principles of trauma-informed care: 1) safety, 2) trustworthiness and transparency, 3) peer support, 4) collaboration and mutuality, 5) empowerment, voice, and choice, and 6) cultural, historical, and gender issues. Reflective supervision may serve as an effective tool for organizations to invest in trauma-informed care, which creates a space for teachers to engage in relational learning. This investment can lead to enhanced support for young children, especially those who have experienced trauma. [ABSTRACT FROM AUTHOR]

Disclosure of near-miss medical error (ME) and how to disclose ME to patients remain controversial. Furthermore, available guidelines on the disclosure of ME have primarily emerged in developing countries; however, their suitability for Central Asian states is unknown. The objective of this study was to determine the proportion of healthcare professionals (HCPs) intending to disclose MEs and their perceptions pertaining to MEs. We conducted a cross-sectional survey in Kazakhstan using a structured questionnaire to collect data from 109 HCPs about the causes of disclosure MEs and the consequences in their practice. The majority of participants believed that they would be sued if they disclosed errors and near misses. There was a positive relationship between the threat of censure (p = 0.03) and the threat of dismissal (p = 0.01) in HCPs. There was also a significant difference between the distributions of liable for malpractice after disclosing an error to a patient or family member and experience of reporting a ME to administration. In this study, most HCPs reported MEs to a hospital administration, although about half perceived that disclosing MEs to a patient is ethically unnecessary. Poor disclosure could be due to the fear of litigation and dismissal. [ABSTRACT FROM AUTHOR]

Objective: This study assessed incivility during mortality and morbidity (M&M) conference. Background: A psychologically safe environment at M&M conference enables generative discussions to improve care. Incivility and exclusion demonstrated by “shame and blame” undermine generative discussion. Methods: We used a convergent mixed-methods design to collect qualitative data through nonparticipant observations of M&M conference and quantitative data through standardized survey instruments of M&M participants. The M&M conference was attended by attending surgeons (all academic ranks), fellows, residents, medical students on surgery rotation, advanced practice providers, and administrators from the department of surgery. A standardized observation guide was developed, piloted and adapted based on expert nonparticipant feedback. The Positive and Negative Affect Schedule Short-Form (PANAS) and the Uncivil Behavior in Clinical Nursing Education (UBCNE) survey instruments were distributed to the Department of Surgery clinical faculty and categorical general surgery residents in an academic medical center. Results: We observed 11 M&M discussions of 30 cases, over 6 months with 4 different moderators. Case presentations (virtual format) included clinical scenario, decision-making, operative management, complications, and management of the complications. Discussion was free form, without a standard structure. The central theme was that limited discussion participation from attending surgeon of record, as well as absence of a systems-approach led to blame and then blame then set the stage for incivility. Among 147 eligible to participate in the survey, 54 (36.7%) responded. Assistant professors had a 2.60 higher Negative Affect score (P=0.02), a 4.13 higher Exclusion Behavior score (P= 0.03), and a 7.6 higher UBCNE score (P=0.04) compared with associate and full professors. Females had a 2.7 higher Negative Affect Score compared with males (P= 0.04). Conclusion: Free-form M&M discussions led to incivility. Structuring discussion to focus upon improving care may create inclusion and more generative discussions to improve care. [ABSTRACT FROM AUTHOR]

Background: The Global Patient Safety Action Plan, an initiative of the World Health Organization (WHO), draws attention to patient safety as being an issue of utmost importance in healthcare. In response, the World Federation of Chiropractic (WFC) has established a Global Patient Safety Task Force to advance a patient safety culture across all facets of the chiropractic profession. This commentary aims to introduce principles and call upon the chiropractic profession to actively engage with the Global Patient Safety Action Plan beginning immediately and over the coming decade. Main text: This commentary addresses why the chiropractic profession should pay attention to the WHO Global Patient Safety Action Plan, and what actions the chiropractic profession should take to advance these objectives. Each strategic objective identified by WHO serves as a focal point for reflection and action. Objective 1 emphasizes the need to view each clinical interaction as a chance to improve patient safety through learning. Objective 2 urges the implementation of frameworks that dismantle systemic obstacles, minimizing human errors and strengthening patient safety procedures. Objective 3 supports the optimization of clinical process safety. Objective 4 recognizes the need for patient and family engagement. Objective 5 describes the need for integrated patient safety competencies in training programs. Objective 6 explains the need for foundational data infrastructure, ecosystem, and culture. Objective 7 emphasizes that patient safety is optimized when healthcare professionals cultivate synergy and partnerships. Conclusions: The WFC Global Patient Safety Task Force provides a structured framework for aligning essential considerations for patient safety in chiropractic care with WHO strategic objectives. Embracing the prescribed action steps offers a roadmap for the chiropractic profession to nurture an inclusive and dedicated culture, placing patient safety at its core. This commentary advocates for a concerted effort within the chiropractic community to commit to and implement these principles for the collective advancement of patient safety. [ABSTRACT FROM AUTHOR]

Background: Healthcare costs are rising worldwide. At the same time, a considerable proportion of care does not benefit or may even be harmful to patients. We aimed to explore attitudes towards low-value care and identify the most important barriers to the de-implementation of low-value care use in primary care in high-income countries. Methods: Between May and June 2022, we email surveyed primary care physicians in six high-income countries (Austria, Finland, Greece, Italy, Japan, and Sweden). Physician respondents were eligible if they had worked in primary care during the previous 24 months. The survey included four sections with categorized questions on (1) background information, (2) familiarity with Choosing Wisely recommendations, (3) attitudes towards overdiagnosis and overtreatment, and (4) barriers to de-implementation, as well as a section with open-ended questions on interventions and possible facilitators for de-implementation. We used descriptive statistics to present the results. Results: Of the 16,935 primary care physicians, 1,731 answered (response rate 10.2%), 1,505 had worked in primary care practice in the last 24 months and were included in the analysis. Of the respondents, 53% had read Choosing Wisely recommendations. Of the respondents, 52% perceived overdiagnosis and 50% overtreatment as at least a problem to some extent in their own practice. Corresponding figures were 85% and 81% when they were asked regarding their country's healthcare. Respondents considered patient expectations (85% answered either moderate or major importance), patient's requests for treatments and tests (83%), fear of medical error (81%), workload/lack of time (81%), and fear of underdiagnosis or undertreatment (79%) as the most important barriers for de-implementation. Attitudes and perceptions of barriers differed significantly between countries. Conclusions: More than 80% of primary care physicians consider overtreatment and overdiagnosis as a problem in their country's healthcare but fewer (around 50%) in their own practice. Lack of time, fear of error, and patient pressures are common barriers to de-implementation in high-income countries and should be acknowledged when planning future healthcare. Due to the wide variety of barriers to de-implementation and differences in their importance in different contexts, understanding local barriers is crucial when planning de-implementation strategies. [ABSTRACT FROM AUTHOR]

Point-of-care testing (POCT) is the fastest-growing segment of laboratory medicine. this review focuses on the essential aspects of setting analytical performance specifications (APS) and performing quality assurance for POCT in primary healthcare. In-vitro diagnostic medical devices for POCT are typically small and easy to operate. Users often have little to no laboratory experience and may not necessarily see the value of conducting quality assurance on their devices. therefore, training, guidance, and motivation should be integral parts of the total quality management system, as they are vital for managing errors and ensuring reliable results. It is common to believe that the analytical quality of POCT should be comparable to that of laboratory testing, and as a result, APS should be the same. this paper challenges this concept. the APS for POCT can often be less stringent compared to those used in a central laboratory because the requester is closer to both the analytical and clinical situation. Point-of-care instruments should be selected based on clinical needs, the required analytical quality and user-friendliness in the intended usage setting. Quality assurance should include both internal quality control (IQC) and external quality assessment (EQA). It is recommended that IQC protocols should be dependent on the complexity of the POCt device. A scoring system to determine how frequent IQC should be analyzed in primary healthcare on different types of POCt devices has been suggested. the main challenge in EQA for POCT involves using suitable control materials that reflect instrument performance on patient samples. Obtaining commutable control materials for POCT is difficult since the matrix often is whole blood. An essential aspect of EQA for POCT is that feedback reports should be easily interpretable. Users should receive advice from the EQA organizer regarding the root causes of deviating results. Quality assurance for POCT is not an easy task and presents numerous challenges. However, there is evidence that quality assurance improves the quality of POCT measurements and, consequently, can enhance patient outcomes. [ABSTRACT FROM AUTHOR]

To provide an overview of medication errors (MEs) in veterinary medicine, with a focus on the perianesthetic period; to compare MEs in veterinary medicine with human anesthesia practice, and to describe factors contributing to the risk of MEs and strategies for error reduction. PubMed and CAB abstracts; search terms: [("patient safety" or "medication error∗") AND veterin∗]. Human anesthesia is recognized as having a relatively high risk of MEs. In veterinary medicine, MEs were among the most commonly reported medical error. Predisposing factors for MEs in human and veterinary anesthesia include general (e.g. distraction, fatigue, workload, supervision) and specific factors (e.g. requirement for dose calculations when dosing for body mass, using several medications within a short time period and preparing syringes ahead of time). Data on MEs are most commonly collected in self-reporting systems, which very likely underestimate the true incidence, a problem acknowledged in human medicine. Case reports have described a variety of MEs in the perianesthetic period, including prescription, preparation and administration errors. Dogs and cats were the most frequently reported species, with MEs in cats more commonly associated with harmful outcomes compared with dogs. In addition to education and raising awareness, other strategies described for reducing the risk of MEs include behavioral, communication, identification, organizational, engineering and cognitive aids. [ABSTRACT FROM AUTHOR]

Simple Summary: Myelodysplastic Neoplasms (MDS) are a type of blood cancer presenting as ineffective production of blood cells, even though the bone marrow appears active. Traditionally, the response to treatment has been studied by examining blood cell counts, morphologic features, and chromosomal changes. Recently, the ability to evaluate neoplastic status has been significantly improved by the development of highly sensitive flow cytometry and molecular assays, allowing for the identification of residual low-level neoplastic components. In this review, we discuss the evolving concept of measurable (minimal) residual disease (MRD) in MDS in clinical practice, elaborate on the laboratory methods utilized to identify low-level neoplasms, and provide an overview of the published studies correlating MRD with the clinical outcomes of MDS patients. Myelodysplastic Neoplasms (MDS) have been traditionally studied through the assessment of blood counts, cytogenetics, and morphology. In recent years, the introduction of molecular assays has improved our ability to diagnose MDS. The role of Measurable (minimal) Residual Disease (MRD) in MDS is evolving, and molecular and flow cytometry techniques have been used in several studies. In this review, we will highlight the evolving concept of MRD in MDS, outline the various techniques utilized, and provide an overview of the studies reporting MRD and the correlation with outcomes. [ABSTRACT FROM AUTHOR]

Large language models (LLMs) are artificial intelligence systems trained by deep learning algorithms to process natural language and generate text responses to user prompts. Some approach physician performance on a range of medical challenges, leading some proponents to advocate for their potential use in clinical consultation and prompting some consternation about the future of cognitive specialties. However, LLMs currently have limitations that preclude safe clinical deployment in performing specialist consultations, including frequent confabulations, lack of contextual awareness crucial for nuanced diagnostic and treatment plans, inscrutable and unexplainable training data and methods, and propensity to recapitulate biases. Nonetheless, considering the rapid improvement in this technology, growing calls for clinical integration, and healthcare systems that chronically undervalue cognitive specialties, it is critical that infectious diseases clinicians engage with LLMs to enable informed advocacy for how they should—and shouldn't—be used to augment specialist care. [ABSTRACT FROM AUTHOR]

Background: Missed nursing care occurs globally, and the consequences are severe for the patients when fundamental care needs are not fulfilled, nor delivered in a person-centred way. This study aimed to investigate the occurrence and cause of missed nursing care, and the relationship between registered nurses' and nursing assistants' perceptions of missed nursing care, in a surgical care context. Methods: A quantitative study was performed using the MISSCARE survey, measuring missed nursing care and associated reasons, in three surgical wards with registered nurses and nursing assistants as the participants (n = 118), during May-November in 2022. The MISSCARE survey also covers background data such as job satisfaction and intention to leave. The survey was distributed paper-based and the response rate was 88%. Results: Aspects of nursing care rated to be missed the most were 'attending interdisciplinary care conferences', 'turning patient every 2 h', 'ambulation 3 times per day or as ordered', and 'mouth care'. Differences between registered nurse and nursing assistant ratings were detected for eight out of 24 items, where registered nurses rated more missed nursing care. The uppermost reasons for missed nursing care were 'inadequate number of staff' and 'unexpected rise in patient volume and/or acuity on the unit'. Registered nurses and nursing assistants rated differently regarding six of 17 items. Almost every fourth staff member (24.6%, n = 29) had the intention to leave within a year in the present department. Conclusions: The occurrence of missed nursing care is frequent in the surgical context, and in combination with a high number of staff members intending to leave their employment, poses a hazard to patient safety. Registered nurses, holding higher educational levels, reported more missed care compared with the nursing assistants. The main reason for missed nursing care was an inadequate number of staff. These findings support a warranted investment in nursing within the organisation. The results can be used to form strategies and interventions, to reduce nurse attrition and optimise competence utilisation, and to achieve safe person-centered fundamental care. [ABSTRACT FROM AUTHOR]

Introduction: The work phenomenon of emotional exhaustion occurs among nursing professionals, affecting their personal health and well-being, influencing their skills and performance, and negatively impacting the quality of care and patient safety. Aim: This study aimed to explore the experiences of emotional exhaustion among nursing professionals working in an emergency unit and its influence on patient safety. Methods: A qualitative phenomenological study was conducted with emergency nurses from a type C health center in the city of Quito, Ecuador. The study was limited to 10 participants based on saturation of information in the interviews. Coding and categorization were used to interpret the results. Results: The findings showed that nurses' exhaustion can manifest as stress, fatigue, insomnia, frustration, poor performance, forgetfulness, and overload. When they must cover areas such as pharmacy and statistics within the unit, they are unable to adequately concentrate, leading to inadvertent errors in healthcare activities and thus negatively influencing patient safety. Conclusions: This exploration of emotional exhaustion among nurses reveals that they experience high workloads that can hinder their competencies and activities and prevent them from performing their work efficiently due to reduced physical and cognitive abilities. In terms of patient safety, which demands effective communication in the nurse-patient relationship, emotional exhaustion decreases nurse performance throughout the workday. [ABSTRACT FROM AUTHOR]

3D printing is an essential technology for clinical decision-making, affording significant improvements over conventional imaging alone. Product usefulness surveys offer potential in measuring the quality and impact of 3DP to assist clinical decision-making and patient communication. A narrative literature review (Scoping Review articles only) frames the benefits and limitations of 3D print surgical workflow and user experiences. A usability survey was co-designed with a company to measure the impact of their 3D prints on surgical practice, and secondary data analysis was conducted of to understand the effectiveness and usefulness of the technology in a real-world healthcare setting. Three categories of usefulness and relevance were identified. High-value relevance (positive Likert scores over 70%) related to pre-operative planning, clinical communication, and the value of the technology. Moderate scores (50% to 69%) related to time saving with pre-operative surgery, and effectiveness of patient care and diagnosis. Minor relevance (less than 50%) included direct cost savings, physical resource efficiencies, time in intra-operative surgery, or intra-operative risks. This research considers 3D printings relationship to medical error prevention, limitations and future recommendations for usability surveys of this type and it identified issues around gender inclusion in Design for Health research. [ABSTRACT FROM AUTHOR]

Background: Improving triage accuracy for accurate patient identification and appropriate resource allocation is essential. Little is known about the trend of triage accuracy, and factors associated with mistriage vary from study to study. Aim: To identify incidence and risk factors of mistriage, such as overtriage and undertriage. Design: This is a cross-sectional study. Methods: The data came from the National Emergency Department Information System database in 2016–2020. All patients 15 years and older visiting emergency departments in Korea were assessed for eligibility, and 20,641,411 emergency patients' data were used. Multivariable logistic regressions were conducted to confirm the associated factors with overtriage and undertriage compared to expected triage. Demographic characteristics, disease-related signs and triage-related factors were independent variables. Results: Expected triage decreased from 96.8% in 2016 to 95.7% in 2020. Overtriage (0.5%–0.7%) and undertriage (2.4%–3.3%) increased. The occupation that performed triage the most (over 85%) was nurses. Associated factors with overtriage were demographic characteristics (40–64 age group, female), disease-related signs (known disease, direct visit) and triage-related factors (regional emergency medical centre). Risk factors to undertriage were disease-related signs (systolic/diastolic blood pressure and pulse rates within normal range). Conclusions: While the acuity degree remained within the recommended range, the accuracy of triage decreased, and there was a gradual increase in mistriaged cases. Nurses have performed most of the triage and played a key role in expected triage. Associated factors with overtriage were demographic characteristics, disease-related signs and triage-related factors and risk factors to undertriage were disease-related signs. Patient or public contribution: No patient or public contribution. Implications for the profession: Nurses should be aware of what factors are associated with mistriage and why the factors cause mistriage to improve the triage accuracy because they are responsible for the majority of the triage assessments. [ABSTRACT FROM AUTHOR]

Introduction: Medical malpractice claims in our country, which ranks among the nations with a high frequency of esthetic interventions according to the International Society of Aesthetic Plastic Surgery (ISAPS), have been on the rise. This study aims to evaluate the claims of medical malpractice related to medical interventions for esthetic purposes. Materials and Methods: Files belonging to esthetic medical interventions which were referred from the court and the official institutions or were applicant individually for the purpose of identifying the malpractice between 2011 and 2022 to our institution were reviewed. Results: One hundred cases (82% - female, 18% - male, average age: 35.6) were evaluated. It was determined that 57% of the cases were sent from the consumer court, 33% from the court of first instance, and 7% of them were individual applications. Eighty percent of the cases were operated in operating room conditions, while 20% were office-type interventional procedures. It was determined that 84% of medical practices were performed by doctors and 16% by nonphysicians. After 2016, 85% of cases were referred from the consumer court. Above half of the whole cases (54.2%) had medical malpractice. The most important reason for medical malpractice was the lack of or insufficient informed consent. Conclusion: To prevent errors in esthetic medical interventions, it is necessary to comply with the legal regulations, to have a responsible physician in office-type interventions, to duly prepare and obtain (sign and hide) informed consent, to make the surgery/intervention plan, and to manage complications. [ABSTRACT FROM AUTHOR]

Aim: The aim of this qualitative meta‐synthesis was to discover the factors impacting on missed nursing care of nurses through systematic thinking. Background: Although nurses are responsible for high‐quality care, missed nursing care is common, endangering patient safety. Understanding of the causes related to missed nursing care could help nursing managers improve the quality of nursing care. Design: A qualitative meta‐synthesis guided by the Preferred Reporting Items for Systematic Reviews and Meta‐analyses (PRISMA). Methods: As a method designed to contribute to knowledge development, meta‐synthesis allows for integration of qualitative study findings using thematic synthesis. Six databases were searched up to October 2021; nine studies met the inclusion and quality assessment criteria and meta‐synthesis were conducted. Results: Three themes related to the causes why nurses missed nursing care were found. The themes included intrinsic resources (professional and ethical values, ambiguous nurse role, prioritization, education system, and knowledge), system structure (staff and resources shortage, heavy workload but limited time, and organizational management failure), and social environment (communication, working relationship and skill mix, and inappropriate ward layout). Conclusion: The phenomenon of missed nursing care is a global tissue, with variations in its elements but also notable similarities. Meta‐synthesis provides evidence of intrinsic and extrinsic factors that contribute to missed nursing care. Relevance to Clinical Practice: Recognizing and understanding the causes of missed nursing care is essential for nursing managers to ensure patient safety and the provision of high‐quality care. [ABSTRACT FROM AUTHOR]

Background: Working for extended hours in a physically and mentally demanding profession has subjected nurses to occupational fatigue. Limited evidence exists about nurse fatigue and alertness changes throughout shift work and their relationship with medication errors and near misses. Purpose: The purposes of this study were to: (1) assess the relationship between nurses' fatigue and alertness, (2) evaluate nurses' fatigue and alertness changes throughout their shift, and (3) examine the relationship between nurses' fatigue, alertness, and medication errors and near misses. Methods: This prospective study is part of a larger mixed-method study. Fatigue and alertness data from 14 work and non-workdays were collected from a convenience sample of 90 nurses. A wearable actigraph (ReadibandTM) was used to measure alertness, while ecological momentary assessment (EMA) using text messaging was used to measure nurses' fatigue. Results: A 1-unit increase in fatigue was associated with a 1.06-unit reduction in nurses' alertness score (β = –1.06, 95% CI: [–1.33, –0.78], p <.01). Night-shift nurses experienced a 31-point reduction in alertness from the start to the end of the work shift. Nurses' fatigue, but not alertness, was associated with medication errors and near misses (OR = 1.26, 95% CI [1.07, 1.48], p =.01). Conclusion: Initiating fatigue mitigation measures during mid-shift, especially for night-shift nurses, may be a viable option to mitigate fatigue and alertness deterioration among nurses and to maintain patient safety. The multifaceted nature of fatigue, as captured by EMA, is a stronger predictor of medication errors and near misses than device-measured alertness. [ABSTRACT FROM AUTHOR]

Background: In the hospital, interprofessional team members must work collaboratively. That creates a gap in medical practice, particularly in a hectic emergency that may lead to medical errors, with associated ethical, legal, and financial consequences. Mannequin-based simulation can be a solution to bridge this gap in team training. While mannequin-based simulations are effective as a synchronous method, they are expensive, time and space-bound, use hospital resources, and require the whole team to be present. Objective: To develop a prototype of a 3D virtual simulation emergency room (ER) environment for interprofessional team training. And to assess the usability of the prototype in a simulation environment for team training using a clinical scenario. Methods: Tools and technologies used for this prototype included the Unity platform, C# programming language, and Photon Voice 2. With 3DS Max, we modified and created 3d assets in the ER simulation room. Adobe XD was used to create interactive prototype iterations. Clinical cases were developed with simple algorithms to prove the concepts. We used complex algorithms with Artificial Intelligence and Machine Learning capabilities for the final product. We conducted two usability tests (n = 10, n = 9) using a think-aloud method, a semi-structured follow-up interview, and a survey. Results: A prototype was built to achieve asynchronous team training with easy user access from anywhere in the world. The prototype, which includes voice communication and control of the avatars by players from a distance, supported the usability of the technology for asynchronous team training in health education. Conclusions: CyberPatient ER can be used as an additional tool to support team training and communication skills in the health education and healthcare environment. [ABSTRACT FROM AUTHOR]

Addressing flow disruptions (FDs) in neurosurgery requires a multifaceted approach. Strategies like improved communication protocols, minimizing interruptions, improving coordination among team, optimizing operating room layout, and promoting user‐centered design can help mitigate the challenges and enhance the overall flow and safety of neurosurgical procedures. Thirty neurosurgery cases were observed at two tertiary care facilities. The data collected were from wheels into the operating room to wheels out from the operating room. Data points were categorized using a human factors taxonomy known as RIPCHORD‐TWA (Realizing Improved Patient Care Through Human‐Centered Operating Room Design for Threat Window Analysis). Of the 541 total disruptions observed, coordination issues were the most prevalent (26.25%), followed by layout issues (26.06%), issues related to interruption (22.55%), communication (22.37%), equipment issues (2.40%) and usability issues (0.37%) comprised the remainder of the observations. This translated into one disruption every 2.7 min. Instead of focusing exclusively on errors and adverse events, we propose conceptualizing the accumulation of disruptions as "threat windows" to analyze potential threats to the integrity of the care system. This perspective allows for the improved identification of system weaknesses or threats, affording us the ability to address these inefficiencies and intervene before errors and adverse events may occur. [ABSTRACT FROM AUTHOR]

This research aims to thoroughly explore the impact and practical application of Jordan's Medical and Health Liability Law No. 25 of 2018, critically analyzing its compatibility with existing criminal and civil laws and its effectiveness in addressing medical error cases. Through an analytical methodology, this study delves into the legal texts concerning medical liability, establishing criteria for liability and fault in medical acts. The findings underscore significant insights into the legislative nuances that govern medical practices within Jordan, offering a nuanced understanding of the law's implications for both medical professionals and patients. By avoiding complex terminology and maintaining a formal register, the research elucidates the intricate balance between legal requirements and medical ethics, providing a comprehensive overview of the legal landscape surrounding medical liability. The study's outcomes aim to contribute valuable perspectives to the ongoing discourse on legal reforms in the medical sector, highlighting the necessity for laws that support both patient safety and medical professionals' rights. [ABSTRACT FROM AUTHOR]

Deaf patients who communicate in American Sign Language (ASL) experience communication challenges leading to medical errors, treatment delays, and health disparities. Research on Deaf patient communication preferences is sparse. Researchers conducted focus groups based on the Health Belief Model with culturally Deaf patients and interpreters. The ASL focus groups were interpreted and transcribed into written English, verified by a third-party interpreting agency, and uploaded into NVivo. Deductive coding was used to identify communication methods and inductive coding was used to identify themes within each. Writing back-and-forth introduced challenges related to English proficiency, medical terminology, poor penmanship, and tendencies of providers to abbreviate. Participants had various speechreading abilities and described challenges with mask mandates. Multiple issues were identified with family and friends as proxy interpreters, including a lack of training, confidentiality issues, emotional support, and patient autonomy. Video remote interpreter challenges included technical, environmental, and interpreter qualification concerns. Participants overwhelmingly preferred on-site interpreters for communication clarity. While there was a preference for direct care, many acknowledged this is not always feasible due to lack of providers fluent in ASL. Access to on-site interpreters is vital for many Deaf patients to provide full access to critical medical information. Budget allocation for on-call interpreters is important in emergency settings. [ABSTRACT FROM AUTHOR]

Background: Missed nursing care (MNC) negatively impacts the quality of patient care. There may be a relationship between the nursing practice environment (NPE) and MNC; however, this relationship has not been examined in developing countries during the COVID-19 pandemic. Purpose: To determine the relationship between the NPE and MNC during the COVID-19 pandemic. Methods: A cross-sectional study of 300 participants was conducted in 4 teaching hospitals in Iran. Data were collected using a demographic and clinical form, the Nursing Professional Practice Environment Questionnaire, and MISSCARE survey and analyzed using structural equation modeling. Results: The hypothesized model was well fit, showing that 1 unit improvement of the NPE domains of patient-centered care , effective leadership , and policy transparency decreased MNC by 0.18, 0.12, and 0.05, respectively. Conclusion: The model confirmed the association between the dimensions of the NPE and MNC. These findings can assist health policymakers and nursing managers in improving the NPE. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To honor the legacy of John Senders, a distinguished member of the Human Factors and Ergonomics Society, by a short, personal history of him, but then to honor his legacy by extending it through our own professional opinions, with an emphasis on the study of human error and its implications for healthcare systems-two topics in which he excelled. BACKGROUND: The authors are familiar with the topic and subject matter. One was a friend of Senders for over 50 years. Another was a collaborator and joint author with Senders (as well as his stepdaughter). All three authors have extensive publications in the topic areas. METHOD, RESULTS, AND CONCLUSION: The authors used personal accounts of interactions with Senders at conferences, experiences living and working with him, and a brief review of his most personal, notable publications in healthcare. The reflections indicate a strong resonance on Senders contributions to system design that are relevant today in healthcares most challenging period in its history.

Errors in clinical decision-making are disturbingly common. Recent studies have found that 10 to 15% of all clinical decisions regarding diagnoses and treatment are inaccurate. Here, we experimentally study the ability of structured information-sharing networks among clinicians to improve clinicians diagnostic accuracy and treatment decisions. We use a pool of 2,941 practicing clinicians recruited from around the United States to conduct 84 independent group-level trials, ranging across seven different clinical vignettes for topics known to exhibit high rates of diagnostic or treatment error (e.g., acute cardiac events, geriatric care, low back pain, and diabetes-related cardiovascular illness prevention). We compare collective performance in structured information-sharing networks to collective performance in independent control groups, and find that networks significantly reduce clinical errors, and improve treatment recommendations, as compared to control groups of independent clinicians engaged in isolated reflection. Our results show that these improvements are not a result of simple regression to the group mean. Instead, we find that within structured information-sharing networks, the worst clinicians improved significantly while the best clinicians did not decrease in quality. These findings offer implications for the use of social network technologies to reduce errors among clinicians.

Abstract Background The Global Patient Safety Action Plan, an initiative of the World Health Organization (WHO), draws attention to patient safety as being an issue of utmost importance in healthcare. In response, the World Federation of Chiropractic (WFC) has established a Global Patient Safety Task Force to advance a patient safety culture across all facets of the chiropractic profession. This commentary aims to introduce principles and call upon the chiropractic profession to actively engage with the Global Patient Safety Action Plan beginning immediately and over the coming decade. Main text This commentary addresses why the chiropractic profession should pay attention to the WHO Global Patient Safety Action Plan, and what actions the chiropractic profession should take to advance these objectives. Each strategic objective identified by WHO serves as a focal point for reflection and action. Objective 1 emphasizes the need to view each clinical interaction as a chance to improve patient safety through learning. Objective 2 urges the implementation of frameworks that dismantle systemic obstacles, minimizing human errors and strengthening patient safety procedures. Objective 3 supports the optimization of clinical process safety. Objective 4 recognizes the need for patient and family engagement. Objective 5 describes the need for integrated patient safety competencies in training programs. Objective 6 explains the need for foundational data infrastructure, ecosystem, and culture. Objective 7 emphasizes that patient safety is optimized when healthcare professionals cultivate synergy and partnerships. Conclusions The WFC Global Patient Safety Task Force provides a structured framework for aligning essential considerations for patient safety in chiropractic care with WHO strategic objectives. Embracing the prescribed action steps offers a roadmap for the chiropractic profession to nurture an inclusive and dedicated culture, placing patient safety at its core. This commentary advocates for a concerted effort within the chiropractic community to commit to and implement these principles for the collective advancement of patient safety.

Abstract Background In spite of the global implementation of surgical safety checklists to improve patient safety, patients undergoing surgical procedures remain vulnerable to a high risk of potentially preventable complications and adverse outcomes. The present study was designed to explore the surgical teams’ perceptions of patient safety culture, capture their perceptions of the risk for adverse events, and identify themes of interest for quality improvement within the surgical department. Methods This qualitative study had an explorative design with an abductive approach. Individual semi-structured in-depth interviews were conducted between 10/01/23 and 11/05/23. The participants were members of surgical teams (n = 17), general and orthopedic surgeons (n = 5), anesthesiologists (n = 4), nurse anesthetists (n = 4) and operating room nurses (n = 4). Middle managers recruited purposively from general and orthopedic surgical teams in two tertiary hospitals in Norway, aiming for a maximum variation due to gender, age, and years within the specialty. The data material was analyzed following Braun and Clarke’s method for reflexive thematic analysis to generate patterns of meaning and develop themes and subthemes. Results The analysis process resulted in three themes describing the participants’ perceptions of patient safety culture in the surgical context: (1) individual accountability as a safety net, (2) psychological safety as a catalyst for well-being and safe performance in the operating room, and (3) the importance of proactive structures and participation in organizational learning. Conclusions This study provided an empirical insight into the culture of patient safety in the surgical context. The study highlighted the importance of supporting the individuals’ competence, building psychological safety in the surgical team, and creating structures and culture promoting a learning organization. Quality improvement projects, including interventions based on these results, may increase patient safety culture and reduce the frequency of adverse events in the surgical context.

Mohsin Al-Maghrabi,1 Silvia Mamede,2 Henk G Schmidt,3 Aamir Omair,4– 6 Sami Al-Nasser,4– 6 Nouf Sulaiman Alharbi,4– 6 Mohi Eldin Mohammed Ali Magzoub7 1Department of Pediatrics, Imam Abdulrahman Alfaisal Hospital, Riyadh, Saudi Arabia; 2Institute of Medical Education Research Rotterdam, Erasmus University Rotterdam, Rotterdam, the Netherlands; 3Department of Psychology, Erasmus University Rotterdam, Rotterdam, the Netherlands; 4Department of Medical Education, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; 5King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; 6Ministry of the National Guard - Health Affairs, Riyadh, Saudi Arabia; 7Department of Medical Education, United Arab Emirates University, Al Ain, United Arab EmiratesCorrespondence: Nouf Sulaiman Alharbi, Department of Medical Education, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia, Email ns.alharbi@gmail.comBackground: Literature suggest that physicians’ high level of confidence has a negative impact on medical decisions, and this may lead to medical errors. Experimental research is lacking; however, this study investigated the effects of high confidence on diagnostic accuracy.Methods: Forty internal medicine residents from different hospitals in Saudi Arabia were divided randomly into two groups: A high-confidence group as an experimental and a low-confidence group acting as a control. Both groups solved each of eight written complex clinical vignettes. Before diagnosing these cases, the high-confidence group was led to believe that the task was easy, while the low-confidence group was presented with information from which it could deduce that the diagnostic task was difficult. Level of confidence, response time, and diagnostic accuracy were recorded.Results: The participants in the high-confidence group had a significantly higher confidence level than those in the control group: 0.75 compared to 0.61 (maximum 1.00). However, neither time on task nor diagnostic accuracy significantly differed between the two groups.Conclusion: In the literature, high confidence as one of common cognitive biases has a strong association with medical error. Even though the high-confidence group spent somewhat less time on the cases, suggesting potential premature decision-making, we failed to find differences in diagnostic accuracy. It is suggested that overconfidence should be studied as a personality trait rather than as a malleable characteristic.Keywords: overconfidence, diagnostic accuracy, medical errors, premature closure

Abstract Background The possibility of adverse effects of medical treatment (AEMT) is increasing worldwide, but little is known about AEMT in China. This study analyzed the health burden of AEMT in China in recent years through the Global Burden of Disease Study (GBD) 2019 and compared it with the worldwide average level and those in different sociodemographic index (SDI) regions. Methods We calculated the age-standardized rate (ASR) of deaths, disability-adjusted life years (DALYs), years of life lost (YLLs), years lived with disability (YLDs), incidence and prevalence attributed to AEMT in China, worldwide and countries with different sociodemographic indices during 1990–2019 using the latest data and methods from the GBD 2019. Results From 1990 to 2019, the global age-standardized death rate (ASDR), DALYs, and YLLs for AEMT showed a significant downward trend and were negatively associated with the SDI. By 2040, the ASDR is expected to reach approximately 1.58 (95% UI: 1.33–1.80). From 1990 to 2019, there was no significant change in the global incidence of AEMT. The occurrence of AEMT was related to sex, and the incidence of AEMT was greater among females. In addition, the incidence of AEMT-related injuries and burdens, such as ASR of DALYs, ASR of YLLs and ASR of YLDs, was greater among women than among men. Very old and very young people were more likely to be exposed to AEMT. Conclusions From 1990 to 2019, progress was made worldwide in reducing the harm caused by AEMT. However, the incidence and prevalence of AEMT did not change significantly overall during this period. Therefore, the health sector should pay more attention to AEMT and take effective measures to reduce AEMT.

Abstract Background Nursing interns often face the serious challenges and stress of clinical training. Identifying effective strategies in reducing medical errors can improve student performance and decrease patient risk and injury from errors. The purpose of this study was to identify strategies to prevent medical errors by nursing interns in Medical Universities in Sistan and Baluchistan, Southeast of Iran. Methods This is a qualitative study using a content analysis approach. Purposive sampling was used. The study was conducted in 3 medical universities. Ten nursing interns participated in this study. Open-ended, semi-structured, and face-to-face, interviews were used to explore the experience of nursing interns about strategies to prevent medical errors during their internship. Results Findings include 20 subcategories, 6 categories and one theme. The main theme is “strategies to prevent medical errors during internship”. Six categories included “strategies to prevent medical errors during internship”. These included “Professional acceptance and support”, “Revision of the implementation of the educational curriculum”, “Retraining courses for challenging skills”, ”Creating learning opportunities” “Professionalization”, and “Facilities and requirements”. Conclusions Preventing medical errors requires different strategies before and during nursing internship. Error prevention strategies include retraining and preparatory courses for challenging areas, evaluation of students’ performance, and accepting students as members of the health care team, respecting and supporting them and protecting their rights. Learning from medical errors, analysis and reflection on errors should be part of the curriculum during the internship.

People often fail to notice unexpected stimuli when their attention is directed elsewhere. Most studies of this "inattentional blindness" have been conducted using laboratory tasks with little connection to real-world performance. Medical case reports document examples of missed findings in radiographs and CT images, unintentionally retained guidewires following surgery, and additional conditions being overlooked after making initial diagnoses. These cases suggest that inattentional blindness might contribute to medical errors, but relatively few studies have directly examined inattentional blindness in realistic medical contexts. We review the existing literature, much of which focuses on the use of augmented reality aids or inspection of medical images. Although these studies suggest a role for inattentional blindness in errors, most of the studies do not provide clear evidence that these errors result from inattentional blindness as opposed to other mechanisms. We discuss the design, analysis, and reporting practices that can make the contributions of inattentional blindness unclear, and we describe guidelines for future research in medicine and similar contexts that could provide clearer evidence for the role of inattentional blindness. [ABSTRACT FROM AUTHOR]

Background: In Italy, nursing research has paid special attention to 'missed nursing care'. The studies carried out, varying in tools and settings, describe considerable percentages of missed care. In the field of stoma care, the phenomenon has not been investigated to date. Aim: To investigate the prevalence of missed nursing care (MNC) in the Italian ostomy patient population and the most relevant causes suggested for this by stoma care nurses. Design: Cross-sectional study. Method: The Italian version of the MISSCARE survey was used with some questions related to the stoma care pathway. The survey was targeted at hospitals in the country with dedicated services and/or pathways for ostomy patients, between February and April 2023. Findings: A total of 461 questionnaires were sent out, 214 (53.3%) were analysed. The majority of the participants were female (160, 76.2%), median age of 50 years (35.0–53.8). The most common qualification was a Bachelor's degree (n=117; 54.9%) and work experience in stoma care was more than 10 years in 95 cases (50.3%). Prominent instances of MNC were identified, with hand washing (score 4.6 out of 5), compilation of nursing documentation and hygiene/skin care (score 4.5 out of 5) and patient/family education (score 4.4 out of 5) emerging as the most prevalent. The most notable omissions in the stoma care process encompassed educational facets, clinical monitoring, a comprehensive discharge plan, and diligent follow-up. Among the most frequent reasons were staff shortages (score 3.1 out of 4), unsuitable nurse–patient ratios (score of 3 out of 4) and insufficient numbers of experienced stoma care personnel (score of 3 out of 4). Conclusion: A substantial number of basic and clinically relevant nursing interventions were perceived to be missed, and this may lead to an increase in negative outcomes for ostomy patients. [ABSTRACT FROM AUTHOR]

Objective: To assess knowledge, attitudes, and practices (KAPs) toward patient safety among nurses working at primary and comprehensive health care centers in Jordan; to identify factors that predict KAPs among nurses. Methods: A descriptive cross-sectional design was conducted using a convenience sample of 307 primary health care nurses in Jordan. A self-reported questionnaire (KAPs) toward patient safety was distributed to the nurses between August 2022 and October 2022. Results: The results revealed that the mean score of knowledge was 9.51 out of 11 (SD = 1.35), the mean score of attitudes was 57.66 out of 75 (SD = 9.17), and the mean score of practices was 5.64 out of 8 (SD = 1.72). Where 59% of participants reported good knowledge about patient safety. 61% of participants reported positive attitudes toward patient safety. A significant regression equation was found (R² = 0.073, F= (2.94), p = 0 0.003). Age and having information on patient safety during continuing education were significant predictors of the attitude score (p ≤ 0.05). Conclusion: It is necessary to implement patient safety education programs and training. [ABSTRACT FROM AUTHOR]

Background: Missed care rates are an indicator of healthcare quality. Missed nursing care can reduce patient safety and lead to adverse events. Moral sensitivity enables nurses to interpret and respond to clients' needs according to ethical principles. Despite the importance of moral sensitivity and its role in the quality of care, the relationship between nurses' moral sensitivity and missed nursing care has not been extensively studied. This raises the question of whether there is an association between nurses' moral sensitivity and missed care. This study was conducted to investigate the relationship between nurses' moral sensitivity and missed nursing care in the medical and surgical departments of Imam Khomeini Hospital in Urmia, Iran. Methods: A cross-sectional study was conducted in 2022, on 202 nurses working in the medical and surgical departments of Imam Khomeini Medical Education Center, Urmia, Iran. Stratified random sampling was used to select the participants. A questionnaire on demographic characteristics, Kalisch's missed care questionnaire, and Lutzen's moral sensitivity questionnaire were used to collect data. Data were analyzed using the Pearson correlation test and linear regression analysis. Results: Most participants (52.97%) showed moderate moral sensitivity. Nurses' mean moral sensitivity and total missed care scores were 149.07 ± 21.60 and 59.45 ± 4.87, respectively. Pearson correlation test showed no significant correlation between moral sensitivity scores and the total missed care scores (r = 0.041, p = 0.152). However, in the regression analysis, moral sensitivity (β = 0.213, p < 0.001), age (β = 0.131, p < 0.001), working in rotating shifts (β = 0.183, p < 0.001), monthly income (β = 0.079, p = 0.004), work experience (β = 0.030, p = 0.010), and monthly work hours (β = 0.247, p = 0.010) influenced missed care. Approximately, 0.98% of the variance in the missed care was explained by these variables. Conclusion: Our nurses reported moderate levels of moral sensitivity and a concerning level of missed care. Missed care can have detrimental effects on patient safety. Therefore, nursing managers must address this issue promptly. [ABSTRACT FROM AUTHOR]

Background: Despite the increase in disclosures of medical errors, transparency remains a challenge. Recognized barriers include shame, fear of litigation, disciplinary actions, and loss of patient trust. In 2018, the Israeli Ministry of Health initiated a series of workshops about disclosure of medical errors. The workshops involved medical center executives, healthcare providers, patients, and family members of patients who had previously been harmed by a medical error. This study presents the lessons learned about perceived challenges in disclosure of errors in 15 such workshops. Methods: Data collection included participant observations in 15 workshops, full audio recordings of all of the workshops, and documentation of detailed field notes. Analysis was performed under thematic analysis guidelines. Results: We identified four main themes: "Providers agree on the value of disclosure of a medical error to the patient"; "Emotional challenges of disclosure of medical error to patients"; "The medico-legal discourse challenges transparency"; and "Providers and patients call for a change in the culture regarding disclosure of medical errors". Participant observations indicated that the presence of a patient who had experienced a tragedy in another hospital, and who was willing to share it created an intimate atmosphere that enabled an open conversation between parties. Conclusion: The study shows the moral, human, and educational values of open discourse in a protective setting after the occurrence of a medical error. We believe that workshops like these may help foster a culture of institutional disclosure following medical errors. We recommend that the Ministry of Health extend such workshops to all healthcare facilities, establish guidelines and mandate training for skills in disclosure for all providers. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To recognise differences in adverse incident reporting between mental health and general healthcare settings • To appreciate the need to alter adverse incident reporting processes in mental health to consider workforce-related issues • To acknowledge the need for nurses to feel able to include workforce-related issues in adverse incident reports. While overall incident reporting in mental health settings has increased in recent years, so too has the frequency of self-harm and aggression towards patients and staff, which continue to be leading causes of adverse incidents. However, unlike adverse incident reporting in general hospitals, which focuses on factors such as suboptimal treatment or care, adverse incidents in mental health still focus on patients and their acts of self-harm or perceived aggression. Mental health adverse incident policy needs to change to emphasise that incidents occur when staff are unable to provide appropriate care, rather than simply when a patient becomes aggressive or engages in self-harm. However, this requires a shift in the values used to monitor adverse incidents so that patients’ self-harm or aggression is regarded partly as an outcome of inappropriate or omitted care, rather than solely a result of the patient’s actions. [ABSTRACT FROM AUTHOR]

The construction of medical knowledge graphs (MKGs) is steadily progressing from manual to automatic methods, which inevitably introduce noise, which could impair the performance of downstream healthcare applications. Existing error detection approaches depend on the topological structure and external labels of entities in MKGs to improve their quality. Nevertheless, due to the cost of manual annotation and imperfect automatic algorithms, precise entity labels in MKGs cannot be readily obtained. To address these issues, we propose an approach named Enhancing error detection on Medical knowledge graphs via intrinsic labEL (EMKGEL). Considering the absence of hyper-view KG, we establish a hyper-view KG and a triplet-level KG for implicit label information and neighborhood information, respectively. Inspired by the success of graph attention networks (GATs), we introduce the hyper-view GAT to incorporate label messages and neighborhood information into representation learning. We leverage a confidence score that combines local and global trustworthiness to estimate the triplets. To validate the effectiveness of our approach, we conducted experiments on three publicly available MKGs, namely PharmKG-8k, DiseaseKG, and DiaKG. Compared with the baseline models, the Precision@K value improved by 0.7%, 6.1%, and 3.6%, respectively, on these datasets. Furthermore, our method empirically showed that it significantly outperformed the baseline on a general knowledge graph, Nell-995. [ABSTRACT FROM AUTHOR]

Accurate diagnosis of paediatric appendicitis remains a challenge due to its diverse clinical presentations and reliance on subjective assessments. The integration of artificial intelligence (AI) with an expert's "clinical sense" has the potential to improve diagnostic accuracy. In this study, we aimed to evaluate the effectiveness of the Artificial Intelligence Pediatric Appendicitis Decision-tree (AiPAD) model in enhancing the diagnostic capabilities of trainees and compare their performance with that of an expert supervisor. Between March 2019 and October 2022, we included paediatric patients aged 0–12 years who were referred for suspected appendicitis. Trainees collected clinical findings using five predefined parameters before ordering any imaging studies. The AiPAD model, which was blinded to the surgical team, made predictions from the supervisor's and trainees' findings independently. The diagnosis verdicts of the supervisor and the trainees were statistically evaluated in comparison to the prediction of the AI model, taking into account the revealed correct diagnosis. A total of 136 cases were included, comprising 58 cases of acute appendicitis (AA) and 78 cases of non-appendicitis (NA). The supervisor's correct verdict showed 91% accuracy compared to an average of 70% for trainees. However, if trainees were enabled with AiPAD, their accuracy would improve significantly to an average of 97%. Significantly, a strong association was observed between the expert's clinical sense and the predictions generated by AiPAD. Conclusion: The utilisation of the AiPAD model in diagnosing paediatric appendicitis has significant potential to improve trainees' diagnostic accuracy, approaching the level of an expert supervisor. This hybrid approach combining AI and expert knowledge holds promise for enhancing diagnostic capabilities, reducing medical errors and improving patient outcomes. What is Known: • Sharpening clinical judgement for pediatric appendicitis takes time and seasoned exposure. Traditional training leaves junior doctors yearning for a faster path to diagnostic mastery. What is New: • AI-generated models unlock the secrets of expert intuition, crafting an explicit guide for juniors to rapidly elevate their diagnostic skills. This leapfrog advancement empowers young doctors, democratizing medical expertise and paving the way for brighter outcomes in clinical training. [ABSTRACT FROM AUTHOR]

Background: The nursing workforce remains in a vulnerable state post pandemic as working conditions are difficult and exacerbated by a global nursing shortage. Identifying factors leading to turnover intentions are thus critical for health care system recovery. Purpose: The purpose of this study was to examine the impact of nurses' work environment and the pandemic on missed nursing care, scope of practice, emotional exhaustion, and intent to leave. Methods: This study was a cross-sectional, self-reporting online survey, sent to hospital-based nurses in a Canadian province (n = 419). Mediation analysis was used to examine both direct and indirect effects of work environment and COVID-19 impact on nurse outcomes (emotional exhaustion and intent to leave) through missed care and scope of practice. Results: The results showed that 73% of nurses were considering leaving the profession. Several direct and indirect pathways predicted emotional exhaustion and intent to leave. A better work environment was related to both decreased emotional exhaustion and intent to leave. Nurses' scope of practice partially mediated the relationship between work environment and intent to leave. On the other hand, missed care did not mediate emotional exhaustion or intent to leave. Conclusions: While considering the global nursing shortage, it is imperative to implement strategies to promote nurses' well-being and their retention within the health care system. [ABSTRACT FROM AUTHOR]

Introduction: During laparoscopic surgery, surgeons may experience prolonged periods without fluid intake, which might impact surgical performance, yet there are no objective data investigating this issue. Therefore, the aim of this study was to elucidate the effect of prolonged dehydration on laparoscopic surgical performance and tissue handling. Methods: A total of 51 laparoscopic novices participated in a single-center, open-label, prospective randomized cross-over trial. All participants were trained to proficiency using a standardized laparoscopic training curriculum. Afterward, all participants performed four different laparoscopic tasks twice, once after 6 h without liquid intake (dehydrated group) and once without any restrictions (control group). Primary endpoints were tissue handling defined by force exertion, task time, and error rate. The real hydration status was assessed by biological parameters, like heart rate, blood pressure, and blood gas analysis. Results: 51 laparoscopic novices finished the curriculum and completed the tasks under both hydrated and dehydrated conditions. There were no significant differences in mean non-zero and peak force between the groups. However, dehydrated participants showed significantly slower task times in the Peg transfer task (hydrated: 139.2 s vs. dehydrated: 147.9 s, p = 0.034) and more errors regarding the precision in the laparoscopic suture and knot task (hydrated: 15.7% accuracy rate vs. dehydrated: 41.2% accuracy rate, p < 0.001). Conclusion: Prolonged periods of dehydration do not appear to have a substantial effect on the fundamental tissue handling skills in terms of force exertion among surgical novices. Nevertheless, the observed impact on speed and precision warrants attention. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To examine nurse managers' perspectives on missed nursing care (MNC) on surgical units. BACKGROUND: The phenomenon of MNC is an important concern for nurse researchers. However, the reality of how it is experienced by clinical nurse managers is largely unexplored. Understanding nurse managers' experiences with MNC could help develop useful approaches to reducing levels of MNC. METHODS: A descriptive qualitative study was conducted between December and June 2020, using face-to-face semistructured interviews with 10 nurse managers. RESULTS: Five themes were identified: 1) awareness of MNC; 2) rationale for MNC; 3) consequences of MNC; 4) questions of reporting; and 5) management of MNC. CONCLUSIONS: Nurse managers must use their positions and leadership skills to expect appropriate staffing approaches and material resources for surgical units, effective process for newly hired nurses, and the establishment of a reporting system for MNC to reduce the phenomenon in practice. [ABSTRACT FROM AUTHOR]

The implementation of an Electronic Prescribing (EP) system offers numerous advantages in enhancing the efficiency of prescribing practices. To ensure successful implementation, a comprehensive understanding of the workflow in paper- based prescribing is crucial. In Iran, the Ministry of Health, and Medical Education (MOHME) has been actively involved in developing an EP system since 2011. The pilot results within MOHME have garnered significant support from all basic insurance organizations, primarily due to the importance of addressing financial considerations. As a result, these insurance organizations have taken the lead in the national development of the EP system, as responsibilities have shifted. The development of an Integrated Care Electronic Health Record (ICEHR or EHR) and the approach adopted by MOHME have paved the way for the creation of a standardized set of Application Programming Interfaces (APIs) based on openEHR and ISO13606 standards. These APIs facilitate the secure transfer of consolidated data from the EP systems, stored in the data warehouses of basic insurance organizations, to the Iranian EHR. This model follows an ICEHR architecture that emphasizes the transmission of this information to the Iranian EHR. This paper provides a detailed discussion of the various aspects and accomplishments related to these developments. [ABSTRACT FROM AUTHOR]

Background Death certificate (DC) errors are common. At our institution, all deaths have a preliminary death certificate (PDC) written by a clinician and then revised by a pathologist prior to the clinician signing the final death certificate (FDC). In autopsy cases, the FDC is signed by the pathologist who performs the autopsy. Methods A total of 100 in-hospital deaths (50 with autopsy and 50 without) occurred in 2020 were arbitrarily selected from a tertiary care center. All PDCs and FDCs were compared to identify/classify errors as major (incorrect cause of death (COD) or significant contributing factors) or minor (abbreviations, inappropriate non-essential contributing factors, immediate/intermediate COD errors). Frequency of PDC errors was compared by autopsy status, duration of hospital stay and PDC author. Results Ninety percent of cases had at least one PDC error and 39% had a major error. Major errors were more common in autopsy cases (50% versus 28%, P  = 0.035), although minor/overall errors were not. Error rates did not significantly differ for the other variables assessed. Conclusions There is significance of having a pathologist review and revise DCs before they are signed. The increased frequency in major errors in cases with autopsy suggests that autopsy findings provided additional information to elucidate COD. [ABSTRACT FROM AUTHOR]