Background

Intraoperative hypothermia can lead to adverse clinical outcomes and avoidable financial and environmental costs. Environmentally preferable warming practices have been identified, including using reusable resistive blankets, extending the life cycle of forced air warming (FAW) garments and minimising flannel blanket use. This study integrates existing environmental data with best practices and quality improvement methodology to develop an optimised patient warming pathway (OPWP). This pathway was adapted to our local context, implemented and evaluated.

Methods

The OPWP was developed using a scoping review, prior environmental impact assessment and root cause analysis. It was tailored to the workflows, patient population and warming practices at a tertiary care hospital and implemented using a multifaceted approach encompassing nine PDSA (Plan-Do-Study-Act) cycles. Major interventions included expanding pre-warming criteria to meet best practice guidelines, preserving the FAW Flex Gown, staff education and training, behaviourally informed strategies, gamification and policy development. Pre-intervention and post-intervention audits assessed environmental and financial savings, incidence of hypothermia and patient-reported outcomes (PROs).

Results

The OPWP recommends preferential use of the resistive blanket for intraoperative warming, preservation of the Flex Gown for postoperative use when warming with FAW and minimising flannel blanket use. A modified pathway was implemented using FAW with preservation of a single Flex Gown throughout the perioperative journey. From pre-intervention (N=51) to post-intervention (N=64), flannel blanket use decreased from an average of 6 to 3 per patient (p<0.01). Active warming increased from 55% to 80% (p=0.04) preoperatively and from 0% to 55% (p<0.01) postoperatively. There was no significant change in the incidence of hypothermia (18% to 15%, p=0.77) and PROs remained favourable. Implementation of this pathway could lead to annual environmental savings of 940 339 kg of carbon dioxide equivalents and cost savings of $C117 978.

Conclusions

This study demonstrates the successful implementation of an evidence-based and environmentally sustainable perioperative warming pathway to achieve low-carbon, high-quality patient care.

Artificial intelligence (AI) has great potential to assist healthcare staff and organisations in maintaining and improving the quality and safety of healthcare1 in the face of workforce shortages, rising service demand and escalating costs. Despite hundreds of regulator-approved AI-enabled tools internationally, relatively few feature in routine clinical care,2 in part due to inattention to how AI tools integrate into sociotechnical healthcare environments.3 In this Viewpoint, based on our experience as AI implementation researchers, we discuss what we see as seven key barriers to the adoption of AI in healthcare and offer some solutions.

AI literacy and engagementUnderdeveloped professional skills and consumer understanding

AI will never be adopted at scale unless health professionals better understand AI and its limitations, acquire competencies in co-designing, co-evaluating and effectively using AI tools, undertake continual vigilance of AI tool performance and avoid over-reliance on AI with...

Navajo Manufacturing company is recalling certain heating pads that overheat when folded leading to potential burn injuries

Omnipod Pods may not deliver insulin as intended due to a tear in the internal tubing

Certain SureForm Surgical Stapler reloads may form incomplete staple lines, leading to severe bleeding or death

Prismaflex Set deaeration chambers may dislodge from the Prismaflex Control Unit during use.

Integra LifeSciences is removing certain lots of Microsensor and Cerelink ICP Kits with potential corrosion stains on the included Tuohy Needle.

ACTON, Mass.--(BUSINESS WIRE)-- Insulet Corporation (NASDAQ: PODD) (“Insulet” or the “Company”) today initiated a voluntary Medical Device Correction for specific lots of Omnipod® 5 Pods after identifying a manufacturing issue through its ongoing product monitoring. This action applies to specific i

Erbe Cryoprobes may rupture during activation, leading to potential hearing loss, tinnitus, injury, or burns

Integra is removing certain Wound and Burn Dressing products that may have breached sterile barriers.

Certain reprocessed catheters may contain residual particulates that could cause infection, embolism, or thrombosis.

Certain reprocessed catheters may contain residual particulates that could cause infection, embolism, or thrombosis

These choking rescue protocols include abdominal thrusts (also called the “Heimlich” maneuver) for children and adults but not anti-choking devices.

Boston Scientific is removing certain stents and delivery systems due to issues with deployment and expansion.

Fresenius Kabi is correcting Ivenix LVP software due to anomalies that could cause serious patient harm or death

Impella Generation 1 Purge Cassettes have an increased risk of purge leaks. Purge leaks can lead to low pump pressure and pump stops

Olympus is removing certain High Flow Insufflation Unit models due to software issues that may lead to overpressure events.

Language barriers between healthcare professionals and their patients remain a persistent challenge. Patients with limited proficiency in the primary language of the country where they receive care face higher risks of adverse events, misdiagnosis and unplanned readmissions.1 2 In linguistically diverse countries, services often fall short of meeting the needs of patients who speak minority languages. This leads to inequities in care across inpatient, outpatient and emergency settings. While concern for language discordance in healthcare is by no means a novel development, guidelines have rarely progressed beyond recommending implementation of professional interpreter services.3 In-person interpretation is generally considered the gold standard for addressing language barriers during direct care delivery4 5 and is in line with regulatory and ethical standards.6 Other modalities of interpretation, including telephone and video, are alternative options, although the feasibility of providing timely written...

Introduction

Machine translation of patient-specific information could mitigate language barriers if sufficiently accurate and non-harmful and may be particularly useful in healthcare encounters when professional translators are not readily available. We evaluated the translation accuracy and potential for harm of ChatGPT-4 and Google Translate in translating from English to Spanish, Chinese and Russian.

Methods

We used ChatGPT-4 and Google Translate to translate 50 sets (316 sentences) of deidentified, patient-specific, clinician free-text emergency department instructions into Spanish, Chinese and Russian. These were then back-translated into English by professional translators and double-coded by physicians for accuracy and potential for clinical harm.

Results

At the sentence level, we found that both tools were ≥90% accurate in translating English to Spanish (accuracy: GPT 97%, Google Translate 96%) and English to Chinese (accuracy: GPT 95%; Google Translate 90%); neither tool performed as well in translating English to Russian (accuracy: GPT 89%; Google Translate 80%). At the instruction set level, 16%, 24% and 56% of Spanish, Chinese and Russian GPT-translated instruction sets contained at least one inaccuracy. For Google Translate, 24%, 56% and 66% of Spanish, Chinese and Russian translations contained at least one inaccuracy. The potential for harm due to inaccurate translations was ≤1% for both tools in all languages at the sentence level and ≤6% at the instruction set level. GPT was significantly more accurate than Google Translate in Chinese and Russian at the sentence level; the potential for harm was similar.

Conclusion

These results support the potential of machine translation tools to mitigate gaps in translation services for low-stakes written communication from English to Spanish, while also strengthening the case for caution and for professional oversight in non-low-risk communication. Further research is needed to evaluate machine translation for other languages and more technical content.

Background

Healthcare patient safety investigations inappropriately focus on individual culpability and the target of recommendations is often on the behaviours of individuals, rather than addressing latent failures of the system. The aim of this study was to explore whether outcome bias might provide some explanation for this. Outcome bias occurs when the ultimate outcome of a past event is given excessive weight, in comparison to other information, when judging the preceding actions or decisions.

Methods

We conducted a survey in which participants were each presented with three incident scenarios, followed by the findings of an investigation. The scenarios remained the same, but the patient outcome was manipulated. Participants were recruited via social media and we examined three groups (general public, healthcare staff and experts) and those with previous incident involvement. Participants were asked about staff responsibility, avoidability, importance of investigating and to select up to five recommendations to prevent recurrence. Summary statistics and multilevel modelling were used to examine the association between patient outcome and the above measures.

Results

212 participants completed the online survey. Worsening patient outcome was associated with increased judgements of staff responsibility for causing the incident as well as greater motivation to investigate. More participants selected punitive recommendations when patient outcome was worse. While avoidability did not appear to be associated with patient outcome, ratings were high suggesting participants always considered incidents to be highly avoidable. Those with patient safety expertise demonstrated these associations but to a lesser extent, when compared with other participants. We discuss important comparisons between the participant groups as well as those with previous incident involvement, as victim or staff member.

Interpretation

Outcome bias has a significant impact on judgements following incidents and investigations and may contribute to the continued focus on individual culpability and individual focused recommendations observed following investigations.