Background

Hospital incident reporting and patient concerns systems are widely used to detect and respond to patient harm. Despite increasing recognition of the link between equity and safety, equity remains poorly integrated into the design and function of these systems. Consequently, these systems risk obscuring or reproducing inequities rather than revealing and attending to them.

Objective

To examine how issues of equity are currently considered in research about hospital incident reporting and patient concerns systems and identify opportunities to more systematically include equity in how patient safety is addressed.

Methods

A critical interpretive synthesis was conducted to develop a theoretical understanding of the topic through inductive analysis and interpretation. The databases CINAHL, EMBASE, MEDLINE and PsycINFO were searched from database inception to 6 February 2024. Select social science, patient safety and health services literature supported the interpretive process.

Results

After screening 6508 abstracts and conducting hand searches, we included 30 articles in our review. Our analysis identified four equity-related themes. The first theme describes how knowledge injustices in ‘what counts as a safety event or contributor’ shape what patient issues are recognised, recorded and addressed. The second theme examines how individual bias and systemic discrimination affect which safety events and concerns get reported. The third theme explores both opportunities and limitations of stratifying data to uncover equity-related patterns of harm. The fourth theme presents alternate frameworks, including restorative and human rights approaches, as ways to address inequities and humanise harm.

Conclusion

The findings provide direction for changes within incident reporting and patient concerns practices (eg, expanding definitions of harms; creating accessible and culturally safe patient concerns systems). They also affirm the opportunity to learn from, and build on, initiatives such as taking a restorative approach that moves beyond a customer service and risk management framing.

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GE HealthCare issues updated use instructions for certain Carestation 600 and 700 series Anesthesia Systems

Olympus ligation loops may be unable to release or detach as expected during use and may become unintentionally anchored around patient anatomy
 

Certain Abbott Diabetes Care Continuous Glucose Monitor sensors may provide incorrect low glucose readings

Certain SJM Pericardial Patches from Glycar SA may not meet the required tensile strength specification

Dropping or severely jarring Alaris Pumps may damage critical pump components. Do not use dropped or jarred devices until thoroughly inspected and tested

Baxter is permanently removing all Life2000 Ventilation Systems after discovering a cybersecurity issue that may allow unauthorized access to the device

Balt USA is removing their Mega Ballast because of the unintended presence of loose hydrophilic coating inside the tube at the tip end

SpeedControl Dials used with SmartDrive MX2+ Power Assist Devices may be unresponsive to users and fail to stop or start unexpectedly, causing injury

Some Ivenix LVP Primary Administration Sets were assembled with the drip chamber and Luer Lock components in reversed positions, potentially leading to clinical complications

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Medline is updating labels for their medical kits containing the Flexicare BritePro Solo due to the light not illuminating as intended.

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Since the Institute of Medicine released its landmark report in 19991 highlighting serious concerns about patient safety (PS) and the quality of healthcare in the USA, training programmes around the world have made quality improvement (QI) and PS key components of resident education and experience. In recognising that physicians must learn to interact with and adapt to a constantly changing healthcare environment, the Accreditation Council for Graduate Medical Education (ACGME) and ACGME International (ACGME-I) identified QI and PS as two of the six ‘Pathways of Excellence’ expected in an optimal clinical learning environment.2 In this journal, Molina et al present an exemplary effort to train the next generation of healthcare professionals in improvement science.3 This 13-year QI initiative in a large paediatric residency programme demonstrated how applying QI methodology to the educational programme itself can strengthen resident training. Through phased interventions—including structured didactics,...

Medication-related problems remain one of the leading causes of patient harm.1 Studies show that advances in electronic health records (EHR) and computerised prescribing systems with clinical decision support (CDS) have reduced prescription errors, improved physician performance and patient outcomes. However, these effects are not universally experienced and are influenced by usability, perceived usefulness, relevance and efficiency.2 3

Medication-related CDS can be classified as basic (eg, drug-drug interaction (DDI) or drug-allergy checks) or advanced, whereby patient-specific information in the EHR is used (eg, drug-disease contraindication or drug-laboratory test checks).4 However, a key persistent issue with CDS is alert fatigue, where clinically important alerts are ignored alongside alerts that are not clinically important or relevant. This is exacerbated when healthcare providers are presented with excessive and unimportant alerts, resulting in high alert override rates.5 Indeed, DDI software is often associated with...

Background

Drug–drug interaction (DDI) alerts target the co-prescription of two potentially interacting medications and are a frequent feature of electronic medical records (EMRs). There have been few controlled studies evaluating the effectiveness of DDI alerts. This study aimed to determine the impact of DDI alerts on rates of DDIs and on associated patient harms.

Methods

Quasi-experimental controlled pre–post study in five Australian hospitals. Three hospitals acted as control hospitals (EMR with no DDI alerts) and two as intervention (EMR with DDI alerts). Only DDI alerts at the highest severity level (defined as ‘major contraindicated’) were switched on at intervention hospitals. These alerts were not tailored to clinical context (ie, patient, drug). A total of 2078 patients were randomly selected from all patients (adult and paediatric) admitted to hospitals 6 months before and 6 months after EMR implementation. A retrospective chart review was performed by study pharmacists. The primary outcome was the proportion of admissions with a clinically relevant DDI. Secondary outcomes included the proportions of admissions with a potential DDI and with DDI-related harm.

Results

Potential DDIs were identified in the majority of admissions (n=1574, 74.7%) and clinically relevant DDIs identified in half (n=1026, 48.7%). DDI alerts were associated with a reduction in the proportion of admissions with potential DDIs (adjusted OR (AOR)=0.38 (0.19, 0.78)) but no change in clinically relevant DDIs (AOR=1.12 (0.68, 1.84)) or in DDI-related harm (AOR=2.42 (0.47,12.31)). 199 DDIs (76 at control and 123 at intervention hospitals) for 35 patient admissions were associated with patient harm, and 2 patients experienced severe DDI-related harm pre-EMR implementation.

Discussion

Implementation of DDI alerts, without tailoring alerts to clinical context, is unlikely to reduce patient harms from DDIs. Organisations should reconsider implementation of DDI alerts in EMRs where significant tailoring of alerts is not possible. Future research should focus on identifying safe, efficient and cost-effective ways of refining DDI alerts, so expected clinical benefits are achieved, and negative consequences of excessive alerting are minimised.

Background

Self-management support (SMS) is a recommended component of cancer survivorship care that improves health-related quality of life and reduces healthcare utilisation. However, widespread implementation has been difficult to achieve, with a gap in the literature on system-wide implementation efforts. This study examines contextual factors perceived to influence SMS adoption and sustainment in cancer centres in the Republic of Ireland.

Method

Semistructured interviews were conducted with 47 key informants from 20 cancer organisations across community and hospital settings. Participants were asked to report the level of adoption and sustainment of SMS at their organisation. This information was used to categorise organisations as low, medium or high implementers. We conducted cross-case analysis following the principles of Framework Analysis. Using the Consolidated Framework for Implementation Research as a menu of constructs, we examined factors influencing adoption and sustainment and variation in levels of implementation.

Results

National policy, external accreditation, external financing opportunities and the presence of champions in organisations are influential early in the implementation process driving adoption. Healthcare provider-led programmes and evidence of SMS improving patient outcomes and aligning with an organisation’s priorities are necessary to secure buy-in, particularly among senior leadership. An organisational culture of entrepreneurship enables adoption and sustainment, with resources and a culture supporting staff well-being enabling sustainment.

Conclusion

While national policy is a driver, additional factors related to programme attributes and local contextual features such as the presence of champions, organisational readiness and culture influence implementation. The results may be used for future evaluations of SMS implementation in cancer survivorship care and to inform the development of tailored implementation strategies.