Sara Albolino

The collaborative communication model for patient handover at the interface between high-acuity and low-acuity care

Background Cross-unit handovers transfer responsibility for the patient among healthcare teams in different clinical units, with missed information, potentially placing patients at risk for adverse events. Objectives We analysed the communications between high-acuity and low-acuity units, their content and social context, and we explored whether common conceptual ground reduced potential threats to patient safety posed by current handover practices. Methods We monitored the communication of five content items using handover probes for 22 patient transitions of care between high-acuity ‘sender units’ and low-acuity ‘recipient units’. Data were analysed and discussed in focus groups with healthcare professionals to acquire insights into the characteristics of the common conceptual ground. Results High-acuity and low-acuity units agreed about the presence of alert signs in the discharge form in 40% of the cases. The focus groups identified prehandover practices, particularly for anticipatory guidance that relied extensively on verbal phone interactions that commonly did not involve all members of the healthcare team, particularly nursing. Accessibility of information in the medical records reported by the recipient units was significantly lower than reported by sender units. Common ground to enable interpretation of the complete handover content items existed only among selected members of the healthcare team. Conclusions The limited common ground reduced the likelihood of correct interpretation of important handover information, which may contribute to adverse events. Collaborative design and use of a shared set of handover content items may assist in creating common ground to enable clinical teams to communicate effectively to help increase the reliability and safety of cross-unit handovers.

Interruptions and multitasking in surgery: a multicentre observational study of the daily work patterns of doctors and nurses*

Abstract The aim of this study was to obtain baseline data on doctors’ and nurses’ work activities and rates of interruptions and multitasking to improve work organisation and processes. Data were collected in six surgical units with the WOMBAT (Work Observation Method by Activity Timing) tool. Results show that doctors and nurses received approximately 13 interruptions per hour, or one interruption every 4.5 min. Compared to doctors, nurses were more prone to interruptions in most activities, while doctors performed multitasking (33.47% of their time, 95% CI 31.84–35.17%) more than nurses (15.23%, 95% CI 14.24–16.25%). Overall, the time dedicated to patient care is relatively limited for both professions (37.21%, 95% CI 34.95–39.60% for doctors, 27.22%, 95% CI 25.18–29.60% for nurses) compared to the time spent for registration of data and professional communication, that accounts for two-thirds of doctors’ time and nearly half of nurses’ time. Further investigation is needed on strategies to manage job demands and professional communications. Practitioner Summary: This study offers further findings on the characteristics and frequency of multitasking and interruptions in surgery, with a comparison of how they affect doctors and nurses. Further investigation is needed to improve the management of job demands and communications according to the results.

Safety and quality in maternal and neonatal care: the introduction of the modified WHO Safe Childbirth Checklist

Abstract Maternal and neonatal mortality and morbidity associated with childbirth is a problem of the highest priority. This research has been aimed at testing a modified version of the WHO Safe Childbirth Checklist in one Italian hospital and to evaluate the tool in terms of its impact on clinical practice and safety. Results show that the presence of correctly compiled partogram tool is strongly and significantly associated with the checklist implementation (OR = 14.9, 95% confidence interval [CI] = 3.5, 63.9). Compliance to the checklist was high for mid-wives (96%) and very low for obstetricians (3%). The discrepancy is the result of a misinterpretation by obstetricians: they signed only in case they prescribed therapy or when they identified risk factors, but not to underline that they checked for those factors independently by their existence. While the checklist promotes the interdisciplinary work, field studies generally show strong hierarchical rather than partnership interaction. Practitioner Summary: The study is aimed at evaluating: the checklist impact on clinical practice through a prospective pre- and post-intervention study based on clinical records review, the usability of the tool and the user’s compliance. The research gives evidences on the importance of the tool for reducing risks related to delivery.

Towards a safer healthcare system

While the terms ergonomics and human factors have distinctive origins (in Europe, ergonomics referred to the laws of work or how work conditions affect people such as leading to physiological stress or musculoskeletal injury; in the USA, human factors originally focused on the user–system interface or how people interact with equipment, workplaces and their environment), today the two terms are used interchangeably. A basic premise shared by the authors of the present supplement is that the creation of safer healthcare involves taking into account human strengths and limitations as we design and interact with open dynamic systems that comprise patients and providers, processes of care, tools and technology, the physical environment, the organisational environment and a host of external influences. The supplement actually has its origins in an international conference, Healthcare Systems Ergonomics and Patient Safety (HEPS), held in Florence in 2005.1 The idea of bridging the worlds of the varied healthcare professions and the ergonomics and human factors community in the form of a conference arose from the Italian Ergonomic Society and was spearheaded by S Bagnara and R Tartaglia. A second international HEPS conference was organised collaboratively by Italian, French and German ergonomic societies. Held in Strasbourg in 2008, it highlighted the role and experiences of patients and providers. Representatives from over 20 countries participated. The conference gained the endorsement of the International Ergonomics Association and is now recognised by those with a serious interest in patient safety and …

Health and social care ergonomics: patient safety in practice

This is an Accepted Manuscript of an article published by Taylor & Francis in Ergonomics on 09 Oct 2017, available online: https://doi.org/10.1080/00140139.2017.1386454.

Safety and Quality of Maternal and Neonatal Pathway: Implementation of the Modified WHO Safe Childbirth Checklist in Two Hospitals of the Tuscany Center Trust, Italy

Data monitoring and reporting systems are extremely important for safety and quality of care. The use of tools to support the work of health professionals in managing clinical risk is widespread particularly in high income countries. In 2008 the World Health Organization designed a checklist for the safety during childbirth (safe Childbirth Checklist) initially dedicated to low and middle-income countries, now available also for developed countries. Two studies have been conducted by the Centre for clinical risk management and Patient safety (Florence) in hospitals in Tuscany with the aim of evaluating the impact of a modify version of the WHO checklist on clinical practice, the usability of the tool and the users’ compliance through prospective pre- and post-intervention studies based on clinical records review. The effects of the checklist on professionals’ adherence to clinical practices and on the standardization of processes have been investigated, in order to design and refine the tool. Both studies show that the presence of correctly compiled partogram tool in the clinical charts is strongly and significantly associated with the checklist implementation (OR1 = 14.9, 95% confidence interval [CI] = 3.5, 63.9 and OR2 = 2.51, 95% confidence interval [CI] = 1.41−4.47) and that the checklist promotes the interdisciplinary work.

Patient Safety in Complementary Medicine through the Application of Clinical Risk Management in the Public Health System

Aim: To develop a systematic approach to detect and prevent clinical risks in complementary medicine (CM) and increase patient safety through the analysis of activities in homeopathy and acupuncture centres in the Tuscan region using a significant event audit (SEA) and failure modes and effects analysis (FMEA). Methods: SEA is the selected tool for studying adverse events (AE) and detecting the best solutions to prevent future incidents in our Regional Healthcare Service (RHS). This requires the active participation of all the actors and external experts to validate the analysis. FMEA is a proactive risk assessment tool involving the selection of the clinical process, the input of a multidisciplinary group of experts, description of the process, identification of the failure modes (FMs) for each step, estimates of the frequency, severity, and detectability of FMs, calculation of the risk priority number (RPN), and prioritized improvement actions to prevent FMs. Results: In homeopathy, the greatest risk depends on the decision to switch from allopathic to homeopathic therapy. In acupuncture, major problems can arise, mainly from delayed treatment and from the modalities of needle insertion. Conclusions: The combination of SEA and FMEA can reveal potential risks for patients and suggest actions for safer and more reliable services in CM.

Progettazione e sicurezza del paziente

Riassunto Il termine design ha molti significati; più in generale si pensa al disegno di una forma, di una figura o di una struttura. Per i progettisti, tuttavia, il termine implica un significato più ampio: “creare e sviluppare concetti e caratteristiche che ottimizzino la funzione, il valore e l’aspetto di prodotti e sistemi” (Ulrich, Eppinger, 1995). La progettazione di un processo o di una tecnologia clinica implica, dunque, una fondamentale revisione di un prodotto o di un sistema. Più che cercare di apportare qualche miglioramento marginale, un progettista tende a raffigurarsi il prodotto partendo da zero, ricorrendo alla comprensione del modo naturale in cui gli esseri umani lavorano e interagiscono con la tecnologia. Per contro, l’espressione “miglioramento del processo” suggerisce che il processo in questione presenta alcune carenze, ma che è abbastanza robusto e funzionale. È chiaro, tuttavia, che alcuni processi e sistemi sanitari si sono sviluppati in maniera tale che il miglioramento non è più una soluzione sufficiente. È capitato, per esempio, che un team abbia desistito dall’analisi del sistema di gestione dei farmaci in uso nel proprio ospedale perché era talmente complicato che nessuno riusciva a comprenderlo effettivamente.