Effective communication and teamwork have been identified in the literature as key enablers of patient safety. The SBAR (Situation-Background-Assessment-Recommendation) process has proven to be an effective communication tool in acute care settings to structure high-urgency communications, particularly between physicians and nurses; however, little is known of its effectiveness in other settings. This study evaluated the effectiveness of an adapted SBAR tool for both urgent and non-urgent situations within a rehabilitation setting. In phase 1 of this study, clinical staff, patient and family input was gathered in a focus-group format to help guide, validate and refine adaptations to the SBAR tool. In phase 2, the adapted SBAR was implemented in one interprofessional team; clinical and support staff participated in educational workshops with experiential learning to enhance their profi
Patient safety has been relatively unexplored in rehabilitation and complex continuing care (CCC) settings. From the perspectives of staff members, this qualitative study aimed to explore patient safety phenomena that exist within rehabilitation/CCC and to identify the characteristics of the current workplace culture that act as enablers of or barriers to patient safety. Sixty-six staff members in a large, multisite, academic rehabilitation/CCC health centre volunteered to participate in one of six interprofessional focus groups, designed to model patient care teams that exist within the clinical programs; one focus group was also conducted with support services staff. Thematic analysis revealed that rehabilitation/CCC settings present with distinct patient safety issues due to the unique and increasingly complex populations that are served, and the place of rehabilitation/CCC along the continuum of care. Enablers and barriers identified related to teamwork, culture, resources and organizational and individual responsibility. Results of this study have helped form the foundation for future patient safety initiatives within our settings, with clear emphasis on enhancing an open and just culture in which to discuss safety issues through development of improved leadership-staff relations, teamwork and communication and clearer processes and structures for accountability. The approach to addressing these issues must fit within our rehabilitation models of care.
Broadening the Patient Safety Agenda S afety literature specific to rehabilitation is extremely sparse. Most of the attention to date has been on developing standards for acute care hospitals, an environment of short stays, acute illnesses, invasive interventions and frequent changes in applied therapeutic modalities. At the other end of the spectrum, long-term care standards are also being developed, primarily focusing on input measures (e.g., number of medications, use of restraints). We do not know if these standards can be appropriately applied whole or in a modified manner to a medium-sized rehabilitation hospital that falls between these two sectors in terms of acuity and intensity of intervention. The purpose of this article is to describe an organizational patient safety change management plan within a large academic rehabilitation institution, how this plan was developed and implemented and key learnings from this initiative as we continue to move forward. This safety initiative was undertaken at the Toronto Rehabilitation Institute, an institution born in 1998 from a four-hospital merger. The hospital, a fully affiliated hospital of the University of Toronto, operates in-patient and outpatient facilities on five sites and employs approximately 1,800 people.
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