Objective: Healthcare institutions have taken efforts to communicate to their healthcare workers (HCWs) about the concepts and importance of clinical quality and patient safety (CQPS). However, implementing interventions to promote pro CQPS behaviour without fully evaluating the factors that direct such behaviour may be costly and counter-productive. This study aimed to investigate HCWs’ perception of their competence and attitudes towards CQPS. It also looked into their perceived behaviour pattern to unsafe practices and usefulness of the different avenues to improve CQPS behavior in the hospital.Methods: A survey was conducted among doctors, nurses and allied health workers over two months in 2017. Paper surveys were distributed during departmental staff meetings. Participation was strictly voluntary, and responses were de-identified and kept confidential. Responses were measured using a five-point Likert scale. Data was analyzed using descriptive statistics.Results: The participation rate was 90.2% (541/600). Of the respondents, 88.0% and 85.6% agreed that CQPS was important and relevant to their work respectively. However, when asked if they execute a series of pro-CQPS behaviour, results showed a knowledge-behaviour disconnect. Only 36.2% will intervene when they see unsafe practice and 27.2% see the importance of reporting near miss events.Conclusions: While respondents are generally aware of the importance and relevance of CQPS, this is not reflected in their behaviour as they are unmotivated and show disinterest in practising pro-CQPS behaviour. Further studies are needed to address the factors associated with this knowledge-behaviour disconnect.
Objective: Documentation of the discharge against medical advice (AMA) is poorly performed in the emergency department (ED). Little is known about the impacts of a checklist on this. Our study aimed to compare the quality of AMA documentation before and after implementation of a checklist. Methods: A retrospective review was conducted followed by a prospective study; each over three months of AMA interactions in our ED pre and post implementation of a checklist. An 11-point checklist was used to determine documentation quality during these two periods. Quality was assessed based on the number of points fulfilled on this tool. Documentation was classified as "good" (8-11), "average" (4-7) and "poor" (0-3). The primary outcome measured was the proportions of discharged AMA records that showed "good", "average" and "poor" documentation. Secondary outcomes were compliance rates to each of the categories of the checklist before and after its use. Results: 339 and 309 complete records were retrieved from the retrospective and prospective arms respectively. The proportions of case records in the three grades before and after use of the checklist respectively were: poor, 199/339 (59%) vs. 7/313 (2%); fair, 133/339 (39%) vs. 66/313 (21%) and good 7/339 (2%) vs. 240/313 (77%); all p-values were statistically significant. There were also statistically significant differences in compliance rates to each of the categories of the checklist pre and post checklist implementation. Conclusions: This study shows improvement in quality and compliance rates in the audit categories after the implementation of an AMA checklist.
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