Reclaiming the systems approach to paediatric safety

Cheung, Ronny; Roland, Damian; Lachman, Peter

doi:10.1136/archdischild-2018-316401

Cited by 8 publications

(6 citation statements)

References 33 publications

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“…Patient outcomes from the CIs were similar to the rates of temporary harm and minimal harm reported previously 3. However, some other studies have reported higher rates of temporary harm 4–6 9 29…”

Section: Discussionsupporting

confidence: 75%

“…CI management systems have been developed from human factors and ergonomic (HFE) systems theory to investigate, analyse, and manage adverse events, and near misses that occur during the delivery of care to patients 1 3. The principles of HFE theory originated from safety critical industries such as aviation and have been adapted to the healthcare setting, for example, Systems Engineering Initiative for Patient Safety (SEIPS) 4 5. The core patient safety principles of HFE include the evaluation of work systems, processes, and outcomes when an adverse event occurs within the framework of the complex organisational and system factors within healthcare settings 3 4…”

Section: Introductionmentioning

confidence: 99%

“… 1 3 The principles of HFE theory originated from safety critical industries such as aviation and have been adapted to the healthcare setting, for example, Systems Engineering Initiative for Patient Safety (SEIPS). 4 5 The core patient safety principles of HFE include the evaluation of work systems, processes, and outcomes when an adverse event occurs within the framework of the complex organisational and system factors within healthcare settings. 3 4 …”

Section: Introductionmentioning

confidence: 99%

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Clinical incidents in the emergency department: is there an association with emergency nursing shift patterns? A retrospective observational study

Roberts

Thom

Hocking³

et al. 2022

BMJ Open Qual

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IntroductionClinical incident (CI) management within healthcare settings is a crucial component of patient safety and quality improvement. The complex environment in the emergency department (ED) and nursing work schedules are important aspects of human factor ergonomic (HFE) systems that requires closer examination. Nursing shifts are closely related to fatigue, including the late/early shift pattern and night shift. All nursing shifts were examined over a 1-year period when a CI occurred to a patient in the ED to identify if there was an association.MethodsThis was a retrospective observational study, conducted and reported using the Strengthening of the Reporting of Observational Studies in Epidemiology statement. All CIs reported in the ED over a 1-year period were reviewed by accessing the CI database, emergency department information system and patient health records. The nursing roster database was accessed to record nursing shifts and were de-identified.ResultsA total of n=244 CIs were eligible for inclusion into the study. ED nursing shift analysis included n=1095 nursing shifts. An analysis of early, late and night shifts, including days not worked by the ED nurse was conducted over a 48-hour and 96-hour period. There was no significant relationship identified between the CI and nursing shift patterns. ED length of stay (LOS) was significantly higher for a patient presentation when a CI occurred.ConclusionThis study focused on the HFE system of nursing work schedules and CI events that occurred in the ED. This study found there was no relationship between emergency nursing shift patterns and an increased risk for the occurrence of a CI in the ED. Although a strong link was found between patients experiencing a CI in the ED and an extended LOS. This demonstrates the need for studies to investigate the interrelationships of multiple HFE systems in the ED, including the environment, patient, clinical team and organisational factors.

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Section: Discussionsupporting

confidence: 75%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Clinical incidents in the emergency department: is there an association with emergency nursing shift patterns? A retrospective observational study

Roberts

Thom

Hocking³

et al. 2022

BMJ Open Qual

View full text Add to dashboard Cite

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“…16 We adapted the systems approach and looked into the independent and interdependent modifiable factors. 17 The key initiatives were to identify our objectives, bring out changes to the organizational processes, and integrate the same into the existing system. The strong commitment and reassurance to all employees' safety by the hospital board helped the department execute the infrastructure changes, reallocation of resources from its annual budgeting, roles and responsibilities of HCW, and handholding.…”

Section: Discussionmentioning

confidence: 99%

Preparedness for Pediatric COVID-19 Using Systems Approach: Experience of a Health Care Facility from India

Shenoy

Nayak

Jacob

et al. 2021

Journal of Health and Allied Sciences NU

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A pandemic leads to disruption and stretching of an existing health care system and its resources. Coronavirus disease 2019 (COVID-19) data show distinct and severe manifestations in children necessitating critical care. Children need prioritization as they are susceptible to COVID-19 as part of the family cluster, varied presentations, and mortality. The purpose of this report is to discuss the optimization of the health care system for pediatric care. The key initiatives were to identify our objectives, bring out changes to the organizational processes, and integrate the same into the existing system. A systems approach to health care delivery by optimizing infrastructure, human resources, materials, funding, leadership, and governance was undertaken. This resulted in creation of distinct COVID-19 and non-COVID-19 service areas, management protocols, and trained health care workers. Partnership was forged with the public health system. This preparedness and continued responses to the demands of the health care system helped us manage children ranging from neonates to adolescents efficiently. Though the health care system is mostly open, acting upon the modifiable factors gave better preparedness in a short time.

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“…Health care systems are complex. Layering interventions like safety event reporting systems, early warning scores, safety huddles, staff training, and other interventions that enhance visibility and transparency of safety work and potential threats are recognized as important steps toward a strong safety culture [ 82 , 83 ].…”

Section: Where Safety and Stewardship Alignmentioning

confidence: 99%

Aligning Patient Safety and Stewardship: A Harm Reduction Strategy for Children

Schefft

Noda

Godbout

2021

Curr Treat Options Peds

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Purpose of review Review important patient safety and stewardship concepts and use clinical examples to describe how they align to improve patient outcomes and reduce harm for children. Recent findings Current evidence indicates that healthcare overuse is substantial. Unnecessary care leads to avoidable adverse events, anxiety and distress, and financial toxicity. Increases in antimicrobial resistance, venous thromboembolism, radiation exposure, and healthcare costs are examples of patient harm associated with a lack of stewardship. Studies indicate that many tools can increase standardization of care, improve resource utilization, and enhance safety culture to better align safety and stewardship. Summary The principles of stewardship and parsimonious care can improve patient safety for children.

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Reclaiming the systems approach to paediatric safety

Cited by 8 publications

References 33 publications

Clinical incidents in the emergency department: is there an association with emergency nursing shift patterns? A retrospective observational study

Clinical incidents in the emergency department: is there an association with emergency nursing shift patterns? A retrospective observational study

Preparedness for Pediatric COVID-19 Using Systems Approach: Experience of a Health Care Facility from India

Aligning Patient Safety and Stewardship: A Harm Reduction Strategy for Children

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