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Characteristics of morbidity and mortality conferences associated with the implementation of patient safety improvement initiatives, an observational study.

ABSTRACT: The aim of this study was to identify the characteristics of morbidity and mortality conferences (MMCs) associated with the implementation of patient health-care quality and safety improvement initiatives.We conducted an observational study of MMCs and followed up improvement initiatives for 1 year. Data on MMC baseline characteristics were abstracted using document analysis and observation of a meeting in three university hospitals in France (Grenoble, Nice, and Cochin [Paris] hospitals). Fifty-nine MMCs were included in medical (n?=?24), surgical (n?=?21), and anesthesiology and/or intensive care (n?=?14) departments. An effectiveness index was computed by summing a composite score for each initiative pertaining to the MMC.Overall, 282 initiatives were identified in 42 MMCs. During the follow-up period, 215 initiatives (76%) were totally or partially implemented and the impact was evaluated for 73 (26%). An effectiveness index higher than the median (i.e., ?10) was associated with a standardized presentation of cases (81% versus 29%, p <0.001), recording of improvement initiatives (94 versus 57, p?=?0.001), the existence of an annual activity report (94% versus 68%, p?=?0.01), the prior dissemination of a meeting agenda (71% versus 36%, p?=?0.007), longer meeting duration (109 versus 80 min, p?=?0.005), anesthesiology and/or intensive care specialty (39% versus 7%, p?=?0.02), a theme-focused MMC (29% versus 4 %, p?=?0.01), and a thorough analysis of failures (58% versus 25%, p?=?0.01).This study suggests that the implementation of improvement initiatives relates to MCC characteristics. Recommendations for developing more effective patient safety-oriented MMCs can be proposed.

SUBMITTER: Francois P

PROVIDER: S-EPMC4734851 | biostudies-other | 2016 Jan

REPOSITORIES: biostudies-other

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Characteristics of morbidity and mortality conferences associated with the implementation of patient safety improvement initiatives, an observational study.

François Patrice P Prate Frédéric F Vidal-Trecan Gwenaëlle G Quaranta Jean-François JF Labarere José J Sellier Elodie E

BMC health services research 20160130

<h4>Background</h4>The aim of this study was to identify the characteristics of morbidity and mortality conferences (MMCs) associated with the implementation of patient health-care quality and safety improvement initiatives.<h4>Methods</h4>We conducted an observational study of MMCs and followed up improvement initiatives for 1 year. Data on MMC baseline characteristics were abstracted using document analysis and observation of a meeting in three university hospitals in France (Grenoble, Nice, a ...[more]

PMID: 26831501

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Project description:ObjectivesThis review was commissioned by WHO, South Africa-Country office because of an exponential increase in medical litigation claims related to patient safety in obstetrical care in the country. A rapid review was conducted to examine the effectiveness of quality improvement (QI) strategies on maternal and newborn patient safety outcomes, risk of litigation and burden of associated costs.DesignA rapid review of the literature was conducted to provide decision-makers with timely evidence. Medical and legal databases (eg, MEDLINE, Embase, LexisNexis Academic, etc) and reference lists of relevant studies were searched. Two reviewers independently performed study selection, abstracted data and appraised risk of bias. Results were summarised narratively.InterventionsWe included randomised clinical trials (RCTs) of QI strategies targeting health systems (eg, team changes) and healthcare providers (eg, clinician education) to improve the safety of women and their newborns. Eligible studies were limited to trials published in English between 2004 and 2015.Primary and secondary outcome measuresRCTs reporting on patient safety outcomes (eg, stillbirths, mortality and caesarean sections), litigation claims and associated costs were included.ResultsThe search yielded 4793 citations, of which 10 RCTs met our eligibility criteria and provided information on over 500 000 participants. The results are presented by QI strategy, which varied from one study to another. Studies including provider education alone (one RCT), provider education in combination with audit and feedback (two RCTs) or clinician reminders (one RCT), as well as provider education with patient education and audit and feedback (one RCT), reported some improvements to patient safety outcomes. None of the studies reported on litigation claims or the associated costs.ConclusionsOur results suggest that provider education and other QI strategy combinations targeting healthcare providers may improve the safety of women and their newborns during childbirth.

Project description:OBJECTIVE:To investigate whether the daily workload per nurse (Oulu Patient Classification (OPCq)/nurse) as measured by the RAFAELA system correlates with different types of patient safety incidents and with patient mortality, and to compare the results with regressions based on the standard patients/nurse measure. SETTING:We obtained data from 36 units from four Finnish hospitals. One was a tertiary acute care hospital, and the three others were secondary acute care hospitals. PARTICIPANTS:Patients' nursing intensity (249?123 classifications), nursing resources, patient safety incidents and patient mortality were collected on a daily basis during 1?year, corresponding to 12?475 data points. Associations between OPC/nurse and patient safety incidents or mortality were estimated using unadjusted logistic regression models, and models that adjusted for ward-specific effects, and effects of day of the week, holiday and season. PRIMARY AND SECONDARY OUTCOME MEASURES:Main outcome measures were patient safety incidents and death of a patient. RESULTS:When OPC/nurse was above the assumed optimal level, the adjusted odds for a patient safety incident were 1.24 (95% CI 1.08 to 1.42) that of the assumed optimal level, and 0.79 (95% CI 0.67 to 0.93) if it was below the assumed optimal level. Corresponding estimates for patient mortality were 1.43 (95% CI 1.18 to 1.73) and 0.78 (95% CI 0.60 to 1.00), respectively. As compared with the patients/nurse classification, models estimated on basis of the RAFAELA classification system generally provided larger effect sizes, greater statistical power and better model fit, although the difference was not very large. Net benefits as calculated on the basis of decision analysis did not provide any clear evidence on which measure to prefer. CONCLUSIONS:We have demonstrated an association between daily workload per nurse and patient safety incidents and mortality. Current findings need to be replicated by future studies.

Project description:Background and objectivesThe EvidenceNOW: Advancing Heart Health in Primary Care was designed to assist primary care practices in the US in implementing evidence-based practices in cardiovascular care and building capacity for quality improvement. EvidenceNOW, NCT03054090, was registered with ClinicalTrials.gov on 15/02/2017. The goals of this study were to gain a comprehensive understanding of perspectives from research participants and research team members on the value of implementation strategies and factors that influenced the EvidenceNOW initiative in Virginia.MethodsIn 2018, we conducted 25 focus groups with clinicians and staff at participating practices, including 80 physicians, advanced practice clinicians, practice managers and other practice staff. We also conducted face-to-face and telephone interviews with 22 research team members, including lead investigators, practice facilitators, physician expert consultants, and evaluators. We used the integrated-Promoting Action on Research Implementation in the Health Services (i-PARIHS) framework in our qualitative data analysis and organization of themes.ResultsImplementation strategies valued by both practice representatives and research team members included the kick-off event, on-site practice facilitation, and interaction with physician expert consultants. Remote practice facilitation and web-based tools were used less frequently. Contextual factors that influence quality improvement efforts include leadership support, access to resources, previous quality improvement experience, and practice ownership type (independent compared to health system owned). Many clinicians and staff were overwhelmed by day-to-day activities and experience initiative fatigue, which hindered their ability to fully participate in the EvidenceNOW initiative.ConclusionsThis study provides details on how the practice environment plays an essential role in the implementation of evidence-based practices in primary care. Future efforts to improve quality in primary care practices should consider the context and environment of individual practices, with targeted implementation strategies to meet the needs of independent and health system owned practices. Future efforts to improve quality in primary care practices require strategies to address initiative fatigue among clinicians and practice staff. External support for building capacity for quality improvement could help primary care practices implement and sustain evidence-based practices and improve quality of care.Trial registrationThis project was registered with ClinicalTrials.gov on 15/02/2017 and the identifier is NCT03054090.

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Characteristics of morbidity and mortality conferences associated with the implementation of patient safety improvement initiatives, an observational study.

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Characteristics of morbidity and mortality conferences associated with the implementation of patient safety improvement initiatives, an observational study.

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