PerspectivesReality check for checklists
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Assessing the impact of real-time random safety audits through full propensity score matching on reliable data from the clinical information system
2024, International Journal of Medical InformaticsEvidence-based care processes are not always applied at the bedside in critically ill patients. Numerous studies have assessed the impact of checklists and related strategies on the process of care and patient outcomes. We aimed to evaluate the effects of real-time random safety audits on process-of-care and outcome variables in critical care patients.
This prospective study used data from the clinical information system to evaluate the impact of real-time random safety audits targeting 32 safety measures in two intensive care units during a 9-month period. We compared endpoints between patients attended with safety audits and those not attended with safety audits. The primary endpoint was mortality, measured by Cox hazard regression after full propensity-score matching. Secondary endpoints were the impact on adherence to process-of-care measures and on quality indicators.
We included 871 patients; 228 of these were attended in ≥ 1 real-time random safety audits. Safety audits were carried out on 390 patient-days; most improvements in the process of care were observed in safety measures related to mechanical ventilation, renal function and therapies, nutrition, and clinical information system. Although the group of patients attended in safety audits had more severe disease at ICU admission [APACHE II score 21 (16−27) vs. 20 (15−25), p = 0.023]; included a higher proportion of surgical patients [37.3 % vs. 26.4 %, p = 0.003] and a higher proportion of mechanically ventilated patients [72.8 % vs. 40.3 %, p < 0.001]; averaged more days on mechanical ventilation, central venous catheter, and urinary catheter; and had a longer ICU stay [12.5 (5.5−23.3) vs. 2.9 (1.7−5.9), p < 0.001], ICU mortality did not differ significantly between groups (19.3 % vs. 18.8 % in the group without safety rounds). After full propensity-score matching, Cox hazard regression analysis showed real-time random safety audits were associated with a lower risk of mortality throughout the ICU stay (HR 0.31; 95 %CI 0.20−0.47).
Real-time random safety audits are associated with a reduction in the risk of ICU mortality. Exploiting data from the clinical information system is useful in assessing the impact of them on the care process, quality indicators, and mortality.
Going beyond compliance: A qualitative study of the practice of surgical safety checklist
2024, Social Science and MedicineThe World Health Organization Surgical Safety Checklist (SSC) is a tool designed to enhance team communication and patient safety. When used properly, the SSC acts as a layer of defence against never events. In this study, we performed secondary qualitative analysis of operating theatres (OT) SSC observational notes to examine how the SSC was used after an intensive SSC re-implementation effort and drew on relevant theories to shed light on the observed patterns of behaviours. We aimed to go beyond assessing checklist compliance and to understand potential sociopsychological mechanisms of the variations in SSC practices.
Direct observation notes of 109 surgical procedures across 13 surgical disciplines were made by two trained nurses in the OT of a large tertiary hospital in Singapore from February to April 2022, three months after SSC re-implementation. Only notes relevant to the use of SSC were extracted and analyzed using reflexive thematic analysis. Data were coded following an inductive process to identify themes or patterns of SSC practices. These patterns were subsequently interpreted against a relevant theory to appreciate the potential sociopsychological forces behind them.
Two broad types of SSC practices and their respective sub-themes were identified. Type 1 (vs. Type 2) SSC practices are characterized by patience and thoroughness (vs. hurriedness and omission) in carrying out the SSC process, dedication and attention (vs. delegation and distraction) to the SSC safety checks, and frequent (vs. absence of) safety voices during the conduct of SSC. These patterns were conceptualized as safety-seeking action vs. ritualistic action using Merton's social deviance theory.
Ritualistic practice of the SSC can undermine surgical safety by creating conditions conducive to never events. To fully realize the SSC's potential as an essential tool for communication and safety, a concerted effort is needed to balance thoroughness with efficiency. Additionally, fostering a culture of collaboration and collegiality is crucial to reinforce and enhance the culture of surgical safety.
A longitudinal study on the impact of occupational health and safety practices on employee productivity
2024, Safety ScienceOccupational health and safety (OHS) are vital for employee well-being and productivity. This study explores the impact of OHS practices on employee productivity within a UAE Fire and Security company, focusing on shifts in employee perceptions of OHS. We adopted a mixed-methods approach, using both qualitative and quantitative data. Surveys were administered to 293 employees before and after OHS interventions. Productivity data were collected correspondingly. Qualitative insights came from discussions with the company’s QHSE director. Data revealed that OHS interventions can enhance workplace ambiance and significantly boost employee productivity. A direct link between improved OHS practices and heightened productivity was observed, along with a marked shift in employee OHS perceptions. OHS practices are pivotal for both a secure working atmosphere and heightened employee productivity. Embracing proactive OHS strategies offers dual advantages: better well-being and improved organizational output. UAE businesses should prioritize solid OHS measures to ensure safety and enhance productivity. Methods like audits, training, and strategic management promote effective workplaces. Strict adherence to government standards, like the OHSMS National Standard, is essential. Adopting strategic OHS initiatives, as demonstrated here, augments operational efficiency while cultivating a safety-conscious workforce.
Where is the human in human-centered AI? Insights from developer priorities and user experiences
2023, Computers in Human BehaviorHuman-centered artificial intelligence (HCAI) seeks to shift the focus in AI development from technology to people. However, it is not clear whether existing HCAI principles and practices adequately accomplish this goal. To explore whether HCAI is sufficiently focused on people, we conducted a qualitative survey of AI developers (N = 75) and users (N = 130) and performed a thematic content analysis on their responses to gain insight into their differing priorities and experiences. Through this, we were able to compare HCAI in principle (guidelines and frameworks) and practice (developer priorities) with user experiences. We found that the social impact of AI was a defining feature of positive user experiences, but this was less of a priority for developers. Furthermore, our results indicated that improving AI functionality from the perspective of the user is an important part of making it human-centered. Indeed, users were more concerned about being understood by AI than about understanding AI. In line with HCAI guidelines, developers were concerned with issues such as ethics, privacy, and security, demonstrating an ‘avoidance of harm’ perspective. However, our results suggest that an increased focus on what people need in their lives is required for HCAI to be truly human-centered.
“Some version, most of the time”: The surgical safety checklist, patient safety, and the everyday experience of practice variation
2022, American Journal of SurgeryThis study investigated checklist compliance to highlight where assumptions about the Surgical Safety Checklist might not be met in practice.
We used ethnographic methods to investigate the practice of the Surgical Safety Checklist in one hospital. Fifty-one observation days, eight semi-structured interviews, and two surveys of operating room staff over two years were conducted. Data were collected and analyzed iteratively.
Despite the near 100% compliance rates reported to the Ministry of Health, practice of the Surgical Safety Checklist varied widely: 82% of Briefings, 76% of Time-Outs, and 22% of Debriefings included some sort of team huddle. Gaps between policy and practice were identified at four different levels: compliance with the stages and items; responsibility for the checklist; documentation of adherence; and interprofessional teamwork.
Checklist compliance data are insufficient to understand how complex interventions impact care delivery. Greater and continued attention to practice in healthcare is needed.