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Morris, John A.; Carrillo, Ysela; Jenkins, Judith M.; Smith, P. J.; Bledsoe, Sandy; Pichert, James W.; White, Andrew A.

doi:10.1097/00000658-200306000-00013

Cited by 13 publications

(8 citation statements)

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“…Checklists for emergency management have been used for years by individual clinicians as personal aides de memoire, and health care administrators have encouraged the adoption of checklists in the hope that they will minimize the risk, increase patient safety and cost of litigation [36]. However, as experience with the WHO surgical checklist has demonstrated, the benefits of checklists are only realised when the clinical staff are engaged and they are used to change the dynamics of a team’s culture [37].…”

Section: Discussionmentioning

confidence: 99%

Crisis checklists for in-hospital emergencies: expert consensus, simulation testing and recommendations for a template determined by a multi-institutional and multi-disciplinary learning collaborative

Kellett

Barach

Chaloner

et al. 2017

BMC Health Serv Res

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Background‘Failure to rescue’ of hospitalized patients with deteriorating physiology on general wards is caused by a complex array of organisational, technical and cultural failures including a lack of standardized team and individual expected responses and actions. The aim of this study using a learning collaborative method was to develop consensus recomendations on the utility and effectiveness of checklists as training and operational tools to assist in improving the skills of general ward staff on the effective rescue of patients with abnormal physiology.MethodsA scoping study of the literature was followed by a multi-institutional and multi-disciplinary international learning collaborative. We sought to achieve a consensus on procedures and clinical simulation technology to determine the requirements, develop and test a safe using a checklist template that is rapidly accessible to assist in emergency management of common events for general ward use.ResultsSafety considerations about deteriorating patients were agreed upon and summarized. A consensus was achieved among an international group of experts on currently available checklist formats performing poorly in simulation testing as first responders in general ward clinical crises. The Crisis Checklist Collaborative ratified a consensus template for a general ward checklist that provides a list of issues for first responders to address (i.e. ‘Check In’), a list of prompts regarding common omissions (i.e. ‘Stop & Think’), and, a list of items required for the safe “handover” of patients that remain on the general ward (i.e. ‘Check Out’). Simulation usability assessment of the template demonstrated feasibility for clinical management of deteriorating patients.ConclusionsEmergency checklists custom-designed for general ward patients have the potential to guide the treatment speed and reliability of responses for emergency management of patients with abnormal physiology while minimizing the risk of adverse events. Interventional trials are needed.

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Section: Discussionmentioning

confidence: 99%

Crisis checklists for in-hospital emergencies: expert consensus, simulation testing and recommendations for a template determined by a multi-institutional and multi-disciplinary learning collaborative

Kellett

Barach

Chaloner

et al. 2017

BMC Health Serv Res

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“…Under a No-Fault system, patients who experience significant injuries could be covered under “Accelerated Compensable Events (ACE)”, defined as those events that are normally avoidable given an adequate standard of care (e.g., quadriplegia, wrong-sided surgery, wrong-level surgery, death, etc.). [12] ACE could be identified and reasonably compensated within a shorter period of time. [1–4] For example, Swedish patients apply for No-Fault system claims utilizing forms provided in clinics and hospitals where their physicians/health professionals help fill them out.…”

Section: Discussionmentioning

confidence: 99%

“…[12] ACE could be identified and reasonably compensated within a shorter period of time. [1–4] For example, Swedish patients apply for No-Fault system claims utilizing forms provided in clinics and hospitals where their physicians/health professionals help fill them out. [5] A claim is reviewed by 1 or more specialists and a decision rendered, usually within 6 months.…”

Section: Discussionmentioning

confidence: 99%

A medico-legal review of cases involving quadriplegia following cervical spine surgery: Is there an argument for a no-fault compensation system?

Epstein

2010

Surg Neurol Int

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Background:To determine whether patients who become quadriplegic following cervical spine surgery are adequately compensated by our present medico-legal system. The outcomes of malpractice suits obtained from Verdict Search (East Islip, NY, USA), a medico-legal journal, were evaluated over a 20-year period. Although the present malpractice system generously rewards many quadriplegic patients with substantial settlements/ Plaintiffs' verdicts, a subset receive lesser reimbursements (verdicts/settlements], while others with defense verdicts receive no compensatory damages.Methods:Utilizing Verdict Search, 54 cases involving quadriplegia following cervical spine surgery were reviewed for a 20-year interval (1988–2008). The reason(s) for the suit, the defendants, the legal outcome, and the time to outcome were identified. Operations included 25 anterior cervical procedures, 22 posterior cervical operations, 1 circumferential cervical procedure, and 6 cases in which the cervical operations were not defined.Results:The four most prominent legal allegations for suits included negligent surgery (47 cases), lack of informed consent (23 cases), failure to diagnose/treat (33 cases), and failure to brace (15 cases). Forty-four of the 54 suits included spine surgeons. There were 19 Plaintiffs' verdicts (average US $5.9 million, range US $540,000-US $18.4 million), and 20 settlements (average US $2.8 million, range US $66,500-US $12.0 million). Fifteen quadriplegic patients with defense verdicts received no compensatory damages. The average time to verdicts/settlements was 4.3 years.Conclusions:For 54 patients who were quadriplegic following cervical spine surgery, 15 (28%) with defense verdicts received no compensatory damages. Under a No-Fault system, quadriplegic patients would qualify for a “reasonable” level of compensation over a “shorter” time frame.

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“…One article included five specific adverse events: medication errors, patient falls, urinary tract infection, pneumonia, and pressure ulcers 16. Another article evaluated costs related only to surgical adverse events, but did not further define them 17. The three remaining studies related to adverse events were either case series18 or prospective cohorts with nested cases and controls 19,20.…”

Section: Methodologic Qualitymentioning

confidence: 99%

The economic burden of patient safety targets in acute care: a systematic review

Mittmann

Koo²,

Daneman³

et al. 2012

DHPS

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BackgroundOur objective was to determine the quality of literature in costing of the economic burden of patient safety.MethodsWe selected 15 types of patient safety targets for our systematic review. We searched the literature published between 2000 and 2010 using the following terms: “costs and cost analysis,” “cost-effectiveness,” “cost,” and “financial management, hospital.” We appraised the methodologic quality of potentially relevant studies using standard economic methods. We recorded results in the original currency, adjusted for inflation, and then converted to 2010 US dollars for comparative purposes (2010 US$1.00 = 2010 €0.76). The quality of each costing study per patient safety target was also evaluated.ResultsWe screened 1948 abstracts, and identified 158 potentially eligible studies, of which only 61 (39%) reported any costing methodology. In these 61 studies, we found wide estimates of the attributable costs of patient safety events ranging from $2830 to $10,074. In general hospital populations, the cost per case of hospital-acquired infection ranged from $2132 to $15,018. Nosocomial bloodstream infection was associated with costs ranging from $2604 to $22,414.ConclusionThere are wide variations in the estimates of economic burden due to differences in study methods and methodologic quality. Greater attention to methodologic standards for economic evaluations in patient safety is needed.

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Cited by 13 publications

References 0 publications

Crisis checklists for in-hospital emergencies: expert consensus, simulation testing and recommendations for a template determined by a multi-institutional and multi-disciplinary learning collaborative

Crisis checklists for in-hospital emergencies: expert consensus, simulation testing and recommendations for a template determined by a multi-institutional and multi-disciplinary learning collaborative

A medico-legal review of cases involving quadriplegia following cervical spine surgery: Is there an argument for a no-fault compensation system?

The economic burden of patient safety targets in acute care: a systematic review

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