Engaging staff to improve quality and safety in an austere medical environment: a case–control study in two Sierra Leonean hospitals

Rosen, Michael A.; Chima, Adaora; Sampson, J.B.; Jackson, Eric; Koka, Rahul; Marx, Megan K.; Kamara, Thaim B.; Ogbuagu, Onyebuchi U.; Lee, Benjamin H.

doi:10.1093/intqhc/mzv030

Cited by 15 publications

(16 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In a cohort of patients with severe sepsis in Uganda, the mean number of heart rate measurements documented in 24 hours was only 1.0 (interquartile range, 0.8-1.3). 11 Similarly, in a quality improvement study in two Sierra Leonean hospitals, daily vital signs were documented in only 26.6% of patients, 1 and in a larger study of 13 Kenyan county hospitals more than a third (37.1%) of pediatric admissions had no documented heart rate. 8 While the magnitude of its contribution to patient outcomes is difficult to study directly, the lack of frequent vital sign monitoring certainly results in a decreased identification of clinical deterioration and disease progression.…”

Section: Introductionmentioning

confidence: 97%

“…Due in large part to overburdened hospital staff with exceptionally high nursing ratios, vital sign monitoring in developing countries often fails to occur in a reliable fashion. 1 This results in many unmonitored patients at risk for clinical deterioration and adverse outcomes. In the developed world, the technology has been rapidly expanding in the area of at home and ambulatory monitoring.…”

Section: Introductionmentioning

confidence: 99%

“…One of the many challenges facing healthcare providers in low resource settings is that of vital sign monitoring. Due in large part to overburdened hospital staff with exceptionally high nursing ratios, vital sign monitoring in developing countries often fails to occur in a reliable fashion [ 1 ]. This results in many unmonitored patients at risk for clinical deterioration and adverse outcomes.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Use of ultra-low cost fitness trackers as clinical monitors in low resource emergency departments

Dagan

Mechanic

2020

Clin Exp Emerg Med

View full text Add to dashboard Cite

In low resource hospitals, strained staffing ratios and lack of telemetry can put patients at risk for clinical deterioration and unexpected cardiac arrest. While traditional telemetry systems can provide real-time continuous vital signs, they are too expensive for widespread use in these settings. At the same time, developed countries such as the United States have been increasingly utilizing remote monitoring systems to shift patient care from hospital to home. While the context is dramatically different, the challenge of monitoring patients in otherwise unmonitored settings is the same. At-home monitoring solutions range from highly comprehensive and expensive systems to inexpensive fitness trackers. In the field of global health, the adoption of this technology has been somewhat limited. We believe that low cost fitness trackers present an opportunity to address the challenge of vital sign monitoring in resource-poor settings at a fraction of the cost of existing technical solutions.

show abstract

Section: Introductionmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Use of ultra-low cost fitness trackers as clinical monitors in low resource emergency departments

Dagan

Mechanic

2020

Clin Exp Emerg Med

View full text Add to dashboard Cite

show abstract

“…The importance of adopting a structured risk assessment for enhancing care of patients is discussed in literature. Several methods for structuring the risk assessment process, are discussed, for example, the Healthcare Failure Mode and Effect Analysis (HFMEA) (McElroy et al 2016;Franklin et al 2012;Rosen et al 2015;Garfield et al 2018;De Giorgi et al 2010), Preliminary hazard analysis (PHA) (Schlatter 2018;Riou et al 2017;Grespan et al 2019Grespan et al , 2007De Giorgi et al 2010), and the Fault Tree Analysis (FTA) (McElroy et al 2017;Rogith et al 2017;Teixeira et al 2016;Ong and Coiera 2010). Nonetheless, owing to the uncertain nature of risks embedded in the clinical care pathways, applying specific risk assessment methods is not straightforward because of factors such as the need for patient records (for quantitative methods), domain knowledge, or user-knowledge on using different methods while assessing risks (Chemweno et al 2018;Beaussier et al 2016;Paine et al 2018).…”

Section: Introductionmentioning

confidence: 99%

A comparative risk assessment of dialysis care processes in the home and hospital care contexts

Chemweno

Pintelon

2020

Int J Syst Assur Eng Manag

View full text Add to dashboard Cite

Dialysis processes within the home care context is associated with risk factors which are not very prominent in the hospital context. This includes risk factors such as unanticipated device malfunction, or erroneous operation of the equipment, which exposes the patient to injury while undergoing dialysis. Importantly, the mentioned risk factors are further attributed to technical aspects such as sub-optimal equipment maintenance or following improper clinical procedures when administering care to the patient. Hence, it is important to follow a methodological approach to identify and assess hazards embedded within the dialysis treatment process, and on this basis, formulate effective strategies to mitigate their negative consequences on patient safety. This paper presents a comparative risk assessment for in-hospital versus in-home dialysis care. For the two cases, the risk assessment considers expertise of care givers involved in administering dialysis. The findings show that performing risk assessment for hospital environment, is more structured owing to expertise of clinicians and care givers responsible for administering dialysis. However, assessing risks for the home-care environment is more challenging owing to absence of domain knowledge, hence a survey approach to structure the risk assessment process is necessary. Moreover, risks in the home care context is influenced by logistical aspects, and lack of domain knowledge for maintaining dialysis equipment. Overall, insights from the comparative studies yields important learning points expected to improve dialysis care as more healthcare providers transfer care to the home environment.

show abstract

“…The FMEA method has been used before in medical processes and has shown improvements in multidisciplinary areas, including documentation compliance,7 blood transfusion,8 and improvement of insulin pumps 9. The model is relevant to medical fields and patient safety because it can be applied to new processes before substantial damage or failure occurs.…”

Section: Introductionmentioning

confidence: 99%

Using the failure mode and effects analysis model to improve parathyroid hormone and adrenocorticotropic hormone testing

Magnezi

Hemi

2016

RMHP

View full text Add to dashboard Cite

BackgroundRisk management in health care systems applies to all hospital employees and directors as they deal with human life and emergency routines. There is a constant need to decrease risk and increase patient safety in the hospital environment. The purpose of this article is to review the laboratory testing procedures for parathyroid hormone and adrenocorticotropic hormone (which are characterized by short half-lives) and to track failure modes and risks, and offer solutions to prevent them. During a routine quality improvement review at the Endocrine Laboratory in Tel Hashomer Hospital, we discovered these tests are frequently repeated unnecessarily due to multiple failures. The repetition of the tests inconveniences patients and leads to extra work for the laboratory and logistics personnel as well as the nurses and doctors who have to perform many tasks with limited resources.MethodsA team of eight staff members accompanied by the Head of the Endocrine Laboratory formed the team for analysis. The failure mode and effects analysis model (FMEA) was used to analyze the laboratory testing procedure and was designed to simplify the process steps and indicate and rank possible failures.ResultsA total of 23 failure modes were found within the process, 19 of which were ranked by level of severity. The FMEA model prioritizes failures by their risk priority number (RPN). For example, the most serious failure was the delay after the samples were collected from the department (RPN =226.1).ConclusionThis model helped us to visualize the process in a simple way. After analyzing the information, solutions were proposed to prevent failures, and a method to completely avoid the top four problems was also developed.

show abstract

Engaging staff to improve quality and safety in an austere medical environment: a case–control study in two Sierra Leonean hospitals

Cited by 15 publications

References 28 publications

Use of ultra-low cost fitness trackers as clinical monitors in low resource emergency departments

Use of ultra-low cost fitness trackers as clinical monitors in low resource emergency departments

A comparative risk assessment of dialysis care processes in the home and hospital care contexts

Using the failure mode and effects analysis model to improve parathyroid hormone and adrenocorticotropic hormone testing

Contact Info

Product

Resources

About