Hospital Climate and Peer Report Intention on Adverse Medical Events: Role of Attribution and Rewards

Adverse medical events (AMEs) often occur in the healthcare workplace, and studies have shown that a positive atmosphere can reduce their incidence by increasing peer report intention. However, few studies have investigated the effect and action mechanism therein. We aimed to extend upon these studies by probing into the relationship between hospital climate and peer report intention, along with the mediating effect of attribution tendency and moderating effects of rewards. For this purpose, a cross-sectional survey was administered in a hospital among health professionals. We collected 503 valid questionnaires from health professionals in China and verified the hypothesis after sorting the questionnaires. The results of empirical analysis show that a positive hospital climate significantly induces individual internal attribution tendency, which in turn exerts a positive effect on peer report intention. Contract reward also helps to increase peer report intention, especially for health professionals with an internal attribution tendency. The findings contribute to the literature regarding AME management in hospitals by providing empirical evidence of the necessity for hospital climate and contract reward, and by providing insights to improve their integrated application.

Extension to ‘combined SNA and LDA methods to understand adverse medical events’: Doctor and nurse perspectives

BACKGROUND: Physicians and nurses are responsible for reporting medical adverse events. Each views these events through a different lens subject to their role-based perceptions and barriers. Physicians typically engage with diagnosis and treatment while nurses primarily care for patients’ daily lives and mental well-being. This results in reporting and describing medical adverse events differently. OBJECTIVE: We aimed to compare adverse medical event reports generated by physicians and nurses to better understand the differences and similarities in perspective as well as the nature of adverse medical events using social network analysis (SNA) and latent Dirichlet allocation (LDA). METHODS: The current study examined data from the Maccabi Healthcare Community. Approximately 17,868 records were collected from 2000 to 2017 regarding medical adverse events. Data analysis used SNA and LDA to perform descriptive text analytics and understand underlying phenomenon. RESULTS: A significant difference in harm levels reported by physicians and nurses was discovered. Shared topic keyword lists broken down by physicians and nurses were derived. Overall, communication, lack of attention, and information transfer issues were reported in medical adverse events data. Specialized keywords, more likely to be used by a physician were determined as: repeated prescriptions, diabetes complications, and x-ray examinations. For nurses, the most common special adverse event behavior keywords were vaccine problem, certificates of fitness, death and incapacity, and abnormal dosage. CONCLUSIONS: Communication and inattentiveness appeared most frequently in medical adverse events reports regardless of whether doctors or nurses did the reporting. Findings suggest feedback and information sharing processes could be implemented as a step toward alleviating many issues. Institutional management, healthcare managers and government officials should take actions to decrease medical adverse events, many of which may be preventable.

Behavioral and neuroanatomical outcomes following altered serotonin expression in a hypoxic-ischemic injury neonate rodent model

BACKGROUND: Children born prematurely (<37 gestational weeks) are at risk for a variety of adverse medical events. They may experience ischemic and/or hemorrhagic events leading to negative neural sequelae. They are also exposed to repeated stressful experiences as part of life-saving care within the neonatal intensive care unit (NICU). These experiences have been associated with methylation of SLC6A4, a gene which codes for serotonin transport proteins, and is associated with anxiety, depression, and increased incidence of autism spectrum disorders. The purpose of this study was to examine the effects of altered serotonin levels on behavioral and neuroanatomical outcomes in a neonatal rodent model with or without exposure to hypoxic-ischemic (HI) injury. METHODS: Wistar rat pups were randomly assigned to either HI injury or sham groups. Pups within each group were treated with a chronic SSRI (Citalopram HBr) to simulate the effects of SLC6A4 methylation, or saline (NS). Subjects were assessed on behavioral tasks and neuropathologic indices. RESULTS: HI injured subjects performed poorly on behavioral tasks. SSRI subjects did not display significantly greater anxiety. HI + SSRI subjects learned faster than HI+NS. Histologically, SSRI subjects had predominantly larger brain volumes than NS. CONCLUSION: SSRI treated subjects without injury showed patterns of increased anxiety, consistent with theories of SLC6A4 methylation. The paradoxical trend to improved cognition in HI+SSRI subjects relative to HI alone, may reflect an unexpected SSRI neuroprotective effect in the presence of injury, and may be related to serotonin-induced neurogenesis.

Routine Preoperative Medical Testing Before Cataract Surgery

The Study of Medical Testing for Cataract Surgery was a randomized clinical trial in patients scheduled to undergo elective cataract surgery to determine whether routine medical testing before cataract surgery reduced the rate of complications during the perioperative period. The study showed that routine preoperative medical testing before cataract surgery does not reduce the risk of intraoperative or postoperative adverse medical events when compared to selective or no testing, nor does it reduce the rate of ocular surgical complications (such as posterior capsule rupture) or influence visual acuity outcome. The authors recommended that preoperative clinical assessment by a physician at least 7 days before surgery is a more logical and efficient approach. Tests should be ordered only when indicated by the history or findings on physical examination.

Systematic Literature Review of My Health Record System

Background: On 2010 Australia launched a personally controlled electronic health record (PCEHR) later renamed and augmented by the My Health Record Act 2012 Cth. The main goal of the present systematic literature review was to assess if the system has improved Australia’s healthcare system according to the objectives stated by the federal government in the My Health Record Act 2012 Cth. Methods: This systematic literature review was based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Results: Despite the MyHR system being available for seven years, there is limited empirical evaluation regarding its progress in achieving the stated goals. The results were segregated in four themes: (1) health information fragmentation, (2) Health information quality and management, (3) adverse medical events and duplication of treatment and (4) coordination of care. Regarding theme 1, it was evidenced that the system could reduce health information fragmentation; however, gaps in the workforce adoption were identified as a problem. About topic 2, improved access to information and possible misinterpretation were found. Theme 3 lacked research and theme 4 presented contradiction in the results. Conclusion: The My Health Record (MyHR) system is founded on four key objectives. However, there is insufficient evidence that any outcomes have been achieved relating to any of the objectives. Research is required to determine whether the MyHR system helped improve Australia’s healthcare system according to the objectives stated in the Act 2012.

The second victim phenomenon in health care: A literature review

Aim: This study aimed to explore the knowledge on the second victim phenomenon (SVP) in health care, more specifically within the speciality of obstetrics. Methods: An extensive electronic search of multiple databases, with additional hand searching of the reference lists of pertinent articles regarding the SVP, was performed from May 2017 to December 2018. Results: A review of the literature suggests consistent evidence of the substantial impact of adverse medical events on health-care professionals across a range of specialities. The effects of an adverse medical event for the health-care professional are ominous, with many experiencing feelings of sadness, guilt and anxiety, as well as some displaying symptoms consistent with post-traumatic stress disorder. Negative effects may be exacerbated for health-care professionals in the case of an adverse maternal event due to its highly sensitive and dramatic nature, involving both maternal and neonatal lives. The provision of timely and effective support at the individual and more specifically the organisational level has been positively correlated with a second victim’s recovery. Yet, limited organisations have formal support interventions designed specifically for the needs of the second victim. Conclusions: It is evident that the consequences of adverse medical events on health-care professionals can be intense and numerous. The unique nature and high sensitivities surrounding obstetric care have the potential to exacerbate the negative consequences for the health-care professional following an adverse event. Still, there remains a dearth of information of the extent of adverse medical events and the SVP in the speciality of obstetrics.