Leader Rounding for High Reliability and Improved Patient Safety.

Background: Critical to providing safe, effective patient care is ensuring that communication is open and transparent among all members of the health care team. However, current evidence shows that poor communication is commonplace, contributing to medical errors and poor patient outcomes. Implementing leader rounding may improve communication and reliability. The purpose of this initiative was to create an evidence-based process for the implementation of leader rounding for high reliability at the Veterans Affairs Bedford Healthcare System in Massachusetts. Observations: We conducted a review of medical literature from 2015 to 2022 that found little research specifically related to leader rounding for high reliability. We created a formal and interactive process to improve patient safety by increasing communication among senior leadership, interdisciplinary teams, and frontline staff. Conclusions: Open, transparent, and bidirectional communication among all staff is critical to improving patient safety and promoting a culture of safety in health care. This initiative may be of value to other health care organizations that are working to improve patient safety. Future efforts will focus on developing a robust evaluation program to explore the impact of leader rounding for high reliability on safety outcomes. The hospital is altogether the most complex human organization ever devised. Peter Drucker1.

Requirements for implementing a 'just culture' within healthcare organisations: an integrative review.

PURPOSE: To identify requirements for implementing a 'just culture' within healthcare organisations. METHODS: Using Whittemore and Knafl's methodology for integrative reviews, we searched PubMed, PsychInfo, Cumulative Index of Nursing and Allied Health Literature, ScienceDirect, Cochrane Library and ProQuest Dissertations and Theses. Publications were considered eligible when reporting requirements for implementing a 'just culture' within healthcare organisations. RESULTS: After screening for inclusion and exclusion criteria, 16 publications were included in the final review. Four main themes were identified: leadership commitment, education and training, accountability and open communication. CONCLUSION: The themes identified in this integrative review provide some insight into the requirements for implementing a 'just culture' within healthcare organisations. To date, most of the published literature on 'just culture' is theoretical in nature. Additional efforts are needed to conduct research to explore further what requirements must be addressed in order to successfully implement a 'just culture' which is needed to promote and sustain a culture of safety.

Implementing Just Culture to Improve Patient Safety.

INTRODUCTION: The number of deaths in the United States related to medical errors remains unacceptably high. Further complicating this situation is the problem of underreporting due to the fear of the consequences. In fact, the most commonly reported cause of underreporting worldwide is the fear of the negative consequences associated with reporting. As health care organizations along the journey to high-reliability strive to improve patient safety, a concerted effort needs to be focused on changing how medical errors are addressed. A paradigm shift is needed from immediately assigning blame and punishing individuals to one that is trusting and just. Staff must trust that when errors occur, organizations will respond in a manner that is fair and appropriate. MATERIALS AND METHODS: An extensive review of the literature from 2017 until January 2022 was conducted for the most current evidence describing the principles and practices of "just culture" in health care organizations. Additionally, recommendations were sought on how health care organizations can go about implementing "just culture" principles. RESULTS: Twenty sources of evidence on "just culture' were retrieved and reviewed. The evidence was used to describe the concept and principles of "just culture" in health care organizations. Furthermore, five strategies for implementing "just culture" principles were identified. CONCLUSIONS: Improving patient safety requires that high-reliability organizations strive to ensure that the culture of the organization is trusting and just. In a trusting and just culture, adverse events are recognized as valuable opportunities to understand contributing factors and learn rather than immediately assign blame. Moving away from a blame culture is a paradigm shift for many health care organizations yet critically important for improving patient safety.

Serologic screening of United States blood donors for Babesia microti using an investigational enzyme immunoassay.

BACKGROUND: The tick-borne pathogen Babesia microti has become recognized as the leading infectious risk associated with blood transfusion in the United States, yet no Food and Drug Administration-licensed screening tests are currently available to mitigate this risk. The aim of this study was to evaluate the performance of an investigational enzyme immunoassay (EIA) for B. microti as a screening test applied to endemic and nonendemic blood donor populations. STUDY DESIGN AND METHODS: The study aimed to test 20,000 blood donors from areas of the United States considered endemic for B. microti and 10,000 donors from a nonendemic area with the investigational B. microti EIA. Repeat-reactive samples were retested by polymerase chain reaction (PCR), blood smear, immunofluorescent assay (IFA), and immunoblot assay. In parallel, serum samples from symptomatic patients with confirmed babesiosis were tested by EIA, IFA, and immunoblot assays. RESULTS: A total of 38 of 13,757 (0.28%) of the donors from New York, 7 of 4583 (0.15%) from Minnesota, and 11 of 8363 (0.13%) from New Mexico were found repeat reactive by EIA. Nine of the 56 EIA repeat-reactive donors (eight from New York and one from Minnesota) were positive by PCR. The specificity of the assay in a nonendemic population was 99.93%. Among IFA-positive clinical babesiosis patients, the sensitivity of the assay was 91.1%. CONCLUSION: The B. microti EIA detected PCR-positive, potentially infectious blood donors in an endemic population and exhibited high specificity among uninfected and unexposed individuals. The EIA promises to provide an effective tool for blood donor screening for B. microti in a format amenable to high-throughput and cost-effective screening.

Laser treatment of dyschromia with a novel 607 nm pulsed-dye laser.

BACKGROUND: Due to the hemoglobin-selective wavelength of the 595 nm pulsed-dye laser, it is a device of choice for treating cutaneous vascular lesions. However, it is less effective and removing dyschromia, which along with hypervascularity is a cardinal sign of cutaneous photodamage. A novel 607 nm dye laser was developed as a first step in creating a dual-wavelength pulsed-dye laser. STUDY DESIGN/MATERIALS AND METHODS: Twenty-five subjects with dyschromia on the chest due to chronic photodamage were enrolled into an open-label study to explore the safety and efficacy of a 607 nm pulsed-dye laser, with 22 completing the study. Two treatments were administered to the chest, one month apart, with fluences ranging from 3-6 J/cm,2 using a 10 mm diameter spot and pulse duration of 1.5 msec. Cross-polarized digital photographs were taken before and two months following the final treatment and rated for improvement by physicians in a blinded fashion. RESULTS: Improvement was rated on a five-point scale with no subjects rated as poor(less than 25%) clearance, three subjects (13.6%) demonstrating fair (26-50%) improvement, seven subjects (31.8%) rated as good (51-75%) improvement, 12 (54.5%) were rated as excellent (76-95%) improvement, while none were rated as outstanding improvement (greater than 95%). CONCLUSION: This is the first study of the 607 nm pulsed-dye laser which showed it to be safe and effective for treating dyschromia of the chest due to chronic photodamage, and may in the future expand the ability of the pulsed-dye laser to treat photodamaged skin.

Treatment of tattoos with a 755-nm Q-switched alexandrite laser and novel 1064 nm and 532 nm Nd:YAG laser handpieces pumped by the alexandrite treatment beam.

BACKGROUND: Multi-colored and even black tattoos often require more than one wavelength to remove the target pigment. The authors report here a novel alexandrite laser with two Nd:YAG laser handpieces pumped by the alexandrite treatment beam enabling the delivery of three wavelengths from a single device. OBJECTIVE: To describe and evaluate the effectiveness of a novel Q-switched laser-pumped laser for treating tattoos. MATERIALS AND METHODS: Twenty tattoos in 14 subjects were treated at four-week intervals using a combination of available wavelengths (532, 755 and 1064 nm) as determined by the treating physician. Digital cross-polarized photographs were taken before treatment and two months following the fourth and final treatment. Photographs were evaluated by three physician observers blinded as to the treatment condition and rated for clearance by the following scale: 1 = > 95 percent, 2 = 76-95 percent, 3 = 51-75 percent, 4 = 26-50 percent and 5 = 0-25 percent clearance. RESULTS: The average clearance score was 3.1, in the 51-75 percent range, two months following four treatments. No scarring, hyper- or hypopigmentation was noted on post-treatment photographs or by the treating physician. CONCLUSION: The alexandrite and alexandrite-pumped 532 nm and 1064 nm Q-switched lasers are effective for removing decorative tattoos, and represents the first commercial laser with laser-pumped, laser handpieces.

Effects of a 1,450 nm diode laser on facial sebum excretion.

BACKGROUND AND OBJECTIVE: Laser therapy with a 1,450 nm diode laser is a clinically effective treatment for acne vulgaris, although the mechanism of action is unknown. To investigate this, we conducted a small, prospective, controlled clinical trial to assess this laser's effects on the facial sebum excretion rate (SER). MATERIALS AND METHODS: Fourteen healthy volunteers without active acne were enrolled in this study and received three laser treatments on test areas of the nose and forehead. Nine subjects completed the treatment regimen and were available for follow-up. SER was measured with Sebumeter prior to the first treatment, and at 1 week and 1 month after the third treatment. Photographs were taken and subjective assessment of skin oiliness and pore size determined by questionnaires at 1 month follow-up. RESULTS: No significant reduction in SER was observed comparing treated with control on all treatment sites (P>0.05) on the nose. Reduction in the absolute SER was observed for both test and control sites on the forehead, reaching significance on the treatment site (P = 0.04) and marginal significance on the control site (P = 0.08). CONCLUSION: While our study was designed to detect only large changes in SER, we conclude that three 1,450 nm laser treatment sessions did not cause marked changes in SER compared to the control (i.e., >44%). Thus, major destruction of sebaceous glands as a result of this treatment is unlikely. However, reduced sebum production was observed on both treatment and control sides at 1 month. Therefore alternative mechanisms should also be considered to explain the clinical efficacy of this treatment for acne vulgaris.

Subsurface skin renewal by treatment with a 1450-nm laser in combination with dynamic cooling.

A new nonablative laser device, Smoothbeam, has been under evaluation for nonablative wrinkle reduction in skin with minimal side effects. This device incorporates a laser at 1450-nm wavelength to heat the dermis and cryogen spray cooling to prevent epidermal damage. The thermal injury created is internal and imperceptible. The wound-healing response to this internal injury causes improvement in the appearance of skin wrinkles. Biopsies taken immediately after treatment showed mild residual thermal damage (RTD) at a depth range of 150 to 400 microm, which is the dermal zone where most solar elastosis resides. Biopsies from two months after treatment showed fibroplasia extending over a range of depths similar to the acute RTD zones. An improvement in wrinkle severity was noted on the treated side compared with the control side.