Determinants of aggression against all health care workers in a large-sized university hospital.

BACKGROUND: The paper aims to describe the 3-year incidence (2015/17) of aggressive acts against all healthcare workers to identify risk factors associated to violence among a variety of demographic and professional determinants of assaulted, and risk factors related to the circumstances surrounding these events. METHODS: A retrospective observational study of all 10,970 health workers in a large-sized Italian university hospital was performed. The data, obtained from the "Aggression Reporting Form", which must be completed by assaulted workers within 72 h of aggression, were collected for the following domains: worker assaulted (sex, age class, years worked); profession (nurses, medical doctors, non-medical support staff, administrative staff, midwives); aggressive acts (activity type during aggressive acts, season, time and location of aggressive acts); and type of aggressive acts (verbal, non-verbal, consequences, aggressors). RESULTS: Three hundred sixty-four (3.3%) workers experienced almost one aggression. The majority of the assaulted workers were female (77.5%), had worked for 6/15 years and were Nurses (64.3%). The majority of aggressive acts occurred during assistance and patient care (38.2%), in the spring and during the afternoon/morning shifts and took place in locations where patients were present (47.3%). The most prevalent aggression type was verbal (76.9%). The patient was the most common aggressor (46.7%). 56% of those assaulted experienced interruptions in their work. Being female, being < 50 years of age, having worked for 6-15 years were significant risk factors for aggression. Midwives suffered the highest risk of experiencing aggression (RR = 12.95). The risk analysis showed that non-verbally aggressive acts were related to assistance and patient care with respect to activity type, to the presence of patients and during the spring and afternoon/evening. CONCLUSIONS: The findings suggest the parallel use of future qualitative studies to clarify the motivation behind aggression. These suggestions are needed for the implementation of additional adequate prevention strategies on either an organizational or a personal level.

Gender differences in reporting workplace violence: a qualitative analysis of administrative records of violent episodes experienced by healthcare workers in a large public Italian hospital.

OBJECTIVES: This study aims to analyse, from a descriptive and qualitative point of view, the episodes of violence reported by healthcare workers (HCWs) in a large public Italian hospital. Qualitative analysis permits us to collect the victims' words used to describe the event and the ways in which they dealt with it. A comparison between genders was performed to better understand what type of different strategies could be used to improve the prevention of workplace violence for HCWs. DESIGN AND SETTING: The retrospective observational study was carried out in 'Città della Salute e della Scienza', a complex of four interconnected hospitals situated in Northern Italy. This study analysed aggression data from the 4-year period of 2015-2018 that included all HCW categories. The data were obtained from the aggression reporting form. PARTICIPANTS: The analysed records were supplied by 396 HCWs (3.6% of all HCWs in the hospital). RESULTS: Male HCWs aged <30 years did not report violent episodes that occurred in the workplace, while male HCWs with 6-15 years of work experience reported more violent episodes than their female counterparts. Among the HCW professions, nursing was the profession, in which HCWs were more prone to experience a violent episode, while male medical doctors were more prone to report violent episodes than female medical doctors. Moreover, female HCWs experienced more verbal violence (insults) than male HCWs did, while male HCWs experienced more physical violence (bodily contact) than female HCWs did. CONCLUSIONS: The findings from this explorative study suggest that there is a gender difference in the characteristics of workplace violence perpetrated by patients, patients' relatives and visitors and in the way in which these episodes are described. Consequently, it is important for informative and preventive courses to consider gender differences in experiencing a violent episode.

[Diagnostic imaging procedures and prescribing appropriateness: are administrative data a proper instrument? An experience from Piedmont Region (Northern Italy)]. / Diagnostica per immagini e appropriatezza prescrittiva: i dati amministrativi possono essere uno strumento informativo adeguato? Un'esperienza nella Regione Piemonte.

OBJECTIVES: to assess at population level if healthcare administrative data can be suitable to identify variability and determinants of the prescribing rates for some diagnostic imaging procedures at high-risk of inappropriateness. DESIGN: population-based observational study. SETTING AND PARTICIPANTS: Piedmont Region (Northern Italy) adult population (>20 years) in year 2013. The subjects included were 3,566,147, referring to 3,016 general practitioners (GPs), in 12 Local Health Authorities (LHAs). MAIN OUTCOME MEASURES: prescription rates of 4 diagnostic imaging procedures at high-risk of inappropriateness (vertebral and joint magnetic resonance - MR, vertebral computed tomography - CT, and bone densitometry). The following factors have been investigated: sociodemographic and clinical data of the subjects, prescribing GPs' characteristics, and organizational environment of the LHA for whom the GP is working. For each procedure, prescription rate determinants have been estimated by a logistic regression modelling of the probability of receiving at least one prescription during the year. Hierarchical data structure has been managed. The Intraclass Correlation Coefficient (ICC) and the Median Odds Ratio (MOR) were used as measures of variability due to GPs and LHAs. RESULTS: the degree of variability among LHAs and, within each LHA, among GPs was moderate (ICC for LHA: 0.009 and 0.004; ICC for GP: 0.015 and 0.014, respectively, for vertebral and joint MR). Prescribing probability was mainly explained by the demographic and clinical characteristics of the subjects. Most of the GPs' characteristics did not show any relevant association. Results suggest also a potential role of the private technology availability in the LHA where the GP is working. CONCLUSIONS: administrative healthcare data did not describe a relevant degree of variability in prescribing diagnostic imaging procedures in Piedmont Region, except for some GPs and LHAs with a different rate from the regional average. To explain differences in prescribing rates of some GPs or LHAs and to assess their appropriateness, outpatient databases should be enriched with clinical data (mainly, diagnosis or clinical suspicion) or different tools, such as clinical audit, should be used.

Medication discrepancies across multiple care transitions: A retrospective longitudinal cohort study in Italy.

PURPOSE: Medication discrepancies are defined as unexplained differences among regimens across different sites of care. The problem of medication discrepancies that occur during the entire care pathway from hospital admission to a local care setting discharge (namely all types of settings dedicated to formal care other than hospitals) has received little attention in the medical literature. The present study aims to (1) determine the prevalence of medication discrepancies that occur during the entire care pathway from hospital admission to local care setting discharge, (2) describe the discrepancy and medication type, and (3) identify potential risk factors for experiencing medication discrepancies in patient care transitions. Evidence from an integrated health care system, such as the Italian one, may explain results from other studies in different healthcare systems. METHODS: A retrospective longitudinal cohort study of patients admitted from July 2015 to July 2016 to the Giovanni Bosco Hospital serving Turin, Italy and its surrounding territory was performed. Discrepancies were recorded at the following four care transitions: T1: Hospital admission; T2: Hospital discharge; T3: Admission into local care settings; T4: Discharge from local care settings. All evaluations were based on documented regimens and were performed by a team (doctor, nurse and pharmacists). RESULTS: Of 366 included patients, 25.68% had at least one discrepancy. The most frequent type of discrepancy was from medication omission (N = 74; 71.15%). Only discharge from a long-stay care setting (T4) was significantly associated with the onset of discrepancies (p = 0.045). When considering a lack of adequate documentation, not as missing data but as a discrepancy, 43.72% of patients had at least one discrepancy. CONCLUSIONS: This study suggests that an integrated health care system, such as Italian system, may influence the prevalence of discrepancies, thus highlighting the need for structured multidisciplinary and, if possible, computerized medication reconciliation to prevent medication discrepancies and improve the quality of medical documentation.

[Overcrowding in emergency departments: the case of the San Giovanni Battista (Molinette) university hospital in Turin (Italy)]. / Il sovraffollamento dei Dipartimenti di Emergenza: il caso dell'Azienda Ospedaliera Universitaria San Giovanni Battista (Molinette) di Torino.

Overcrowding in Emergency Departments (ED) is a common phenomenon worldwide, especially in metropolitan areas. The main reason for overcrowding is not inappropriate emergency department use by patients but rather a shortage of available hospital beds which results in extended ED stays for patients who need emergency admission. The aims of this study, conducted at the San Giovanni Battista (Molinette) University hospital in Turin (Italy), were a) to verify the existence of overcrowding in the hospital ED and b) to test whether, as stated in the literature, overcrowding is due to restricted access to hospital beds for patients needing emergency admission, and to identify contributing factors. Results show the existence of overcrowding and confirm the hypothesized cause.