Proactive patient safety: enhancing hospital readiness through simulation-based clinical systems testing and healthcare failure mode and effect analysis.

BACKGROUND: Recognizing and identifying latent safety threats (LSTs) before patient care commences is crucial, aiding leaders in ensuring hospital readiness and extending its impact beyond patient safety alone. This study evaluated the effectiveness of a combination of Simulation-based Clinical Systems Testing (SbCST) with Healthcare Failure Mode and Effect Analysis (HFMEA) with regard to mitigating LSTs within a newly constructed hospital. METHODS: Three phases of the combined SbCST and HFMEA approach were implemented across all hospital settings. The scenarios tested system functionalities, team responses, and resource availability. The threats thus identified were categorized into system-related issues, human issues, and resource issues, after which they were prioritized and addressed using mitigation strategies. Reassessment confirmed the effectiveness of these strategies before hospital commissioning. RESULTS: More than 76% of the LSTs were mitigated through the combined approach. System-related issues, such as nonfunctional communication devices and faulty elevators, were addressed by leadership. Human issues such as miscommunication and nonadherence to hospital policy led to improvements in interprofessional communication and teamwork. Resource issues, including missing equipment and risks of oxygen explosion, were addressed through procurement, maintenance, and staff training for equipment preparation. CONCLUSION: The SbCST and HFMEA were highly effective with regard to proactively identifying and mitigating LSTs across all aspects of hospital preparedness. This systematic and comprehensive approach offers a valuable tool for enhancing patient safety in new healthcare facilities, thereby potentially setting a new standard for proactive hazard identification and risk management in the context of healthcare construction and commissioning.

Framework for obstetrics and gynecology department change management in response to COVID-19 pandemic: A tertiary center experience.

Coronavirus (cov) disease 2019 pandemic caused by severe acute respiratory syndrome cov 2 has imposed significant demands on healthcare systems across the world. These demands were more significant on obstetrics and gynecology (obgyn) patients, who required services that had to continue despite the closure of other services. This paper describes the change management of an obgyn department at a tertiary health-care center. That experience resulted in a complete management shift in the institution and the formation of an infectious disease epidemic plan for respiratory infections. Description of the change management performed, difficulties encountered, and achievements obtained can assist other departments change management when they face similar situations.

Factors Associated With Increased Rates of Caesarean Section in Women of Advanced Maternal Age.

OBJECTIVE: To compare rates of Caesarean section between mothers of advanced age (35 to 40, and over 40 years) and those aged 20 to 34, using the Robson classification system to examine additional maternal factors. METHODS: A total of 134 088 hospital deliveries in Ontario between April 1, 2011, and March 31, 2012, were grouped into Robson's 10 mutually exclusive and totally inclusive classification categories. Records from the three Robson groups that made the greatest contribution to the overall CS rate were stratified by maternal age, health condition, obstetrical complication, assisted reproductive technology usage, smoking during pregnancy, and socioeconomic status. RESULTS: Rates of CS increased with advancing maternal age; in women aged 20 to 34, 35 to 40, and over 40, the rates were 26.2%, 35.9%, and 43.1%, respectively. The top three Robson groups by contribution to CS rates involved women who had one or more of the following factors: previous Caesarean section, primiparity, conception by means of assisted reproductive technology, chronic hypertension, gestational diabetes, diabetes mellitus, preeclampsia, placenta previa, placental abruption, or large for gestational age infants. The prevalence of these factors increased with advancing maternal age, yet mothers aged ≥ 35 with one or more health conditions or obstetrical complications had higher CS rates than mothers aged 20 to 34 with the same condition(s) or complication(s). CONCLUSION: Health conditions and obstetrical complications alone in older women do not account for increased rates of CS. The preferences of the individual care provider and the mother on CS rates may play a key role and require further investigation.

Objectif : Comparer les taux de césarienne des mères d'âge avancé (de 35 à 40 ans et de plus de 40 ans) à ceux des mères âgées de 20 à 34 ans, en utilisant le système de classification de Robson en vue d'examiner des facteurs maternels additionnels. Méthodes : Au total, 134 088 accouchements s'étant déroulés en milieu hospitalier en Ontario entre le 1er avril 2011 et le 31 mars 2012 ont été groupés en fonction des 10 catégories mutuellement exclusives et totalement inclusives de Robson. Les dossiers des trois groupes Robson ayant le plus contribué au taux global de césarienne ont été stratifiés en fonction de l'âge maternel, de l'état de santé, des complications obstétricales, du recours à des techniques de procréation assistée, du tabagisme pendant la grossesse et du statut socioéconomique. Résultats : Les taux de césarienne étaient proportionnels à l'âge maternel : chez les femmes de 20 à 34 ans, de 35 à 40 ans et de plus de 40 ans, les taux ont été de 26,2 %, de 35,9 % et de 43,1 %, respectivement. Les trois groupes Robson ayant le plus contribué au taux global de césarienne étaient composés de femmes qui présentaient un ou plusieurs des facteurs suivants : antécédents de césarienne, primiparité, conception au moyen de techniques de procréation assistée, hypertension chronique, diabète gestationnel, diabète sucré, prééclampsie, placenta praevia, décollement placentaire ou hypertrophie fœtale. Bien que la prévalence de ces facteurs ait été proportionnelle à l'âge maternel, les mères âgées de 35 ans ou plus qui comptaient un ou plusieurs troubles de santé (ou complications obstétricales) présentaient des taux de césarienne supérieurs à ceux des mères âgées de 20 à 34 ans qui comptaient le ou les mêmes troubles (ou complications). Conclusion : Les taux accrus de césarienne chez les femmes plus âgées ne peuvent être attribués qu'à la seule présence de troubles de santé et de complications obstétricales. Les préférences des fournisseurs de soins et des mères en matière d'accouchement pourraient jouer un rôle clé en ce qui concerne les taux de césarienne, ce qui nécessite la tenue d'études plus approfondies.