[New ways to evaluate patient safety relevant topics: Patient-safety feedback]. / Neue Wege zur Evaluierung von patientensicherheitsrelevanten Aspekten: Feedback-Patientensicherheit.

BACKGROUND: Patient safety has become a hot topic, and there are numerous initiatives ongoing to improve patient-relevant processes. But how can both the effectiveness and sustainability of these initiatives be evaluated? The aim of the present paper was to describe the development of an instrument to assess patient safety aspects which can be used for normal hospital ward and intensive care unit rounds or in the operating room. METHODOLOGY: All relevant patient safety guidelines and checklists of the University Hospital Graz were screened. Subsequently, questions were extracted from these documents which can be used in a checklist for "real-time" ward rounds by local observers. RESULTS: Based on the document screening two sets of criteria were prepared, one for operating rooms and one for normal hospital wards and intensive care units. Using a survey tool two checklists were then generated on the basis of these criteria, which can be used for the so-called "patient-safety feedback" from the observers. CONCLUSION: Whether guidelines or checklists, which should theoretically improve patient safety, are properly understood and applied as intended by healthcare professionals can only be evaluated by using methods like monitoring the respective processes. The checklists for conducting the so-called "patient-safety feedback" seem to be an effective instrument to assess patient safety-relevant processes in "real-time".

[The evolution of the Critical Incident Reporting System in an Austrian university hospital]. / Die Entwicklung des Critical Incident Reporting Systems in einem Österreichischen Universitätsspital.

BACKGROUND: Critical Incident Reporting Systems (CIRS) are an important tool to identify potential hazards in healthcare. However, in Europe CIR systems are differently used with respect to whether its use is voluntary or mandatory. The aim of the present paper was to describe the development of the recently implemented CIRS in the University Hospital Graz. METHODOLOGY: In 2012, in a pilot unit CIRS was implemented within an intensive care unit. After evaluating its results, CIRS was then implemented in all organizational units of the University Hospital Graz in 2013. The definition of a CIRS report as well as the processing of CIRS reports was described in a CIRS manual. RESULTS: On average, 1.6 CIRS reports per week were submitted in the University Hospital Graz. Compared to data from a university hospital in Switzerland (27 CIRS reports per week), it becomes evident that, in general, CIRS is used, but the question arises whether CIRS is commonly known and whether information on the proceeding of CIRS cases is sufficiently transparent. CONCLUSION: Overall, the implementation of CIRS is relatively simple, but in order to achieve acceptance and thereby continuous reports, trust and a value-free handling of critical reports is required. Meetings with openly discussed case analysis could help to increase the awareness of CIRS among healthcare professionals. In Europe CIR systems are used in different ways. In Austria, both an academic exchange process on how to use CIRS and a common definition of CIRS reports has so far been lacking. The preparation of a guidance document for Austria is recommended.

The Gap between Individual Perception and Compliance: A Qualitative Follow-Up Study of the Surgical Safety Checklist Application.

BACKGROUND: "The Surgical Safety Checklist (SSC) is important, but we don't use it adequately" is a well-suited statement that reflects the SSC's application in hospitals. Our aim was to follow up on our initial study on compliance (2014) by analysing differences between individual perception and compliance with the SSC. METHODS: We conducted a follow-up online survey to assess healthcare professionals' individual perception of, as well as satisfaction and compliance with the SSC three years following its thorough implementation. RESULTS: 171 (19.5%) of 875 operating team members completed the online survey. 99.4% confirmed using the SSC. Self-estimated subjective knowledge about the intention of the checklist was high, whereas objective knowledge was moderate, but improved as compared to 2014. According to an independent audit the SSC was used in 93.1% of all operations and among the SSCs used the completion rate was 57.2%. The use of the SSC was rated as rather easy [median (IQR): 7 (6-7)], familiar [7 (6-7)], generally important [7 (7-7)], and good for patients [7 (6-7)] as well as for employees [7 (7-7)]. Only comfort of use was rated lower [6 (5-7)]. CONCLUSION: There is a gap between individual perception and actual application of the SSC. Despite healthcare professionals confirming the importance of the SSC, compliance was moderate. The introduction of SSCs in the health care sector remains a constant challenge and requires continuous re-evaluation as well as a sensible integration into existing workflows in hospitals.

Implementation of a surgical safety checklist: interventions to optimize the process and hints to increase compliance.

BACKGROUND: A surgical safety checklist (SSC) was implemented and routinely evaluated within our hospital. The purpose of this study was to analyze compliance, knowledge of and satisfaction with the SSC to determine further improvements. METHODS: The implementation of the SSC was observed in a pilot unit. After roll-out into each operating theater, compliance with the SSC was routinely measured. To assess subjective and objective knowledge, as well as satisfaction with the SSC implementation, an online survey (N = 891) was performed. RESULTS: During two test runs in a piloting unit, 305 operations were observed, 175 in test run 1 and 130 in test run 2. The SSC was used in 77.1% of all operations in test run 1 and in 99.2% in test run 2. Within used SSCs, completion rates were 36.3% in test run 1 and 1.6% in test run 2. After roll-out, three unannounced audits took place and showed that the SSC was used in 95.3%, 91.9% and 89.9%. Within used SSCs, completion rates decreased from 81.7% to 60.6% and 53.2%. In 2014, 164 (18.4%) operating team members responded to the online survey, 160 of which were included in the analysis. 146 (91.3%) consultants and nursing staff reported to use the SSC regularly in daily routine. CONCLUSION: These data show that the implementation of new tools such as the adapted WHO SSC needs constant supervision and instruction until it becomes self-evident and accepted. Further efforts, consisting mainly of hands-on leadership and training are necessary.

Systematic implementation of clinical risk management in a large university hospital: the impact of risk managers.

BACKGROUND: For health care systems in recent years, patient safety has increasingly become a priority issue. National and international strategies have been considered to attempt to overcome the most prominent hazards while patients are receiving health care. Thereby, clinical risk management (CRM) plays a dominant role in enabling the identification, analysis, and management of potential risks. CRM implementation into routine procedures within complex hospital organizations is challenging, as in the past, organizational change strategies using a top-down approach have often failed. Therefore, one of our main objectives was to educate a certain number of risk managers in facilitating CRM using a bottom-up approach. METHODS: To achieve our primary purpose, five project strands were developed, and consequently followed, introducing CRM: corporate governance, risk management (RM) training, CRM process, information, and involvement. The core part of the CRM process involved the education of risk managers within each organizational unit. To account for the size of the existing organization, we assumed that a minimum of 1 % of the workforce had to be trained in RM to disseminate the continuous improvement of quality and safety. Following a roll-out plan, CRM was introduced in each unit and potential risks were identified. RESULTS: Alongside the changes in the corporate governance, a hospital-wide CRM process was introduced resulting in 158 trained risk managers correlating to 2.0 % of the total workforce. Currently, risk managers are present in every unit and have identified 360 operational risks. Among those, 176 risks were scored as strategic and clustered together into top risks. Effective meeting structures and opportunities to share information and knowledge were introduced. Thus far, 31 units have been externally audited in CRM. CONCLUSION: The CRM approach is unique with respect to its dimension; members of all health care professions were trained to be able to identify potential risks. A network of risk managers supported the centrally coordinated CRM process. There is a strong commitment among management, academia, clinicians, and administration to foster cooperation. The introduction of CRM led to a visible shift with regard to patient safety culture throughout the entire organization. Still, there is a long way to go to keep people engaged in CRM and work on national and international patient safety initiatives to continuously decrease potential hazards.