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Background: Patient safety culture is crucial for improving health care quality, however, there is no consensus on its definition. Purpose: This study aimed to clarify and update the concept of patient safety culture. Methods: We employed Norris' 6-step concept clarification method. The content was organized through a scoping review of 4 databases. Twelve health professionals participated in focus groups and 10 experts participated in content validation. The content validity coefficient (CVC) was calculated for agreement between experts. Results: Three patient safety culture domains were identified: organizational, professional, and patient and family participation. The experts rated the definitions favorably, with high CVC scores (>0.87), indicating good agreement. The operational definitions were reduced from 76 to 54 items after expert evaluation. Conclusion: An updated definition of patient safety culture is provided, which can inform development of assessment instruments by managers and health care professionals. [ABSTRACT FROM AUTHOR]

Objective: To evaluate whether an electronic health record (EHR) reminder improves rates of screening for type 2 diabetes in women with prior gestational diabetes.Methods: We randomly allocated primary care providers (by clinic site) to a reminder for type 2 diabetes screening within the EHR or to usual care. Women with previous gestational diabetes mellitus were identified through an automated search of laboratory results and the problem list. We compared rates of screening during the study period (2010-2012) in women at intervention sites with those at control sites. With a sample size of 850 participants, we had 80% power to detect a 15% difference in screening rates.Results: We included 847 individuals seen at a participating clinic during the study period, of whom 471 were at a reminder clinic and 376 were at a control clinic. A similar proportion of women were screened for type 2 diabetes in both groups (n=265, 56.3% of the reminder group compared with n=206, 54.8% of the control group, P=.67; adjusted odds ratio [OR] 1.04, 95% confidence interval [CI] 0.79-1.38). Patient characteristics associated with risk for diabetes including body mass index (adjusted OR per kg/m 1.05, 95% CI 1.01-1.08) and race (adjusted OR for nonwhite race 2.14, 95% CI 1.57-2.92) were significantly associated with screening.Conclusion: A simple EHR reminder did not increase the rate of diabetes screening in women with prior gestational diabetes mellitus.Clinical Trial Registration: ClinicalTrials.gov, www.clinicaltrials.gov, NCT01288144.Level Of Evidence: I. [ABSTRACT FROM AUTHOR]

Background: Medication errors and adverse drug events are common after hospital discharge due to changes in medication regimens, suboptimal discharge instructions, and prolonged time to follow-up. Pharmacist-based interventions may be effective in promoting the safe and effective use of medications, especially among high-risk patients such as those with low health literacy.Methods and Results: The Pharmacist Intervention for Low Literacy in Cardiovascular Disease (PILL-CVD) study is a randomized controlled trial conducted at 2 academic centers-Vanderbilt University Hospital and Brigham and Women's Hospital. Patients admitted with acute coronary syndrome or acute decompensated heart failure were randomly assigned to usual care or intervention. The intervention consisted of pharmacist-assisted medication reconciliation, inpatient pharmacist counseling, low-literacy adherence aids, and tailored telephone follow-up after discharge. The primary outcome is the occurrence of serious medication errors in the first 30 days after hospital discharge. Secondary outcomes are health care utilization, disease-specific quality of life, and cost-effectiveness. Enrollment was completed September 2009. A total of 862 patients were enrolled, and 430 patients were randomly assigned to receive the intervention. Analyses will determine whether the intervention was effective in reducing serious medication errors, particularly in patients with low health literacy.Conclusions: The PILL-CVD study was designed to reduce serious medication errors after hospitalization through a pharmacist-based intervention. The intervention, if effective, will inform health care facilities on the use of pharmacist-assisted medication reconciliation, inpatient counseling, low-literacy adherence aids, and patient follow-up after discharge. Clinical Trial Registration- clinicaltrials.gov. Identifier: NCT00632021. [ABSTRACT FROM AUTHOR]

The article determines the cost of adverse events among medical intensive care unit patients in the U.S. The Institute of Medicine report, To Err is Human, highlighted the problem of iatrogenic injuries, estimating that 44,000-98,000 deaths per year were due to medical errors. Furthermore, they conclude that patients who require intensive care are at risk for adverse events, and the associated costs with such events are substantial.

Background: Reducing the rate of adverse drug events in the ambulatory setting may require large investments in quality improvement efforts and technologic innovations. Little evidence is available on the potential resulting savings.Objective: The objective of this study was to estimate the costs associated with adverse drug events among older adults in the ambulatory setting.Research Design: This study consisted of a 1-year retrospective cohort study among Medicare enrollees of a large multispecialty group practice. The study included 1210 older adults with an adverse drug event. A matched comparison group was randomly selected from enrollees with recent healthcare encounters and medication dispenses.Outcome Measure: Difference between estimated costs for medical care utilization during the 6 weeks before and 6 weeks beginning on the day of an adverse drug event.Results: For all adverse drug events, the increase in postevent costs over the preevent period was $1310 (95% confidence interval [CI], $625-$1995) greater for those experiencing an adverse drug event than the comparison group after controlling for age, sex, comorbidity, number of scheduled medications, and having been hospitalized during the preevent period. For preventable adverse drug events, the adjusted increase was $1983 (95% CI, $193-$3773) greater for cases. Based on rates of adverse drug events and these cost estimates, 1000 older adults would have annual costs related to adverse drug events in the ambulatory setting of $65,631 with $27,365 of this associated with preventable events.Conclusions: Adverse drug events in the ambulatory setting substantially increase the healthcare costs of elderly persons. [ABSTRACT FROM AUTHOR]

Objectives: The purpose of this study was to examine the impact of a contact-free continuous monitoring system on clinical outcomes including unplanned intensive care unit (ICU) transfer (primary), length of stay (LOS), code blue, and mortality. A secondary aim was to evaluate the return on investment associated with implementing the contact-free continuous monitoring program during the COVID public health emergency., Methods: An interrupted time series evaluation was conducted to examine the association between the use of contact-free continuous monitoring and clinical outcomes. A cost-benefit analysis was planned to evaluate the return on investment., Results: Use of contact-free continuous monitoring was not significantly associated with unplanned ICU transfers, deaths, ICU LOS, and or rapid response team calls. However, there were significant increases in code blue events (P = 0.02) and mean hospital LOS (P = 0.01) in the postimplementation period when compared with the preimplementation period. Due to the lack of improvement, costs were calculated but a cost-benefit analysis was not conducted., Conclusions: Contact-free continuous monitoring bed use during the COVID-19 public health emergency was not associated with improvements in clinical outcomes, although there was substantial confounding. Future studies should include large randomized controlled trials to control for factors not under direct experimental control including unit staffing, staff turnover, and differences in the patient population related to surges in the COVID-19 pandemic., Competing Interests: Conflicts of interest and source of funding: Dr. Bates reports grants and personal fees from EarlySense, personal fees from CDI Negev, equity from ValeraHealth, equity from Clew, equity from MDClone, personal fees and equity from AESOP, personal fees and equity from Feelbetter, equity from Guided Clinical Solutions, and grants from IBM Watson Health, outside the submitted work. Dr. Bates has a patent pending (PHC-028564 US PCT), on intraoperative clinical decision support. This project was funded by Hillrom under a research grant. Hillrom was not involved in the conduct of the research, analysis, or development of the manuscript. For the remaining authors none were declared., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)