搜索结果：Global journal on quality and safety in healthcare

Generalized anxiety disorder (GAD) is a common mental health condition encountered in primary care settings. GAD screening, diagnosis, and management are challenging, among other issues that capture the attention of primary care physicians (PCPs). Measurement-based care (MBC) involves the systematic assessment of patients' symptoms and treatment progress using standardized tools. Generalized Anxiety Disorder 7-Item (GAD-7) is a well-known screening and symptom-monitoring tool for GAD. It quantifies subjective symptoms objectively by measuring the patient's anxiety level. We aimed to increase utilization of GAD-7 in outpatient clinics to improve diagnosis and management of GAD through educational interventions and by educating PCPs to access the GAD-7 tool in the EPIC electronic medical record (EMR) with ease. This study employed a quasi-experimental interrupted time series design over 12 months. The intervention involved displaying posters educating family physicians on accessing GAD-7 screening tools in EMR and using smart phrases to document GAD-7 results in two outpatient family medicine clinics. SlicerDicer measured total anxiety encounters and GAD-7 utilization 3 months before and 9 months after intervention. Statistical process control was used, and control charts were created using the statistical software JMP Pro-16. A Poisson regression model was used to detect statistically significant differences using statistical software SAS 9.4. GAD-7 utilization increased from 4.5 in the preintervention period to 20.5 in the postintervention period. There was a significant increase in GAD-7 utilization over time after implementing our QI intervention. The control chart phase analysis showed a shift in the process with an increase in the average rate of GAD-7 utilization from 11.5 per 100 encounters per week in the preintervention phase to an average of 35.8 per 100 encounters per week postintervention phase. The effect was sustained over a year postintervention. The Poisson regression model also showed a 21% increase (p < 0.0001) in the incidence rate ratio in the post-intervention period as compared with the preintervention. Utilization of GAD-7 as an application of MBC improved with the implementation of a bundled intervention using quality improvement tools. Other programs may replicate this in their similar quality improvement endeavors.

Chronic obstructive pulmonary disease (COPD) is a chronic, inflammatory, progressive respiratory disease characterized by chronic symptoms, such as cough, dyspnea, and expectoration, owing to persistent airway abnormalities that can lead to airflow limitations and inflammation, increasing the risk of exacerbations. Exacerbations are a characteristic feature of moderate and severe COPD, and they are considered a main cause of morbidity, mortality, and reduced quality of life. Patients with moderate to severe COPD are more susceptible to future exacerbations, which usually necessitate hospital admission and readmission, imposing a devastating burden on patients' quality of life and daily activities while posing an enormous burden on healthcare systems. This study aimed to assess the societal and economic burden of different COPD severity stages and their associated events among adult patients in Saudi Arabia over a 10-year period. A prevalence- and incidence-based cost-of-illness Markov model was constructed in Microsoft Excel 365 to estimate the direct medical and indirect costs incurred by patients with COPD in Saudi Arabia. The model projects the burden over 10 years. We developed a state-transition Markov model comprising five health states defined by exacerbation status. The five health states included: no exacerbations, one moderate exacerbation; two or more moderate exacerbations; one or more severe exacerbations; and death. Based on the ABE scheme classification in the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines, we mapped the health states accordingly; the no exacerbation state was considered equivalent to A0/B0; one moderate exacerbation corresponded to A1/B1; and the E group was equally divided between patients experiencing two or more moderate exacerbations and those with one or more severe exacerbations. A 4-week cycle was used to capture changes in health states based on exacerbation status. Sensitivity analysis was conducted. The total cost per patient per year was estimated at SAR 273,874 ($148,040 USD). The percent of work impairment among patients with moderate or severe exacerbations of COPD was the most impactful parameter that could increase costs. COPD imposes a substantial and growing burden on the Saudi economy, both in terms of direct and indirect medical costs. Our findings underscore the need to adopt policies that ensure comprehensive prevention and management strategies.

Integrating process improvement tools into healthcare has shown promising results, yet the application of "training within industry" (TWI) still needs to be explored in this context. This study focuses on implementing job instruction (JI), one of the three components of TWI, within a large breakthrough series collaborative (BTS) in a middle-income country. We evaluated the deployment of JI during a nationwide initiative aimed at reducing three critical healthcare-associated infections (HAIs)-central line-associated bloodstream infections (CLABSI), ventilator-associated pneumonia (VAP), and catheter-associated urinary tract infections (CAUTI)-across 189 Brazilian public intensive care units (ICUs). Our quality improvement (QI) project outlines the integration of JI to enhance the reliability of care bundles and empower frontline teams to reduce variation, one fundamental condition to maintain ongoing improvements. The implementation strategy included structured JI training for the hub's leaders, which facilitated the gradual adoption and customization of JI and visual management techniques into daily ICU care. We detailed the four stages of JI training, the content of each session, and how they were incorporated into the existing BTS framework alongside visual management tools. The mean compliance to prevention bundles exceeded 90%, and the project results reached an overall reduction of 44%, 52%, and 54% for CLABSI, VAP, and CAUTI, respectively. Our findings suggest that JI can be seamlessly integrated into routine QI activities. This structure promotes consistency in carrying out each aspect of care bundles, preventing HAI and strengthening patient safety.

To improve resource allocation within our healthcare system, the Egyptian Authority for Unified Procurement, Medical Supply and the Management of Medical Technology (UPA) and Universal Health Insurance Authority (UHIA) established a joint economic evaluation process to support UHIA reimbursement decisions and UPA procurement decisions. The main objective of this study is to describe the developed national pharmacoeconomic guidelines in Egypt, especially for reimbursement and procurement for new pharmaceuticals. A focus group was formed as a national initiative activity by governmental authorities in Egypt. The aim of this focus group was to develop national pharmacoeconomic guidelines for the evaluation of innovative and high-budget pharmaceutical products. This group consisted of various stakeholders with experience in health economics, outcomes research, public health, and pharmacy practice. To develop our national pharmacoeconomic guidelines, three steps were taken. First, the focus group reviewed the European Network for Health Technology Assessment (EUnetHTA) methods for health economic evaluations for new pharmaceuticals as well as the Canadian Agency for Drugs and Technologies in Health (CADTH) guidelines and the Academy of Managed Care Pharmacy (AMCP) Format for Formulary Submissions. Second, the focus group used the EUnetHTA guideline as a reference and adapted it to our local context. The focus group added the value assessment component, using the CADTH and AMCP guidelines. Third, the focus group collected input and feedback from key stakeholders through a focus group by using the quasi-Delphi panel approach. The results of the focus group are a main structure of national pharmacoeconomic guidelines for the evaluation of innovative and high-budget pharmaceutical products, consisting of seven main topics. Economic evaluation is a core element of Health Technology Assessment, (HTA); therefore, the UHIA and UPA were encouraged to produce unified joint pharmacoeconomic guidelines for innovative products as an initial step in their commitment to implement the use of HTA in decision-making. This standardization of guidelines not only ensures transparency but also guarantees an accurate and transparent process to support evidence-based decision-making. These guidelines are expected to help decision-makers improve their process and attain better health outcomes for Egyptian patients.

Electronic medical records (EMR) have been recognized as practical tools for the improvement of the quality and safety of healthcare despite their occasional use in hospitals worldwide. Epic is an integrated software suite with functionality ranging from patient administration through systems for healthcare providers to billing systems, integration to the primary health sector, and a facility for granting patients access to their data. The implementation process is complicated; creating effective methods requires understanding users' attitudes about these information technologies. This study aimed to develop and validate a questionnaire that measures the efficacy of using workflow during the EMR (Epic) implementation. Furthermore, it describes the nurses' views on the use of quality and satisfaction of workflow. Following a literature review, an initial pool of 57 items was generated based on the following three primary constructs: use, quality, and user satisfaction with the tool's workflow. Internal consistency reliability was assessed by calculating Cronbach's alpha and correlation coefficients for construct validity. The final scale comprised 53 items corresponding to the following five distinct factors: use of workflow, information quality, service quality, use of EMR, and user satisfaction and the influence of workflow on clinical care. The full scale was assessed, and Cronbach's alpha of 0.95 was found. The construct validity was assessed using the Kaiser-Meyer-Olkin measure of sampling adequacy and Bartlett's Test of Sphericity (0.976). Construct validity was tested twice using Exploratory Factor Analysis-Principal Component Analysis. The use of workflow, quality of information, quality of service, use of EMR, and user satisfaction scale have good reliability and validity and can be used to implement technology in healthcare.

The misuse of emergency landings by passengers fabricating medical crises presents serious healthcare quality and patient safety challenges in aviation. Such incidents undermine the integrity of medical protocols, divert critical healthcare resources, and erode trust in emergency response systems. This article examines the ethical, operational, and legal implications of these exploitations, applying the Ethical Decision-Making Model and drawing parallels to patient safety policies in healthcare systems. It highlights how the misuse of emergency protocols in aviation mirrors the misuse of emergency medical services in hospitals, leading to resource misallocation and potential harm to genuine patients. The discussion explores existing aviation and healthcare policies, including Federal Aviation Administration regulations, International Civil Aviation Organization guidelines, and hospital triage models, to propose policy interventions that reinforce safety without compromising access to emergency care. Strengthening penalties for fraudulent claims, enhancing telemedicine verification, and improving data collection on in-flight medical incidents are crucial steps toward ensuring passenger safety, maintaining trust in emergency systems, and protecting public health.

Continuous assessment of community health needs is essential to predict, recognize, and act on healthcare issues. Conducting community health needs assessments (CHNAs) in Saudi Arabia has become a priority to overcome the current healthcare challenges and keep pace with the Saudi Arabia 2030 vision. Studies reporting community health needs in Saudi Arabia regions are limited despite the high incidence of chronic diseases. This study aims to understand the community's health problems and the range of healthy behaviors and determine the priority health problems. We conducted a cross-sectional study based on the adults in Primary Health Care Centers in Hail, Northern Saudi Arabia, by using the CHNA standard questionnaire. In addition to the demographic information, the questionnaire collects data on personal health status, the health status of adults and children, health facilities access information, receiving of healthcare procedures, traveling for healthcare, source of medical information, safety measures and behaviors, health problems, childcare (special needs), and perceived community problems. In all, 336 individuals were approached to participate in this study; 303 agreed to participate (response rate: 90%). The analysis comprised 276 individuals after eliminating 27 who did not fulfill the age inclusion criteria or had missing gender data. Of these, 107 (38.8%) were men and 169 (61.2%) were women. Our data revealed that almost half of the participants, 135 (52.9%) constantly or 107 (42%) occasionally, were able to visit the doctors when needed. Our findings reported positive health behaviors and good accessibility to healthcare services when needed. However, the study findings also revealed healthcare challenges that required urgent action from Hail healthcare leaders. Developing healthcare strategies, screening/prevention programs, and changing healthcare policies in the Hail region are needed to control and prevent health problems and improve the population's health.

Patient safety is a global concern for both health professionals and the public. Research indicates that assessing patient safety culture can help improve patient safety outcomes. Nursing care strategically positions nurses at the center of patient safety promotion, and their proximity to patients makes them the drivers of patient safety. The actions of frontline staff in healthcare organizations have a notable influence on healthcare outcomes, particularly reporting of adverse events. This study aimed to evaluate the actions of frontline staff on adverse event reporting among nurses in three hospitals in the Savannah Region, Ghana. A quantitative cross-sectional method was used to gather data from 210 respondents across three hospitals. Data were analyzed with descriptive statistics, Pearson correlation, and hierarchical linear regression. The findings revealed that teamwork within units had a good positive rating score of 82.9%. This was followed by teamwork across hospital units (68.0%) and handover of care (69.8%). Overall, nurses demonstrated a negative attitude toward adverse events reporting (37.3%). Furthermore, enacting safety practices that had a significant relationship with adverse events reporting were teamwork across units (r = .24, p < 0.001) and handover and transition of patient care (r = .19, p < 0.001). Again, the significant predictor of adverse events reporting was teamwork across units (&#x3b2; = .20, p < 0.001). Nurses' perceptions of patient safety culture within and across hospital units as well as handover of patient care were positive. Though the attitude of nurses toward adverse event reporting was low, teamwork across hospital units significantly predicted adverse event reporting. Therefore, frontline staff should continually strengthen teamwork processes and handover practices to achieve the best healthcare outcomes.

The introduction of the innovative group antenatal and postnatal care model into the private health sector in India has the potential to pivot the experiences of families during pregnancy and beyond. Growing evidence worldwide shows this model moves fragmented healthcare systems toward a more integrated model to improve quality in care and outcomes for mothers and children. The aim of this study was to better understand the challenges and benefits of implementation of the group model of antenatal care in the Indian private health sector for the purpose of improving quality of care. Through a collaborative innovation project led by a master's student of public health and an international organization with expertise in implementing this model, an urban 35-bed private hospital in Pune was identified with readiness to explore the model with stakeholders, train hospital staff as facilitators, and initiate group antenatal care. Semi-structured interviews with facilitators, along with feedback from participants in cohorts and observation of the groups by the trainer, were done for qualitative analysis of themes related to the strengths and barriers in implementing the model. A total of 31 pregnant women participated in two cohorts over their second to third trimesters for group antenatal care with a team of three facilitators from November 2022 to June 2023. On review of experiences in implementing the model, the top strengths demonstrated were meeting of felt needs of the participants, high engagement, and relative advantage of the model. Challenges for implementation included for scheduling and attendance, adapting the model for compatibility, capacity-building, and need for more ongoing planning, monitoring, and evaluation. Through this innovation project, important lessons were learned for robust planning for a future pilot study. Patient-centered and integrated antenatal care are markers of quality of care that this group model can bring not only in the private healthcare sector but throughout India.

Stroke is a prevalent health issue that poses substantial challenges for individuals and healthcare providers alike. It not only results in physical disabilities but also significantly affects the overall quality of life (QoL) for stroke survivors. Addressing these challenges necessitates a comprehensive approach that prioritizes improving functional abilities, fostering independence, and enhancing overall well-being of stroke survivors. A critical issue was observed at Al Hada Armed Forces Hospital (Taif, Saudi Arabia), where the average modified Rankin Scale (mRS) score for ischemic stroke survivors was estimated at 3.33, reflecting a poor QoL in terms of holistic limitations and, more importantly, limitations in daily activities. This improvement project, conducted from May 2022 to July 2023, focused on establishing a comprehensive case management approach for patients with ischemic stroke, involving evidence-based best practices. The study was conducted in three phases: performing a literature review, development of an intervention protocol, and implementation and evaluation to assess feasibility and effectiveness. The evaluation used a quasi-experimental preintervention and postintervention evaluation approach, with qualitative data assessing the effect of the case management strategies on patient QoL as well as qualitative data estimating patient compliance and satisfaction. The target population of the study consisted of 136 patients diagnosed with ischemic stroke. This project yielded significant improvements in the QoL of patients with ischemic stroke, evident by the reduction in the average mRS score from 3.33 to 0.91 (p < 0.001). The effective implementation of case management services also had a positive effect on postdischarge patient satisfaction, which rose from 45% to 94%, as well as on readmission rates secondary to stroke, reduced from an average of 6.2% to 4%. Additionally, improving the QoL of patients with ischemic stroke resulted in a gain of approximately 0.41 quality-adjusted life-years per patient, with estimated cost savings of 76,897-153,794 Saudi riyals (20,467-40,935 US dollars [USD]). This study highlights the effectiveness of an evidence-based case management intervention in improving outcomes for individuals facing poststroke challenges. Our findings support the importance of case management-based interventions in addressing the unique needs of this population.

Telemedicine, also known as e-health, utilizes computer technology to deliver clinical healthcare remotely. Since its inception in the 1960s, telemedicine has evolved significantly, offering several advantages to both patients and healthcare providers, including remote care and monitoring. This study contributes to existing literature by exploring the effectiveness of telemedicine and patient satisfaction in managing health conditions in Canada, with a focus on service delivery, accessibility, efficiency, doctor-patient relationships, and network interconnectivity. The study aims to identify key challenges and barriers to telemedicine efficacy, including patient experience, technologic and accessibility issues, healthcare provider perspectives, and potential future improvements. The research population comprises Canadians, including family doctors, specialists, pharmacists, and patients. A questionnaire featuring closed-ended questions was used to collect primary data. The study found that telehealth is widely accepted in Canada, with 73.1% of respondents reporting ease of use, and 48.1% disagreeing that telehealth is time-consuming. Additionally, the findings indicate high satisfaction levels regarding expertise and technical challenges on telehealth platforms, with 47.4% of participants stating that it provided easier access to instructions. The study underscores the necessity for a robust legal framework and increased patient education on privacy risks. The study concludes that telehealth can help reduce costs, decrease waiting times, and support regional reference centers. However, its broader societal impact remains uncertain. The COVID-19 pandemic improved telemedicine measures, yet effective use requires reliable smartphone or computer connectivity.

Medication errors represent a global issue that can adversely affect patients and healthcare systems. Inappropriate medication reconciliation (MedRec) is the leading cause of prescribing errors, with over 40% of such incidents. Evidence shows that clinical pharmacy resident-run MedRec programs can identify and resolve unintentional medication discrepancies (UMDs) in 60.2% of patients, demonstrating these services' potential impact on patient care. This study evaluated clinical pharmacy residents' impact on MedRec during their clinical rotations in a tertiary care hospital. This retrospective, observational, single-center study was conducted from November 2021 to the end of March 2022 by four clinical pharmacy residents on adult patients aged 18 years or older who were admitted to the hospital within 48 hours. Data were obtained by using a MedRec form and the hospital's electronic medical record system during a 5-month period. The primary outcome was to measure clinical pharmacy residents' impact on the MedRec service by identifying the number and proportion of UMDs observed among admitted patients during residents' clinical rotations. In total, 205 patients were included, with 193 UMDs identified. Most of the discrepancies were omissions (119 [62%]), followed by non-compliance (20 [11%]), commission (19 [9%]), and duplication (13 [7%]). Healthcare providers accepted 151 (86%) physician-directed interventions. Resumption of medication was the most common intervention, accounting for 66% of all interventions. Clinical pharmacy residents significantly contribute to improving medication safety by detecting and resolving UMDs during patient admission. Their involvement highlights the value of pharmacist-led MedRec and supports its integration as a core element of residency training to reduce adverse drug events and improve outcomes.

The Kayakalp guidelines for public healthcare facilities under the Swachh Bharat Abhiyan (Clean India Mission) focus on improving sanitation, cleanliness, and infection control at public hospitals in India. This study was conducted in a 960-bed tertiary-level teaching hospital in eastern India. Housekeeping has been a challenge in public institutions, with factors like overcrowding and resource constraints. Tobacco and betel nut chewing, spitting, poor sanitation practices, and open urination are major challenges in ensuring sanitation at the hospital. The research objective was to study the implementation of the Kayakalp guidelines for quality improvement in housekeeping services at the institution. A pre- and post-interventional study was conducted using the Plan-Do-Check-Act (PDCA) quality tool. Plan phases included the gap assessment using the Kayakalp checklist with numerical scoring. Necessary interventions were done under three headings: structure, processes, and outcomes in the "Do" phase. The "Check" phase included monitoring of the activities followed by the "Act" phase, which included a review of the action plan. External experts nominated by the government conducted the final assessments and recommended it as one of the cleanest hospitals. A 360-degree improvement was observed in hospital services, with assessment score improvement from 73.68% to 95.0%. The institution received the first prize in 2020 and 2021 and runners-up Kayakalp National Award under category "B" (Institute of National Importance) Hospitals in 2019. The implementation of Kayakalp guidelines of the Government of India proved to be efficient in the improvement of housekeeping and infection control practices in the institution.

Behavioral health conditions affect a substantial proportion of the United States population each year, yet many individuals do not receive treatment due to multiple barriers. The Clinically Optimal Access to Collaborative Healthcare (COACH) program is a virtual implementation of the Collaborative Care Model (CCM) that addresses these barriers. This was a retrospective study evaluating the outcomes of a QI project aimed at improving the care of patients with major depressive disorder (MDD) and/or generalized anxiety disorder (GAD) through enrollment into the COACH Program from Nov 1, 2021, to Oct 31, 2024. Patient Health Questionnaire-9 (PHQ-9), GAD-7 scores, and demographics were collected from electronic medical records at baseline and 3 and 6 months after enrollment in the COACH program. Remission and attrition rates were calculated at 3 and 6 months. A phase analysis over 18 months was conducted of PHQ-9 and GAD-7 mean scores before and after enrollment in the COACH program A paired t-test was used to assess changes in scores from baseline to follow-up, with statistical significance set at p < 0.05, using SPSS. A total of 531 patients were included in the analysis (median age 45 y, 50% White, 27% Hispanic). Most patients were referred from primary care provider (PCP) offices (95%) and spoke English (99%). Fifty-four percent (n = 284) had MDD as a primary diagnosis, and 75% (n = 211) had GAD as a secondary diagnosis. By 3 months, 32% with MDD and 40.1% with GAD achieved remission with an overall attrition of 26%. Over 18 months, the phase analysis showed that post-intervention mean monthly PHQ-9 and GAD-7 scores dropped from 11.8 to 7.5 and 10.8 to 6.4, respectively, indicating a shift in the process, which was statistically significant (p < 0.001 and < 0.0001, respectively). The care provided using the COACH Program was associated with a reduction in depression and anxiety symptoms at 3 and 6 months, achieving significant remission rates, while maintaining good patient engagement. The COACH program, as an iteration of the collaborative care model, presents an alternative for the traditional delivery of care for anxiety and depression.

As healthcare organizations strive to improve the quality and safety of their services, there is growing recognition of the importance of fostering a patient safety culture to enhance patient safety and improve patient care outcomes. This study aims to evaluate healthcare professionals' perceptions of patient safety culture in accredited vs nonaccredited hospitals within a network of 68 hospitals in Brazil. This cross-sectional, multicenter study included 68 hospitals from a private network. The Hospital Survey on Patient Safety Culture (HSOPSC) was administered across all participating hospitals in September 2022. Hospitals that had been formally recognized for their quality and safety standards were compared with nonaccredited hospitals. Scores for various dimensions of patient safety culture were compared between groups. A logistic regression model was applied to assess the association between the frequency of event reporting in the past 12 months and participant characteristics. A total of 31,919 healthcare professionals responded to the survey. Compared with nonaccredited hospitals, accredited hospitals reported higher scores in communication openness (3% higher, p = 0.04), frequency of events reported (4% higher, p = 0.02), and overall perception of patient safety (4% higher, p = 0.02). Accreditation was associated with a reduced likelihood of event underreporting (odds ratio = 0.80; 95% CI, 0.74-0.87), and physicians were more likely to underreport compared with nursing staff. Although accreditation enhances patient safety culture, its effect may be more limited in healthcare networks with robust quality management systems already in place. To drive meaningful improvements, policymakers should go beyond accreditation and prioritize the reinforcement of ongoing institutional safety initiatives. Particular attention should be given to persistent challenges, such as fostering a nonpunitive approach to errors and addressing underreporting of adverse events. A graphical abstract is provided in the supplemental material.

Nurses are integral to the healthcare delivery team (multidisciplinary team). They are involved and play vital roles with responsibilities to ensure the quality of healthcare for their patients. The key to those varied roles is the administration of medication. Depending on the clinical setting, nurses spend up to 40% of their hours on medication administration and its management processes. They are liable to identify and prevent medication administration errors (MAEs) and their consequences. This study aimed to explore the barriers and facilitators to the reporting behavior for MAEs among nurses in Ghana. A descriptive qualitative cross-sectional study was conducted among nurses in a district catholic hospital in Ghana. The level of nurses' knowledge of MAEs, causes of such errors, barriers to reporting, and strategies for minimizing errors were assessed. Purposive sampling was used to select a total sample of 20 nurses interviewed face-to-face using an in-depth method. The interviews were recorded, transcribed, and analyzed thematically. The study found that all nurses are aware of MAEs, which serve as the basis for decision-making. However, some nurses do not report these errors when they occur. Factors such as workload, stress and tiredness, staff shortage, difficulty calculating drug dosage, inadequate knowledge about specific medications, distractions during administration, and patient-related factors were identified as common causes of MAEs. The study also revealed that hospital management and the potential negative consequences of reporting errors, such as unpleasant reactions, lawsuits, and loss of a job, are significant barriers to reporting. Regular training workshops should be conducted to update nurses' knowledge about the importance of reporting medication errors, the reporting process, new medications and their administration, to develop a policy document that promotes a nonblaming, nonpunitive, and supportive learning culture for MAE medic reporting.

Hospital performance is significantly affected by external factors (political and economic) rather than internal factors (effectiveness and efficiency). Emergency department (ED) overcrowding is a significant issue for emergency care services globally, characterized by a rising number of visits and persistent unsolved issues, resulting in increased challenges faced by ED staff and decreased patient satisfaction. This study aimed to explore the obstacles and challenges that cause variation in ED quality indicators (QIs) based on five domains: infrastructure, population, workflow, workforce, and administration. A tertiary emergency center in Saudi Arabia administered a questionnaire with standardized measures to 180 nurses, using a cross-sectional descriptive design. Most nurses (75.5%) believed that crowded waiting rooms in the ED were the most influential factor affecting QIs. Many other challenges were identified, including bed capacity, triage area/workflow, increased volume during peak periods, demand for nonemergency visits, staff and shortages. Significant differences in nurses' responses were found on the basis of education level (for infrastructure only, p = 0.004), specialty (for nursing administration only, p = 0.052), and ED experience (for all variables, p = 0.008-0.039). The analysis uncovered various critical aspects of infrastructure, workflow, population, workforce, and nursing administration that have a major effect on patient flow in the ED. Comprehending these aspects will greatly affect the quality measures of ED performance and assist policymakers in formulating strategic plans to enhance ED performance. Therefore, successful implementation and optimization of ED resources depend greatly on considering the right decision variables and resource restrictions.

Medication or medical mistakes, the third highest cause of death in the United States, occur from prescription writing to administering the therapy, with serious clinical and cost repercussions. Digital health technologies, such as connected healthcare systems, have the potential to reduce pharmaceutical errors and increase patient safety. This systematic review was conducted to find literature evidence to improve patient safety and reduce medication errors with connected healthcare interventions. This systematic review was conducted using the PRISMA 2020 guidelines. PubMed, SCOPUS, EBSCO, and Google Scholar databases were searched from January 1, 2000 to June 30, 2024 using keywords: medication errors, patient safety, and connected healthcare. A qualitative narrative analysis was conducted for the review. The detailed search yielded 9524 papers in total. In the process of duplicate removal, 4856 duplicate articles were found. After the removal of duplicate articles, 4615 were found not suitable or relevant to the topic of this study and were removed. Finally, 53 articles were chosen for the review study after screening and duplication removal. Ten of the 53 articles were review articles (18.9%), and 43 (81.1%) were original. The research indicates that various connected healthcare system technologies are more effective in minimizing errors and enhancing care quality. Integrating computerized physician order entry and clinical decision support systems may further reduce medical errors. However, many areas require additional research, and the outcomes are mixed. A balanced strategy that combines innovation, practical safety, and outcome evaluation is preferable.

The OncotypeDX test for patients with breast cancer with early-stage, hormone-receptor-positive, HER2-negative disease can predict the benefit of adjuvant chemotherapy in addition to hormone therapy. Delivering OncotypeDX results in a timely manner is important to inform treatment decisions. We implemented a strategy to reduce the turnaround time (TAT) from breast surgery to OncotypeDX report at a large urban public safety-net hospital in New York City. The Plan-Do-Study-Act model was used to implement quality improvement changes. The goal was to improve efficiency to get treatment information for treatment decisions for patients with breast cancer and encourage teamwork with existing resources in the large public hospital. The primary measure was TAT from surgery to receiving OncotypeDX results in the electronic medical record (EMR). We compared TAT before and after the implementation of our strategy. The historical control included patients from May 2021 through March 2022, whereas the timeline after strategy implementation was from June 2023 to February 2024. The strategy involved the creation of a smartphrase in the EMR for breast surgery to identify and order OncotypeDX in eligible patients, and collaboration between breast surgery, pathology, vendor, and medical oncology. The patient characteristics were similar both before and after implementing the strategy, including patient number (26 vs. 27) and mean age (61 vs. 59 years). Both groups were composed predominantly of ethnic minorities (64% vs. 59%). A higher percentage of patients were from medically underserved areas and populations (MUAs and MUPs) in the group after strategy implementation (35% vs. 44%, p = 0.65). Our strategy reduced the average TAT from 42 to 30 days. We developed a strategy to optimize the OncotypeDX workflow in a large safety net health system despite an increase in patients from MUAs and MUPs. Initiating ordering of OncotypeDX by breast surgery, along with communication with pathology, vendor, and medical oncology, significantly reduced TAT.