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Orientador: Daniele Cristina Cataneo / Resumo: Introdução: Considerando que no Brasil, observou-se um crescimento exponencial das demandas judiciais relacionadas aos serviços prestados pelos profissionais da saúde, entende-se necessário um estudo aprofundado à respeito do erro médico com abordagem direta a esse profissional, carecedor de tratamento especial e protetivo sempre que, diante das falhas oriundas do seu exercício profissional, forem verificados fatores de imprevisibilidade capazes de comprometer a exitosa prestação do serviço ofertado. Necessária também, a abordagem no presente trabalho, das mudanças na relação entre o profissional da saúde e o paciente, as prerrogativas de facilitação do acesso ao judiciário, o atendimento aos protocolos clínicos preestabelecidos, dentre outras variáveis, sendo que tais pontos são relevantes para o crescente aumento das ações judiciais e, por consequência, a forma que as decisões são proferidas ao apreciar problemáticas dessa natureza. Objetivos: Descrever acerca da problemática do erro médico quando analisado sob a ótica da responsabilidade civil. Explorar a teoria da responsabilidade civil, a extensão das variáveis de responsabilidade, legislações pertinentes, além de comparar decisões proferidas no Brasil e em outros países. Metodologia: Fora realizada uma revisão da literatura existente sobre o tema e assim elaborada uma dissertação que reuniu e analisou doutrinas acerca do erro médico. Dentre os materiais que foram utilizados, estão as legislações nacionais e internaciona... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Introduction: Considering that in Brazil, there has been an exponential increase in the legal demands related to the services provided by health professionals, it is necessary to conduct an in-depth study about medical error with a direct approach to this professional, who needs special and protective treatment, whenever, in the face of failures arising from their professional practice, unpredictable factors are verified that can compromise the successful provision of the service offered. It is also necessary, the approach in the present work, of the changes in the relationship between the health professional and the patient, the prerogatives of facilitating access to the judiciary, the attendance to the pre-established clinical protocols, among other variables, and such points are relevant to the increasing increase in lawsuits and, consequently, the way in which decisions are rendered when considering problems of this nature. Objectives: To describe the problem of medical error when analyzed from the perspective of civil liability. Explore the theory of civil liability, the extent of liability variables, relevant legislation, and compare decisions made in Brazil and other countries. Methodology: A review of the existing literature on the topic had been carried out and a dissertation was prepared, which brought together and analyzed doctrines about medical error. Among the materials that were used, there are national and international laws covering the theme and existing leg... (Complete abstract click electronic access below) / Mestre

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Every year, 2 million patients in the United States suffer with at least 1 hospital-acquired infection resulting in an estimated 99,000 deaths annually. The purpose of this exploratory single case study was to explore strategies healthcare managers in U.S. hospitals used to reduce hospital-acquired infections. The study included face-to-face, semistructured interviews with 5 healthcare managers from a hospital in Maryland who were successful in reducing these infections. The conceptual framework was human capital theory. Field notes, hospital documents, and transcribed interviews were analyzed to identify themes regarding strategies used by healthcare managers. The data analysis and coding process resulted in 5 major themes: use of HAI-related data; implementation of detailed cleaning method; implementation of define, measure, analyze, implement, and control; education and training of staff; and implementation of the Antimicrobial Stewardship Program. The findings from this study might benefit healthcare managers in implementing and sustaining successful strategies to reduce hospital-acquired infections. The implications for positive social change included reducing hospital-acquired infections, thereby leading to fewer hospitalization days for patients and a faster recovery time to return to normal life. Reducing hospital acquired infections might reduce patient deaths related to the infections.

Medical errors are the 3rd leading cause of death in the U.S.. The problem is timely recognition and management of inappropriate healthcare worker behaviors that lead to intimidation and loss of staff focus, eventually leading to errors. The purpose of this qualitative modified Delphi study was to seek consensus among a panel of experts in hospital risk management practices on the practical methods for early detection of inappropriate behaviors among hospital staff, which may be used by hospital managers to considerably mitigate the risk of medical mishaps. High reliability theory guided the research process, utilizing the conceptual framework of fair and just culture patient safety model. A single research question asked what level of consensus exists among hospital risk management experts as to the practical methods for early detection of inappropriate behavior among hospital staff, which managers may use to ultimately mitigate the risk of preventable medical mishaps. This study included nonprobability purposive sampling (n=34) and 3 rounds of questionnaires. Consensus was reached on 8 factors: setting expectations, developing a culture of respect, holding staff accountable, enforcing a zero-tolerance policy, confidentiality of reporting, communicating expected behavior, open communication, and investigating inappropriate behaviors. The implications for positive social change include a better understanding of inappropriate behaviors among healthcare workers as well as the potential to minimize its negative impacts and improve patient safety in healthcare organizations.

The majority of laboratory testing errors originate in the pre-analytical phase. While the causes and frequencies of pre-analytical errors are well characterized, there are few studies investigating the cost of these errors. The objective of this research was to build a model to quantify the cost of pre-analytical errors occurring during inpatient complete blood count (CBC) testing at Sunnybrook Health Sciences Centre (Sunnybrook). The resultant cost model accounts for the costs of materials, resources, and personnel-time consumed in the CBC testing process. In 2011, pre-analytical errors in inpatient CBC testing cost Sunnybrook $43,462, and represented a loss of 775 employee hours due to laboratory test repetition and error-related activities. This cost model represents the minimum cost of a pre-analytical error, as costs extraneous to the laboratory were beyond the study scope. Future studies investigating downstream effects of pre-analytical errors and the costs associated with them should be conducted.

The majority of laboratory testing errors originate in the pre-analytical phase. While the causes and frequencies of pre-analytical errors are well characterized, there are few studies investigating the cost of these errors. The objective of this research was to build a model to quantify the cost of pre-analytical errors occurring during inpatient complete blood count (CBC) testing at Sunnybrook Health Sciences Centre (Sunnybrook). The resultant cost model accounts for the costs of materials, resources, and personnel-time consumed in the CBC testing process. In 2011, pre-analytical errors in inpatient CBC testing cost Sunnybrook $43,462, and represented a loss of 775 employee hours due to laboratory test repetition and error-related activities. This cost model represents the minimum cost of a pre-analytical error, as costs extraneous to the laboratory were beyond the study scope. Future studies investigating downstream effects of pre-analytical errors and the costs associated with them should be conducted.

Darbo tikslas – įvertinti pacientų nuomonę ir požiūrį apie atliekamų paslaugų saugą PSP grandyje. Uždaviniai: Išanalizuoti pacientų nuomonę apie atliekamų medicininių paslaugų saugą PSP įstaigoje. Įvertinti paciento požiūrį apie gydymo vaistais saugumą. Išanalizuoti, paciento ir gydytojo tarpusavio pasitikėjimo aspektus, siekiant efektyvaus ir saugaus gydymo. Ištirti pacientų požiūrį į nepageidaujamų įvykių priežastis ir jų registravimo sistemą. Tyrimo metodika. Kiekybinis momentinis tyrimas. Tyrimo laikas: 2013 m. sausio - balandžio mėn. Tyrimo vieta - UAB „Šilainių šeimos sveikatos centras“. Tiriamoji imtis 378 respondentai. Atsako dažnis - 94,5 proc. Rezultatai. Respondentams svarbus sveikatos priežiūros paslaugų prieinamumas ir jų savalaikiškumas (22,49 proc. ir 20,37 proc., atitinkamai). 63,49 proc. pacientų žino, kas yra pacientų sauga, todėl vertina komunikavimą su gydytoju, teiraujasi apie paskirtus vaistus, jų pašalines reakcijas, domisi paskirtu gydymu. 38,89 proc. respondentų nuomonė apie antibiotikų skyrimo pagrįstumą yra teigiama, o juos vartoja pagal gydytojo rekomendacijas. Bendravimo tarp personalo ir paciento analizė, parodė, kad visais analizuotais atvejais tarpusavio bendravimas tarp personalo ir paciento yra vertinamas pakankamai gerai. Jaunesni respondentai žymiai dažniau nei vyresni linkę reikšti savo nuomonę, dažniau teiraujasi apie savo sveikatą, dalyvauja jiems svarbių sprendimų priėmime. Respondentai mano, kad dažniausia... [toliau žr. visą tekstą] / Objective of the work – to assess the patients’ opinion and attitude to the safety in the primary health care. Tasks: To analyze the patients’ opinion about the safety of medical services provided in the primary health care facilities. To evaluate the patient’s attitude to the safety of conservative treatment. To analyze the aspects of mutual trust of doctor and patient in order to achieve effective and safe treatment. To examine the patients’ attitude to the reasons of undesirable events and their registration system. Research methodology. Quantitative survey. Study time: January-April 2013. Place of research – Silainiai Family Health Center Ltd. Analyzed sample – 378 respondents. Response frequency – 94,5 percent. Results. The respondents find the accessability and timeliness of the health care services important (22,49 percent and 20,37 percent accordingly). 63,49 percent of the patients are familiar with the safety of patients, thus they appreciate communication with the doctor, inquire about the prescribed medicine, their side effects, and show interest in the prescribed treatment. 38,89 –percent of respondents think that prescription of antibiotics is reasonable and they use antibiotics according to the recommendations of the doctor. The analysis of the communication of the patient and the doctor revealed that in all the analyzed cases the interrelations between the staff and the patient are evaluated quite well. The younger respondents tend to... [to full text]

Background: The status of Safety Management is highly relevant to evaluate an organization’s ability to deal with unexpected events or errors, especially in times of crisis. However, it remains unclear to what extent Safety Management was developed and suffciently implemented within the healthcare system during the COVID-19 pandemic. Providing insights of potential for improvement is expected to be directional for ongoing Safety Management efforts, in times of crisis and beyond. Method: A nationwide survey study was conducted among healthcare professionals and auxiliary staff on German Intensive Care Units (ICUs) evaluating their experiences during the first wave of the COVID-19 pandemic. Error Management and Patient Safety Culture (PSC) measures served to operationalize Safety Management. Data were analyzed descriptively and by using quantitative content analysis (QCA). Results: Results for n = 588 participants from 53 hospitals show that there is a gap between errors occurred, reported, documented, and addressed. QCA revealed that low quality of safety culture (27.8%) was the most mentioned reason for errors not being addressed. Overall, ratings of PSC ranged from 26.7 to 57.9% positive response with Staffng being the worst and Teamwork Within Units being the best rated dimension. While assessments showed a similar pattern, medical staff rated PSC on ICUs more positively in comparison to nursing staff. Conclusion: The status-analysis of Safety Management in times of crisis revealed relevant potential for improvement. Human Factor plays a crucial role in the occurrence and the way errors are dealt with on ICUs, but systemic factors should not be underestimated. Further intensified efforts specifically in the fields of staffng and error reporting, documentation and communication are needed to improve Safety Management on ICUs. These findingsmight also be applicable across nations and sectors beyond the medical field.

Yes / Objectives: Making a medical error can have serious implications for clinician wellbeing, affecting the quality and safety of patient care. Despite an advancing literature base, cross-country exploration of this experience is limited and a paucity of studies has examined the coping strategies used by clinicians. A greater understanding of clinicians¿ responses to making an error, the factors that may influence these, and the various coping strategies used are all essential for providing effective clinician support and ensuring optimal outcomes. The objectives were therefore to investigate a) the professional or personal disruption experienced after making an error, b) the emotional response and coping strategies used, c) the relationship between emotions and coping strategy selection, d) influential factors in clinicians¿ responses, and e) perceptions of organisational support. Methods: A cross-sectional, cross-country survey of 265 physicians and nurses was undertaken in two large teaching hospitals in the UK and USA. Results: Professional and personal disruption was reported as a result of making an error. Negative emotions were common, but positive feelings of determination, attentiveness and alertness were also identified. Emotional response and coping strategy selection did not differ due to location or perceived harm, but responses did appear to differ by professional group; nurses in both locations reported stronger negative feelings after an error. Respondents favoured problem-focused coping strategies and associations were identified between coping strategy selection and the presence of particular emotions. Organisational support services, particularly including peers, were recognised as helpful, but fears over confidentiality may prohibit some staff from accessing these. Conclusions: Clinicians in the UK and US experience professional and personal disruption after an error. A number of factors may influence clinician recovery; these factors should be considered in the provision of comprehensive support programmes so as to improve clinician recovery and ensure higher quality, safer patient care. / This research was funded by the Bradford Institute for Health Research as part of a PhD studentship and supported by a travel grant through the Postgraduate Study Visits scheme by the British Psychological Society.