Test-retest reliability of the VA National Center for Patient Safety culture questionnaire.

Rationale, Aims And Objectives: Patient safety culture may have a significant influence on safety processes and outcomes. Therefore, it is important to have valid tools to measure patient safety culture in order to identify potential levers for cultural change that could improve patient safety. The 65-item Department of Veterans Affairs Patient Safety Culture Survey (VA PSCS) consists of 14 dimensions and is administered biannually to VA employees.

Flash Burns While on Home Oxygen Therapy: Tracking Trends and Identifying Areas for Improvement.

The objective was to analyze reported flash burns experienced by patients on home oxygen therapy (HOT) in the Veterans Health Administration (VHA) using a qualitative, retrospective review of VHA root cause analysis reports between January 2009 and November 2015. Of 123 cases of reported adverse events related to flash burns, 100 cases (81%) resulted in injury, and 23 (19%) resulted in death. Although 89% of veterans claimed to have quit smoking (n = 109), 92% (n = 113) of burns occurred as a result of smoking.

What's the Evidence: A Review of the One-Minute Preceptor Model of Clinical Teaching and Implications for Teaching in the Emergency Department.

Background: The 2012 Academic Emergency Medicine Consensus Conference, "Education Research in Emergency Medicine: Opportunities, Challenges, and Strategies for Success" noted that emergency medicine (EM) educators often rely on theory and tradition in molding their approaches to teaching and learning, and called on the EM education community to advance the teaching of our specialty through the performance and application of research in teaching and assessment methods, cognitive function, and the effects of education interventions.

Objective: The purpose of this article is to review the research-based evidence for the effectiveness of the one-minute preceptor (OMP) teaching method, and to provide suggestions for its use in clinical teaching and learning in EM.

Discussion: This article reviews hypothesis-testing education research related to the use of the OMP as a pedagogical method applicable to clinical teaching.

Identification of Inpatient Falls Using Automated Review of Text-Based Medical Records.

Objectives: Although falls are among the most common adverse event in hospitals, they are difficult to measure and often unreported. Mechanisms to track falls include incident reporting and medical records review. Because of limitations of each method, researchers suggest multimodal approaches.

Changing Practice in Gastrointestinal Endoscopy: Reducing Distractions for Patient Safety.

Failure in communication during the process of delivering healthcare can have dangerous repercussions. Specifically, failure in interdisciplinary team communication contributes to lapses in patient care. Distractions in procedural areas disrupt team communication.

Site of Treatment for Non-Urgent Conditions by Medicare Beneficiaries: Is There a Role for Urgent Care Centers?

Background: There is limited information on where and how often Medicare beneficiaries seek care for non-urgent conditions when a physician office visit is not available. Emergency departments are often an alternative site of care, and urgent care centers have now also emerged to fill this need. The purpose of the study was to characterize the site of care for Medicare beneficiaries with non-urgent conditions; the relationship between physician office, urgent care center, and emergency department utilization; and specifically the role of urgent care centers.

Explanation and elaboration of the SQUIRE (Standards for Quality Improvement Reporting Excellence) Guidelines, V.2.0: examples of SQUIRE elements in the healthcare improvement literature.

Since its publication in 2008, SQUIRE (Standards for Quality Improvement Reporting Excellence) has contributed to the completeness and transparency of reporting of quality improvement work, providing guidance to authors and reviewers of reports on healthcare improvement work. In the interim, enormous growth has occurred in understanding factors that influence the success, and failure, of healthcare improvement efforts. Progress has been particularly strong in three areas: the understanding of the theoretical basis for improvement work; the impact of contextual factors on outcomes; and the development of methodologies for studying improvement work.

The Challenges of Conscientious Objection in Health care.

Conscientious objection (CO) is the refusal to perform a legal role or responsibility because of personal beliefs. In health care, conscientious objection involves practitioners not providing certain treatments to their patients, based on reasons of morality or "conscience." The development of conscientious objection among providers is complex and challenging.

Understanding and meeting information needs for patients with posttraumatic stress disorder.

Background: Posttraumatic Stress Disorder (PTSD) is a commonly occurring mental illness. There are multiple treatments for PTSD that have similar effectiveness, but these treatments differ substantially in other ways. It is desirable to have well-informed patients involved in treatment choices.

Factors Influencing Time-Dependent Quality Indicators for Patients With Suspected Acute Coronary Syndrome.

Objectives: Rapid risk stratification and timely treatment are critical to favorable outcomes for patients with acute coronary syndrome (ACS). Our objective was to identify patient and system factors that influence time-dependent quality indicators (QIs) for patients with unstable angina/non-ST elevation myocardial infarction (NSTEMI) in the emergency department (ED).

Methods: A retrospective, cohort study was conducted during a 42-month period of all patients 24 years or older suspected of having ACS as defined by receiving an electrocardiogram and at least 1 cardiac biomarker test.

A Meta-Analysis of Depressive Symptom Outcomes in Randomized, Controlled Trials for PTSD.

Posttraumatic stress disorder (PTSD) often co-occurs with depression. Current PTSD practice guidelines lack specific guidance for clinicians regarding the treatment of depressive symptoms. We conducted a meta-analysis of all randomized, placebo-controlled trials for PTSD therapies focusing on depression outcomes to inform clinicians about effective treatment options for depressive symptoms associated with PTSD.

Errors upstream and downstream to the Universal Protocol associated with wrong surgery events in the Veterans Health Administration.

Background: The Universal Protocol has been associated with the prevention of wrong surgery procedures; however, such events still occur. This article explores wrong surgery events, defined as those incorrect procedures (wrong site, wrong side, wrong procedure, wrong patient, wrong level, wrong implant) that would have occurred despite the Universal Protocol including the performance of a time-out by the surgical team. Understanding why some of these events are not caught by the steps of the Universal Protocol, culminating in the time-out, can help the field to add upstream and downstream safeguards to help prevent these never events.

Clinicians' Perception of Patient Readiness for Treatment: An Emerging Theme in Implementation Science?

Despite a training program to help veterans administration (VA) clinicians implement evidence-based psychotherapies (EBPs) for posttraumatic stress disorder (PTSD), uptake has been limited. To understand clinicians' implementation challenges, we performed thematic analysis of semi-structured telephone interviews guided by the Promoting Action on Research Implementation in Health Services framework. Our sample included 22 psychotherapists in VA PTSD clinics in one region.

A randomized controlled clinical trial of a patient decision aid for posttraumatic stress disorder.

Objective: Patient decision aids have been used in many clinical situations to improve the patient centeredness of care. A patient decision aid for patients with posttraumatic stress disorder (PTSD) has not been developed or tested. The authors evaluated the effects of a patient decision aid on the patient centeredness of PTSD treatment.

The provision of mental health treatment after screening: exploring the relationship between treatment setting and treatment intensity.

Objective: Primary care screening programs for mental health disorders are designed to detect patients who might benefit from treatment. As such, the utility of these programs is predicated on the actions that take place in response to a positive screen. Our objective was to characterize the cascade of care delivery steps following a positive screen for a mental health disorder.

Wrong-side thoracentesis: lessons learned from root cause analysis.

Importance: Despite the recognized value of the Joint Commission's Universal Protocol and the implementation of time-outs, incorrect surgical procedures are still among the most common types of sentinel events and can have fatal consequences.

Objectives: To examine a root cause analysis database for reported wrong-side thoracenteses and to determine the contributing factors associated with their occurrence.

Design, Setting, And Participants: We searched the National Center for Patient Safety database for wrong-side thoracenteses performed in ambulatory clinics and hospital units other than the operating room reported from January 1, 2004, through December 31, 2011.

Attitudes and practices related to clinical alarms.

Background: The number of devices with alarms has multiplied in recent years, causing alarm fatigue in bedside clinicians. Alarm fatigue is now recognized as a critical safety issue.

Objective: To determine if attitudes and practices related to clinical alarms have changed since 2005.

Health systems engineering fellowship: curriculum and program development.

Industrial engineering and related disciplines have been used widely in improvement efforts in many industries. These approaches have been less commonly attempted in health care. One factor limiting application is the limited workforce resulting from a lack of specific education and professional development in health systems engineering (HSE).

Treatment of asymptomatic hyperuricemia and prevention of vascular disease: a decision analytic approach.

Objective: Elevated serum urate may be associated with an increase in cardiovascular (CV) disease. Treating asymptomatic hyperuricemia with urate-lowering drugs such as allopurinol may reduce CV events. We designed a model to simulate the effect of allopurinol treatment on reducing frequency of CV events in individuals with elevated serum urate.

Institutional disclosure: promise and problems.

This study explores rationale for and barriers to the prompt and honest disclosure by healthcare organizations of care-related un-intended harm to patients. Although fear of legal action is frequently put forward as the reason that disclosure programs have been slow to be adopted by the medical community, social and nonjurisprudential explanations also pose challenges. This study identifies multiple facilitators and obstacles that transcend concerns about litigation and limit disclosure of adverse events that result in serious injury or death.

Review of the effectiveness of transcranial magnetic stimulation for post-traumatic stress disorder.

Background: Post-traumatic stress disorder (PTSD) is a psychiatric condition with significant morbidity and limited treatment options. Transcranial magnetic stimulation (TMS) has been shown to be an effective treatment for mental illnesses including major depressive disorder.

Objective: Review effectiveness of TMS for PTSD.

Inclusion and exclusion criteria in randomized controlled trials of psychotherapy for PTSD.

Objective: Posttraumatic stress disorder (PTSD) is a prevalent and often disabling condition. Fortunately, effective psychological treatments for PTSD are available. However, research indicates that these treatments may be underutilized in clinical practice.