TY - JOUR AU - Hanskamp-Sebregts, M.E. AU - Zegers, M. AU - Westert, G.P. AU - Boeijen, W.M.J. AU - Teerenstra, S. AU - Gurp, P.J.M. van AU - Wollersheim, H.C. PY - 2019 UR - https://hdl.handle.net/2066/215427 AB - OBJECTIVE: To evaluate the effectiveness of internal auditing in hospital care focussed on improving patient safety. DESIGN, SETTING AND PARTICIPANTS: A before-and-after mixed-method evaluation study was carried out in eight departments of a university medical center in the Netherlands. INTERVENTION(S): Internal auditing and feedback focussed on improving patient safety. MAIN OUTCOME MEASURE(S): The effect of internal auditing was assessed 15 months after the audit, using linear mixed models, on the patient, professional, team and departmental levels. The measurement methods were patient record review on adverse events (AEs), surveys regarding patient experiences, safety culture and team climate, analysis of administrative hospital data (standardized mortality rate, SMR) and safety walk rounds (SWRs) to observe frontline care processes on safety. RESULTS: The AE rate decreased from 36.1% to 31.3% and the preventable AE rate from 5.5% to 3.6%; however, the differences before and after auditing were not statistically significant. The patient-reported experience measures regarding patient safety improved slightly over time (P < 0.001). The SMR, patient safety culture and team climate remained unchanged after the internal audit. The SWRs showed that medication safety and information security were improved (P < 0.05). CONCLUSIONS: Internal auditing was associated with improved patient experiences and observed safety on wards. No effects were found on adverse outcomes, safety culture and team climate 15 months after the internal audit. TI - Effects of patient safety auditing in hospital care: results of a mixed-method evaluation (part 1) EP - 15 SN - 1353-4505 IS - iss. 7 SP - 8 JF - International Journal for Quality in Health Care VL - vol. 31 DO - https://doi.org/10.1093/intqhc/mzy134 L1 - https://repository.ubn.ru.nl/bitstream/handle/2066/215427/215427.pdf?sequence=1 ER - TY - JOUR AU - Hanskamp-Sebregts, M.E.C. AU - Zegers, M. AU - Boeijen, W.M.J. AU - Wollersheim, H.C. AU - Gurp, P.J. van AU - Westert, G.P. PY - 2019 UR - https://hdl.handle.net/2066/209687 TI - Process evaluation of the effects of patient safety auditing in hospital care (part 2) EP - 441 SN - 1353-4505 IS - iss. 6 SP - 433 JF - International Journal for Quality in Health Care VL - vol. 31 DO - https://doi.org/10.1093/intqhc/mzy173 L1 - https://repository.ubn.ru.nl/bitstream/handle/2066/209687/209687.pdf?sequence=1 ER - TY - JOUR AU - Gelderen, S.C. van AU - Zegers, M. AU - Robben, P.B. AU - Boeijen, W.M.J. AU - Westert, G.P. AU - Wollersheim, H.C.H. PY - 2018 UR - https://hdl.handle.net/2066/198467 TI - Important factors for effective patient safety governance auditing: a questionnaire survey SN - 1472-6963 JF - BMC Health Services Research VL - vol. 18 DO - https://doi.org/10.1186/s12913-018-3577-9 L1 - https://repository.ubn.ru.nl/bitstream/handle/2066/198467/198467.pdf?sequence=1 ER - TY - JOUR AU - Sluisveld, N. van AU - Oerlemans, A.J.M. AU - Westert, G.P. AU - Hoeven, J.G. van der AU - Wollersheim, H.C. AU - Zegers, M. PY - 2017 UR - https://hdl.handle.net/2066/174300 AB - BACKGROUND: Evidence indicates that suboptimal clinical handover from the intensive care unit (ICU) to general wards leads to unnecessary ICU readmissions and increased mortality. We aimed to gain insight into barriers and facilitators to implement and use ICU discharge practices. METHODS: A mixed methods approach was conducted, using 1) 23 individual and four focus group interviews, with post-ICU patients, ICU managers, and nurses and physicians working in the ICU or general ward of ten Dutch hospitals, and 2) a questionnaire survey, which contained 27 statements derived from the interviews, and was completed by 166 ICU physicians (21.8%) from 64 Dutch hospitals (71.1% of the total of 90 Dutch hospitals). RESULTS: The interviews resulted in 66 barriers and facilitators related to: the intervention (e.g., feasibility); the professional (e.g., attitude towards checklists); social factors (e.g., presence or absence of a culture of feedback); and the organisation (e.g., financial resources). A facilitator considered important by ICU physicians was a checklist to structure discharge communication (92.2%). Barriers deemed important were lack of a culture of feedback (55.4%), an absence of discharge criteria (23.5%), and an overestimation of the capabilities of general wards to care for complex patients by ICU physicians (74.7%). CONCLUSIONS: Based on the barriers and facilitators found in this study, improving handover communication, formulating specific discharge criteria, stimulating a culture of feedback, and preventing overestimation of the general ward are important to effectively improve the ICU discharge process. TI - Barriers and facilitators to improve safety and efficiency of the ICU discharge process: a mixed methods study EP - 251 SN - 1472-6963 IS - iss. 1 SP - 251 JF - BMC Health Services Research VL - vol. 17 DO - https://doi.org/10.1186/s12913-017-2139-x L1 - https://repository.ubn.ru.nl/bitstream/handle/2066/174300/174300.pdf?sequence=1 ER - TY - JOUR AU - Sluisveld, N. van AU - Bakhshi-Raiez, F. AU - Keizer, N. de AU - Holman, R. AU - Westert, G.P. AU - Wollersheim, H.C. AU - Hoeven, J.G. van der AU - Zegers, M. PY - 2017 UR - https://hdl.handle.net/2066/174318 AB - BACKGROUND: Variation in intensive care unit (ICU) readmissions and in-hospital mortality after ICU discharge may indicate potential for improvement and could be explained by ICU discharge practices. Our objective was threefold: (1) describe variation in rates of ICU readmissions within 48 h and post-ICU in-hospital mortality, (2) describe ICU discharge practices in Dutch hospitals, and (3) study the association between rates of ICU readmissions within 48 h and post-ICU in-hospital mortality and ICU discharge practices. METHODS: We analysed data on 42,040 admissions to 82 (91.1%) Dutch ICUs in 2011 from the Dutch National Intensive Care Evaluation (NICE) registry to describe variation in standardized ICU readmission and post-ICU mortality rates using funnel-plots. We send a questionnaire to all Dutch ICUs. 75 ICUs responded and their questionnaire data could be linked to 38,498 admissions in the NICE registry. Generalized estimation equations analyses were used to study the association between ICU readmissions and post-ICU mortality rates and the identified discharge practices, i.e. (1) ICU discharge criteria; (2) bed managers; (3) early discharge planning; (4) step-down facilities; (5) medication reconciliation; (6) verbal and written handover; (7) monitoring of post-ICU patients; and (8) consulting ICU nurses. In all analyses, the outcomes were corrected for patient-related confounding factors. RESULTS: The standardized rate of ICU readmissions varied between 0.14 and 2.67 and 20.8% of the hospitals fell outside the 95% control limits and 3.6% outside the 99.8% control limits. The standardized rate of post-ICU mortality varied between 0.07 and 2.07 and 17.1% of the hospitals fell outside the 95% control limits and 4.9% outside the 99.8% control limits. We could not demonstrate an association between the eight ICU discharge practices and rates of ICU readmissions or post-ICU in-hospital mortality. Implementing a higher number of ICU discharge practices was also not associated with better patient outcomes. CONCLUSIONS: We found both variation in patient outcomes and variation in ICU discharge practices between ICUs. However, we found no association between discharge practices and rates of ICU readmissions or post-ICU mortality. Further research is necessary to find factors, which may influence these patient outcomes, in order to improve quality of care. TI - Variation in rates of ICU readmissions and post-ICU in-hospital mortality and their association with ICU discharge practices SN - 1472-6963 IS - iss. 1 SP - 281 JF - BMC Health Services Research VL - vol. 17 DO - https://doi.org/10.1186/s12913-017-2234-z L1 - https://repository.ubn.ru.nl/bitstream/handle/2066/174318/174318.pdf?sequence=1 ER - TY - JOUR AU - Gelderen, S.C. van AU - Zegers, M. AU - Boeijen, W.M.J. AU - Westert, G.P. AU - Robben, P.B. AU - Wollersheim, H.C.H. PY - 2017 UR - https://hdl.handle.net/2066/177345 AB - OBJECTIVES: Hospital boards are legally responsible for safe healthcare. They need tools to assist them in their task of governing patient safety. Almost every Dutch hospital performs internal audits, but the effectiveness of these audits for hospital governance has never been evaluated. The aim of this study is to evaluate the organisation of internal audits and their effectiveness for hospitals boards to govern patient safety. DESIGN AND SETTING: A mixed-methods study consisting of a questionnaire regarding the organisation of internal audits among all Dutch hospitals (n=89) and interviews with stakeholders regarding the audit process and experienced effectiveness of audits within six hospitals. RESULTS: Response rate of the questionnaire was 76% and 43 interviews were held. In every responding hospital, the internal audits followed the plan-do-check-act cycle. Every hospital used interviews, document analysis and site visits as input for the internal audit. Boards stated that effective aspects of internal audits were their multidisciplinary scope, their structured and in-depth approach, the usability to monitor improvement activities and to change hospital policy and the fact that results were used in meetings with staff and boards of supervisors. The qualitative methods (interviews and site visits) used in internal audits enable the identification of soft signals such as unsafe culture or communication and collaboration problems. Reported disadvantages were the low frequency of internal audits and the absence of soft signals in the actual audit reports. CONCLUSION: This study shows that internal audits are regarded as effective for patient safety governance, as they help boards to identify patient safety problems, proactively steer patient safety and inform boards of supervisors on the status of patient safety. The description of the Dutch internal audits makes these audits replicable to other healthcare organisations in different settings, enabling hospital boards to complement their systems to govern patient safety. TI - Evaluation of the organisation and effectiveness of internal audits to govern patient safety in hospitals: a mixed-methods study SN - 2044-6055 IS - iss. 7 SP - e015506 JF - BMJ Open VL - vol. 7 DO - https://doi.org/10.1136/bmjopen-2016-015506 L1 - https://repository.ubn.ru.nl/bitstream/handle/2066/177345/177345.pdf?sequence=1 ER - TY - JOUR AU - Sluisveld, P.H.J. van AU - Hesselink, G.J. AU - Hoeven, J.G. van der AU - Westert, G.P. AU - Wollersheim, H.C. AU - Zegers, M. PY - 2015 UR - https://hdl.handle.net/2066/153116 AB - PURPOSE: To systematically review and evaluate the effectiveness of interventions in order to improve the safety and efficiency of patient handover between intensive care unit (ICU) and general ward healthcare professionals at ICU discharge. METHODS: PubMed, CINAHL, PsycINFO, EMBASE, Web of Science, and the Cochrane Library were searched for intervention studies with the aim to improve clinical handover between ICU and general ward healthcare professionals that had been published up to and including June 2013. The methods for article inclusion and data analysis were pre-specified and aligned with recommendations outlined in the PRISMA guideline. Two reviewers independently extracted data (study purpose, setting, population, method of sampling, sample size, intervention characteristics, outcome, and implementation activities) and assessed the quality of the included studies. RESULTS: From the 6,591 citations initially extracted from the six databases, we included 11 studies in this review. Of these, six (55 %) reported statistically significant effects. Effective interventions included liaison nurses to improve communication and coordination of care and forms to facilitate timely, complete and accurate handover information. Effective interventions resulted in improved continuity of care (e.g., reduced discharge delay) and in reduced adverse events. Inconsistent effects were observed for use of care, namely, reduction of length of stay versus increase of readmissions to higher care. No statistically significant effects were found in the reduction of mortality. The overall methodological quality of the 11 studies reviewed was relatively low, with an average score of 4.5 out of 11 points. CONCLUSIONS: This review shows that liaison nurses and handover forms are promising interventions to improve the quality of patient handover between the ICU and general ward. More robust evidence is needed on the effectiveness of interventions aiming to improve ICU handover and supportive implementation strategies. TI - Improving clinical handover between intensive care unit and general ward professionals at intensive care unit discharge EP - 604 SN - 0342-4642 IS - iss. 4 SP - 589 JF - Intensive Care Medicine VL - vol. 41 DO - https://doi.org/10.1007/s00134-015-3666-8 L1 - https://repository.ubn.ru.nl/bitstream/handle/2066/153116/153116.pdf?sequence=1 ER - TY - JOUR AU - Sluisveld, P.H. van AU - Zegers, M. AU - Westert, G.P. AU - Hoeven, J.G. van der AU - Wollersheim, H.C. PY - 2013 UR - https://hdl.handle.net/2066/118558 AB - BACKGROUND: To use intensive care unit (ICU) facilities efficiently and ensure high quality of care, an optimal patient flow is necessary. Discharging patients relieves the pressure on ICU beds but the risk of premature discharge must be managed carefully. Suboptimal patient discharge may result in ICU readmissions and in patients' death.The aim of this study is to obtain insight into the safety and efficiency of current ICU discharge practices and into barriers and facilitators to the implementation of effective ICU discharge interventions, and to develop an implementation strategy tailored to the barriers and facilitators identified. METHODS/DESIGN: This study exists of five phases. Phase A: analysis of routinely registered data on variation in ICU readmissions and hospital mortality after ICU discharge of all ICUs participating in the Dutch National Intensive Care Evaluation registry (n=83). Phase B: systematic review of effective interventions aiming to improve the efficiency and safety of the ICU discharge process. Phase C: assessing the intervention adherence with a questionnaire survey among all Dutch ICUs (n=90). Phase D: assessing barriers and facilitators to the implementation of effective ICU discharge interventions with a questionnaire survey among all Dutch intensivists (n=700). The questionnaire will be based on barriers and facilitators identified by focus groups (n=4) and individual interviews with professionals of ICUs and general wards and adult discharged ICU patients (n=25 to 30). Phase E: systematic development of an implementation strategy based on the sampled data in phase A to D, and effective implementation strategies from the literature using the intervention mapping method. DISCUSSION: Using theory and empirical data, an implementation strategy will be developed to improve the safety and efficiency of the ICU discharge process. The developed strategy will be evaluated in a subsequent study. The knowledge obtained in this study should be used for further implementation of ICU discharge interventions, and can be used for implementation of handover interventions in other healthcare transition settings. TI - A strategy to enhance the safety and efficiency of handovers of ICU patients: study protocol of the pICUp study EP - 67 SN - 1748-5908 SP - 67 JF - Implementation Science VL - vol. 8 L1 - https://repository.ubn.ru.nl/bitstream/handle/2066/118558/118558.pdf?sequence=1 ER - TY - JOUR AU - Hanskamp-Sebregts, M.E. AU - Zegers, M. AU - Boeijen, W.M.J. AU - Westert, G.P. AU - Gurp, P.J.M. van AU - Wollersheim, H.C. PY - 2013 UR - https://hdl.handle.net/2066/125391 AB - BACKGROUND: Auditing of patient safety aims at early detection of risks of adverse events and is intended to encourage the continuous improvement of patient safety. The auditing should be an independent, objective assurance and consulting system. Auditing helps an organisation accomplish its objectives by bringing a systematic, disciplined approach to evaluating and improving the effectiveness of risk management, control, and governance. Audits are broadly conducted in hospitals, but little is known about their effects on the behaviour of healthcare professionals and patient safety outcomes. This study was initiated to evaluate the effects of patient safety auditing in hospital care and to explore the processes and mechanisms underlying these effects.Methods and design: Our study aims to evaluate an audit system to monitor and improve patient safety in a hospital setting. We are using a mixed-method evaluation with a before-and-after study design in eight departments of one university hospital in the period October 2011--July 2014. We measure several outcomes 3 months before the audit and 15 months after the audit. The primary outcomes are adverse events and complications. The secondary outcomes are experiences of patients, the standardised mortality ratio, prolonged hospital stay, patient safety culture, and team climate. We use medical record reviews, questionnaires, hospital administrative data, and observations to assess the outcomes. A process evaluation will be used to find out which components of internal auditing determine the effects. DISCUSSION: We report a study protocol of an effect and process evaluation to determine whether auditing improves patient safety in hospital care. Because auditing is a complex intervention targeted on several levels, we are using a combination of methods to collect qualitative and quantitative data about patient safety at the patient, professional, and department levels. This study is relevant for hospitals that want to early detect unsafe care and improve patient safety continuously.Trial registration: Netherlands Trial Register (NTR): NTR3343. TI - Effects of auditing patient safety in hospital care: design of a mixed-method evaluation SN - 1472-6963 IS - iss. 1 SP - 226 JF - BMC Health Services Research VL - vol. 13 DO - https://doi.org/10.1186/1472-6963-13-226 L1 - https://repository.ubn.ru.nl/bitstream/handle/2066/125391/125391.pdf?sequence=1 ER -