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 - Smeets, X.J.N.M. AU - Costa, D.W. da AU - Fockens, P. AU - Mulder, C.J. AU - Timmer, R. AU - Kievit, W. AU - Zegers, M. AU - Bruno, M.J. AU - Besselink, M.G.H. AU - Vleggaar, F.P. AU - Hulst, R.W. van der AU - Poen, A.C. AU - Heine, G.D.N. AU - Venneman, N.G. AU - Kolkman, J.J. AU - Baak, L.C. AU - Romkens, T.E.H. AU - Dijk, S.M. van AU - Hallensleben, N.D. AU - Vrie, W. van de AU - Seerden, T.C. AU - Tan, A. AU - Voorburg, A. AU - Poley, J.W. AU - Witteman, B.J. AU - Bhalla, A. AU - Hadithi, M. AU - Thijs, W.J. AU - Schwartz, M.P. AU - Vrolijk, J.M. AU - Verdonk, R.C. AU - Delft, F. von AU - Keulemans, Y. AU - Goor, H. van AU - Drenth, J.P.H. AU - Geenen, E.J.M. van PY - 2018 UR - https://hdl.handle.net/2066/190882 AB - BACKGROUND: Post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) is the most common complication of ERCP and may run a severe course. Evidence suggests that vigorous periprocedural hydration can prevent PEP, but studies to date have significant methodological drawbacks. Importantly, evidence for its added value in patients already receiving prophylactic rectal non-steroidal anti-inflammatory drugs (NSAIDs) is lacking and the cost-effectiveness of the approach has not been investigated. We hypothesize that combination therapy of rectal NSAIDs and periprocedural hydration would significantly lower the incidence of post-ERCP pancreatitis compared to rectal NSAIDs alone in moderate- to high-risk patients undergoing ERCP. METHODS: The FLUYT trial is a multicenter, parallel group, open label, superiority randomized controlled trial. A total of 826 moderate- to high-risk patients undergoing ERCP that receive prophylactic rectal NSAIDs will be randomized to a control group (no fluids or normal saline with a maximum of 1.5 mL/kg/h and 3 L/24 h) or intervention group (lactated Ringer's solution with 20 mL/kg over 60 min at start of ERCP, followed by 3 mL/kg/h for 8 h thereafter). The primary endpoint is the incidence of post-ERCP pancreatitis. Secondary endpoints include PEP severity, hydration-related complications, and cost-effectiveness. DISCUSSION: The FLUYT trial design, including hydration schedule, fluid type, and sample size, maximize its power of identifying a potential difference in post-ERCP pancreatitis incidence in patients receiving prophylactic rectal NSAIDs. TRIAL REGISTRATION: EudraCT: 2015-000829-37 . Registered on 18 February 2015. ISRCTN: 13659155 . Registered on 18 May 2015. TI - Fluid hydration to prevent post-ERCP pancreatitis in average- to high-risk patients receiving prophylactic rectal NSAIDs (FLUYT trial): study protocol for a randomized controlled trial SN - 1745-6215 JF - Trials VL - vol. 19 DO - https://doi.org/10.1186/s13063-018-2583-x L1 - https://repository.ubn.ru.nl/bitstream/handle/2066/190882/190882.pdf?sequence=1 ER - TY - JOUR AU - Verlaat, C.W.M. AU - Starre, C. van der AU - Hazelzet, J.A. AU - Tibboel, Dick AU - Hoeven, J.J. van der AU - Lemson, J. AU - Zegers, M. PY - 2018 UR - https://hdl.handle.net/2066/194768 TI - The occurrence of adverse events in low-risk non-survivors in pediatric intensive care patients: an exploratory study EP - 1358 SN - 0340-6199 IS - iss. 9 SP - 1351 JF - European Journal of Pediatrics VL - vol. 177 DO - https://doi.org/10.1007/s00431-018-3194-y L1 - https://repository.ubn.ru.nl/bitstream/handle/2066/194768/194768.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 - Geense, W.W. AU - Zegers, M. AU - Vermeulen, H. AU - Boogaard, M.H.W.A. van den AU - Hoeven, J.G. van der PY - 2017 UR - https://hdl.handle.net/2066/182346 AB - INTRODUCTION: Due to advances in critical care medicine, more patients survive their critical illness. However, intensive care unit (ICU) survivors often experience long-term physical, cognitive and mental problems, summarised as post-intensive care syndrome (PICS), impacting their health-related quality of life (HRQoL). In what frequency PICS occurs, and to what extent this influences ICU survivors' HRQoL, is mostly unknown. The aims of this study are therefore to study the: (1) 5-year patient outcomes, (2) predictors for PICS, (3) ratio between HRQoL of ICU survivors and healthcare-related costs, and (4) care and support needs. METHODS: The MONITOR-IC study is a multicentre prospective controlled cohort study, carried out in ICUs in four Dutch hospitals. Patients will be included between July 2016 and July 2021 and followed for 5 years. We estimated to include 12000 ICU patients. Outcomes are the HRQoL, physical, cognitive and mental symptoms, ICU survivors' care and support needs, healthcare use and related costs. A control cohort of otherwise seriously ill patients will be assembled to compare long-term patient-reported outcomes. We will use a mixed methods design, including questionnaires, medical data from patient records, cost data from health insurance companies and interviews with patients and family members. ETHICS AND DISSEMINATION: Insights from this study will be used to inform ICU patients and their family members about long-term consequences of ICU care, and to develop prediction and screening instruments to detect patients at risk for PICS. Subsequently, tailored interventions can be developed and implemented to prevent and mitigate long-term consequences. Additionally, insights into the ratio between HRQoL of ICU patients and related healthcare costs during 5 years after ICU admission can be used to discuss the added value of ICU care from a community perspective. The study has been approved by the research ethics committee of the Radboud University Medical Center (2016-2724). CLINICAL TRIAL REGISTRATION: NCT03246334. TI - MONITOR-IC study, a mixed methods prospective multicentre controlled cohort study assessing 5-year outcomes of ICU survivors and related healthcare costs: a study protocol SN - 2044-6055 IS - iss. 11 JF - BMJ Open VL - vol. 7 DO - https://doi.org/10.1136/bmjopen-2017-018006 L1 - https://repository.ubn.ru.nl/bitstream/handle/2066/182346/182346.pdf?sequence=1 ER - TY - JOUR AU - Oerlemans, A.J.M. AU - Wollersheim, H.C.H. AU - Sluisveld, N. van AU - Hoeven, J.G. van der AU - Dekkers, W.J.M. AU - Zegers, M. PY - 2016 UR - https://hdl.handle.net/2066/171342 AB - BACKGROUND: Internationally, there is no consensus on how to best deal with admission requests in cases of full ICU bed occupancy. Knowledge about the degree of dissension and insight into the reasons for this dissension is lacking. Information about the opinion of ICU physicians can be used to improve decision-making regarding allocation of ICU resources. The aim of this study was to: Assess which factors play a role in the decision-making process regarding the admission of ICU patients; Assess the adherence to a Dutch guideline pertaining to rationing of ICU resources; Investigate factors influencing the adherence to this guideline. METHODS: In March 2013, an online questionnaire was sent to all ICU physician members (n = 761, in 90 hospitals) of the Dutch Society for Intensive Care. RESULTS: 166 physicians (21.8 %) working in 64 different Dutch hospitals (71.1 %) completed the questionnaire. Factors associated with a patient's physical condition and quality of life were generally considered most important in admission decisions. Scenario-based adherence to the Dutch guideline "Admission request in case of full ICU bed occupancy" was found to be low (adherence rate 50.0 %). There were two main reasons for this poor compliance: unfamiliarity with the guideline and disagreement with the fundamental approach underlying the guideline. CONCLUSIONS: Dutch ICU physicians disagree about how to deal with admission requests in cases of full ICU bed occupancy. The results of this study contribute to the discussion about the fundamental principles regarding admission of ICU patients in case of full bed occupancy. TI - Rationing in the intensive care unit in case of full bed occupancy: a survey among intensive care unit physicians SN - 1471-2253 JF - BMC Anesthesiology VL - vol. 16 DO - https://doi.org/10.1186/s12871-016-0190-5 L1 - https://repository.ubn.ru.nl/bitstream/handle/2066/171342/171342.pdf?sequence=1 ER - TY - JOUR AU - Zegers, H.W. AU - Hesselink, G. AU - Geense, W. AU - Vincent, C. AU - Wollersheim, H. PY - 2016 UR - https://hdl.handle.net/2066/172502 AB - OBJECTIVE: To provide an overview of effective interventions aimed at reducing rates of adverse events in hospitals. DESIGN: Systematic review of systematic reviews. DATA SOURCES: PubMed, CINAHL, PsycINFO, the Cochrane Library and EMBASE were searched for systematic reviews published until October 2015. STUDY SELECTION: English-language systematic reviews of interventions aimed at reducing adverse events in hospitals, including studies with an experimental design and reporting adverse event rates, were included. Two reviewers independently assessed each study's quality and extracted data on the study population, study design, intervention characteristics and adverse patient outcomes. RESULTS: Sixty systematic reviews with moderate to high quality were included. Statistically significant pooled effect sizes were found for 14 types of interventions, including: (1) multicomponent interventions to prevent delirium; (2) rapid response teams to reduce cardiopulmonary arrest and mortality rates; (3) pharmacist interventions to reduce adverse drug events; (4) exercises and multicomponent interventions to prevent falls; and (5) care bundle interventions, checklists and reminders to reduce infections. Most (82%) of the significant effect sizes were based on 5 or fewer primary studies with an experimental study design. CONCLUSIONS: The evidence for patient-safety interventions implemented in hospitals worldwide is weak. The findings address the need to invest in high-quality research standards in order to identify interventions that have a real impact on patient safety. Interventions to prevent delirium, cardiopulmonary arrest and mortality, adverse drug events, infections and falls are most effective and should therefore be prioritised by clinicians. TI - Evidence-based interventions to reduce adverse events in hospitals: a systematic review of systematic reviews SN - 2044-6055 IS - iss. 9 SP - e012555 JF - BMJ Open VL - vol. 6 DO - https://doi.org/10.1136/bmjopen-2016-012555 L1 - https://repository.ubn.ru.nl/bitstream/handle/2066/172502/172502.pdf?sequence=1 ER - TY - JOUR AU - Hanskamp-Sebregts, M.E.C. AU - Zegers, M. AU - Vincent, C. AU - Gurp, P.J.M. van AU - Vet, H.C. de AU - Wollersheim, H.C. PY - 2016 UR - https://hdl.handle.net/2066/170948 AB - OBJECTIVES: Record review is the most used method to quantify patient safety. We systematically reviewed the reliability and validity of adverse event detection with record review. DESIGN: A systematic review of the literature. METHODS: We searched PubMed, EMBASE, CINAHL, PsycINFO and the Cochrane Library and from their inception through February 2015. We included all studies that aimed to describe the reliability and/or validity of record review. Two reviewers conducted data extraction. We pooled kappa values (kappa) and analysed the differences in subgroups according to number of reviewers, reviewer experience and training level, adjusted for the prevalence of adverse events. RESULTS: In 25 studies, the psychometric data of the Global Trigger Tool (GTT) and the Harvard Medical Practice Study (HMPS) were reported and 24 studies were included for statistical pooling. The inter-rater reliability of the GTT and HMPS showed a pooled kappa of 0.65 and 0.55, respectively. The inter-rater agreement was statistically significantly higher when the group of reviewers within a study consisted of a maximum five reviewers. We found no studies reporting on the validity of the GTT and HMPS. CONCLUSIONS: The reliability of record review is moderate to substantial and improved when a small group of reviewers carried out record review. The validity of the record review method has never been evaluated, while clinical data registries, autopsy or direct observations of patient care are potential reference methods that can be used to test concurrent validity. TI - Measurement of patient safety: a systematic review of the reliability and validity of adverse event detection with record review SN - 2044-6055 IS - iss. 8 SP - e011078 JF - BMJ Open VL - vol. 6 DO - https://doi.org/10.1136/bmjopen-2016-011078 L1 - https://repository.ubn.ru.nl/bitstream/handle/2066/170948/170948.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 - Merten, H. AU - Johannesma, P.C. AU - Lubberding, S. AU - Zegers, M. AU - Langelaan, M. AU - Jukema, G.N. AU - Heetveld, M.J. AU - Wagner, C. PY - 2015 UR - https://hdl.handle.net/2066/152982 AB - OBJECTIVES: Hip fracture patients of 65 years and older are a complex patient group who often suffer from complications and difficult rehabilitation with disappointing results. It is unknown to what extent suboptimal hospital care contributes to these poor outcomes. This study reports on the scale, preventability, causes and prevention strategies of adverse events in patients, aged 65 years and older, admitted to the hospital with a primary diagnosis of hip fracture. DESIGN, SETTING AND OUTCOME MEASURES: A retrospective record review study was conducted of 616 hip fracture patients (>/=65 years) admitted to surgical or orthopaedic departments in four Dutch hospitals in 2007. Experienced physician reviewers determined the presence and preventability of adverse events, causes and prevention strategies using a structured review form. The main outcome measures were frequency of adverse events and preventable adverse events in hospitalised hip fracture patients of 65 years and older, and strategies to prevent them in the future. RESULTS: 114 (19%) of the 616 patients in the study experienced one or more adverse events; 49 of these were preventable. The majority of the adverse events (70%) was related to the surgical procedure and many resulted in an intervention or additional treatment (67%). Human causes contributed to 53% of the adverse events, followed by patient-related factors (39%). Training and close monitoring of quality of care and the health professional's performance were the most often selected strategies to prevent these adverse events in the future. CONCLUSIONS: The high percentage of preventable adverse events found in this study shows that care for older hospitalised hip fracture patients should be improved. More training and quality assurance is required to provide safer care and to reduce the number of preventable adverse events in this vulnerable patient group. TI - High risk of adverse events in hospitalised hip fracture patients of 65 years and older: results of a retrospective record review study SN - 2044-6055 IS - iss. 9 SP - e006663 JF - BMJ Open VL - vol. 5 DO - https://doi.org/10.1136/bmjopen-2014-006663 L1 - https://repository.ubn.ru.nl/bitstream/handle/2066/152982/152982.pdf?sequence=1 ER - TY - JOUR AU - Oerlemans, A.J. AU - Sluisveld, N. van AU - Leeuwen, E.S. van AU - Wollersheim, H.C. AU - Dekkers, W.J.M. AU - Zegers, M. PY - 2015 UR - https://hdl.handle.net/2066/155205 AB - BACKGROUND: There have been few empirical studies into what non-medical factors influence physicians and nurses when deciding about admission and discharge of ICU patients. Information about the attitudes of healthcare professionals about this process can be used to improve decision-making about resource allocation in intensive care. To provide insight into ethical problems that influence the ICU admission and discharge process, we aimed to identify and explore ethical dilemmas healthcare professionals are faced with. METHODS: This was an explorative, descriptive study using qualitative methods (individual and focus group interviews). We conducted 19 individual interviews and 4 focus group interviews with nurses and physicians working in the ICU or the general ward of 10 Dutch hospitals. RESULTS: The ethical problems in the context of ICU admission and discharge can be divided into problems concerning full bed occupancy and problems related to treatment decisions. The gap between the high level of care the ICU can provide and the lower care level in the general ward sometimes leads to mutual misunderstandings. Our results indicate that when professionals of different wards feel there is a collective responsibility and effort to solve a problem, this helps to prevent or alleviate moral distress. ICU patients' wishes are often unknown, causing healthcare professionals to err on the side of more treatment. Additionally, the highly technological nature of intensive care appears to encourage over-treatment. CONCLUSIONS: It is important for ICUs and general wards to communicate and cooperate well, since there is a mutual dependency for optimal patient flow between the different departments. Interventions that improve the understanding and cooperation between these wards may help mitigate ethical problems. The nature of the ICU environment makes it important for healthcare professionals to be aware of the risk of over-treatment, reflect on why they do what they do, and be mindful of a possible negative impact of over-treatment on their patients. Early discussion of a patient's wishes with regard to treatment options is important in preventing over-treatment. TI - Ethical problems in intensive care unit admission and discharge decisions: a qualitative study among physicians and nurses in the Netherlands SN - 1472-6939 SP - 9 JF - BMC Medical Ethics VL - vol. 16 DO - https://doi.org/10.1186/s12910-015-0001-4 L1 - https://repository.ubn.ru.nl/bitstream/handle/2066/155205/155205.pdf?sequence=1 ER - TY - JOUR AU - Hesselink, G.J. AU - Zegers, M. AU - Vernooij-Dassen, M.J.F.J. AU - Barach, P. AU - Kalkman, C.J. AU - Flink, M. AU - Ohlen, G. AU - Olsson, M. AU - Bergenbrant, S. AU - Orrego, C. AU - Sunol, R. AU - Toccafondi, G. AU - Venneri, F. AU - Dudzik-Urbaniak, E. AU - Kutryba, B. AU - Schoonhoven, L. AU - Wollersheim, H.C. AU - et al. PY - 2014 UR - https://hdl.handle.net/2066/138258 AB - BACKGROUND: There is a growing impetus to reorganize the hospital discharge process to reduce avoidable readmissions and costs. The aim of this study was to provide insight into hospital discharge problems and underlying causes, and to give an overview of solutions that guide providers and policy-makers in improving hospital discharge. METHODS: The Intervention Mapping framework was used. First, a problem analysis studying the scale, causes, and consequences of ineffective hospital discharge was carried out. The analysis was based on primary data from 26 focus group interviews and 321 individual interviews with patients and relatives, and involved hospital and community care providers. Second, improvements in terms of intervention outcomes, performance objectives and change objectives were specified. Third, 220 experts were consulted and a systematic review of effective discharge interventions was carried out to select theory-based methods and practical strategies required to achieve change and better performance. RESULTS: Ineffective discharge is related to factors at the level of the individual care provider, the patient, the relationship between providers, and the organisational and technical support for care providers. Providers can reduce hospital readmission rates and adverse events by focusing on high-quality discharge information, well-coordinated care, and direct and timely communication with their counterpart colleagues. Patients, or their carers, should participate in the discharge process and be well aware of their health status and treatment. Assessment by hospital care providers whether discharge information is accurate and understood by patients and their community counterparts, are important examples of overcoming identified barriers to effective discharge. Discharge templates, medication reconciliation, a liaison nurse or pharmacist, regular site visits and teach-back are identified as effective and promising strategies to achieve the desired behavioural and environmental change. CONCLUSIONS: This study provides a comprehensive guiding framework for providers and policy-makers to improve patient handover from hospital to primary care. TI - Improving patient discharge and reducing hospital readmissions by using Intervention Mapping SN - 1472-6963 SP - 389 JF - BMC Health Services Research VL - vol. 14 DO - https://doi.org/10.1186/1472-6963-14-389 L1 - https://repository.ubn.ru.nl/bitstream/handle/2066/138258/138258.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 - TY - JOUR AU - Booij, J.C. AU - Zegers, M. AU - Evers, P.M. AU - Hendriks, M. AU - Delnoij, D.M. AU - Rademakers, J.J.D.J.M. PY - 2013 UR - https://hdl.handle.net/2066/118621 AB - BACKGROUND: To develop a Consumer Quality Index (CQI) Cancer Care questionnaire for measuring experiences with hospital care of patients with different types of cancer. METHODS: We derived quality aspects from focus group discussions, existing questionnaires and literature. We developed an experience questionnaire and sent it to 1,498 Dutch cancer patients. Another questionnaire measuring the importance of the quality aspects was sent to 600 cancer patients. Data were psychometrically analysed. RESULTS: The response to the experience questionnaire was 50 percent. Psychometric analysis revealed 12 reliable scales. Patients rated rapid and adequate referral, rapid start of the treatment after diagnosis, enough information and confidence in the healthcare professionals as most important themes. Hospitals received high scores for skills and cooperation of healthcare professionals and a patient-centered approach by doctors; and low scores for psychosocial guidance and information at completion of the treatment. CONCLUSIONS: The CQI Cancer Care questionnaire is a valuable tool for the evaluation of the quality of cancer care from the patient's perspective. Large scale implementation is necessary to determine the discriminatory powers of the questionnaire and may enable healthcare providers to improve the quality of cancer care. Preliminary results indicate that hospitals could improve their psychosocial guidance and information provision. TI - Improving cancer patient care: development of a generic cancer consumer quality index questionnaire for cancer patients SN - 1471-2407 JF - BMC Cancer VL - vol. 13 DO - https://doi.org/10.1186/1471-2407-13-203 L1 - https://repository.ubn.ru.nl/bitstream/handle/2066/118621/118621.pdf?sequence=1 ER - TY - JOUR AU - Sluisveld, P.H. van AU - Zegers, M. AU - Natsch, S.S. AU - Wollersheim, H.C. PY - 2012 UR - https://hdl.handle.net/2066/108640 AB - BACKGROUND: Medication errors are a leading cause of patient harm. Many of these errors result from an incomplete overview of medication either at a patient's referral to or at discharge from the hospital. One solution is medication reconciliation, a formal process in which health care professionals partner with patients to ensure an accurate and complete transfer of medication information at interfaces of care. In 2007, the Dutch government compelled hospitals to implement a bundle concerning medication reconciliation at hospital admission and discharge. But to date many hospitals have failed to implement this bundle fully. The aim of this study was to gain insight into the barriers and drivers of the implementation process. METHODS: We performed face to face, semi-structured interviews with twenty health care professionals and managers from several departments at a 953 bed university hospital in the Netherlands and also from the surrounding community health services. The interviews were analysed using a combined theoretical framework of Grol and Cabana to classify the drivers and barriers identified. RESULTS: There is lack of awareness and insufficient knowledge of health care professionals about the health care problem and the bundle medication reconciliation. These result in a lack of support for implementing the bundle. In addition clinicians are reluctant to reallocate tasks to nurses or pharmacy technicians. Another major barrier is a lack of communication, understanding and collaboration between hospital and community caregivers. The introduction of more competitive market forces has made matters worse. Major drivers are a good implementation plan, patient awareness, and obligation by the government. CONCLUSIONS: We identified a wide range of barriers and drivers which health care professionals believe influence the implementation of medication reconciliation. This reflects the complexity of implementation. Implementation can be improved if these factors are adequately addressed. The feasibility and effectiveness of these strategies should be tested in controlled trails. TI - Medication reconciliation at hospital admission and discharge: insufficient knowledge, unclear task reallocation and lack of collaboration as major barriers to medication safety EP - 170 SN - 1472-6963 SP - 170 JF - BMC Health Services Research VL - vol. 12 DO - https://doi.org/10.1186/1472-6963-12-170 L1 - https://repository.ubn.ru.nl/bitstream/handle/2066/108640/108640.pdf?sequence=1 ER -