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Williams L.C.,National Center for Patient Safety
Human Factors and Ergonomics In Manufacturing | Year: 2012

The illusions that occur in healthcare are inadvertent, certainly unintended, and unfortunately accepted as an aspect of practice with which clinicians have to cope. There are inadvertent illusions and unintended magic in medical devices, software, and in the healthcare environment generally. The engineer, programmer, manufacturer, or architect may not recognize the unintended magic in his or her own designs. Yet the clinician is seen as responsible when the illusion results in unexpected harm to a patient. By being unwilling to suspend disbelief in the face of illusion when it isn't clear what's real, clinicians can end the magic. It is possible to use magic and illusion to show the value of human factors engineering and ergonomics (HFE) in identifying and solving patient safety issues. HFE experts with this ability are equipped to unmask illusion and reveal magic at work in healthcare. Clinicians may see unmasking illusion as equivalent to accurate diagnosis of system ills and the first step in being able to treat system illness. In considering the state of healthcare culture, the use of simple magic tricks brings heightened awareness of tricky medical systems in need of repair and the need for tool-based problem solving native to HFE. © 2011 Wiley Periodicals, Inc. Source

Konkani A.,Oakland University | Oakley B.,Oakland University | Bauld T.J.,National Center for Patient Safety
Biomedical Instrumentation and Technology | Year: 2012

Increasing noise in hospital environments, especially in intensive care units (ICUs) and operating rooms (ORs), has created a formidable challenge for both patients and hospital staff. A major contributing factor for the increasing noise levels in these environments is the number of false alarms generated by medical devices. This study focuses on discovering best practices for reducing the number of false clinical alarms in order to increase patient safety and provide a quiet environment for both work and healing. The researchers reviewed Pub Med, Web of Knowledge and Google Scholar sources to obtain original journal research and review articles published through January 2012. This review includes 27 critically important journal articles that address different aspects of medical device alarms management, including the audibility, identification, urgency mapping, and response time of nursing staff and different solutions to such problems. With current technology, the easiest and most direct method for reducing false alarms is to individualize alarm settings for each patient's condition. Promoting an institutional culture change that emphasizes the importance of individualization of alarms is therefore an important goal. Future research should also focus on the development of smart alarms. © Copyright AAMI 2012. Source

McKnight S.D.,National Center for Patient Safety
Journal of Patient Safety | Year: 2012

Objectives: The Veterans Health Administration patient safety reporting system receives more than 100,000 reports annually. The information contained in these reports is primarily in the form of natural language text. Improving the ability to efficiently mine these patient safety reports for information is the objective of a proposed semi-supervised method. Methods: A semi-supervised classification method leverages information from both labeled and unlabeled reports to predict categories for the unlabeled reports. RESULTS: Two different scenarios involving a semi-supervised learning process are examined, and both demonstrate good predictive results. Conclusions: The semi-supervised method shows much promise in assisting researchers and analysts toward accurately and more quickly separating reports of varying and often overlapping topics. The method is able to use the "stories" provided in patient safety reports to extend existing patient safety taxonomies beyond their static design. © Copyright 2012 Lippincott Williams & Wilkins. Source

Ronconi J.M.,White River Junction Veterans Affairs Medical Center | Shiner B.,White River Junction Veterans Affairs Medical Center | Watts B.V.,National Center for Patient Safety
Journal of Psychiatric Practice | Year: 2014

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. One reason for this underutilization may be clinicians' unwarranted exclusion of patients from these treatments based on their understanding of exclusion criteria used in clinical trials of psychological treatments for PTSD. There is no comprehensive and up-to-date review of inclusion and exclusion criteria used in randomized clinical trials (RCTs) of psychological treatments for PTSD. Therefore, our objective was to better understand how patients were excluded from such RCTs in order to provide guidance to clinicians regarding clinical populations likely to benefit from these treatments. Methods. We conducted a comprehensive literature review of RCTs of psychological treatments for PTSD from January 1, 1980 through April 1, 2012. We categorized these clinical trials according to the types of psychotherapy discussed in the major guidelines for treatment of PTSD and reviewed all treatments that were studied in at least two RCTs (N=64 published studies with 75 intervention arms since some studies compared two or more interventions). We abstracted and tabulated information concerning exclusion criteria for each type of psychotherapy for PTSD. Results. We identified multiple RCTs of cognitive behavioral therapy (n=56), eye movement desensitization and reprocessing (n=11), and group psychotherapy (n=8) for PTSD. The most common exclusions were psychosis, substance abuse and dependence, bipolar disorder, and suicidal ideation. Clinical trials varied in how stringently these criteria were applied. It is important to note that no exclusion criterion was used in all studies and there was at least one study of each type of therapy that included patients from each of the commonly excluded groups. A paucity of evidence exists concerning the treatment of patients with PTSD and four comorbidities: alcohol and substance abuse or dependence with current use, current psychosis, current mania, and suicidal ideation with current intent. Conclusions. Psychological treatments for PTSD have been studied in broad and representative clinical populations. It appears that more liberal use of these treatments regardless of comorbidities is warranted. (Journal of Psychiatric Practice 2014;20:25-37) Copyright © 2014 Lippincott Williams & Wilkins Inc. Source

Shanawani H.,National Center for Patient Safety
Journal of Religion and Health | Year: 2016

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. While there may exist good reasons to accommodate COs of clinical providers, the exercise of rights and beliefs of the provider has an impact on a patient’s health and/ or their access to care. For this reason, it is incumbent on the provider with a CO to minimize or eliminate the impact of their CO both on the delivery of care to the patients they serve and on the medical system in which they serve patients. The increasing exercise of CO, and its impact on large segments of the population, is made more complex by the provision of government-funded health care benefits by private entities. The result is a blurring of the lines between the public, civic space, where all people and corporate entities are expected to have similar rights and responsibilities, and the private space, where personal beliefs and restrictions are expected to be more tolerated. This paper considers the following questions: (1) What are the allowances or limits of the exercise a CO against the rights of a patient to receive care within accept practice? (2) In a society where there exist “private,” personal rights and responsibilities, as well as “civil” or public/shared rights and responsibilities, what defines the boundaries of the public, civil, and private space? (3) As providers and patients face the exercise of CO, what roles, responsibilities, and rights do organizations and institutions have in this interaction? © 2016, Springer Science+Business Media New York. Source

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