Medication errors pose a serious threat to patient safety, causing preventable harm and increasing healthcare costs. Nurses' competence in medication safety is critical and develops with clinical experience. This study aimed to identify factors influencing medication safety competence across different clinical career stages, focusing on nursing organizational culture, communication competence, and patient safety culture. A survey was conducted from December 2021 to February 2022 among 757 nurses, categorized as novice, advanced novice, competent, or proficient. Communication competence and patient safety culture consistently emerged as significant predictors of medication safety competence across all career stages. Nursing organizational culture showed differential effects: relationship- and innovation-oriented cultures were significant predictors in the novice group, while a hierarchy-oriented culture was a significant predictor in the competent group. The regression models explained 30.8%-41.4% of the variance. Findings suggest that interventions to enhance medication safety competence should be tailored to nurses' career stages, incorporating relevant cultural and communication factors. Moreover, healthcare organizations should consider nurse-specific organizational culture profiles while designing training programs and selecting preceptors to optimize medication safety outcomes.
Scandinavian journal of caring sciencesAna María Besoaín-Cornejo, Montserrat Gil-Girbau, Luisa Baladón Higueras, Cristina Pou Matarranz, Maria Rubio-Valera
AIMS: This study aimed to identify and prioritize key strategies for improving a psychiatric home-based care programme, the Crisis Resolution and Home Treatment (CRHT) intervention in Catalonia, Spain. The objective was to incorporate the perspectives of service users, family caregivers and healthcare professionals to guide quality improvement efforts. METHODS: A modified Delphi method was used to reach consensus among stakeholders previously involved in a qualitative evaluation of the CRHT programme. The expert panel included 130 participants: 31 CRHT service users/caregivers and 99 healthcare professionals. Over three rounds of online surveys, participants rated 18 pre-identified improvement strategies across three dimensions: problem significance, change agency and feasibility of change. Service users and caregivers assessed only problem significance. Open-ended responses were also collected and analysed. FINDINGS: Consensus was reached in the third round, with five strategies prioritized: (1) training on CRHT referral and eligibility criteria, (2) standardized discharge and continuity of care protocols, (3) feedback loop between CRHT and referring professionals, (4) scheduling and communication of visiting hours, and (5) available updates for CRHT slots. These areas were rated highest in terms of feasibility and change agency, though not necessarily in problem significance. Notably, the same individuals who participated in the initial qualitative phase contributed to the prioritization process, ensuring continuity and relevance in stakeholder input. CONCLUSION: The study demonstrates the value of collaborative, consensus-based approaches to quality improvement in mental health care. Prioritized strategies reflect feasible and actionable areas for enhancing CRHT services. Involving service users, caregivers and professionals in both evaluation and decision-making processes strengthens the relevance, person-centredness and effectiveness of care. Implementation of these strategies is underway, with further improvements planned based on stakeholder feedback and continuous assessment.
Health expectations : an international journal of public participation in health care and health policyMartin Blanc, Marie-Pierre Gagnon, Daphney St-Germain, Boutheina Mejri, Marie Gagné, Isabel Bean, Gratianne Vaisson
INTRODUCTION: HOPtimise is an organisational innovation in paediatric oncology in the province of Québec (Canada) destined to improve and reinforce best nursing practices through digital training using a serious game and create dashboards focused on indicators sensitive to the quality of care. This complex intervention is led by a quality improvement committee, a joint committee of user partners (former patients and family members) and healthcare providers. The present study aims to demonstrate how innovation and training are co-created with multiple stakeholders. The involvement of patients and their families is at the core of the innovation's design. The aim of this study was to create and elaborate on the components of the logic model of the innovation in order to make it easily understandable for any stakeholder, to set the central roles and activities of the innovative process and to be able to verify the progress of the elaboration and the implementation of the innovation afterwards. The study also intended to generate guidance for future complex interventions in nursing practice improvement. DESIGN: This study has a qualitative, descriptive and participatory design with a mixed data collection destined to create the logic model of the innovation. The qualitative methods used are organised through a three-step timeline: the elaboration of the logic model, the verification phase and validation. Data collection methods involved two focus groups, each one at a different phase of the process (n = 9 and n = 6), semi-structured interviews (n = 4) and verification checklists (n = 9) conducted from June 2022 to June 2024. Data collection guides are based on the Porteus (2009) method for the elaboration of a logic model. Through the process, n = 15 participants took part in at least one data collection (either focus group or interviews). RESULTS: With a 2-year and n = 15 multistakeholder study, the team obtained a logic model of organisational innovation. The HOPtimise logic model is a necessary tool to communicate with all stakeholders from various backgrounds. The study shows that the logic model was clear enough to all the participants (n = 15). As a result, this logic model is a strong base to stabilise the roles and activities of those stakeholders in the elaboration and implementation of the innovation. Indeed, it allowed the building of a stable quality improvement committee. Finally, the logic model became a baseline for the process of identifying barriers and implementation strategies. CONCLUSIONS: The HOPtimise logic model is representative of the complexity of the organisational innovation and the organisational challenges that the project will encounter, and is a necessary tool for evaluation of its implementation in terms of its co-constructive nature. PATIENT AND PUBLIC CONTRIBUTION: This study is a co-creation and is family-centred. It involved the engagement and participation of user partners and organisational members. The research team interacted with them during the three steps of the elaboration of the logic model. They provided opinion and expertise on the content of the innovation, its components, the activities needed to reach the outcomes and implementation strategies.
Journal of evaluation in clinical practiceJulio J Lopez-Picazo, Juan Torres-Ramirez, Juan J Gascon-Canovas, Julian Alcaraz, Ana M Seva, Victor Soria-Aledo, Pilar Escolar
INTRODUCTION: Patient safety culture is a key component of healthcare quality. The Hospital Survey on Patient Safety Culture (HSOPS), developed by AHRQ in 2004, has been widely used internationally to assess healthcare professionals' perceptions of safety. In 2019, version 2 (HSOPSv2) was released, with improvements in structure and item clarity. Although a Spanish version for North America exists, it has not yet been validated in the Spanish hospital context. OBJECTIVES: To adapt and validate HSOPSv2 for the Spanish hospital context, ensuring its cultural, linguistic, and psychometric equivalence with the original version, and to assess its suitability for use in Spanish hospitals. METHODS: A cross-cultural adaptation process was conducted, including translation, back-translation, and expert consensus, followed by a cognitive pretest with 20 healthcare professionals. A pilot study was then carried out in four hospitals in Murcia and Alicante, with 369 participants. Internal consistency (Cronbach's α and composite reliability), convergent validity (AVE, factor loadings), and discriminant validity (Fornell-Larcker criterion and HTMT) were assessed through confirmatory factor analysis using the WLSMV estimator. RESULTS: The 10-factor model showed satisfactory fit indices (CFI and TLI > 0.90; RMSEA < 0.06; SRMR < 0.08). Most dimensions presented acceptable reliability (α and CR > 0.70), except for "Staffing and Work Pace" and "Handoffs and Information Exchange." Convergent validity was adequate in seven of the ten dimensions (AVE ≥ 0.50), with some weaker loadings in negatively worded items. The Fornell-Larcker criterion indicated overlap in some communication-related constructs, although HTMT results supported overall discriminant validity. CONCLUSIONS: The Spanish version of HSOPSv2 shows satisfactory psychometric properties, comparable to other international adaptations. Its availability provides Spanish hospitals with a robust tool to assess patient safety culture, identify areas for improvement, and design interventions aimed at reducing adverse events and strengthening patient safety.
Health expectations : an international journal of public participation in health care and health policyPolina Mesinioti, Laura Sheard, Sarah Hampton, Gemma Louch, Carl Macrae, Jane O'Hara
BACKGROUND: Patient safety incidents cause substantial harm globally, with affected patients and families often experiencing additional 'compounded harm' from inadequate organisational responses. Despite policy imperatives emphasising engagement as essential for safety improvement, significant gaps persist in the National Health Service (NHS), where involvement in Serious Incident (SI) investigations is often overlooked or treated as a passive process. While previous qualitative research has primarily used thematic analysis, discourse analytic approaches can offer deeper insights into nuanced patterns of meaning. DESIGN/OBJECTIVE: We conducted discourse analysis on 49 semi-structured interviews with healthcare professionals across six NHS Trusts to examine how staff construct agency in their accounts of engaging patients and families in SI investigations and how these discourses are linked to the broader organisational context. RESULTS: Findings illustrate two prevailing but contested discourses: one depicting staff engagement with patients and families as inconsistent and limited, and the other emphasising their integral role in the investigation process. Interviewees framed themselves as either powerless or powerful, aligning with these respective discourses, while organisational factors, such as professional roles and work relationships, also influenced those constructions. DISCUSSION: A focus on the linguistic construction of agency, control and responsibility provides a powerful lens for understanding persistent gaps in patient and family engagement and highlights the value of incorporating discourse analytic approaches into health policy development and implementation. PATIENT OR PUBLIC CONTRIBUTION: A Citizens' Panel (n = 16) was involved throughout the broader research programme, ensuring public accountability; supporting wider discussions about the emergent findings of the research and their implications for fairness, equality, diversity and inclusion; and supporting the dissemination of findings in creative and accessible ways.
Journal of robotic surgeryVipin V, Murukan Babu L J, K V Menon, Nitin Kumar, Vivek P S, Paul K Jose, Goutham Santhosh, Libin Thomas Manathara
BACKGROUND: Robotic-assisted total knee arthroplasty (RA-TKA) aims to improve surgical precision with maximum patient safety. This study evaluates the safety and accuracy of the fully active robotic system. METHODS: A retrospective observational study of 315 consecutive RA-TKAs was conducted over a period of 15 months. Primary outcomes included safety (neurovascular injury, ligamentous injury, pin-site complications) and accuracy (concordance between preoperative 3D CT planning and fi nal implant size & targeted polyethylene size). RESULTS: The robotic procedure was successfully completed in 315cases, and 3 cases were abandoned (n=318). Tibial component size concordance was 100%, while femoral concordance was 98.7%. Target polyethylene thickness (9-11mm) was achieved in 97.8% of cases. Safety outcomes showed zero neurovascular or MCL injuries. Iatrogenic PCL injury occurred in one case (0.32%) following a system interruption. Pin-site discharge(1.6%) was observed exclusively in the fi rst 104 cases, and no cases were reported after transitioning to intra-incisional pin placement. No cases of femoral or tibial overhang were recorded. CONCLUSION: The CT-based fully active robotic system provides predictable intraoperative accuracy in implant and polyethylene sizing while maintaining a high safety profi le. Refi ning surgical techniques, such as intra-incisional pin placement, signifi cantly reduces minor perioperative morbidity.
BMJ open qualityErika Petersen, Sanjeef Thampinathan, Joseph A Cafazzo, Laura D Pozzobon
BACKGROUND: Despite the recognised need, there remains a deficit of professionals skilled in the application of human factors theory and methods in patient safety incident reviews in healthcare. Addressing this gap by embedding human factors theory into quality and safety education is needed to develop professional who can drive sustainable and meaningful patient safety improvement. OBJECTIVE: Develop an educational tool to support graduate students in developing knowledge and skills in the practical application of human factors frameworks to real-world patient safety challenges. METHODS: The tool was iteratively developed and used within a graduate-level human factors course using case-based learning to facilitate a theory-to-practice application. RESULT: We developed the Contributing factors, Analysis, and Recommendation Education (CARE) Tool-a practical, integrated tool designed to support students and professionals in applying human factors theory to complex and real-world patient safety challenges. The CARE Tool combines three human factors frameworks: Systems Engineering Initiative for Patient Safety, Human-Tech Ladder and Hierarchy of Intervention Effectiveness (HIE). The CARE Tool's primary use is to guide users through a structured patient safety incident review process grounded in systems thinking. In this paper, we describe the development and use of the tool by a group of interdisciplinary students during a graduate-level course in human factors. CONCLUSION: The CARE Tool was designed to facilitate practical understanding of human factors principles. Importantly, the CARE Tool contributes to addressing the need to develop professionals who can embed systems thinking into patient safety incident review methods. Beyond the classroom, the tool may be used by those analysing incidents in healthcare settings and/or developing mitigations.
BACKGROUND: To systematically evaluate the impact of standardized nursing protocols in the post-anesthesia care unit (PACU) on patient safety, recovery efficiency, and quality of care during the post-anesthesia transition. METHODS: A systematic literature search was conducted across major databases, including PubMed, Embase, and Web of Science, to identify randomized controlled trials and observational studies comparing standardized PACU nursing protocols with conventional care. The search period extended from database inception to January 20, 2026. Two reviewers independently screened literature, extracted data, and assessed risk of bias. Meta-analysis was performed using RevMan 5.4 and Stata 17.0, with results expressed as mean differences (MD) or odds ratios (OR) with 95% confidence intervals (CI). RESULTS: A total of 14 studies were included (11 randomized controlled trials and 3 cohort studies), encompassing 4268 patients. Meta-analysis demonstrated that, compared with conventional care, the implementation of standardized nursing protocols significantly reduced the overall incidence of adverse events (OR = 0.37, 95% CI: 0.23-0.60, P < .001) and shortened PACU length of stay (MD = -10.65 minutes, 95% CI: -19.10 to -2.19, P = .01). Furthermore, the standardized protocols were associated with significantly improved patient comfort scores (MD = 1.88, 95% CI: 1.63-2.12, P < .001) and higher nursing satisfaction rates (OR = 3.18, 95% CI: 2.01-5.02, P < .001). Subgroup and sensitivity analyses confirmed the robustness of these findings. CONCLUSION: Current evidence indicates that standardized nursing protocols in the PACU significantly enhance patient safety, optimize recovery efficiency, and improve the patient experience. These findings support the widespread clinical adoption and refinement of evidence-based standardized nursing models to minimize perioperative risks.
American journal of physical medicine & rehabilitationMarlon L Addison, Hayden T Nevills, Jacob W Brubacher, Mitchell Birt, Matt Luetke, Sarah M Eickmeyer, Jordan A Borrell
PURPOSE: This quality improvement study evaluated a novel, electronic medical record (EMR)-based order set designed to standardize interdisciplinary care coordination for patients undergoing lower extremity amputation at a large academic medical center. When activated, the order set automatically placed consultations for an interdisciplinary team consisting of physical therapy, occupational therapy, physical medicine and rehabilitation (PM&R), chaplaincy, and orthotics/prosthetics. METHODS: Patients (n=637) who underwent lower extremity amputation were divided into 2 cohorts: those with and without use of the amputation order set. Interdisciplinary consultation patterns, length of stay (LOS), and discharge disposition were analyzed. RESULTS: The order set significantly increased consultations with PM&R, chaplaincy, and orthotics/prosthetics services. While overall hospital LOS was longer in the order set group, patients who received preoperative order set placement had significantly shorter time from surgery to discharge. In addition, patients in the order set group were more likely to be discharged to inpatient rehabilitation facilities, as opposed to skilled nursing facilities or directly home. CONCLUSIONS: Findings suggest that structured interdisciplinary coordination, particularly when initiated preoperatively, can enhance discharge planning and facilitate higher-quality rehabilitation pathways. The implementation of a standardized amputation consultation panel within the EMR supports provider adoption and may reduce disparities in care access.
European journal of pediatricsMélanie Forestier, Laurence Caeymaex, Fabrice Decobert, Xavier Durrmeyer, Gilles Dassieu, Manon Tauzin
UNLABELLED: In many neonatal intensive care units, newborns are exposed to many sounds, including alarms and human activity. Noise consistently exceeds recommendations, having a potential negative impact on newborns' development. This study aimed to evaluate the impact of multimodal interventions on noise reduction in a level 3 neonatal intensive care unit. This was a quality-improvement monocentric study, conducted from February 2022 to May 2023. Interventions included a multiprofessional reflection on ways to reduce noise, a staff training, and a modification of the alarms' thresholds. Noise was evaluated before and after intervention using the number of noise peaks ≥ 45 dB/day, and the number of alarms/patient/day. Peaks ≥ 45 dB/day significantly decreased by 48% from before to after intervention (mean number (SD) 396.4 (152.7) versus 204.8 (64.6), p < 0.001). The mean number of ≥ 50 dB/day decreased from 110.0 (57.9) to 48.8 (22.4). The number of alarms decreased peaks from 257 alarms/patient/day before intervention to 134 alarms/patient/day after intervention. CONCLUSION: A multimodal intervention focused on noise reduction was followed by a significant decrease in noise pollution in a level 3 NICU. Multicenter studies on the impact of interventions to reduce noise pollution on short- and long-term outcomes of preterm newborns are required to confirm these results. SUMMARY: In neonatal intensive care units, sound environment remains above noise recommendations all around the world despite evidence showing that exceeding noises can have negative effects on both patients and staff. A multi-professional reflection on noise reduction, a staff training, and a modification of patients' alarms decreased noise pollution in a neonatal intensive care unit. WHAT IS KNOWN: • Noise levels in NICUs consistently exceed international recommendations, potentially harming the neurodevelopment of preterm infants and increasing staff stress. WHAT IS NEW: • A multimodal approach (staff training, alarm threshold adjustment, and collective reflection) significantly reduced noise peaks over 45dB and the number of daily alarms per patient.
European journal of trauma and emergency surgery : official publication of the European Trauma SocietyLuca Neitzert, Cristiano Druetto, Daniela Forno, Paola Molino, Domenico Vitale, Michele Grio
PURPOSE: Organized trauma systems improve coordination of care and may enhance the efficiency of trauma management, potentially improving outcomes and reducing hospital length of stay and costs. The aim of the study was to evaluate key process-of-care indicators and clinical outcomes before and after the introduction of a comprehensive trauma pathway. METHODS: We conducted a single-center retrospective-prospective cohort study at Rivoli Hospital, Italy. Trauma patients admitted to the Emergency Department (ED) between 2024 and 2025 who met the criteria for trauma team activation were prospectively included. Outcomes were compared with a retrospective cohort from the period prior to the implementation of the dedicated trauma pathway (2023-2024). RESULTS: A total of 465 patients were included. Implementation of a comprehensive trauma pathway was associated with significant improvements in several time-dependent quality indicators, including ED boarding time (888 vs. 1021 min; p = 0.02), time to imaging (48 vs. 78 min; p < 0.01), time to surgery (183 vs. 237 min; p = 0.03), time to ICU admission (226 vs. 343 min; p = 0.02), and time to interhospital transfer (238 vs. 305 min; p = 0.04). We observed a trend toward a reduction in early mortality (2% vs. 3.6%; p = 0.41) and 30-day mortality (3.7% vs. 5.9%; p = 0.62). CONCLUSIONS: The adoption of a structured multidisciplinary trauma management pathway was associated with improved timeliness of care for trauma patients. Although mortality rates were lower after pathway implementation, the study was not powered to demonstrate a survival benefit.
INTRODUCTION: Learning health systems (LHS) are an approach to translate patient data into actionable clinical insights, empower healthcare teams to drive quality improvement and reduce health inequalities. Here we present a protocol for a realist evaluation to explore what works to implement a learning health system approach in primary care settings in Thailand, for whom does it work, how, why and in what circumstances. METHODS AND ANALYSIS: A mixed-methods realist evaluation will run in parallel with an interventional trial [Reg No: NCT06873243] in Northern Thailand which aims to improve the management of hypertension (HTN), type 2 diabetes mellitus (T2DM) and chronic kidney diseases (CKDs) using a data-supported learning health systems approach. As part of the trial, 16 primary care units (PCUs) in Chiang Mai and Lamphun provinces will be randomly selected to receive a learning health system intervention to support quality improvement for care of HTN, T2DM and CKD. Performance will be compared between intervention PCUs and all other PCUs in the region. Participants of the realist evaluation will include clinical and other professional staff involved in the development and implementation of the LHS. This realist evaluation will use both quantitative and qualitative data, including semi-structured interviews, surveys and documents from participating sites. Quantitative and qualitative findings will be systematically integrated to test, refine and validate context-mechanism-outcomes to identify consistencies, contradictions and explanatory mechanisms as part of a final programme theory for the successful implementation of the LHS. ETHICS AND DISSEMINATION: Ethical approval has been granted by all collaborating university Research Ethics Committees (ref: 1090, 0321, 32540). Results will be disseminated to stakeholders, including patients and the public, health providers, the Thai government and WHO office. Our methods and dissemination will be guided by National Institute for Health Research and Guidelines International Network reporting standards for Patient and Public Involvement and Engagement.
Philosophical transactions. Series A, Mathematical, physical, and engineering sciencesYing Xiao, Zhenpeng Chen, Jie Zhang
Large language models (LLMs) demonstrate expert-level performance in various medical scenarios, yet their outputs can exhibit bias against groups or individuals with specific sensitive attributes, posing risks to patient safety and undermining trust in LLMs for healthcare. Recent research suggests that prompt engineering offers a convenient way to adjust model outputs, with the potential to mitigate such biases. However, there is a lack of empirical studies that systematically examine the effectiveness of prompt engineering and its trade-offs among fairness, accuracy and inference overhead. To fill this gap, we empirically evaluate five widely used prompting strategies across five influential LLMs in the latest medical bias benchmark. Results reveal substantial heterogeneity in both effectiveness and overhead across models, with no strategy proving universally effective and some even exacerbating bias. Chain-of-thought prompting yields the largest reduction, lowering the average gap across all scenarios by 2.4 percentage points, where the largest reduction is 6.2 percentage points, obtained in the DeepSeek-V3.1-sex case. Furthermore, the results of the McNemar test also show that it achieves the largest number of significant bias reduction cases (8/15), primarily by improving performance on unprivileged groups. These findings provide practical guidance for the fair deployment of LLMs in healthcare and highlight that mitigating medical bias remains a challenging problem requiring sustained efforts from both the artificial intelligence (AI) and medical communities. To support future research on fair AI in healthcare, we shall release all results and source code. This article is part of the theme issue 'Safe, secure and robust AI for safety-critical systems'.
The prevalence of mental health disorders among adolescents poses a significant global health challenge, with approximately one in seven individuals aged 10-19 affected. The limited access to effective mental health services worsens this issue, particularly within schools, which are critical settings for early intervention. The study aims to develop and implement a school-based support team improvement intervention to enhance the mental health of adolescent learners in secondary schools. This study will employ a sequential explanatory mixed-methods approach design. The research will be conducted at selected secondary schools, and the participants for the study will be adolescents aged 13-19 and members of the school-based support team (SBST). Questionnaires will be administered to learners to determine the prevalence of common mental health challenges among adolescents and to determine the factors associated with mental health challenges among adolescents. A scoping review will also be conducted to examine existing interventions aimed at supporting learners with mental health challenges. Following the quantitative phase, interviews will be conducted with SBST members to explore the challenges and successes in supporting learners with mental health problems. The second phase will involve the development and implementation of the SBST quality-improvement intervention to support adolescents experiencing mental health challenges in secondary schools. The researcher will use Statistical Package for the Social Sciences (SPSS, 30.0.0) for quantitative data analysis and statistical interpretation. In addition, ANOVA will be employed to compare, identify, and understand specific factors that significantly impact adolescents' mental health. The qualitative data will be analysed using Colaizzi's seven-step framework and will be facilitated with NVIVO 15.
Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary TractMatthew Paul Zeller, Rachel Ma, Joseph Wetherell, Jessica Felton, Yosef Nasseri, Joshua Wolf
BACKGROUND: Textbook outcome (TO) is a composite measure of surgical quality, but existing definitions in colon surgery predate the widespread adoption of minimally invasive surgery and contemporary, perioperative recovery pathways. We sought to redefine TO using a contemporary and data-driven length-of-stay (LOS) standard and evaluate its incidence, temporal trends, and predictors after elective colectomy. METHODS: We performed a retrospective cohort study using the American College of Surgeons National Surgical Quality Improvement Program database from 2012 to 2022. Adult patients undergoing elective colectomy were included. TO was defined as LOS ≤ 3 days and the absence of 30-day morbidity, mortality, readmission, or reoperation. The LOS threshold was informed by cohort-level LOS distribution analysis, demonstrating a modal LOS of 3 days. Trends in TO achievement and factors associated with TO were analyzed using multivariable logistic regression. RESULTS: Among the 139,064 patients included, 44.5% achieved TO. TO rates improved significantly from 29.3% in 2012 to 50.2% in 2022 (P <.001), with rates plateauing after 2019. Minimally invasive approaches were strongly associated with TO, particularly robotic (odds ratio [OR], 8.30; 95% CI, 7.90-8.73) and laparoscopic (OR, 4.21; 95% CI, 4.03-4.39) surgery. Reduced odds of TO were associated with age > 80 years (OR, 0.46; 95% CI, 0.43-0.48), frailty index ≥ 3 (OR, 0.48; 95% CI, 0.42-0.55), nonhome discharge (OR, 0.21; 95% CI, 0.19-0.23), indication of bleeding (OR, 0.53; 95% CI, 0.38-0.72), and ostomy creation (OR, 0.52; 95% CI, 0.49-0.55), all P <.001. CONCLUSION: A contemporary TO definition incorporating LOS ≤ 3 days identifies a rigorous and clinically relevant recovery benchmark after elective colectomy. TO achievement improved substantially over the study period. Minimally invasive approaches, particularly robotic surgery, were strongly associated with TO achievement, whereas advanced age, frailty, and nonhome discharge were associated with a lower likelihood of TO. Our contemporary TO definition may provide a patient-centered framework for evaluating perioperative recovery quality and contextualizing outcomes in modern colon surgery.
International emergency nursingNatalie J Tedford, J Bair Diamond, Gregory Nelsen, Nicholas Weaver, Stephanie Spanos
INTRODUCTION: Deliberate practice simulation (DPS) is a tool that can enhance learning through repetitive, task-oriented education with immediate feedback. We aimed to increase emergency nurses' knowledge of commonly used medications and their storage locations in a pediatric emergency department. METHODS: This quality improvement (QI) pilot project utilized an observational, cross-sectional assessment approach. Through plan-do-study-act (PDSA) cycles, we initiated this project in the pediatric emergency department at a level-one pediatric trauma center. Quantitative needs assessment and baseline data on emergency nurse knowledge of the location of resuscitation medications were collected. "Pass" was considered 26 out of 33 correct (∼79%) on graded electronic assessments. DPS sessions used the crash cart with verbal quizzing on the medications. Data were analyzed using descriptive statistics, and paired t-tests were conducted to determine the effect of DPS on emergency nurses' pass rates on our graded electronic assessments. RESULTS: Thirty-six emergency nurses participated in each cycle. With the use of DPS, there was a notable increase in the percentage of those who achieved "pass" from 8.3% to 55.6% (mean increase of 47.3%, p < 0.01). The proportion of correctly identified medication locations increased from 69% to 78% (mean increase of 9%, p < 0.003). Participants improved on the paired t-test in knowledge assessment scores (mean increase of 4.6 points or 22%, p < 0.00001). CONCLUSION: Our QI pilot project demonstrates notable improvement in emergency nurses' knowledge of resuscitation medication location in emergencies through deliberate practice simulation. These findings suggest DPS can improve resuscitation efficiency and offers a promising approach to emergency nursing education.
Scandinavian journal of primary health careGabriella Caleres, Sarah Thelin, Elisabeth Persson, Veronica Milos Nymberg, Sara Modig
BACKGROUND: To improve care for community-dwelling older individuals, Swedish primary care has implemented nurse-led elderly care units targeting this group. AIM: To explore how primary care nurses working in elderly care units view their role regarding medication safety and gain their perspectives on the work model. METHODS: This was a qualitative focus group study with 14 strategically sampled primary care nurses working at elderly care units. Data were collected through three focus groups and two individual interviews between September 2024 and June 2025, audio-recorded and transcribed verbatim. Content analysis was applied, and the person-centred nursing framework was used to interpret the results. Triangulation and reflexivity were pursued, and an audit trail was maintained to ensure trustworthiness. RESULTS: Five categories emerged (1), diverse conditions for elderly care units (2), preventing and managing drug-related problems (3), bridging the gap - a vital function for medication safety (4), the comprehensive geriatric perspective, and (5) perceptions of the nurse's role. CONCLUSION: This study found that nurses in elderly care units recognize their potentially significant role in medication safety. Their comprehensive geriatric perspective enables them to impede or intervene on drug-related problems, compensate for fragmented care and resolve issues as a central coordinator. However, the absence of guidelines leads to inconsistent and inequitable care, insights important for further development of the work model.
Journal of biomedical informaticsYicong Wu, Ting Chen, Irit Hochberg, Zhoujian Sun, Ruth Edry, Zhengxing Huang, Mor Peleg
BACKGROUND: With the advance of large language models (LLMs), researchers are using them to develop medical applications, including diagnosis decision support.However, research on LLM-based therapy recommendation for multimorbidity remains relatively limited and guidelines for their evaluation is lacking. OBJECTIVE: The objective of this Special Communication is to provide medical informatics researchers with guidelines for proper evaluation of LLM-based therapy recommendation systems for multimorbidity management. METHODS: We developed the guidelines based on a review of the state of the art methods and our experience in using LLMs for therapy recommendations for multi-morbidity disease management and evaluating them quantitatively on clinical data sets and qualitatively on benchmark case studies. Our experience improved upon state of the art metrics. We arranged our recommendations, arranged into several categories. RESULTS: A merely technical quantitative evaluation that shows promising results may overlook crucial patient safety issues, which are only discovered in rigorous qualitative evaluation. We share recommendations for evaluation studies that rely on both quantitative and qualitative evaluation and present novel evaluation metrics that are important for therapy decision-support in the context of chronic multimorbidity patients. DISCUSSION: We further discuss considerations for the appropriateness of freely-available datasets and of existing evaluation metrics, and provide suggestions for the operationalization of the proposed recommendations in clinical settings.
The Journal of emergency medicineMargaret L Davis, Navya Gunaje, Jane Hall, Robert Doerning, Fumei Lin, M Kennedy Hall, David Carlbom, Nicholas J Johnson, Robert Klemisch
BACKGROUND: Supplemental oxygen is a common therapy for emergency department (ED) patients undergoing invasive mechanical ventilation. Both hyperoxemia and hypoxemia carry potential risks. However, little is known about ideal oxygenation targets or ED based interventions. OBJECTIVE: To evaluate the effectiveness and safety of implementing an oxygen titration guideline to reduce hyperoxemia in mechanically ventilated ED patients. METHODS: We performed a single-center retrospective cohort study of mechanically ventilated ED patients pre- and postimplementation of a quality improvement (QI) intervention aimed at reducing hyperoxemia. The primary outcome was incidence of severe hyperoxemia (partial pressure of oxygen [PaO2] > 300 mmHg), with safety outcomes including the incidences of hypoxemia (PaO2 < 60 mmHg) and severe hypoxemia (PaO2 < 50 mmHg). Additional secondary outcomes included in-hospital mortality, intensive care unit (ICU) length of stay, hospital length of stay, and median time on the ventilator. RESULTS: The cohort included 1111 patients: 625 preintervention and 486 postintervention. The incidence of severe hyperoxemia decreased from 39.4% preintervention to 30% postintervention, adjusted odds ratio (aOR) 0.68, 95% confidence interval (CI), 0.51-0.91; p = 0.01. The incidence of hypoxemia increased from 7.5% to 13%, aOR 1.87, 95% CI, 1.22-2.88; p < 0.01, severe hypoxemia did not significantly change (3.4% preintervention and 3.1% postintervention). No significant differences were noted in ICU length of stay, hospital length of stay, or in-hospital mortality. Median time on the ventilator increased slightly postintervention. CONCLUSIONS: Implementation of an oxygen titration guideline decreased severe hyperoxemia but increased hypoxemia, without affecting severe hypoxemia. Further research is needed to define ideal oxygenation targets and interventions to maintain patients within range.
Cardiology clinicsElizabeth J Bashian, Emily Hay-Arthur, Thomas F O'Shea, Jessica Y Rove, Michael T Cain, Nicholas R Teman
Failure to rescue (FTR), defined as mortality after a postoperative complication, is now a central quality metric in cardiac surgery, where high-acuity patients and resource-intensive care increase vulnerability to deterioration. Although complications are common, survival depends on timely recognition, effective escalation, and coordinated multidisciplinary management. This article synthesizes current evidence on the epidemiology, mechanisms, and system-level drivers of FTR, highlighting how patient, provider, and institutional factors influence rescue success. We outline practical, evidence-based strategies to reduce FTR in cardiac surgery after prolonged ventilation, renal failure, stroke, and reoperation, by emphasizing protocolized care, staffing models, team communication, and rapid response infrastructure.