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  • 1.
    Ericsson, Carin
    et al.
    Region Östergötland, Sweden;Linköping University, Sweden.
    Skagerström, Janna
    Linköping University, Sweden;Region Östergotland, Sweden.
    Schildmeijer, Kristina
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Årestedt, Kristofer
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Kalmar County Council, Sweden.
    Anders, Broström
    Jönkoping University, Sweden;Region Östergötland, Sweden.
    Pakpour, Amir
    Jönkoping University, Sweden;Qazvin University of Medical Sciences, Iran.
    Per, Nilsen
    Linköping University, Sweden.
    Can patients contribute to safer care in meetings with healthcare professionals?: A cross-sectional survey of patient perceptions and beliefs2019In: BMJ Quality and Safety, ISSN 2044-5415, E-ISSN 2044-5423, Vol. 28, no 8, p. 657-666Article in journal (Refereed)
    Abstract [en]

    Objectives To investigate patients’ perceptions of their meetings with healthcare professionals and the extent to which they believe they can influence patient safety in these meetings.

    Design Cross-sectional survey of patients using a study-specific questionnaire. Data were analysed using both parametric and non-parametric statistics.

    Setting The study was conducted in primary and secondary care in three county councils in southeast Sweden by means of a survey questionnaire despatched in January 2017.

    Participants Survey data were collected from 1445 patients, 333 of whom were complainants (patients who had filed a complaint about being harmed in healthcare) and 1112 regular patients (patients recruited from healthcare units).

    Main outcome measures Patients’ perceptions of meetings with physicians and nurses, beliefs concerning patients’ contributions to safer care and whether the patients had suffered harm in healthcare during the past 10 years.

    Results Most respondents reported that it was easy to ask physicians and nurses questions (84.9% and 86.6%) and to point out if something felt odd in their care (77.7% and 80.7%). In general, complainants agreed to a higher extent compared with regular patients that patients can contribute to safer care (mean 1.92 and 2.13, p<0.001). Almost one-third (31.2%) of the respondents (both complainants and regular patients) reported that they had suffered harm in healthcare during the past 10 years.

    Conclusions Most respondents believed that healthcare professionals can facilitate patient interaction and increase patient safety by encouraging patients to ask questions and take an active part in their care. Further research will need to identify strategies to support such questioning in routine practice and ensure that it achieves its intended goals.

  • 2.
    Lindblad, Marléne
    et al.
    Royal Institute of Technology.
    Schildmeijer, Kristina
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Nilsson, Lena
    Linköping University.
    Ekstedt, Mirjam
    Karolinska Institutet.
    Unbeck, Maria
    Karolinska Institutet.
    Development of a trigger tool to identify adverse events and no-harm incidents that affect patients admitted to home healthcare2018In: BMJ Quality and Safety, ISSN 2044-5415, E-ISSN 2044-5423, Vol. 27, no 7, p. 502-511Article in journal (Refereed)
    Abstract [en]

    Background Adverse events (AEs) and no-harm incidents are common and of great concern in healthcare. A common method for identification of AEs is retrospective record review (RRR) using predefined triggers. This method has been used frequently in inpatient care, but AEs in home healthcare have not been explored to the same extent. The aim of this study was to develop a trigger tool (TT) for the identification of both AEs and no-harm incidents affecting adult patients admitted to home healthcare in Sweden, and to describe the methodology used for this development.

    Methods The TT was developed and validated in a stepwise manner, in collaboration with experts with different skills, using (1) literature review and interviews, (2) a five-round modified Delphi process, and (3) two-stage RRRs. Ten trained teams from different sites in Sweden reviewed 600 randomly selected records.

    Results In all, triggers were found 4031 times in 518 (86.3%) records, with a mean of 6.7 (median 4, range 1–54) triggers per record with triggers. The positive predictive values (PPVs) for AEs and no-harm incidents were 25.4% and 16.3%, respectively, resulting in a PPV of 41.7% (range 0.0%–96.1% per trigger) for the total TT when using 38 triggers. The most common triggers were unplanned contact with physician and/or registered nursemoderate/severe painmoderate/severe worry, anxiety, suffering, existential pain and/or psychological pain. AEs were identified in 37.7% of the patients and no-harm incidents in 29.5%.

    Conclusion This study shows that adapted triggers with definitions and decision support, developed to identify AEs and no-harm incidents that affect patients admitted to home healthcare, may be a valid method for safety and quality improvement work in home healthcare.

  • 3.
    Schildmeijer, Kristina
    et al.
    Linnaeus University, Faculty of Health, Social Work and Behavioural Sciences, School of Health and Caring Sciences.
    Nilsson, Lena
    Årestedt, Kristofer
    Linnaeus University, Faculty of Health, Social Work and Behavioural Sciences, School of Health and Caring Sciences.
    Perk, Joep
    Linnaeus University, Faculty of Health, Social Work and Behavioural Sciences, School of Health and Caring Sciences.
    Assessment of adverse events in medical care: lack of consistency between experienced teams using the global trigger tool.2012In: BMJ Quality and Safety, ISSN 2044-5415, E-ISSN 2044-5423, Vol. 21, no 4, p. 307-314Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Many patients are harmed as the result of healthcare. A retrospective structured record review is one way to identify adverse events (AEs). One such review approach is the global trigger tool (GTT), a consistent and well-developed method used to detect AEs. The GTT was originally intended to be used for measuring data over time within a single organisation. However, as the method spreads, it is likely that comparisons of GTT safety outcomes between hospitals will occur.

    OBJECTIVE: To evaluate agreement in judgement of AEs between well-trained GTT teams from different hospitals.

    METHODS: Five teams from five hospitals of different sizes in the southeast of Sweden conducted a retrospective review of patient records from a random sample of 50 admissions between October 2009 and May 2010. Inter-rater reliability between teams was assessed using descriptive and κ statistics.

    RESULTS: The five teams identified 42 different AEs altogether. The number of identified AEs differed between the teams, corresponding to a level of AEs ranging from 27.2 to 99.7 per 1000 hospital days. Pair-wise agreement for detection of AEs ranged from 88% to 96%, with weighted κ values between 0.26 and 0.77. Of the AEs, 29 (69%) were identified by only one team and not by the other four groups. Most AEs resulted in minor and transient harm, the most common being healthcare-associated infections. The level of agreement regarding the potential for prevention showed a large variation between the teams.

    CONCLUSIONS: The results do not encourage the use of the GTT for making comparisons between hospitals. The use of the GTT to this end would require substantial training to achieve better agreement across reviewer teams.

  • 4.
    Schildmeijer, Kristina
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Nilsson, Lena
    Årestedt, Kristofer
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Perk, Joep
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Reply to Deilkas letter: Imprecision concerning the Global Trigger Tool Reply2013In: BMJ Quality and Safety, ISSN 2044-5415, E-ISSN 2044-5423, Vol. 22, no 3, p. 271-272Article in journal (Refereed)
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