General Practice (Scholarly Articles)

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A systematic review of the use of positive deviance approaches in primary care
(Oxford University Press, 2021-11-25) O’Malley, Roisin; O'Connor, Paul; Madden, Caoimhe; Lydon, Sinéad; Irish Research Council
Abstract Background: The Positive Deviance (PD) approach focuses on identifying and learning from those who demonstrate exceptional performance despite facing similar resource constraints to others. Recently, it has been embraced to improve the quality of patient care in a variety of healthcare domains. PD may offer one means of enacting effective quality improvement in primary care. Objective(s): This review aimed to synthesize the extant research on applications of the PD approach in primary care. Methods: Seven electronic databases were searched; MEDLINE, CINAHL, Embase, PsycINFO, Academic Search Complete, Psychology and Behavioral Sciences Collection, and Web of Science. Studies reporting original data on applications of the PD approach, as described by the PD framework, in primary care were included, and data extracted. Thematic analysis was used to classify positively deviant factors and to develop a conceptual framework. Methodological quality was appraised using the Quality Assessment with Diverse Studies (QuADS). Results: In total, 27 studies were included in the review. Studies most frequently addressed Stages 1 and 2 of the PD framework, and targeted 5 core features of primary care; effectiveness, chronic disease management, preventative care, prescribing behaviour, and health promotion. In total, 268 factors characteristic of exceptional care were identified and synthesized into a framework of 37 themes across 7 system levels. Conclusion: Several useful factors associated with exceptional care were described in the literature. The proposed framework has implications for understanding and disseminating best care practice in primary care. Further refinement of the framework is required before its widespread recommendation.
A systematic review of patient complaints about general practice.
(Oxford University Press (OUP), 2019-11-19) O'Dowd, Emily; Lydon, Sinéad; Madden, Caoimhe; O'Connor, Paul; Hardiman Research Scholarship, National University of Ireland Galway
Health care complaints are an underutilized resource for quality and safety improvement. Most research on health care complaints is focused on secondary care. However, there is also a need to consider patient safety in general practice, and complaints could inform quality and safety improvement. This review aimed to synthesize the extant research on complaints in general practice. Five electronic databases were searched: Medline, Web of Science, CINAHL, PsycINFO and Academic Search Complete. Peer-reviewed studies describing the content, impact of and motivation for complaints were included and data extracted. Framework synthesis was conducted using the Healthcare Complaints Analysis Tool (HCAT) as an organizing framework. Methodological quality was appraised using the Quality Assessment Tool for Studies with Diverse Designs (QATSDD). The search identified 2960 records, with 21 studies meeting inclusion criteria. Methodological quality was found to be variable. The contents of complaints were classified using the HCAT, with 126 complaints (54%) classified in the Clinical domain, 55 (23%) classified as Management and 54 (23%) classified as Relationships. Motivations identified for making complaints included quality improvement for other patients and monetary compensation. Complaints had both positive and negative impacts on individuals and systems involved. This review highlighted the high proportion of clinical complaints in general practice compared to secondary care, patients' motivations for making complaints and the positive and negative impacts that complaints can have on health care systems. Future research focused on the reliable coding of complaints and their use to improve quality and safety in general practice is required.
Initial psychometric evaluation of a psychological resilience measure for physicians
(Taylor and Francis, 2019-10-20) O'Connor, Paul; Lydon, Sinéad; Byrne, Dara; National Doctor Training and Planning, Health Services Executive, Republic of Ireland
Measures of Psychological Resilience (PR) for use with physician populations are lacking. The objective of this study is to develop and assess the validity and internal consistency of a survey designed to measure the perceived Psychological Resilience (PR) of physicians. A 37-item PR survey was developed and distributed to doctors from an Irish teaching hospital. Construct validity was established through a confirmatory factor analysis and internal consistency using Cronbach's alpha. Discriminant and convergent validity were assessed through correlating responses to the PR measure with the three subscales of the Maslach Burnout Inventory-Human Services Survey (MBI-HSS). A total of 292 responses to the survey were suitable for inclusion in the analysis. Confirmatory factor analysis resulted in an 18-item survey with three subscales: job gratification (alpha = 0.79), protective practices (alpha = 0.83), and protective attitudes (alpha = 0.81). There were significant negative correlations between the three subscales of the PR survey and the emotional exhaustion and depersonalization subscales of the MBI-HSS. There were significant positive correlation between each of the three subscales of the PR survey and the MBI-HSS personal accomplishment subscale. This study is the first stage in the development of an appropriate, valid and reliable survey for measuring the PR of physicians.
ASPiH Conference 2019 keynote paper. Quality improvement through simulation: a missed opportunity?
(BMJ Publishing Group, 2020-03-04) O'Connor, Paul
As the use of simulation has become more established in the delivery of healthcare education and training, there has been a corresponding increase in healthcare simulation research. Simulation-based research can be divided into research about simulation (answers research questions in which the focus is on simulation itself) and research through simulation (simulation as a method/tool for research). However, there are barriers, particularly for smaller less well-resourced simulation centres, that may prohibit participation in research. Therefore, it is suggested that quality improvement (QI) through simulation may be a pragmatic way in which simulation centres of all sizes can contribute to improving patient care beyond education and training. QI is defined as systematic, data-guided activities designed to bring about immediate, positive changes in the delivery of healthcare. Although not the case in healthcare, other industries routinely used simulation to support QI. For example, in aviation simulation is used to inform the design of the working environment, the appropriate use of technology, to exercise emergency procedures and to 're-fly' flights following an adverse event as part of the mishap investigation. Integrating simulation within healthcare QI can support the development of novel interventions as well helping to address heretofore intractable issues.
The application of human reliability analysis to three critical care procedures
(Elsevier, 2020-07-10) Reddy, Kiran; Byrne, Dara; Breen, Dorothy; Lydon, Sinéad; O'Connor, Paul; Health Research Board
Background: Procedures carried out in the intensive care unit are prone to human error. Standardisation has been suggested as an approach for reducing errors. This study used human reliability analysis methodologies to examine commonly performed critical care procedures: endotracheal suctioning; ultrasound-guided right internal jugular vein cannulation; and rapid-sequence intubation.Methods: The subgoals, or individual steps, required to complete the three procedures were identified using hierarchical task analysis. The systematic human error reduction and prediction approach was then used to identify potential human errors at each subgoal, the level of risk and how these potential errors could be prevented.Results: Endotracheal suctioning procedure was broken down into 129 subgoals, of which 49 (38.0%) were high-risk. Ultrasound-guided right internal jugular venous cannulation was divided into 224 subgoals, of which 131 (58.4%) were medium-risk, and 20 (8.9%) were identified as high-risk. Rapid sequence intubation was divided into 167 subgoals. A total of 73 (43.7%) of these subgoals were judged to be high-risk.Conclusions: The use of human reliability analysis techniques can support healthcare professionals to gain an indepth understanding of how particular procedures are carried out in order to reduce the risk of, and improve training in, how to perform these procedures.
The 100 most cited articles on healthcare simulation: a bibliometric review
(Lippincott, Williams & Wilkins, 2018-06) Walsh, Chloe; Lydon, Sinéad; Byrne, Dara; Madden, Caoimhe; Fox, Susan; O'Connor, Paul; Health Services Executive; National Doctor Training and Planning, Health Services Executive, Republic of Ireland
This article provides an overview and synthesis of the 100 most cited healthcare simulation publications to provide insight into the articles that have shaped current knowledge and practice. Searches of the Scopus and Web of Science databases were conducted in July 2017. Most articles were concerned with medical education and training (86%) and were most often published in surgical journals (33%). Manikins (20%), standardized patients (16%), inanimate part-task trainers (16%), fully simulated environments (17%), and virtual reality part-task trainers (14%) were the most commonly featured types of simulators. Healthcare simulation research has matured and grown during the preceding decades. There has been a move away from research questions focused on “does simulation work?” to an assessment of the conditions under which simulation is most effective. It is hoped that providing an overview of highly cited works will help identify topics for further research.
A systematic review of measurement tools for the proactive assessment of patient safety in general practice
(Lippincott, Williams & Wilkins, 2017-04-04) Lydon, Sinéad; Cupples, Margaret; Murphy, Andrew W.; Hart, Nigel; O'Connor, Paul; Health Research Board
Background Primary care physicians have reported a difficulty in understanding how best to measure and improve patient safety in their practices. Objectives The aims of the study were to identify measures of patient safety suitable for use in primary care and to provide guidance on proactively monitoring and measuring safety. Methods Searches were conducted using Medline, Embase, CINAHL and PsycInfo in February 2016. Studies that used a measure assessing levels of or attitudes toward patient safety in primary care were considered for inclusion. Only studies describing tools focused on the proactive assessment of safety were reviewed. Two independent reviewers extracted data from articles and applied the Quality Assessment Tool for Studies with Diverse Designs. Results More than 2800 studies were screened, of which 56 were included. Most studies had used healthcare staff survey or interviews to assess patient safety (n = 34), followed by patient chart audit (n = 14) or use of a practice assessment checklist (n = 7). Survey or interview of patients, active monitoring systems, and simulated patients were used with less frequency. Conclusions A lack of appropriate measurement tools has been suggested to limit the ability to monitor patient safety in primary care and to improve patient care. There is no evident “best” method of measuring patient safety in primary care. However, many of the measures are readily available, quick to administer, do not require external involvement, and are inexpensive. This synthesis of the literature suggests that it is possible for primary care physicians to take a proactive approach to measuring and improving safety.
Prevalence of burnout among Irish general practitioners: a cross-sectional study
(Springer, 2016-01-23) O'Dea, B.; O'Connor, Paul; Lydon, Sinéad; Murphy, Andrew W.
Burnout constitutes a significant problem among physicians which impacts negatively upon both the doctor and their patients. Previous research has indicated that burnout is prevalent among primary care physicians in other European countries and North America. However, there is a paucity of research assessing burnout among Irish general practitioners and examining predictive factors.To report the findings of a survey of burnout among Irish general practitioners, and assess variables related to burnout in this population.An online, anonymous questionnaire was distributed to general practitioners working in the Republic of Ireland.In total, 683 general practitioners (27.3 % of practising Irish general practitioners) completed the survey. Of these, 52.7 % reported high levels of emotional exhaustion, 31.6 % scored high on depersonalisation and 16.3 % presented with low levels of personal accomplishment. In total, 6.6 % presented with all three symptoms, fulfilling the criteria for burnout. Emotional exhaustion was higher among this sample than that reported in European and UK studies of burnout in general practitioners. Personal accomplishment was, however, higher in this sample than in other studies. Multiple regression analyses revealed that younger age, non-principal status role, and male gender were related to increased risk of burnout symptoms.The symptoms of burnout appear prevalent among Irish general practitioners. This is likely to have a detrimental impact both upon the individual general practitioners and the patients that they serve. Research investigating the factors contributing to burnout in this population, and evaluating interventions to improve general practitioner well-being, is, therefore, essential.
A mixed method, multiperspective evaluation of a near peer teaching programme
(BMJ Publishing Group, 2017-02-24) Lydon, Sinéad; O'Connor, Paul; Mongan, Orla; Gorecka, Miroslawa; McVicker, Lyle; Stankard, Aiden; Byrne, Dara; Health Services Executive; National Doctors Training and Planning
Purpose of study Peer teaching (PT) has become increasingly popular. PT may offer benefits for students, tutors and institutions. Although resistance to PT has been identified among faculty, research has typically focused on students' experiences and perceptions, rather than those of the peer tutors or senior doctors/medical faculty. The current study comprised of a comprehensive, multiperspective evaluation of a near PT programme delivered by interns to final-year medical students in the Republic of Ireland. Study design This study employed a mixed methods design, using both interviews and questionnaires to assess students' (n=130), interns' (n=49) and medical faculty's or senior doctors' (n=29) perceptions of the programme. Results All three groups were emphatic about the programme's benefits, although senior doctors and faculty reported significantly more positive attitudes than the others. Mean ratings of the programme's value, out of 10, were 8.2 among students, 8.2 among interns and 9.1 among senior doctors and faculty. Challenges identified were largely organisational in nature. Perceived benefits for students included the informality of teaching sessions, increased opportunities in the clinical environment and improvements in exam preparedness. Perceived benefits for the interns included improvements in knowledge and teaching ability and experience as a role model. Conclusions PT programmes have been posited as an ‘easy fix’ to growing numbers of students. However, it is apparent that PT has substantial value outside of this. Future research that conducts economic evaluations of such programmes and that collects objective data on teaching quality and student learning would be of much interest.
A mixed methods evaluation of paediatric trainee preparedness to manage cardiopulmonary arrests
(Springer, 2017-09-21) Walsh, Órla; Lydon, Sinéad; O'Connor, Paul
Paediatric cardiopulmonary arrest (CPA) survival rates are strongly linked to the training of the doctors responding to the event. This study sought to characterise the level of experience in managing CPAs among paediatric trainees and to investigate the nontechnical (NTS) required to effectively lead a paediatric CPA team. A mixed-methods research design was used. For the quantitative phase, a questionnaire was developed to assess training, confidence, and experiences related to CPA management. During the qualitative phase, 17 paediatric trainees participated in a series of critical incident technique (CIT) interviews to explore the NTS used during the management of paediatric CPAs. A total of 56 of 131 (37.1% response rate) trainees responded to the preparedness questionnaire. A total of 48.2% of respondents expressed low confidence in their skill as a team leader during the management of a CPA. The CIT interviews highlighted deficiencies in specific NTS (identifying options, prioritising, and identifying and utilising resources).Conclusion: Our results indicate that there is a desire for more training in CPA management among paediatric trainees, in particular as a team leader, which includes a focus on key NTS.
Interventions to improve hand hygiene compliance in the ICU: A systematic review
(Lippincott, Williams & Wilkins, 2017-11) Lydon, Sinéad; Power, Michael; McSharry, Jennifer; Byrne, Molly; Madden, Caoimhe; Squires, Janet Elaine; O'Connor, Paul
Objectives: To synthesize the literature describing interventions to improve hand hygiene in ICUs, to evaluate the quality of the extant research, and to outline the type, and efficacy, of interventions described. Data Sources: Systematic searches were conducted in November 2016 using five electronic databases: Medline, CINAHL, PsycInfo, Embase, and Web of Science. Additionally, the reference lists of included studies and existing review papers were screened. Study Selection: English language, peer-reviewed studies that evaluated an intervention to improve hand hygiene in an adult ICU setting, and reported hand hygiene compliance rates collected via observation, were included. Data Extraction: Data were extracted on the setting, participant characteristics, experimental design, hand hygiene measurement, intervention characteristics, and outcomes. Interventional components were categorized using the Behavior Change Wheel. Methodological quality was examined using the Downs and Black Checklist. Data Synthesis: Thirty-eight studies were included. The methodological quality of studies was poor, with studies scoring a mean of 8.6 of 24 (sd= 2.7). Over 90% of studies implemented a bundled intervention. The most frequently employed interventional strategies were education (78.9%), enablement (71.1%), training (68.4%), environmental restructuring (65.8%), and persuasion (65.8%). Intervention outcomes were variable, with a mean relative percentage change of 94.7% (sd= 195.7; range, 4.3–1155.4%) from pre to post intervention. Conclusions: This review demonstrates that best practice for improving hand hygiene in ICUs remains unestablished. Future research employing rigorous experimental designs, careful statistical analysis, and clearly described interventions is important.
Barriers and facilitators related to the implementation of a physiological track and trigger system: A systematic review of the qualitative evidence
(Oxford University Press (OUP), 2017-11-21) Connolly, Fergal; Byrne, Dara; Lydon, Sinéad; Walsh, Chloe; O'Connor, Paul; National Doctor Training and Planning, Health Services Executive, Republic of Ireland
Purpose To identify the barriers to, and facilitators of, the implementation of physiological track and trigger systems (PTTSs), perceived by healthcare workers, through a systematic review of the extant qualitative literature. Data sources Searches were performed in PUBMED, CINAHL, PsycInfo, Embase and Web of Science. The reference lists of included studies were also screened. Study selection The electronic searches yielded 2727 papers. After removing duplicates, and further screening, a total of 10 papers were determined to meet the inclusion criteria and were reviewed. Data extraction A deductive content analysis approach was taken to organizing and analysing the data. A framework consisting of two overarching dimensions (‘User-related changes required to implement PTTSs effectively’ and ‘Factors that affect user-related changes’), 5 themes (staff perceptions of PTTSs and patient safety, workflow adjustment, PTTS, implementation process and local context) and 14 sub themes was used to classify the barriers and facilitators to the implementation of PTTSs. Results of data synthesis Successful implementation of a PTTS must address the social context in which it is to be implemented by ensuring that the users believe that the system is effective and benefits patient care. The users must feel invested in the PTTS and its use must be supported by training to ensure that all healthcare workers, senior and junior, understand their role in using the system. Conclusion PTTSs can improve patient safety and quality of care. However, there is a need for a robust implementation strategy or the benefits of PTTSs will not be realized.
The effect of operator position on the quality of chest compressions delivered in a simulated ambulance
(Cambridge University Press, 2019-12-09) Mullin, Scott; Lydon, Sinéad; O'Connor, Paul
Background: Ambulances are where patient care is often initiated or maintained, but this setting poses safety risks for paramedics. Paramedics have found that in order to optimize patient care, they must compromise their own safety by standing unsecured in a moving ambulance. Hypothesis/Problem: This study sought to compare the quality of chest compressions in the two positions they can be delivered within an ambulance. Methods: A randomized, counterbalanced study was carried out with 24 paramedic students. Simulated chest compressions were performed in a stationary ambulance on a cardiopulmonary resuscitation (CPR) manikin for two minutes from either: (A) an unsecured standing position, or (B) a seated secured position. Participants' attitudes toward the effectiveness of the two positions were evaluated. Results: The mean total number of chest compressions was not significantly different standing unsecured (220; SD = 12) as compared to seated and secured (224; SD = 21). There was no significant difference in mean compression rate standing unsecured (110 compressions per minute; SD = 6) as compared to seated and secured (113 compressions per minute; SD = 10). Chest compressions performed in the unsecured standing position yielded a significantly greater mean depth (52 mm; SD = 6) than did seated secured (26 mm; SD = 7; P
A systematic review of interventions to foster physician resilience
(BMJ Publishing Group, 2018-02-21) Fox, Susan; Lydon, Sinéad; Byrne, Dara; Madden, Caoimhe; Connolly, Fergal; O'Connor, Paul; Health Services Executive; National Doctors Training and Planning
This review aimed to synthesise the literature describing interventions to improve resilience among physicians, to evaluate the quality of this research and to outline the type and efficacy of interventions implemented. Searches were conducted in April 2017 using five electronic databases. Reference lists of included studies and existing review papers were screened. English language, peer-reviewed studies evaluating interventions to improve physician resilience were included. Data were extracted on setting, design, participant and intervention characteristics and outcomes. Methodological quality was assessed using the Downs and Black checklist. Twenty-two studies were included. Methodological quality was low to moderate. The most frequently employed interventional strategies were psychosocial skills training and mindfulness training. Effect sizes were heterogeneous. Methodologically rigorous research is required to establish best practice in improving resilience among physicians and to better consider how healthcare settings should be considered within interventions.
Psychometric evaluation of a measure of factors influencing hand hygiene behaviour to inform intervention
(Hospital Infection Society, 2019-02-12) Lydon, Sinéad; Greally, Cathriona; Tujjar, Omar; Reddy, Kiran; Lambe, Kathryn; Madden, Caoimhe; Walsh, Chloe; Fox, Susan; O'Connor, Paul; Health Research Board
Background Although the hand hygiene (HH) procedure is simple, the related behaviour is complex and is not readily understood, explained or changed. There is a need for practical tools to provide data that can guide healthcare managers and practitioners not only on the ‘what’ (the standards that must be met), but also the ‘how’ (guidance on how to achieve the standards). Aim To develop a valid questionnaire to evaluate attitudes to the factors that influence engagement in HH behaviour that can be readily completed, administered and analysed by healthcare professionals to identify appropriate intervention strategies. Construct validity was assessed using confirmatory factor analysis, predictive validity was assessed through comparison with self-reported HH behaviour, and convergent validity was assessed through direct unit-level observation of HH behaviour. Methods The Capability, Opportunity, Motivation-Behaviour (COM-B) model was used to design a 25-item questionnaire that was distributed to intensive care unit (ICU) personnel in Ireland. Direct observation of HH behaviour was carried out at two ICUs. Findings In total, 292 responses to the survey (response rate 41.0%) were included in the analysis. Confirmatory factor analysis resulted in a 17-item questionnaire. Multiple regression revealed that a model including capability, opportunity and motivation was a significant predictor of self-reported behavioural intention [ F(3,209)=22.58, P<0.001]. However, the opportunity factor was not found to make a significant contribution to the regression model. Conclusion The COM-B HH questionnaire is reliable and valid, and provides data to support the development and evaluation of HH interventions that meet the needs of specific healthcare units.
A systematic review of patient complaints about general practice
(Oxford University Press (OUP), 2019-11-19) O’Dowd, Emily; Lydon, Sinéad; Madden, Caoimhe; O'Connor, Paul; Hardiman Research Scholarship, National University of Ireland Galway
Objective This review aimed to synthesize the extant research on complaints in general practice. Methods Five electronic databases were searched: Medline, Web of Science, CINAHL, PsycINFO and Academic Search Complete. Peer-reviewed studies describing the content, impact of and motivation for complaints were included and data extracted. Framework synthesis was conducted using the Healthcare Complaints Analysis Tool (HCAT) as an organizing framework. Methodological quality was appraised using the Quality Assessment Tool for Studies with Diverse Designs (QATSDD). Results The search identified 2960 records, with 21 studies meeting inclusion criteria. Methodological quality was found to be variable. The contents of complaints were classified using the HCAT, with 126 complaints (54%) classified in the Clinical domain, 55 (23%) classified as Management and 54 (23%) classified as Relationships. Motivations identified for making complaints included quality improvement for other patients and monetary compensation. Complaints had both positive and negative impacts on individuals and systems involved. Conclusion This review highlighted the high proportion of clinical complaints in general practice compared to secondary care, patients’ motivations for making complaints and the positive and negative impacts that complaints can have on health care systems. Future research focused on the reliable coding of complaints and their use to improve quality and safety in general practice is required.
A systematic review of 7 years of research on entrustable professional activities in graduate medical education, 2011–2018
(Wiley, 2019-01-04) O'Dowd, Emily; Lydon, Sinéad; O'Connor, Paul; Madden, Caoimhe; Byrne, Dara; National Doctor Training and Planning, Ireland; Health Services Executive
Purpose This review aimed to synthesise some of the extant work on the use of entrustable professional activities (EPAs) for postgraduate physicians, to assess the quality of the work and provide direction for future research and practice. Method Systematic searches were conducted within five electronic databases (Medline, Scopus, Web of Science, PsycINFO and CINAHL) in September 2018. Reference lists, Google Scholar and Google were also searched. Methodological quality was assessed using the Quality Assessment Tool for Studies with Diverse Designs (QATSDD). Results In total, 49 studies were included, classified as Development of EPAs (n = 37; 76% of total included), Implementation and/or assessment of EPAs (n = 10; 20%), or both (n = 2; 4%). EPAs were described for numerous specialties, including internal medicine (n = 14; 36%), paediatrics (n = 8; 21%) and psychiatry (n = 4; 10%). Of the development studies, 92% utilised more than one method to generate EPAs. The two most commonly used methods were developing initial EPAs in a working group, (n = 27; 69%) and revising through deliberation (n = 21; 54%). Development papers were of variable quality (mean QATSDD score = 20, range 6–41). Implementation and assessment studies utilised methods that included observing trainee performance (n = 6; 50%) and enrolling trainees in competency‐based curricula, which included EPAs (n = 4; 33%). The methodological quality of these implementation studies varied (mean QATSDD score = 19.5, range = 6–32). Conclusions This review highlighted a need for: (i) consideration of best practice guidelines for EPA development; (ii) focus on the methodological quality of research on EPA development and of EPAs, and (iii) further work investigating the implementation of EPAs in the curriculum.
Irish policy-makers' perceptions of barriers and facilitators to hand hygiene compliance
(Irish Medical Organisation, 2019-04) Madden, Caoimhe; Lydon, Sinéad; Lambe, Kathryn; O'Connor, Paul; Health Research Board
Introduction Despite its’ role in infection prevention, hand hygiene (HH) compliance rates in healthcare settings remain sub-optimal. Little research has examined policy-makers’ perceptions of contributory barriers and facilitators to compliance, and whether these are addressed in national-level guidelines. Methods Interviews were conducted with national-and hospital-level policy-makers. The COM-B model was used as a coding framework. Google© was used to source suitable Irish health service guidelines, policies, and regulations relating to HH. Data were extracted from documents using a structured tool. Results Six themes emerged from the interviews. Four documents were determined to meet the inclusion criteria, with some of the themes identified from the interviews also present in the documents. Discussion Policy-maker perceptions help identify potential areas for targeting in future interventions. The varied extent to which the issues identified in the interviews were addressed in the guidelines, policies and standards suggest that revision of such documents is required.
An analysis of general practitioners’ perspectives on patient safety incidents using critical incident technique interviews
(Oxford University Press (OUP), 2019-03-30) Curran, Ciara; Lydon, Sinéad; Kelly, Maureen E.; Murphy, Andrew W.; O'Connor, Paul; Health Services Executive; Irish College of General Practitioners
Background General practitioners report difficulty in knowing how to improve patient safety. Objectives To analyse general practitioners’ perspectives of contributing factors to patient safety incidents by collecting accounts of incidents, identifying the contributory factors to these incidents, assessing the impact and likelihood of occurrence of these incidents and examining whether certain categories of contributory factors were associated with the occurrence of high-risk incidents. Methods Critical incident technique interviews were carried out with 30 general practitioners in Ireland about a patient safety incident they had experienced. The Yorkshire Contributory Factors Framework was used to classify the contributory factors to incidents. Seven subject matter experts rated the impact and likelihood of occurrence of each incident. Results A total of 26 interviews were analysed. Almost two-thirds of the patient safety incidents were rated as having a major-to-extreme impact on the patient, and over a third were judged as having at least a bimonthly likelihood of occurrence. The most commonly described active failures were ‘Medication Error’ (34.6%) and ‘Diagnostic Error’ (30.8%). ‘Situational Domain’ was identified as a contributory domain in all patient safety incidents. ‘Communication’ breakdown at both practice and other healthcare-provider interfaces (69.2%) was also a commonly cited contributory factor. There were no significant differences in the levels of risk associated with the contributory factors. Conclusions Critical incident technique interviews support the identification of contributory factors to patient safety incidents. There is a need to explore the use of the resulting data for quality and safety improvement in general practice.
Hand hygiene compliance in the intensive care unit: A systematic review
(Lippincott, Williams & Wilkins, 2019-09) Lambe, Kathryn Ann; Lydon, Sinéad; Madden, Caoimhe; Vellinga, Akke; Hehir, Aoife; Walsh, Mary; O'Connor, Paul
Abstract Objectives: To synthesize the literature describing compliance with World Health Organization hand hygiene guidelines in ICUs, to evaluate the quality of extant research, and to examine differences in compliance levels across geographical regions, ICU types, and healthcare worker groups, observation methods, and moments (indications) of hand hygiene. Data Sources: Electronic searches were conducted in August 2018 using Medline, CINAHL, PsycInfo, Embase, and Web of Science. Reference lists of included studies and related review articles were also screened. Study Selection: English-language, peer-reviewed studies measuring hand hygiene compliance by healthcare workers in an ICU setting using direct observation guided by the World Health Organization’s “Five Moments for Hand Hygiene,” published since 2009, were included. Data Extraction: Information was extracted on study location, research design, type of ICU, healthcare workers, measurement procedures, and compliance levels. Data Synthesis: Sixty-one studies were included. Most were conducted in high-income countries (60.7%) and in adult ICUs (85.2%). Mean hand hygiene compliance was 59.6%. Compliance levels appeared to differ by geographic region (high-income countries 64.5%, low-income countries 9.1%), type of ICU (neonatal 67.0%, pediatric 41.2%, adult 58.2%), and type of healthcare worker (nursing staff 43.4%, physicians 32.6%, other staff 53.8%). Conclusions: Mean hand hygiene compliance appears notably lower than international targets. The data collated may offer useful indicators for those evaluating, and seeking to improve, hand hygiene compliance in ICUs internationally.

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