病案首页与编码质量对病种付费的影响

目的探究病案首页与编码质量对病种付费产生的影响。方法2019年1—12月纳入研究的1056例病案首页均为该院产科、颅脑外科、普通外科、肿瘤科及心外科5个科室所收纳,依照回顾性分析方式进行平均分组,病案首页均经针对性措施解决病案首页问题,并经校对手段质控编码确认无误(试验组,n=528),重新编码前病案首页(对照组,n=528),分析两组数据差异及变化情况。结果试验组的病种付费质量包括医院数据统计分数、病案信息利用分数、疾病分组准确分数及医院经济效益分数评估均显著高于对照组,试验组中出现病案内容与病案首页不符、遗漏诊断、不完整诊断和不正确诊断的病案不良事件发生概率显著低于对照组,试验组发生漏填、错填的缺陷问题发生率显著低于对照组,组间数据差异有统计学意义(P<0.05)。结论分析病案首页质量,对影响病案首页的因素进行分析,进行针对性的改进,有利于提升病案质量,降低病案与编码质量对病种付费产生的不良影响。     

Updates in our understanding of local anaesthetic systemic toxicity: a narrative review

Despite advances in clinical practice, local anaesthetic systemic toxicity continues to occur with the therapeutic use of local anaesthesia. Patterns of presentation have evolved over recent years due in part to the increasing use of ultrasound which has been demonstrated to reduce risk. Onset of toxicity is increasingly delayed, a greater proportion of clinical reports are secondary to fascial plane blocks, and cases are increasing where non-anaesthetist providers are involved. The evolving clinical context presents a challenge for diagnosis and requires education of all physicians, nurses and allied health professionals about these changing patterns and risks. This review discusses: mechanisms; prevention; diagnosis; and treatment of local anaesthetic systemic toxicity. The local anaesthetic and dose used, site of injection and block conduct and technique are all important determinants of local anaesthetic systemic toxicity, as are various patient factors. Risk mitigation is discussed including the care of at-risk groups, such as: those at the extremes of age; patients with cardiac, hepatic and specific metabolic diseases; and those who are pregnant. Advances in the changing clinical landscape with novel applications and settings for the use of local anaesthesia are also described. Finally, we signpost future directions to potentially improve the management of local anaesthetic systemic toxicity. The utility of local anaesthetics remains unquestionable in clinical practice, and thus maximising the safe and appropriate use of these drugs should translate to improvements in patient care.     

Training police trainees about ways to manage trauma and loss

For the second year we were invited to be trainers at a training seminar for senior police educators, held in the German Federal Police University and sponsored by the European Police College, hence, having the opportunity to build on their previous applications. We applied exercises (psychoeducation, mindfulness/awareness, journaling, processing in dyads) that introduced in this training and designed to teach officers how to handle exposure to adversities and minimize potential negative consequences. Police officers expect exposure to potentially traumatic incidents, yet, often suffer deeply because of unresolved trauma related to handling horrific events. Our work aimed to open discussion in order to formulate a standard component in training curricula related to teaching police trainees ways to effectively handle and process trauma.     

What are the critical incidents that affect how people cope with being detained under Section 136 of the Mental Health Act (1983, 2007)?

Abstract

Purpose: Section 136 (S136) of the Mental Health Act (1983, 2007) provides legislative powers for police officers to detain those suspected of being ‘mentally disordered’ for a mental health assessment. Despite its increasing use, there is currently little qualitative research exploring detainee’s experiences.

Methodology: Participants recruited from NHS places of safety participated in a semi-structured interview. The novel application of Critical Incident Technique (CIT) within this study enabled the specific identification of critical incidents which mental health service users thought had either helped with, or worsened the S136 detention experience. A wish list of absent factors was also gathered.

Findings: Six categories of helpful critical incidents, seven categories of unhelpful critical incidents and five categories of wish-list items were identified. The importance of authentic relationships underpinned many categories, as well as challenging stigma, considering previous detentions; and receiving practical support.

Originality/value: The outlined study is the first of its kind to utilise CIT methodology to specifically identify critical incidents related to the process of S136 detention. These findings provide specific ways to improve the experience of detention informed directly by those who have been directly subjected to S136.

• Key points

• Take time to invest in meaningful relationships with those who are detained; asking about the individual’s life experience and their perception of its relationship to their current presenting difficulties.

• Identify the service user’s values -what’s important to them, and what gives meaning to their life – and discuss this in relation to what their worries, concerns or wishes may be for treatment.

• Discuss previous experiences of involuntary admission- this can support all parties involved to consider the impact of detention upon the individual, and services.

• Use problem-free discussions to normalise and help de-stigmatise mental health difficulties and support rapport building.

• Provide practical support, such as food, drink and routinely allow those who are detained to gather personal belongings such as a change of clothes or a book.

• Ensure advocacy services are always available and accessible for those who are detained under S136.

• Where possible, avoid the use of restrictive or stigmatising practices in front of the public where possible (e.g. use of handcuffs, police vehicles as transport) to minimise risk of increasing mental health stigma.

     

Simulation-assisted burn disaster planning

The aim of the study was to evaluate the Swedish medical systems response to a mass casualty burn incident in a rural area with a focus on national coordination of burn care. Data were collected from two simulations of a mass casualty incident with burns in a rural area in the mid portion of Sweden close to the Norwegian border, based on a large inventory of emergency resources available in this area as well as regional hospitals, university hospitals and burn centres in Sweden and abroad. The simulation system Emergo Train System^® (ETS) was used and risk for preventable death and complications were used as outcome measures: simulation I, 18.5% (n = 13) preventable deaths and 15.5% (n = 11) preventable complications; simulation II, 11.4% (n = 8) preventable deaths and 11.4% (n = 8) preventable complications. The last T1 patient was evacuated after 7 h in simulation I, compared with 5 h in simulation II. Better national coordination of burn care and more timely distribution based on the experience from the first simulation, and possibly a learning effect, led to a better patient outcome in simulation II. The experience using a system that combines both process and outcome indicators can create important results that may support disaster planning.     

Learning from Patient Safety Incidents in the Emergency Department: A Systematic Review

BackgroundPatient safety incidents are commonly observed in critical and high demanding care settings, including the emergency department. There is a need to understand what causes patient safety incidents in emergency departments and determine the implications for excellence in practice.ObjectiveOur aim was to systematically review the international literature on patient safety incidents in emergency departments and determine what can be learned from reported incidents to inform and improve practice.DiscussionPatient safety incidents in emergency departments have a number of recognized contributing factors. These can be used as groundwork for the development of effective tools to systematically identify incident risk. Participation in efforts to diminish risk and improve patient safety through appropriate incident reporting is critical for removing barriers to safe care.ConclusionsThis review enhances our awareness of contributing factors to patient safety incidents within emergency departments and encourages researchers from different disciplines to investigate the causes of practice errors and formulate safety improvement strategies.