Abstract

Malnutrition, which signifies a pathological nutritional state, can have numerous negative effects on the patient, including the possibility of a fatal outcome. Furthermore, complications arising from inadequate nutrition burden the capacities of the healthcare system capacities. The research, utilizing national data and interviews, analyzes the current situation of tube feeding in Hungary and the possibilities for system support. The research involved 769 tube-fed patients in 2022 and 705 in 2023, who were admitted into the system of a home care service specialized in tube feeding between May and October of the respective years. The two main indicators of the study are the specialized ENFit syringe, conforming to international standards, suitable for tube feeding, and the safe patient pathway from the hospital. Our interventions in the two pilot hospitals showed significant results. The number of patients equipped with the ENFit syringe increased by more than 40% in one institution, while the other hospital demonstrated a 26% improvement. The process of safe discharge also showed significant improvement from both pilot hospitals. The study highlights the importance of practical implementation of tube feeding, with a special focus on educating patients and healthcare professionals, and the significance of communication and patient pathway management. Discharge from inpatient care requires particular attention from both patient safety and health economics perspectives. During this critical transition period, it is essential to ensure the availability of medical devices, specialized nutritional solutions, and home nursing care necessary for tube feeding. The study will demonstrate the impact that increasing healthcare professionals’ knowledge of feeding tube, engaging and educating patients early, and optimising discharge processes can have on safe patient care and healthcare provider operation

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Abstract

Disappearance of patients can lead to accidents, falls, injuries, or getting lost, which can even endanger the patient’s life. Therefore, the prevention of such events isan important problem and challenge to be solved.
The two largest groups of patients affected by patient disappearances are elderly patients with dementia and psychiatric patients, who we deal with in our announcement. The typical form of patients’ disappearance regarding dementia is called wandering within the literature. It can be sharply distinguished from cases where psychiatric patients leave the medical institution unauthorized with a definite goal, in many cases in a clear state of consciousness. Wandering and leaving unauthorized are denoted together in this paper by the concept of patient disappearance.
The aim of our study is to present the general reasons for disappearance, namely wandering or unauthorized leave of patients receiving inpatient care, and the possible actions that can be taken to prevent them, based on the analysis of the data received by the national NEVES (Unexpected Events) reporting system.
The reported data were entered into the national database in the context of voluntary and anonymous data provision. In this study we processed the data of 133 adults who disappeared. In the reported cases, 75.2%(n=100) of those affected were men, and 24.8% (n=33)were women. Most reports (73.7%) were from patients aged 20–49. Among the factors contributing to disappe-arance, psychological illness was mentioned in the lar-gest proportion (79.7%).
In 62.4% of the reported cases, this was the first disappearance, while in 17.3% of the cases, this had already happened before. 46.8% of the inpatients (n=124) among whom the disappearance event was reported were regularly visited. 75.9% of the data were reported from active wards, while 19.5% of the reports were from rehabilitation wards and 1.5% from nursing/chronic wards. The other category (3.0%) included case reports from addictionology, adult psychiatry, and unknown locations. According to the professional breakdown, the largest proportion of reports came from psychiatric departments (92.5%). There is no noteworthy difference in the type of department providing patient care (closed:45.9%; open: 49.6%). Based on the reports, the patient care at the time of the disappearance was typically carried out with the usual number of care providers (91.7%). According to the reported data within the NEVES reporting system, the nursing staff checked the missing patients every 15–60 minutes in 66.9% of cases, and every 1–3 hours in 23.3% of cases.
90 patients (67.7%) were found on the day of disappearance, in 6 cases (4.5%) the patient was found the next day, in one case (0.8%) it took a month to find the patient. In one case, the patient was found (0.8%), but it was not recorded on the datasheet when. In 35 cases(26.3%), the patient could not be found until the report was sent. Mild injury occurred in 3.1%, moderate injury in 4.1%, severe injury in one case (1.0%).
As a result of the causal research, we formed 10 groups of general causes leading to disappearance, these are: deficiencies in the regulation; employees do not follow the rules; lack of risk assessment; inadequate risk assessment; lack of application of prevention tools/procedures; use of an inappropriate prevention method; inadequate operation of the concierge service; inadequate care environment; communication gaps; the knowledge/experience gained from previous events is not used.
In our paper, we present what concrete measures canhelp solve the problem for each cause.

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Abstract

Background: The high number of cancelled elective surgeries is a major problem in Hungary, as in most parts of the world. Identifying the causes can help to prevent and thus reduce the number of cancelled operations.
Objective: Our objective is to provide as comprehensive picture as it is possible about the reasons behind the cancellation of elective surgeries, and at the same time to help in the selection of appropriate preventive options in the institutions.
Method: Based on our research, published in 2020 and the data entered into NEVES since then, we will explore the reasons and make recommendations to reduce the number of cancellations of elective surgeries.
Results: According to our survey, the most common reasons for cancelled elective surgeries are incorrect patient preparation, some kind of contraindicating condition and time management errors. Interesting patterns in the incidence of these reasons can be observed when looking at days of the week, patient age or even the order of surgeries.
Discussion: Although the reasons behind cancelled elective surgeries are diverse, there are patterns that can help managers to identify adequate institutional preventive measures to reduce the incidence of cancelled operations.
Conclusion: The important message that we want to communicate is that even causes that are thought to be uncontrollable can have roots, which can be eliminated through targeted actions

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Abstract

Background:
Cardiac death in a hospital environment is a relatively common occurrence. Identifying the causes can help in prevention, because although there are some conditions where even a perfectly performed resuscitation may not be successful, it is important to ensure that the resuscitation process is performed properly and that the patient’s chance of survival does not depend on the organization.
Objective:
Our objective is to raise awareness about the possibility of increasing the effectiveness of resuscitation in healthcare institutions.
Method:
Based on our research on this topic and the data that have since been entered into the NEVES system, we will present correlations and present suggestions for improvement based on literature references and institutional good practice.
Results:
Our survey revealed significant differences in institutional, departmental, and equipment availability of cardiac resuscitation in hospital conditions in our country. It is worth for each institution to perform its ownsurvey, but the data and the opinions of the interviewedexperts suggest that there is potential for innovation ineducation and communication improvements in severalinstitutions.
Discussion:
Ensuring the quality of care is an important criterion for improving institutional-level performance, but improvement in equipment and human resources, training about resuscitation and the resuscitation chain, and improving institutional communication can also increase hospital performance.
Conclusion:
The institutional operation of the resuscitation chain is a very complex process where good practice is not always associated with successful resuscitations. This publication describes the reasons behind possible failures in the resuscitation chain and provides appropriate solutions and potentially working good practices.

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Abstract

Quality of care assessments besides the provider level should also include the patient perspective, however, there aren’t widespread solutions for this approach. One possibility is to apply a generic, thus, widely applicable Patient Reported Outcomes Measure (PROM) to assess care outcomes. Taking this notion into consideration, this study aimed to investigate if a generic questionnaire can reliably substitute a disease-specific questionnaire when measuring care effectiveness with patient-reported outcome measures among patients with low back pain.

Between January and December 2019, we conducted a before and after survey in three Hungarian hospitals. Adults with confirmed low back pain expecting spinal surgery were eligible to enter the study. SF-36 Health Survey (SF-36) and Roland‐Morris Disability Questionnaire (RMDQ) were used. Multivariate linear regression analyses were conducted to explore the relationship between the results of the two questionnaires and how service provider, sex, and education level could explain the differences in the calculated PROM-based performance measures.

During the pre-intervention survey, 11 individuals decided to either not sign the consent form or complete the questionnaire. As a result, 116 individuals participated in the first – baseline – survey and 86 in the second – follow-up – survey. The drop-out rate varied by providers: the lowest rate was 15%, and the highest 39%. Of the SF-36 subscale-based performance measures, role limitations due to physical health and physical functioning significantly correlated with the RMDQ performance measure. Considering the necessary minimum clinically important difference, the explanatory analysis showed that the SF-36 physical functioning subscale-based and the RMDQ-based performance measures established the same performance rank order among the participating hospitals.

The physical functioning subscale of the SF-36 provided similar results to the RMDQ regarding care effectiveness. Thus, the SF-36 may be able to measure and compare care effectiveness among providers in low back pain. If future studies investigating other health conditions come to the same conclusion, then the SF-36 could be used by itself to incorporate the patient perspective into healthcare quality assessments, thereby increasing comparability and lowering administrative costs.

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Abstract

In 2000, a study entitled To Err is Human was published, which drew attention to patient safety problems and the importance of unexpected events during healthcare. One form of unexpected event is the mixing up of patients and medical reports due to the result of mis -mis-identification during health care. According to our experience, misidentification and the resulting problems occur much more often than reported in the aforementioned study.

Mixing up of patients and medical reports is of particular importance from the point of view of patient safety to the severity of their consequences, as well as the fact that in the case of a mix-up, up to two patients can be harmed at the same time.

With our article, our goal was to identify the patient group most at risk in terms of mixing up patients and medical reports and to collect as many reasons as possible that may be important in misidentification and its prevention. We also considered it important to take into account what solutions and best practices exist for prevention and to present them in our article.

Until the beginning of the analysis, only 3 cases were reported to the Hungarian database of the NEVES reporting system. Therefore, this low number of cases did not allow statistical analysis. With the involvement of Hungarian professionals, we held expert consultations, reviewed the most important relevant Hungarian and international literature, and based on the systematized information, outlined the causal structure.

We identified 21 groups with high risk from the point of view of mixing up of patients.

Among the many reasons uncovered during the research, in our article we present in more detail the considerations related to regulation and patients with unknown identities. Then we give an overview of the wide-ranging reasons at a system level.

As a result of the research, we created 10 groups for the general reasons leading to the mixing up of patients and medical reports, these are as follows: deficiencies in regulation; employees do not follow the rules; deficiencies in education; deficient work processes; human resources problems; the problems related to the patients; communication gaps; problems with devices; infrastructure issues; the knowledge/experience gained from previous events is not used. In connection with each group, we describe prevention options depending on the roots behind the general cause.

We deal primarily with the topic of regulation, including the identification of unknown patients, the actions to be taken when detecting a mixing up, the importance of data collection and organizational culture, and in our article, we also briefly review the actions to be taken in the event of a misidentification and present some examples of good practices.

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Abstract

The Szent Imre University Teaching Hospital of South Buda Central Hospital has been operating an Emergency Care Service, which is equivalent to the Medical Emergency Team, for almost 20 years. According to international studies, hospital resuscitation is most successful when it is carried out by a team of experienced and cohesive people. In our hospital, resuscitations are performed by the Emergency Department, which has the dedicated task of organising regular, extended basic life support (EBLS) training for the staff.

Our aim is to present the renewal of the procedures of advanced resuscitation in line with the current professional and management knowledge, as well as the reorganisation and re-launch of the EBLS training.

We used the guidelines of the European Resuscitation Council as a professional reference, while the educational and organisational aspects were based on the recommendations for application of these guidelines together with the national general and institutional good practices. The reorganisation of education was defined by the following basic requirements: all hospital staff, both doctors and nurses, in all departments should receive at least one resuscitation training session per year. A training plan and curriculum were developed, then small-group training sessions with theoretical and practical elements, complex situations, and an assessment were conducted. Participants evaluated the training by an anonymous, 9-item questionnaire at the end of the training.

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Abstract

Introduction: Aggressive behavior among psychiatric patients occurs the most frequently during acute inpatient treatment causing significant safety risk for patients and staff.
Objective: As part of a risk-reducing project targeting the reduction of the frequency of physical aggression, a daily routine use of a risk evaluation tool was introduced in the acute psychiatric unit of the Jahn Ferenc South Pest Hospital.
Methods: Selection of the appropriate risk evaluation tool was based on a thorough search of the literature. After preparing the Hungarian translation of V-RISK-10, all acutely admitted patients were assessed with this rating scale completed by the duty psychiatrist. To evaluate the predictive validity of the scale, the authors retrospectively surveyed the number and length of necessary physical restraints due to aggressive behavior in the first week after admission.
Results: The mean score on V-RISK-10 was 6.78 ± 3.36 points and the time patients spent under restraints was 6.96 ± 17.21 hours. The sum score of the V-RISK-10 showed a moderate strength, and significant correlation with the time spent under restraint (r = 0.447; p = 0.001).
Discussion: The results confirmed that V-RISK-10 is an appropriate tool for predicting physical aggression necessitating restraints in the first days following an acute psychiatric admission. History of violent behaviour, drug use, and a psychiatric diagnosis and suspiciousness among current symptoms had the strongest predictive value.
Conclusion: The V-RISK-10 is a risk assessment tool that is user-friendly in the context of acute psychiatric inpatient care and has moderate power for predicting aggressive behaviour. Patients with high risk of aggression can be identified with this tool at the time of admission. With careful monitoring and timely initiation of aggression prevention strategies, the occurrence of aggressive behaviour can be minimized.

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Abstract

The prevention of patient falls during health care is an important development opportunity both in terms of improving the safety of patient care and reducing the costs of health care providers.
The aim of our work is to present the research results based on the analysis of the data received in the NEVES reporting system, which highlights the general causes of patient falls at healthcare providers and their prevention options.
The Patient Falls data sheet in the NEVES reporting system is used to report falls that occurred during healthcare. The concept of a fall is defined in the report as follows: „An event that occurred against the patient’s will, during which the patient’s knee or the part of the body above the knee is in contact with the ground/floor.”
From the start of the NEVES reporting system to the beginning of data processing, 15.077 cases of falls were reported anonymously and voluntarily by Hungarian health care providers. We analysed these data statistically, and applied quality improvement techniques (process analysis, cause-effect diagram, focus group discussion, risk analysis, prioritization) to identify the causes involved in their occurrence.
In 71,4% of the 15.077 reported cases, patients were at least 65 years old. 53,2% of those affected were women and 46,8% were men. In 78,8% of the reported cases, the falls occurred inside the ward (during bed use, regardless of bed use, in the ward’s water block). In 27,4% of cases, the fall occurred while standing up, sitting down, or changing seats, which is particularly the most common of the activities performed before the fall. This is followed by movement started due to an urgent need, falls related to using the toilet, and falls while walking (over 10% of cases). The number of falls associated with staff-related activities (such as physical therapy, patient transportation) is minimal. Out of the 15 077 reported cases, only 25 patients fell under the mentioned conditions.
Based on the answers, environmental factors did not play a role in 60,3% of the falls (n=9.091). Among the environmental factors associated with the institution’s infrastructure, the largest percentages reported were wet floors (6,9%, n=1.037), equipment characteristics (6,4%, n=959) and device displacement (5,2%, n= 788).
At the moment of the fall, 24,4% (n=3.670) of the patients used an assistive device, 54,3% (n=8.177) had no assistive device, and in 14,0% (n=2.112) of the cases no relevant data was reported. A further 7,3% (n=1.104) have had an assistive device, but were not using it at the time of the fall. In 45,1% of the cases, the patient’s muscle weakness was indicated, and in another 24,9%, the patient’s general weakness was reported.
The proportion of mild injuries was 51,1%, and that of serious injuries was 6,7%. No injuries occurred in 42,2% of the cases.
The general reasons involved in the occurrence of patient falls have been classified into 12 main groups, as follows: deficiencies in regulation; employees do not follow the rules; lack of risk assessment; inadequate risk assessment; lack of application of prevention tools/procedures; inadequate patient handling/mobilization; problems with medication; human resource related issues; patient condition; communication gaps; infrastructure problems; the knowledge/experience gained from previous events is not used.
It is important to draw attention to the fact that these causes should be dealt as parts of a system. In order to achieve effective prevention, all possible causes must be explored in the given institutional environment, and complex measures must be taken in an effort to eliminate as many causes as possible. In our work, we outline what specific measures can help to solve the problem when identifying the causes of patient falls.

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