Gotowa bibliografia na temat „Hospital literature index”

Currently, the lean thinking system has not been implemented in all hospitals in Indonesia, where there is a lot of waste that affects the low quality of service and patient safety. The aims of this study is to develop a conceptual framework as a basis for quantitative assessment of lean thinking systems in Indonesian Hospitals to improve services, increase patient satisfaction and improve hospital quality. In preparing the conceptual framework for the quantitative assessment model of the lean thinking system index, a literature study was carried out through a literature search for journals from several countries and textbooks using the keywords "lean thinking" and "hospital". Literature review was conducted through several data sources, including ProQuest, Taylor & Francis, SpringerLink, and ScienceDirect. The types of literature were research articles with range of years 2012–2022. In total, 86 articles were obtained. The next stage includes screening, checking for duplication of articles and filtering articles based on inclusion criteria, so that there are 8 articles remaining. The 8 articles were reviewed to create a new conceptual framework. The result of the study is lean thinking model designed based on current conditions, expected future conditions, implements lean thinking, and maintains it with continuous improvement. This model is still in the early stages of research and forms the basis for the preparation of subsequent instruments. Currently the model is used in the hospital where the author works. The proposed conceptual framework can become the necessary basis for index development, which can then be used as a basis for further policy interventions to improve services in hospitals. In the end, this model can also improve quality and patient satisfaction.

ObjectiveSince China launched its nationwide systemic healthcare reform in 2009, policies such as the elimination of drug markups and the reform of medical insurance payments have forced some hospitals into a crisis threatening their survival. Both public and private hospitals have been building and strengthening their capacity to achieve sustainable development. However, the existing research has not provided a comprehensive evaluation tool required to support this effort. Therefore, this study develops an organisational capability evaluation index system to help public and private hospitals assess their current conditions.DesignThe Delphi method was used to construct a hospital organisational capability evaluation index system in conjunction with the boundary value method and an analytic hierarchical process. Then, a questionnaire survey was administered in 55 hospitals (32 non-profit and 23 for-profit hospitals), and Cronbach’s α and a factor analysis were used to verify the index system’s reliability and validity.Setting and participantsA literature review and semistructured interviews with 23 hospital managers and scholars clarified the definition of hospital organisational capability and formed an indicator pool. Additionally, 20 hospital directors were selected from public and private hospitals to participate in two rounds of the Delphi consultation.ResultsThe Delphi consultation resulted in an index system including 12 primary and 40 secondary indicators demonstrated to be reliable and valid. The three indicators with the largest weights were ‘regulation capability’ (0.251), ‘decision-making capability’ (0.121) and ‘executive capability’ (0.105).ConclusionThis study constructed an index system based on theoretical and practical considerations, and is expected to be applied to quantitatively evaluate the organisational capability of both public and private hospitals in China, and support their adaptation to external environmental changes.

Background: A hospital is a public facility that offers services to improve individual health status. One of the services offered by the hospital is an outpatient installation. As healthcare institutions, hospitals need to optimize their quality to ensure patient satisfaction with outpatient services. Method: This research is a systematic literature review that contains reviews of several studies using the PRISMA method. Related articles carry out by https://sinta.kemdikbud.go.id/journals/index/page. Inclusion criteria are the research articles must be published between the years 2018-2023, journals indexed by SINTA 1 or 2, and research subjects who were undergoing outpatient care at hospitals in Indonesia. There were 6 research articles that were close to the inclusion criteria and were determined to be the study material in this study. Results: The results of studies found that the quality of hospital services significantly influences the level of patient satisfaction. The dimensions of satisfaction including tangible, reliability, assurance, responsiveness, and empathy have a significant influence on patient satisfaction, so hospital management should be able to fulfill the five dimensions of satisfaction. Efforts can be made to improve quality by identifying indicators of patient expectations and needs regarding comfort when accessing outpatient services at hospitals Conclusion: Assessment of patient needs can be evaluated by satisfaction surveys or by providing compliant services centers. Thus, the patient's expectations can be used as an improvisational study in optimizing available facilities, the reliability, and responsiveness of officers, as well as the attitude shown by officers toward outpatients at the hospital.

The Hospital Safety Index is a tool developed by the World Health Organization and the Pan American Health Organization in 2008 and updated in 2015. Although it is the most widely used instrument of its kind to assess the level of hospital preparedness, scientific literature on its application in real life is scarce. This study aimed to investigate the use of the Hospital Safety Index to assess disaster preparedness in healthcare facilities. A retrospective, qualitative study employing semi-structured online interviews was conducted to gather the opinions and perspectives of professionals who have experience in applying the Hospital Safety Index. Authors of scientific publications using the Hospital Safety Index were recruited. A semi-structured interview guide was developed. It addressed different phases of data collection with the Hospital Safety Index, the challenges and facilitators of using it, and recommendations for future adaptations. Data were analysed using inductive thematic analysis. Nine participants who were from three countries (Serbia, Sri Lanka, and Indonesia) and had different professional backgrounds (medical doctors, engineers, spatial planners, etc.) participated in this study. A total of 5 themes and 15 subthemes emerged during data analysis. Most of the participants reported their reasons for choosing the Hospital Safety Index as being its comprehensiveness and the fact that it was issued by the World Health Organization. The tool appears to be very specific and allows investigators to spot details in hospitals; however, it is not easy to use, and training is highly encouraged to learn how to navigate the different components of the tool. Governmental support is a crucial facilitator for investigators to be able to enter hospitals and conduct their evaluations. Overall, the tool has a lot of potential, and it should be used to reach a broader audience, such as community members, and assess the preparedness of other facilities that can take part in the response to disasters (hotels, stadiums, schools, etc.). Nevertheless, it still needs more adaptations to be tailored to different contexts and settings.

EDITORIAL A scientific evidence: the OBJN has more quantitative and qualitative links. (text in English) Aurora de Afonso Costa School of Nursing - from 1944 to 2004: 60 years preparing nurses to care people´s responses to health and illness and to leader the health system. (text in English) The OBJN upgrade: now it is the official journal of the Professional Master in Nursing Program at the Fluminense Federal University Nursing School. (text in English)ORIGINAL ARTICLESClowns doctors: the child talk. (text in Portuguese) Interfaces of geriatric nursing and dental care.(text in Portuguese)Mortality for Accidents of Traffic in Rio Branco – Acre - Brazil, 2001 to 2003.(text in Portuguese)Nursing diagnosis of patients with myocardial infarction, according to the conceptual model of Florence Nightingale. (text in Portuguese)Nursing process: application to the professional practice. (text in Portuguese)Participation of nursing students in the network for the prevention of occupational accidents - REPAT. (text in Portuguese)The american tegumentary leishmaniasis in the perspective of who lives it. (text in Portuguese)The nurse’s leadership: challenges of the practice. (text in Portuguese)Understanding functional health literacy in experiences with prostate cancer: older men as consumers of health information. (text in English)Vancomycin administration in an universitary hospital at general surgical units inpatients (text in Portuguese)We have needs, too: parental needs during a child’s hospitalisation.(text in English)Work accidents with needles and other sharp medical devices in the nursing team at public hospitals - Rio Branco, Acre - Brazil.(text in Portuguese)REVIEW ARTICL ESGender, health and nursing: The male inclusion in the nursing care. (text in Portuguese)Influence of psychosociais needs in the mental health of the children.(text in Portuguese)Literature review on ineffective thermoregulation – OBNJ Club Journal.(text in Portuguese)Literature review on Neonatal Pain – OBJN Club Journal. (text in Portuguese)Literature review on newbons care – OBJN Club Journal.(text in Portuguese)Literature review on risk for impaired parenting – OBJN Club Journal. (text in Portuguese)Literature review on risk of infection in intravenous catheter related to the dialysis treatment – OBJN Club Journal. (text in Portuguese)Public policies regarding family, institutional requirement from the politics philosophy of Hegel and Marx.(text in Portuguese)Review of research about parish nursing practice (text in English)The civil responsibility of nurse as a public agent. (text in Portuguese)The contribution of philosophy, ethics, and bioethics in the Ribeirão Preto School of Nursing – USP(text in Portuguese)The importance of the insert of the thematic " violence against the woman " in the curriculum of nursing. (text in Portuguese)Work of nursing in the family health program of and its relation with the non-institucionalization.(text in Portuguese)ABSTRACTSConstruction and validation of an instrument of collection of data of the aged one in the Program of Health of the Family.Construction and validation of data collection instrument for children from 0 - 5 years.Interaction among teachers and students in the construction of the nurses professional identityKnowledge and practice of beginner and veteran (men and women) nurses in the hospital scenarioNursing in field from training: “ Natural Lab” a professional learningPsycossocial Necessities of the Client at the Unit of Chest Pain: issues for caring in the Emergency Room.The social representation of family: expectation and meaning of cardiac surgery.(text in English)PROFESSIONAL ISSUES2004 Brazilian Women Year: Visual reflections related to the female sexuality in a feminine (sexy) Brazil focusing the female nurse.(pps in Portuguese) 5th European Conference of ACENDIO: Association for Common European Nursing Diagnoses, Interventions and Outcomes (text in English)NURSES: Working with the Poor; Against Poverty. Message from ICN (text in English)OBJN 2004 thanks to the Editorial and Peer-Review Board (text in English)The Professional Master in Nursing Website (EEAAC/UFF): linking knowledge to nursing practice (text in Portuguese)Thirteen National Brazilian Nursing Research Congress (SENPE) June 2005, São Luiz, Maranhão.World Health Organization: Forum 8 + World Summit on Health Research Mexico City, November 6-10, 2004 (text in English)

Fibrolipomatous hamartoma (FLH) of the nerve, also known as lipomatosis of the nerve, neurofibrillary lipomatous lesion, or intraneural li-poma, is a rare benign soft tissue tumor which mainly occurs in the nerves of the upper limb, especially in the median nerve.In April 2021, a 30-year-old male patient was secondly admitted to our hospital and underwent his third surgery, due to the recurrence of a mass and pain in the right palm, noticeable swelling and numbness of the right index and ring fingers, and limited flexion and extension activities of the right ring finger. He first visited our hospital in December 2017 due to a mass and pain in the right palm and swelling and numbness of the right index and ring fingers. When the clinician asked for the patient medical history, his parents stated that his right middle finger was swol-len after birth. When the patient was ten years old; he was diagnosed with “mac-rodactyly” at the local county hospital, not in our hospital, and subsequently, the middle finger was amputated at the metacarpophalangeal joint level at the local county hospital. The postoperative pathological examination was not per-formed at that time, which was the first surgery the patient received.FLH is clinically rare, and its exact epidemiology and etiology are poorly understood. FLH is highly suspected in cases where a painless mass is present in the wrist, combined with macrodactyly. Magnetic resonance imaging and pathological examination are helpful in clarifying the diagnosis. Although FLH is a benign tumor, an individual treatment plan is the best choice according to the severity of the patient’s symptoms. Therefore, further exploration and understanding of this disease by clinicians radiologists, and pathologists is necessary.

ObjectivesAdverse events (AEs) following thoracic surgery place considerable strain on healthcare systems. A rigorous evaluation of the economic impact of thoracic surgical AEs remains lacking and is required to understand the value of money of formal quality improvement initiatives. Our objective was to conduct a systematic review of all available literature focused on specific cost of postoperative AEs following thoracic surgery.DesignSystematic review of the economic literature was performed, following recommendations from the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement.Data sourcesAn economic search filter developed by the Canadian Agency for Drugs and Technologies in Health was applied, and MEDLINE, Embase and The Cochrane Library were searched from inception to January 2022.Eligibility criteriaWe included English articles involving adult patients who underwent a thoracic surgical procedure with estimated costs of postoperative complications. Eligible study designs included comparative observational studies, randomised control trials, decision analytic or cost-prediction models, cost analyses, cost or burden of illness studies, economic evaluation studies and systematic reviews and/or meta-analyses of cost analyses and cost of illness studies.Data extraction and synthesisTwo reviewers independently screened titles and abstracts in the first stage and full-text articles of included studies in the second stage. Disagreements during abstract and full-text screening stages were resolved via discussion until a consensus was reached. Studies were appraised for methodological quality using the Critical Appraisal Skills Program checklist.Results3349 studies were identified: 20 met inclusion criteria. Most were conducted in the USA (12/20), evaluating AE impact on hospital expenditures (18/20). 68 procedure-specific AE mean costs were characterised (USD$). The most commonly described were anastomotic leak (mean:range) (USD$49 278:$6 176–$133 002) and pneumonia ($12 258:$2608–$34 591) following esophagectomy, and prolonged air leak ($2556:$571–$3573), respiratory failure ($19 062:$11 841–$37 812), empyema ($30 189:$23 784–$36 595), pneumonia ($15 362:$2542–$28 183), recurrent laryngeal nerve injury ($16 420:$4224–$28 616) and arrhythmia ($6835:$5833–$8659) following lobectomy.ConclusionsHospital costs associated with AEs following thoracic surgery are substantial and varied. Quantifying costs of AEs enable future economic evaluation studies, which could help prioritising value-directed quality improvement to optimally improve outcomes and reduce costs.

Background:Despite the extensive literature on work ability, few studies have looked at variables associated with work ability of nurses working fixed versus rotating shifts.Objective:The study aims were to explore variables contributing to work ability and to examine the association of demographic, job satisfaction, and work shift to work ability.Method:A cross-sectional design was utilized to assess work ability level and job satisfaction among nurses working 8 or 12 hour rotating or fixed shifts in Jordanian hospitals. The data collection tools were the Work Ability Index and the Mueller/McCloskey Satisfaction Scale. Data were analyzed to determine the extent to which job satisfaction, shift work, and demographic variables were associated with work ability.Results:Work ability level was “moderate”, while job satisfaction level was “moderately dissatisfied”. A positive significant relationship was found between work ability and job satisfaction (r = 0.347, n = 349, p < 0.000). This relationship was higher for fixed-shift workers (r =.507) compared to rotating-shift workers (r = .299). Standard linear multiple regression analysis indicated that job satisfaction level predicted work ability level (β =.347, p = .000).Conclusion:The study confirmed that promoting job satisfaction leads to higher work ability, and thus, enhances the quality of care provided. The finding that job satisfaction is predictive of work ability has implications for training intervention.

Purpose: To conduct an integrative literature review to studies that focus on the transition of premature infants from neonatal intensive care unit (NICU) to home.Method: A literature search was performed in Cumulative Index to Nursing and Allied Health Literature (CINAHL), PubMed, and MEDLINE to identify studies consisting on the transition of premature infants from hospital to home life.Results: The search yielded seven articles that emphasized the need for home visits, child and family assessment methods, methods of keeping contact with health care providers, educational and support groups, and described the nurse’s role in the transition program. The strategy to ease the transition differed in each article.Conclusion: Home visits by a nurse were a key component by providing education, support, and nursing care. A program therefore should consist of providing parents of premature infants with home visits implemented by a nurse or staying in contact with a nurse (e.g., via videoconference).

Objective: To identify the effect of the organizational culture on patient safety in the hospital context. Materials and methods: A systematic review, without meta-analysis, registered in PROSPERO with number CRD42020162981. Cross-sectional and observational studies were selected that assessed the safety environment and safety culture published between 2014 and 2020 in journals indexed in the EMBASE, Latin American and Caribbean Literature in Health Sciences (Literatura Latinoamericana e do Caribe em Ciências da Saúde, LILACS) via the Virtual Health Library (Biblioteca Virtual em Saúde, BVS), Medline (International Literature in Health Sciences) via PubMed, and Cumulative Index to Nursing and Allied Health Literature (CINAHL). Results: The findings show that a positive safety environment exerts a beneficial effect on the safety culture, favors the notification of events, and enables improvements in the quality of health care. Conclusions: The effective interaction between safety culture and organizational culture is still scarce in the literature. Most of the studies carried out investigate the situational diagnosis and little progress is made in terms of deepening the implications for the professional practice and the repercussions for the safety of hospitalized patients.

Patients who are diagnosed with squamous cell carcinoma of the pharynx have a first delayed presentation, with advanced stages of the disease. Therefore, they frequently require a multimodal approach—by surgery, radio, and chemotherapy. Due to anatomic spatial limits and particularities, therapy can imply large organ resection with difficulties in reconstruction. Nowadays, there is a paradigm shift in the management of this pathology, with significant first referral to oncology departments and initiation as the first line of treatment of radio/radio-chemotherapy. As a consequence, salvage surgery may be mandatory in some selected cases. The proposed chapter will address the oncological particularities of the pharynx, with a focus on the oro- and hypopharynx, ways of reconstruction after oncological ablative surgery of these segments, and impact on quality of life (QoL) index. Speech, respiratory, and deglutition rehabilitation of these patients is essential and will be a distinct topic. This paper will have the structure of a literature review with clinical examples of reconstruction from ENT and Head and Neck Surgery Department of Coltea Clinical Hospital, Bucharest. Reconstruction methods used in our clinic are regional flaps and biocompatible prostheses in advanced stages. QoL index in our clinic is assessed with questionnaires developed by the European Organization for Research and Treatment of Cancer – EORTC QLQ C30.

Background: Stroke outcomes depend somehow on the time taken from the symptoms onset until arrival to the specialized service. However, as it lacks literature exploring the impact of socio-demographics factors on this time, we investigated the association between Human Development Index and delay on arrival to specialized service. Design and setting: Cross-sectional study from a prospective cohort (PMID=33719516) at Hospital Geral Roberto Santos. Methods: From a total of 454 stroke patients, 156 were included in this study because they had registered address, time of admission and of symptoms onset. Patients had HDI defined by their address and were grouped into HDI categories. Results: In our sample, 57 (36,5%) individuals had medium HDI, 70 (44,9%) high HDI and 29 (18,6%) very high HDI. Very high HDI patients’ delay (2:01; 1:22-2:57) was lower than high HDI (3:05; 2:05-5:26) and medium HDI (2:25;1:45-4:04) patients. There was statistical significance comparing these groups (X²=11,41;p<0,05), but a post-hoc test revealed statistical difference just between the very high HDI and high HDI groups (p<0.05). Conclusions: We expected to find a direct relation between delay on arrival to the stroke service and HDI categories. However, this was not observed. *Authors contributed equally.

<p>Infrastructure systems are constantly exposed to uncertain demands from the environment, the users and the stakeholders. These uncertainties may negatively affect the life cycle performance and the sustainability of the structure. The traditional robust design approaches may be insufficient to face these changing conditions without compromising the system’s financial sustainability. As an alternative, system managers can implement a design approach based on the concept of flexibility. Designing for flexibility confers to the structure the ability to change when the external conditions evolve, potentially improving the life cycle performance. Unfortunately, the concept seems to be underdeveloped in the infrastructure systems literature; there is no consensus in the academic community regarding how to define flexibility and how to measure it. In this work, this situation is addressed with the formulation of an original flexibility index for a system design variable, based on the available adaptation range and the unitary adaptation cost. The proposed index is tested using a hospital building as practical example to demonstrate its applicability, and highlight some benefits provided by the implementation of flexibility in the structure’s financial performance.</p>

Objective: The immunohistochemical profile of breast cancer is based on the evaluation of estrogen and progesterone receptors, HER2 expression, and cell proliferation index. An investigation of the association of immunophenotyping of invasive breast cancer with sociodemographic characteristics and lifestyle becomes important in view of the scarcity of research in mixed populations such as the Brazilian. Methods: This cross-sectional study investigated the association of immunophenotyping of invasive breast cancer with sociodemographic characteristics and lifestyle in 583 patients seen in a cancer center in southeastern Brazil. The Pearson’s chi-square test or Fisher’s exact test was used for statistical analysis. Results: There was a higher frequency of women with the luminal B HER2-negative subtype (33.9%). The analysis of immunophenotyping with sociodemographic characteristics found a higher frequency of women aged 50 years or older in luminal A, 65.5% (p≤0.040) and medical suspicion of breast cancer at a clinical examination in HER2-positive subtype, 89.7% (p=0.015). In this research, we found no association of immunophenotyping with marital cohabitation (p=0.856), education (p=0.723), ethnicity (p=0.129), access to hospital (p=0.686), tobacco (p=0.099) and alcohol consumption (p=0.270), body mass index (p=0.584), performance of the first mammogram (p=0.477), family cancer history (p=0.254), and parity (p=0.676). Conclusion: Younger women had tumors with a worse prognosis when compared to those aged 50 years or older. Ethnicity showed no association, contrary to the wide discussion in the literature about the high frequency of the triple-negative subtype. There was no association with alcohol consumption, a factor recognized in the literature as a risk factor for the development of breast cancer.

Background: The literature is scarce in descriptions of post-stroke outcomes related to socioeconomic status. Our objective is to describe the association between stroke outcomes and Human Development Index and to evaluate this relation’s geographical distribution in the city of Salvador, Brazil. Design and Settings: Cross-sectional study at Hospital Geral Roberto Santos. Methods: Georeferencing was made using the 2010 Brazil Census. Mortality, post discharge improvement and functional independence at 90 days after stroke were the outcomes obtained with the modified Rankin Scale. Results: From 382 patients with ischemic stroke, 193 were included because they lived in Salvador and had available address information. Only 01 patient was from a low HDI, 74 (38,3%) medium HDI, 90 (46,6%) high HDI and 28 (14,5%) very high HDI region. These groups had, respectively, 4,3%, 12,1% and 10,8% mortality rate, 56,5%, 53% and 56,9% functional independence rate and 45,4%, 40,3% and 35,7% post discharge improvement rate. Only 87 patients had complete address information to be included in the geographical distribution of these results. The results were proportional to the number of individuals in each HDI region. Conclusion: The only outcome that had a direct relation with HDI is post discharge improvement. Likely, it is the outcome that better reflects the recovery assistance available to the patient with stroke. *Authors contributed equally.

<p>Seismic isolation is an effective technique for mitigating the earthquake movements on important infrastructures such as bridges and hospitals. Rubber bearings are one of the most common seismic isolation devices used for the protection of critical infrastructure assets. Isolators are critical elements of an isolated structure, and as such, they should experience limited, if any, damage during earthquake shaking. Damage associated with yielding of the reinforcing steel shims in seismic isolation rubber bearings has received limited attention in the literature. This study investigates the effect of the steel reinforcement characteristics on the behavior of rubber bearings under combined axial load, shear displacement, and rotation. The potential damage of the steel shims and the rubber bearings under design-level lateral loads is investigated using a damage index, <i>r</i>pl, and a damage factor, <i>Ω</i>, respectively, with emphasis placed on the thickness of steel shims.</p>

Introdução: Sentimento de vazio e a falta de sentido são experiências que muitas pessoas chamam de vazio interior. Esse vazio existencial é marcado por sensações de tédio e indiferença, em que o tédio é a representação da perda de interesse pelo mundo. Imprimir uma nova filosofia de entender a relação do vazio existência com o adoecimento psicológico implica na ruptura de paradigmas tradicionais existentes em nossa sociedade e automaticamente leva a questionar sobre os aspectos relacionados a esse entendimento que supostamente vem sendo adotado em todo o espaço social brasileiro. Objetivo: Desta forma, objetivou-se analisar, na literatura nacional e internacional, a relação do vazio existencial com o adoecimento psicológico e a gestão interpessoal. Material e métodos: Trata-se de uma revisão integrativa em que a busca por pesquisa foi realizada no LILACS; MEDLINE; SCIELO e index Psicologia, entre os anos de 2010 a 2020, sendo possível selecionar nove estudos que respondiam ao objetivo proposto. Resultados: Os resultados relevaram que o vazio existencial pode ser gerado por múltiplos fatores, tais como: culpa por estar com câncer, incertezas sofre o futuro, condições de trabalho e remuneração, internação em hospitais psiquiátricos e idade avançada. Como estratégia de enfrentamento os estudos mostraram a organização do trabalho, oportunidades de trabalho para a população em idade avançada, musicoterapia, espiritualidade, a religiosidade, valorização da auto-estima e das capacidades individuais. Desta maneira, o vazio existencial é uma alteração que necessita ser encarada com seriedade pelos profissionais da saúde, em todas as faixas etárias, pois é responsável por gerar sofrimento psíquico e consequentemente transtornos mentais. Conclusão: Portanto, sugere-se mias estudos nesse seguimento para melhores interpretações do vazo existencial para a ocorrência de sofrimento psíquico e precisa ser gerenciada de forma interpessoal por aquelas que sofrem.

Objective. The purpose was to review available evidence of risk factors associated with maternal morbidity and mortality in the United States during the prenatal and postpartum periods to inform a National Institutes of Health Pathways to Prevention Workshop: Identifying Risks and Interventions to Optimize Postpartum Health, held November 29–December 1, 2022. Data sources. We searched MEDLINE®, CINAHL®, and the Social Sciences Citation Index through November 2022. Review methods. We searched for observational studies examining exposures related to social and structural determinants of health and at least one health or healthcare-related outcome for pregnant and birthing people. We extracted basic study information and grouped studies by social and structural determinants of health domains and maternal outcomes. We prioritized studies according to study design and rigor of analytic approaches to address selection bias based on the ROBINS-E. We summarize all included studies and provide additional descriptions of direction of association between potential risk exposures and outcomes. Results. We identified 8,378 unique references, with 118 included studies reporting social and structural determinants of health associated with maternal health outcomes. Studies covered risk factors broadly, including identity and discrimination, socioeconomic, violence, trauma, psychological stress, structural/institutional, rural/urban, environment, comorbidities, hospital, and healthcare use factors. However, the risk factors we identified represent only a subset of potential social and structural determinants of interest. We found an unexpectedly large volume of research on violence and trauma relative to other potential exposures of interest for pregnant people. Outcome domains included maternal mortality, severe maternal morbidity, hypertensive disorders, gestational diabetes, cardio/metabolic disorders, weathering (the physiological effect of premature aging caused by chronic stressful experiences), depression, other mental health or substance use disorders, and cost/healthcare use outcomes. Depression/other mental health outcomes represented a large proportion of medical outcomes captured. Risk of bias was high, and rarely did studies report the excess risk attributable to a specific exposure. Conclusions. Identifying risk factors pregnant and birthing people face is vitally important. Limited depth and quality of available research within each social and structural determinant of health impeded our ability to outline specific pathways, including risk factor interdependence. While more recently published literature showed a trend toward increased rigor, future research can emphasize techniques that estimate the causal impacts of risk factors. Improved reporting in studies, along with organized and curated catalogues of maternal health exposures and their presumed mechanisms, would make it easier to examine exposures in the future. In the longer term, the field could be advanced by datasets designed to more fully capture the data required to robustly examine racism and other social and structural determinants of health, in combination with their intersections and feedback loops with other biologic/medical risk factors.

Objectives. Diagnostic errors are a known patient safety concern across all clinical settings, including the emergency department (ED). We conducted a systematic review to determine the most frequent diseases and clinical presentations associated with diagnostic errors (and resulting harms) in the ED, measure error and harm frequency, as well as assess causal factors. Methods. We searched PubMed®, Cumulative Index to Nursing and Allied Health Literature (CINAHL®), and Embase® from January 2000 through September 2021. We included research studies and targeted grey literature reporting diagnostic errors or misdiagnosis-related harms in EDs in the United States or other developed countries with ED care deemed comparable by a technical expert panel. We applied standard definitions for diagnostic errors, misdiagnosis-related harms (adverse events), and serious harms (permanent disability or death). Preventability was determined by original study authors or differences in harms across groups. Two reviewers independently screened search results for eligibility; serially extracted data regarding common diseases, error/harm rates, and causes/risk factors; and independently assessed risk of bias of included studies. We synthesized results for each question and extrapolated U.S. estimates. We present 95 percent confidence intervals (CIs) or plausible range (PR) bounds, as appropriate. Results. We identified 19,127 citations and included 279 studies. The top 15 clinical conditions associated with serious misdiagnosis-related harms (accounting for 68% [95% CI 66 to 71] of serious harms) were (1) stroke, (2) myocardial infarction, (3) aortic aneurysm and dissection, (4) spinal cord compression and injury, (5) venous thromboembolism, (6/7 – tie) meningitis and encephalitis, (6/7 – tie) sepsis, (8) lung cancer, (9) traumatic brain injury and traumatic intracranial hemorrhage, (10) arterial thromboembolism, (11) spinal and intracranial abscess, (12) cardiac arrhythmia, (13) pneumonia, (14) gastrointestinal perforation and rupture, and (15) intestinal obstruction. Average disease-specific error rates ranged from 1.5 percent (myocardial infarction) to 56 percent (spinal abscess), with additional variation by clinical presentation (e.g., missed stroke average 17%, but 4% for weakness and 40% for dizziness/vertigo). There was also wide, superimposed variation by hospital (e.g., missed myocardial infarction 0% to 29% across hospitals within a single study). An estimated 5.7 percent (95% CI 4.4 to 7.1) of all ED visits had at least one diagnostic error. Estimated preventable adverse event rates were as follows: any harm severity (2.0%, 95% CI 1.0 to 3.6), any serious harms (0.3%, PR 0.1 to 0.7), and deaths (0.2%, PR 0.1 to 0.4). While most disease-specific error rates derived from mainly U.S.-based studies, overall error and harm rates were derived from three prospective studies conducted outside the United States (in Canada, Spain, and Switzerland, with combined n=1,758). If overall rates are generalizable to all U.S. ED visits (130 million, 95% CI 116 to 144), this would translate to 7.4 million (PR 5.1 to 10.2) ED diagnostic errors annually; 2.6 million (PR 1.1 to 5.2) diagnostic adverse events with preventable harms; and 371,000 (PR 142,000 to 909,000) serious misdiagnosis-related harms, including more than 100,000 permanent, high-severity disabilities and 250,000 deaths. Although errors were often multifactorial, 89 percent (95% CI 88 to 90) of diagnostic error malpractice claims involved failures of clinical decision-making or judgment, regardless of the underlying disease present. Key process failures were errors in diagnostic assessment, test ordering, and test interpretation. Most often these were attributed to inadequate knowledge, skills, or reasoning, particularly in “atypical” or otherwise subtle case presentations. Limitations included use of malpractice claims and incident reports for distribution of diseases leading to serious harms, reliance on a small number of non-U.S. studies for overall (disease-agnostic) diagnostic error and harm rates, and methodologic variability across studies in measuring disease-specific rates, determining preventability, and assessing causal factors. Conclusions. Although estimated ED error rates are low (and comparable to those found in other clinical settings), the number of patients potentially impacted is large. Not all diagnostic errors or harms are preventable, but wide variability in diagnostic error rates across diseases, symptoms, and hospitals suggests improvement is possible. With 130 million U.S. ED visits, estimated rates for diagnostic error (5.7%), misdiagnosis-related harms (2.0%), and serious misdiagnosis-related harms (0.3%) could translate to more than 7 million errors, 2.5 million harms, and 350,000 patients suffering potentially preventable permanent disability or death. Over two-thirds of serious harms are attributable to just 15 diseases and linked to cognitive errors, particularly in cases with “atypical” manifestations. Scalable solutions to enhance bedside diagnostic processes are needed, and these should target the most commonly misdiagnosed clinical presentations of key diseases causing serious harms. New studies should confirm overall rates are representative of current U.S.-based ED practice and focus on identified evidence gaps (errors among common diseases with lower-severity harms, pediatric ED errors and harms, dynamic systems factors such as overcrowding, and false positives). Policy changes to consider based on this review include: (1) standardizing measurement and research results reporting to maximize comparability of measures of diagnostic error and misdiagnosis-related harms; (2) creating a National Diagnostic Performance Dashboard to track performance; and (3) using multiple policy levers (e.g., research funding, public accountability, payment reforms) to facilitate the rapid development and deployment of solutions to address this critically important patient safety concern.