Patient safety ethics and human error management in ED contexts part I : development of the global patient safety movement

In recent years there has been increasing recognition internationally that health care is not as safe as it ought to be and that patient safety outcomes need to be improved. To this end patient safety has become the focus of a world-wide endeavour aimed at reducing the incidence and impact of preventable human errors and related adverse events in health care domains. The emergency department has been identified as a significant site of preventable human errors and adverse events in the health care system, raising important questions about the nature of human error management and patient safety ethics in rapidly changing environments. In this article (the first of a two-part discussion on the subject) an overview of the incidence and impact of preventable adverse events in ED contexts is explored. The development of a ‘culture of safety’ in other hazardous industries and the ‘lessons learned’ and applied to the health care industry are also briefly examined. In a second article (to be presented as Part II), some of the ethical tensions that have arisen in the context of implementing patient safety processes and their possible implications for ED contexts are explored.

Patient safety ethics and human error management in ED contexts Part II : Accountability and the challenge to change

In recent years there has been increasing recognition internationally that health care is not as safe as it ought to be and that patient safety outcomes need to be improved. To this end, patient safety has become the focus of a world-wide endeavour – endorsed by the World Health Organisation – to reduce the incidence and impact of preventable human errors and related adverse events in health care domains. The emergency department has been identified as a significant site of preventable human errors and adverse events in the health care system, raising important questions about the nature of human error management and patient safety ethics in rapidly changing environments, of which the Emergency Department is a prime example. In Part I of this article series, an overview of the incidence and impact of preventable adverse events in Emergency Department contexts and the development of the global patient safety movement was presented. In this second article brief attention is given to examining some of the ethical tensions that have arisen in response to the patient safety movement and their possible implications for Emergency Department contexts and staff.

Medical error and decision making : learning from the past and present in intensive care

Background : Human error occurs in every occupation. Medical errors may result in a near miss or an actual injury to a patient that has nothing to do with the underlying medical condition. Intensive care has one of the highest incidences of medical error and patient injury in any specialty medical area; thought to be related to the rapidly changing patient status and complex diagnoses and treatments.

Purpose : The aims of this paper are to: (1) outline the definition, classifications and aetiology of medical error; (2) summarise key findings from the literature with a specific focus on errors arising from intensive care areas; and (3) conclude with an outline of approaches for analysing clinical information to determine adverse events and inform practice change in intensive care.

Data source : Database searches of articles and textbooks using keywords: medical error, patient safety, decision making and intensive care. Sociology and psychology literature cited therein.

Findings : Critically ill patients require numerous medications, multiple infusions and procedures. Although medical errors are often detected by clinicians at the bedside, organisational processes and systems may contribute to the problem. A systems approach is thought to provide greater insight into the contributory factors and potential solutions to avoid preventable adverse events.

Conclusion : It is recommended that a variety of clinical information and research techniques are used as a priority to prevent hospital acquired injuries and address patient safety concerns in intensive care.

A methodology of health information security evaluation

With the conversion of paper health records to electronic health records, the health care sector is increasingly relying on technology to maintain the integrity of and update patients’ data. This reliance on technology requires an acute level of protection from technological disasters and/or threats of human error or sabotage. Research has shown there are inadequacies in the installation and use of security controls for health information records and that current methods of security analysis lack the techniques to analyse the technical and social aspects of security. This paper reports on progress towards development of a health information security evaluation methodology based on Unified Modelling Language techniques, and discusses an imminent case study that will be used for validation of the methodology.

Processes for disciplining nurses for unprofessional conduct of a serious nature : a critique

Aims: This paper critiques the deliberative processes used by the discipline panels of an Australian statutory nurse regulating authority when appraising the alleged unprofessional conduct of nurses and determining appropriate remedies.

Background: Little is known about the nature and effectiveness of the deliberative processes used by nurse regulating authorities (NRAs) disciplinary panels established to appraise and make determinations in response to allegations of unprofessional conduct by nurses.

Methods: A qualitative exploratory descriptive/pragmatic research approach was used. Data were obtained from two case-orientated sampling units: (1) 84 Reasons for Determination made between 1994 and 2000 and (2) a purposeful sample of 12 former and current nurse regulating authority members, nurse regulating authority staff and a nurse regulating authority representative who had experience of disciplinary proceedings and/or who had served on a formal hearing panel. Data were analysed using content and thematic analysis strategies.

Results: Attitudinal considerations (e.g. whether a nurse understood the 'wrongness' of his or her conduct; accepted responsibility for his or her conduct; exhibited contrition/shame during the hearing; was candid in his or her demeanour) emerged as the singularly most significant factor influencing discipline panel determinations. Disciplinary action is taken appropriately against nurses who have committed acts of deliberate malfeasance. NRAs may not, however, be dealing appropriately with nurses when disciplining them for making honest mistakes/genuine practice errors.

Conclusion: Traditional processes used for appraising and disciplining nurses who have made honest mistakes in the course of their work need to be substantially modified as they are at odds with the models of human error management that are currently being advocated and adopted globally to improve patient safety and quality of care in health care domains.

The ethics and practical importance of defining, distinguishing and disclosing nursing errors : a discussion paper

Nurses globally are required and expected to report nursing errors. As is clearly demonstrated in the international literature, fulfilling this requirement is not, however, without risks. In this discussion paper, the notion of ‘nursing error’, the practical and moral importance of defining, distinguishing and disclosing nursing errors and how a distinct definition of ‘nursing error’ fits with the new ‘system approach’ to human-error management in health care are critiqued. Drawing on international literature and two key case exemplars from the USA and Australia, arguments are advanced to support the view that although it is ‘right’ for nurses to report nursing errors, it will be very difficult for them to do so unless a non-punitive approach to nursing-error management is adopted.

The risky business of doctoral management

Universities are under no less pressure to adopt risk management strategies than other public and private organisations. The risk management of doctoral education is a particularly important issue given that a doctorate is the highest academic qualification a university offers and stakes are high in terms of assuring its quality. However, intense risk management can interfere with the intellectual and pedagogical work which are essentially part of doctoral education. This paper seeks to understand how the culture of risk meets the culture of doctoral education and with what effect. The authors draw on sociological understandings of risk in the work of Anthony Giddens (2002) and Ulrich Beck (1992), the anthropological focus on liminality in the work of Mary Douglas (1990), and the psychological theorising of human error in the work of James Reason (1990). The paper concludes that risk consciousness brings its own risks—in particular, the potential transformation of a culture based on intellect into a culture based on compliance.

Rendering optimisations for stylised sketching

We present work that specifically pertains to the rendering stage of stylised, non-photorealistic sketching. While a substantial body of work has been published on geometric optimisations, surface topologies, space-algorithms and natural media simulation, rendering-specific issues are rarely discussed in-depth even though they are often acknowledged. We investigate the most common stylised sketching approaches and identify possible rendering optimisations. In particular, we define uncertainty-functions, which are used to describe a human-error component, discuss how these pertain to geometric perturbation and textured silhouette sketching and explain how they can be cached to improve performance. Temporal coherence, which poses a problem for textured silhouette sketching, is addressed by means of an easily computed visibility-function. Lastly, we produce an effective yet surprisingly simple solution to seamless hatching, which commonly presents a large computational overhead, by using 3-D textures in a novel fashion. All our optimisations are cost-effective, easy to implement and work in conjunction with most existing algorithms.

A new interpolation error expansion based reversible watermarking algorithm considering the human visual system

Reversible watermarking has merged over the past few years as a promising solution for copyright protection, especially for applications like remote sensing, medical imaging and military applications which require lossless recovery of the host media. In this paper, we aim to extend the additive interpolation error expansion technique in [16]. We will consider the human visual system (HVS) to improve the embedding rate while maintaining the image visual quality. To this end, the just noticeable difference (JND) is used to embed more watermark bits. The experimental results show that the proposed algorithm can improve the embedding rate while preserving the image visual quality. © 2014 IEEE.

Temporal causality and the dynamics of exports, human capital and real income in China

This article employs cointegration and error-correction modelling to test the causal relationship between real income, exports and human capital stock using data for China over the period 1960 to 1999. We find that real exports, human capital and real income are cointegrated when real exports is the dependent variable, but are not cointegrated when human capital or real income are the dependent variable. In the short-run we find evidence of bi-directional Granger causality between human capital and real exports, unidirectional Granger causality running from real income to human capital and neutrality between real exports and real income.

Estimating individual glomerular volume in the human kidney : clinical perspectives

Background. Measurement of individual glomerular volumes (IGV) has allowed the identification of drivers of glomerular hypertrophy in subjects without overt renal pathology. This study aims to highlight the relevance of IGV measurements with possible clinical implications and determine how many profiles must be measured in order to achieve stable size distribution estimates.

Methods. We re-analysed 2250 IGV estimates obtained using the disector/Cavalieri method in 41 African and 34 Caucasian Americans. Pooled IGV analysis of mean and variance was conducted. Monte-Carlo (Jackknife) simulations determined the effect of the number of sampled glomeruli on mean IGV. Lin’s concordance coefficient (RC), coefficient of variation (CV) and coefficient of error (CE) measured reliability.

Results. IGV mean and variance increased with overweight and hypertensive status. Superficial glomeruli were significantly smaller than juxtamedullary glomeruli in all subjects (P < 0.01), by race (P < 0.05) and in obese individuals (P < 0.01). Subjects with multiple chronic kidney disease (CKD) comorbidities showed significant increases in IGV mean and variability. Overall, mean IGV was particularly reliable with nine or more sampled glomeruli (RC > 0.95, <5% difference in CV and CE). These observations were not affected by a reduced sample size and did not disrupt the inverse linear correlation between mean IGV and estimated total glomerular number.

Conclusions. Multiple comorbidities for CKD are associated with increased IGV mean and variance within subjects, including overweight, obesity and hypertension. Zonal selection and the number of sampled glomeruli do not represent drawbacks for future longitudinal biopsy-based studies of glomerular size and distribution.

Adaptive washout algorithm based fuzzy tuning for improving human perception

The aim of this paper is to provide a washout filter that can accurately produce vehicle motions in the simulator platform at high fidelity, within the simulators physical limitations. This is to present the driver with a realistic virtual driving experience to minimize the human sensation error between the real driving and simulated driving situation. To successfully achieve this goal, an adaptive washout filter based on fuzzy logic online tuning is proposed to overcome the shortcomings of fixed parameters, lack of human perception and conservative motion features in the classical washout filters. The cutoff frequencies of highpass, low-pass filters are tuned according to the displacement information of platform, workspace limitation and human sensation in real time based on fuzzy logic system. The fuzzy based scaling method is proposed to let the platform uses the workspace whenever is far from its margins. The proposed motion cueing algorithm is implemented in MATLAB/Simulink software packages and provided results show the capability of this method due to its better performance, improved human sensation and exploiting the platform more efficiently without reaching the motion limitation.

Human capital formation and US economic growth: A causality analysis

In this paper, Granger causality tests are applied to a new data set on human capital formation and US private sector GDP. The study is the first to test for causality between human capital formation and economic growth. It employs an error correction mechanism and is estimated through canonical cointegration regression. The results show strong evidence of casuality from human capital formation to private sector GDP and vice versa.

Incorporating human perception with the motion washout filter using fuzzy logic control

Abstract—Nowadays, classical washout filters are extensively used in commercial motion simulators. Even though there are several advantages for classical washout filters, such as short processing time, simplicity and ease of adjustment, they have several shortcomings. The main disadvantage is the fixed scheme and parameters of the classical washout filter cause inflexibility of the structure and thus the resulting simulator fails to suit all circumstances. Moreover, it is a conservative approach and the platform cannot be fully exploited. The aim of this research is to present a fuzzy logic approach and take the human perception error into account in the classical motion cueing algorithm, in order to improve both the physical limits of restitution and realistic human sensations. The fuzzy compensator signal is applied to adjust the filtered signals on the longitudinal and rotational channels online, as well as the tilt coordination to minimize the vestibular sensation error below the human perception threshold. The results indicate that the proposed fuzzy logic controllers significantly minimize the drawbacks of having fixed parameters and conservativeness in the classical washout filter. In addition, the performance of motion cueing algorithm and human perception for most occasions is improved.