Despite efforts over the past 20 years, the patient safety movement still struggles to establish lasting prevention strategies for adverse outcomes, with miscommunication being a major contributor to medical errors.
Healthcare continues to face vulnerabilities like inconsistent processes, skills, and communication. To address this, many organizations are reviving efforts to become High Reliability Organizations (HROs), led by quality and patient safety leaders.
This session will focus on reducing process and communication variability, particularly during handoffs. We’ll explore data from malpractice carriers, findings from the Joint Commission, and research on the impact of variation on patient safety. By implementing structured communication models, especially in handoffs, healthcare can enhance reliability and significantly improve safety, quality, and patient experience outcomes.
We learn in TeamSTEPPS training that “conflict is inevitable in all groups.” Fortunately, TeamSTEPPS provides tools and strategies to prevent and mitigate conflict in teams.
We’ll review real TeamSTEPPS examples from the Emergency Department and consider how conflict was potentially prevented. We’ll also examine a case where conflict was present and discuss how TeamSTEPPS tools kept the team safe and helped maintain professional relationships.
To Err is Human, Do no harm, Safety Culture, High Reliability to just name a few are all terms within the Medication Safety community. Join us as we discuss medication error events, path to prevention, and pitfalls when we fail to act accordingly.
This session will explore Gabby’s journey as she sought medical help for failure to thrive. Gabby’s mother will share their experiences with multiple doctor visits, a pediatric Gastroenterology (GI) specialist will discuss the failure to thrive workup, and an emergency department (ED) and trauma specialist will address the ultimate diagnosis and strategies for supporting patients like Gabby. Ultimately, Gabby was admitted to the hospital where her diagnosis was determined, marking the beginning of a new chapter in her life.
As research has grown to show that clinical care is not the strongest determinant in health outcomes, it’s increasingly more common for healthcare entities to prioritize health equity and address health disparities in patients and the community. Additionally, recent shifts in state and federal policy encourage healthcare organizations to take accountability for addressing social determinants […]
In this enlightening session, speaker will delve into the complexities surrounding the timely detection of sepsis, emphasizing the importance of not overanalyzing its signs and symptoms. Sepsis, a global issue, often presents itself in a way that mimics other causes, leading to misdiagnosis or delayed intervention. By addressing this challenge head-on, we aim to equip […]
Medication reconciliation is an essential process in healthcare that plays a crucial role in ensuring patient safety and positive health outcomes. It involves reviewing and verifying a patient’s medication history to ensure accurate and comprehensive medication lists. This process is particularly crucial during care transitions, such as hospital admission or discharge, to avoid medication-related adverse […]
Managing a patient who is withdrawing from alcohol is a complex balance of accurate assessments, consistent and aggressive medication management, and clear communication between the multi-disciplinary team. The case being presented follows a comprehensive Root Cause Analysis that was performed following the death of a patient withdrawing from alcohol. The case highlights the many challenges […]
Despite California’s recent improvements in perinatal care and outcomes, Black mothers / birthing people are still multiple times more likely to die from pregnancy/birth-related causes and twice as likely to suffer a maternal morbidity (such as hemorrhage and infection) than those in other racial/ethnic groups. Hospitals are naturally called upon to help address these disparities, and […]
CHPSO invites member hospitals to attend a Safe Table Forum via teleconference. Click here to see if your hospital is a CHPSO member.