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2nd Edition of Clinical Risk Management: As Modern Tool for Prevention and Management of Care and Prevention Occupational Risk

A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Occupational Safety and Health".

Deadline for manuscript submissions: closed (15 May 2023) | Viewed by 8414

Special Issue Editors


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Guest Editor
Department of Human Neurosciences, “Sapienza” University of Rome, 00185 Rome, Italy
Interests: neuroscience; psychology; health professions; environment science; forensic science
Special Issues, Collections and Topics in MDPI journals

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Guest Editor
Department of Clinical and Experimental Medicine, Section of Legal Medicine, University of Foggia, 71122 Foggia, Italy
Interests: forensic science; ethic and law; toxicology; pathology; clinical risk management
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Patient safety is a growing concern in many countries, and deciphering available data and improving risk management policies are at the heart of future healthcare systems.

Over the years, the publication of the reports of the Institute of Medicine “To err is human”, “To cross the chasm of quality” and “Organization of the NHS” has shown that 8%–16.7% of patients admitted to hospitals suffer an adverse event, at least half of which are preventable. This entails enormous economic costs related to increases in hospital stay and the therapies implemented and can lead to unnecessary injuries or deaths that lead to medical liability cases. Although the subject of patient safety is so current, some disciplines struggle to produce valid analyses and therefore to set up a systematic management of clinical risks.

For example, one of the less explored disciplines today is mental health, where there is a “lack of awareness of the problems, as well as a lack of research and information on the subject”. A comprehensive review of the literature highlights an inconsistency in the basic concepts of patient safety in mental health (e.g., definition and calculation of adverse events), as well as a lack of research on high-quality patient safety in mental health. The reporting of adverse events should be encouraged in order to maintain the underpinning safety climate in order to prompt corrective and improvement actions.

In addition, the introduction of clinical risk management policies concerns both patient safety and health personnel safety, and in this perspective, there are few studies in the fields of ergonomics, infectious risk, biological risk, and environmental risk, all of which deserve further exploration. The current pandemic we are experiencing due to COVID-19 has raised a whole series of new problems that compound the issues of patient and healthcare worker safety. In this regard, an important issue is precisely the evaluation and management of biological, physical, and chemical risk in clinical care and necropsy activities.

Questions from physicians working on the front line and a series of recommendations have been developed referring to documents and papers published by national institutions and international scientific societies and journals.

Work system processes involve a variety of factors, and according to the SEIPS Human Factors approach, to be able to assess a work system and how it is organized, we also need to assess:

  1. Team and organizational culture and communication
  2. Environment
  3. Tasks required and skills to complete tasks
  4. Equipment for patient care and to protect staff
  5. The people needed to provide care
  6. The patients who will receive care

In this Special Issue on “Clinical Risk Management”, we invite front-line researchers and investigators to submit both original research and review articles regarding—but not limited to—the following potential topics:

  • National rules and laws in clinical risk management
  • Clinical risk management policies
  • Medical liability
  • Patient safety indicator
  • Adverse events
  • Violence against health workers
  • Suicide risk prevention
  • Adverse drug reactions
  • Environmental risks for healthcare personnel
  • Biological risk
  • Healthcare-associated infections

Prof. Dr. Stefano Ferracuti
Prof. Dr. Raffaele La Russa
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2500 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • clinical risk management
  • medical liability
  • HAI
  • ADR
  • suicide
  • violence
  • environmental risk

Published Papers (4 papers)

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Research

20 pages, 1070 KiB  
Article
Sleep Architecture and Sleep-Related Breathing Disorders of Seafarers on Board Merchant Ships: A Polysomnographic Pilot Field Study on the High Seas
by Fiona Kerkamm, Dorothee Dengler, Matthias Eichler, Danuta Materzok-Köppen, Lukas Belz, Felix Alexander Neumann, Birgit-Christiane Zyriax, Volker Harth and Marcus Oldenburg
Int. J. Environ. Res. Public Health 2023, 20(4), 3168; https://doi.org/10.3390/ijerph20043168 - 10 Feb 2023
Viewed by 2727
Abstract
As seafarers are assumed to have an increased risk profile for sleep-related breathing disorders, this cross-sectional observational study measured (a) the feasibility and quality of polysomnography (PSG) on board merchant ships, (b) sleep macro- and microarchitecture, (c) sleep-related breathing disorders, such as obstructive [...] Read more.
As seafarers are assumed to have an increased risk profile for sleep-related breathing disorders, this cross-sectional observational study measured (a) the feasibility and quality of polysomnography (PSG) on board merchant ships, (b) sleep macro- and microarchitecture, (c) sleep-related breathing disorders, such as obstructive sleep apnea (OSA), using the apnea–hypopnea index (AHI), and (d) subjective and objective sleepiness using the Epworth Sleepiness Scale (ESS) and pupillometry. Measurements were carried out on two container ships and a bulk carrier. A total of 19 out of 73 male seafarers participated. The PSG’s signal qualities and impedances were comparable to those in a sleep laboratory without unusual artifacts. Compared to the normal population, seafarers had a lower total sleep time, a shift of deep sleep phases in favor of light sleep phases as well as an increased arousal index. Additionally, 73.7% of the seafarers were diagnosed with at least mild OSA (AHI ≥ 5) and 15.8% with severe OSA (AHI ≥ 30). In general, seafarers slept in the supine position with a remarkable frequency of breathing cessations. A total of 61.1% of the seafarers had increased subjective daytime sleepiness (ESS > 5). Pupillometry results for objective sleepiness revealed a mean relative pupillary unrest index (rPUI) of 1.2 (SD 0.7) in both occupational groups. In addition, significantly poorer objective sleep quality was found among the watchkeepers. A need for action with regard to poor sleep quality and daytime sleepiness of seafarers on board is indicated. A slightly increased prevalence of OSA among seafarers is likely. Full article
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9 pages, 313 KiB  
Article
Proactive Risk Assessment through Failure Mode and Effect Analysis (FMEA) for Perioperative Management Model of Oral Anticoagulant Therapy: A Pilot Project
by Fausta Micheletta, Michela Ferrara, Giuseppe Bertozzi, Gianpietro Volonnino, Maria Nasso and Raffaele La Russa
Int. J. Environ. Res. Public Health 2022, 19(24), 16430; https://doi.org/10.3390/ijerph192416430 - 07 Dec 2022
Cited by 2 | Viewed by 1650
Abstract
Introduction: Correct perioperative management of anticoagulant therapy is essential to prevent thromboembolic events and reduce the risk of bleeding. The lack of universally accepted guidelines makes perioperative anticoagulant therapy management difficult. The present study aims to identify the perioperative risks of oral anticoagulant [...] Read more.
Introduction: Correct perioperative management of anticoagulant therapy is essential to prevent thromboembolic events and reduce the risk of bleeding. The lack of universally accepted guidelines makes perioperative anticoagulant therapy management difficult. The present study aims to identify the perioperative risks of oral anticoagulant therapy and to reduce adverse events through Failure Mode and Effect Analysis (FMEA). Materials and Methods: A multidisciplinary working group was set up, and four main phases of the process were identified. Each of these phases was divided into micro-activities to identify the related possible failure modes and their potential consequences. The Risk Priority Number was calculated for each failure mode. Results and Discussion: Seventeen failure modes were identified in the entire perioperative period; those with a higher priority of intervention concern the incorrect timing between therapy suspension and surgery, and the incorrect assessment of the bleeding risk related to the invasive procedure. Conclusion: The FMEA method can help identify anticoagulant therapy perioperative failures and implement the management and patient safety of surgical procedures. Full article
15 pages, 1944 KiB  
Article
Malpractice Claims and Incident Reporting: Two Faces of the Same Coin?
by Giuseppe Vetrugno, Federica Foti, Vincenzo M. Grassi, Fabio De-Giorgio, Andrea Cambieri, Renato Ghisellini, Francesco Clemente, Luca Marchese, Giuseppe Sabatelli, Giuseppe Delogu, Paola Frati and Vittorio Fineschi
Int. J. Environ. Res. Public Health 2022, 19(23), 16253; https://doi.org/10.3390/ijerph192316253 - 05 Dec 2022
Cited by 4 | Viewed by 1292
Abstract
Incident reporting is an important method to identify risks because learning from the reports is crucial in developing and implementing effective improvements. A medical malpractice claims analysis is an important tool in any case. Both incident reports and claims show cases of damage [...] Read more.
Incident reporting is an important method to identify risks because learning from the reports is crucial in developing and implementing effective improvements. A medical malpractice claims analysis is an important tool in any case. Both incident reports and claims show cases of damage caused to patients, despite incident reporting comprising near misses, cases where no event occurred and no-harm events. We therefore compare the two worlds to assess whether they are similar or definitively different. From 1 January 2014 to 31 December 2021, the claims database of Policlinico Universitario A. Gemelli IRCCS collected 843 claims. From 1 January 2020 to 31 December 2021, the incident-reporting database collected 1919 events. In order to compare the two, we used IBNR calculation, usually adopted by the insurance industry to determine loss to a company and to evaluate the real number of adverse events that occurred. Indeed, the number of reported adverse events almost overlapped with the total number of events, which is indicative that incurred-but-not-reported events are practically irrelevant. The distribution of damage events reported as claims in the period from 1 January 2020 to 31 December 2021 and related to incidents that occurred in the months of the same period, grouped by quarter, was then compared with the distribution of damage events reported as adverse events and sentinel events in the same period, grouped by quarter. The analysis of the claims database showed that the claims trend is slightly decreasing. However, the analysis of the reports database showed that, in the period 2020–2021, the reports trend was increasing. In our study, the comparison of the two, malpractice claims and incident reporting, documented many differences and weak areas of overlap. Nevertheless, this contribution represents the first attempt to compare the two and new studies focusing on single types of adverse events are, therefore, desirable. Full article
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10 pages, 2518 KiB  
Article
The Importance of Post-Mortem Investigations in Stillbirths: Case Studies and a Review of the Literature
by Carmen Scalise, Fabrizio Cordasco, Matteo Antonio Sacco, Pietrantonio Ricci and Isabella Aquila
Int. J. Environ. Res. Public Health 2022, 19(14), 8817; https://doi.org/10.3390/ijerph19148817 - 20 Jul 2022
Cited by 6 | Viewed by 2153
Abstract
Stillbirth has an important economic and social impact, though it remains “inexplicable” in many cases. We report the analysis of 11 cases of intrauterine fetal death carried out through a retrospective study conducted in the period between 2014 and 2017. The purpose of [...] Read more.
Stillbirth has an important economic and social impact, though it remains “inexplicable” in many cases. We report the analysis of 11 cases of intrauterine fetal death carried out through a retrospective study conducted in the period between 2014 and 2017. The purpose of the study is to quantify the contribution of the autopsy and placental examination in identifying the cause of stillbirths. For each case, the medical record was analyzed with the relative maternal and partner data, the results of the external fetal and autopsy examination as well as the macroscopic and histological placental examination. The peak of stillbirth was found in a maternal age group between 30 and 39 years, below the 32nd week and above the 37th week of gestation. The results obtained from the clinical history and external fetal examination make it possible to trace the cause of death in only 18.2% of cases. By adding to these data, the results of the fetal autopsy and the placental examination, it is possible to establish the cause of death in 90.9% of cases. The most frequent abnormalities found in the placenta and cord were short or hypercoiled cord, umbilical cord vascular thrombosis, turns around the neck or stretching of the funiculus, placental infarction and placental insufficiency; also, amniotic fluid abnormalities, such as suspected oligohydramnios and chorioamniositi, were found. The accurate analysis of post-mortem placental and fetal examination is essential to reduce the number of unresponsive intrauterine fetal deaths. Determining the cause of fetal death must help clinicians and parents in better management and care in future pregnancies. Full article
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