Journal of Patient Safety and Risk Management

Cybersecurity is a patient safety concern. Recent cyberattacks on healthcare institutions around the world have shown the risks to patients: from delayed treatment as hospitals and clinics are shutdown, to the threat of harm from the theft of personal data, to patient death. The recent Covid-19 pandemic has further increased cyber-attacks on health organisations. In low- and middle-income countries (LMICs) digital health, including the use of health informatics systems and electronic health records, is an increasing part of the health agenda as national governments move to scale up healthcare on the path to achieving Universal Health Coverage. Frontline healthcare workers are often warned of the dangers of data mismanagement and are advised to take precautions to ensure data is safe. However, as many workers are already overstretched with conflicting administrative priorities, cybersecurity risks are going unnoticed.

In this commentary we argue that future education and training interventions for frontline healthcare workers on cybersecurity in LMICs can benefit from lessons learned from other areas of patient safety. Validated interventions, including education and awareness programmes and other simple tools, exist which can offer guidance on how cybersecurity awareness and education may be scaled up in frontline healthcare facilities, without adding an unacceptable burden to staff.

Efforts to develop frontline interventions on cybersecurity that can be easily implemented and sustained are essential to ensure patient safety is a top priority in a digitally reliant health system.

The Coroners and Justice Act allows coroners in England or Wales to issue reports after inquest, if they believe that action should be taken to prevent a future death. Coroners are under a statutory duty to issue a Prevention of Future Death (PFD) report to persons or organisations that they believe have the power to act. Cumulatively, these reports may contain useful intelligence for patient safety. The aim of this study was to examine the feasibility of extracting data from these reports and to evaluate if learning was possible from any common themes.

Reports were extracted from 2016 to 2019 for deaths in hospitals, care homes and the community in England and Wales. These were subjected to descriptive statistics and thematic analysis of coroner’s concerns. Application of data mining techniques was not possible due to data quality.

710 reports were examined, with 3469 concerns being raised (mean 4.88, range 1–33). 36 reports expressed concern about having to issue repeat PFDs to the same organisation for the same or similar concerns. Thematic analysis reliability was high (κ 0.89 unweighted) with five emerging primary themes: deficit in skill or knowledge, missed, delayed or uncoordinated care, communication and cultural issues, systems issues and lack of resources. A codebook of 53 subthemes were identified.

PFD reports offer valuable insight. Aggregation and continued analysis of these reports could offer more informed patient safety, workforce development and organisational policy. Improved data quality would allow for possible automation of analysis and faster feedback into practice.

Venous thromboembolism (VTE) is a leading cause of preventable harm in hospitalized patients. However, many doses of prescribed pharmacologic VTE prophylaxis are frequently missed. We investigated the effect of a patient-centered education bundle on missed doses of VTE prophylaxis in a community hospital.

We performed a pre-post analysis examining missed doses of VTE prophylaxis in a community hospital. A real-time alert from the electronic health record system facilitated the delivery of a patient education bundle intervention. We included all patient visits on a single floor where at least 1 dose of VTE prophylaxis was prescribed during pre- (January 1, 2018, - November 31, 2018) and post- (January 1 - June 31, 2019) intervention periods. Outcomes included any missed dose (primary) and reasons for missed doses (refusal, other [secondary]) and were compared between both periods.

1,614 patient visits were included. The proportion of any missed dose significantly decreased (13.8% vs. 8.2% [OR, 0.56; 95% CI, 0.48, 0.64]) between the pre-post intervention periods. Patient refusal was the most frequent reason for missed doses. In the post-intervention period, patient refusal significantly decreased from 8.8% to 5.0% (OR, 0.54; 95% CI, 0.46, 0.64). Similarly, other reasons for missed doses significantly decreased from 5.0% to 3.2% (OR, 0.62; 95% CI, 0.51, 0.77).

A real-time alert-triggered patient-centered education bundle developed and tested in an academic hospital, significantly reduced missed doses of prescribed pharmacologic VTE prophylaxis when disseminated to a community hospital.