Henry Thomas Stelfox
Dissertation Title： "Patient Safety Challenges: An Inpatient, Outpatient and Patient Satisfaction Example"This dissertation is composed of three separate studies that examined three different patient safety challenges.
In the first paper, "The safety of patients isolated for infection control," a retrospective cohort study was undertaken to examine the quality of medical care received by patients isolated for methicillin resistant Staphylococcus aureus at two large North American teaching hospitals. Two matched controls were selected for each isolated patient and we examined quality of care measures encompassing processes, outcomes, and satisfaction. We concluded that compared to controls, patients isolated for infection control reasons experience more preventable adverse events, express greater dissatisfaction with their treatment, and have less documented care.
In the second paper, "Monitoring amiodarone's toxicities: recommendations, evidence and clinical practice," we developed an evidence-based model of outpatient medication monitoring and examined monitoring practices for one medication, amiodarone. Explicit monitoring criteria were derived from the literature and a cross sectional retrospective chart review of 99 outpatients receiving amiodarone therapy between January 1, 2000 and January 1, 2001 at a large tertiary care hospital was performed to assess adherence to monitoring recommendations. We found that only 9% of outpatients received the recommended monitoring and speculated that complex monitoring requirements made it difficult for all criteria to be simultaneously satisfied.
In the third paper, "Patient ratings of physician performance: a guide to physician complaint and malpractice experiences," we examined whether it might be possible to use commonly distributed patient satisfaction surveys to identify physicians at high risk of complaints and malpractice lawsuits. Our cross-sectional study of 353 physicians at a large teaching hospital between January 1, 1983 and March 31, 2003 demonstrated that physician complaint and risk management experiences were inversely correlated with patient survey rating of physician performance. We concluded that commonly distributed satisfaction surveys might be useful tools for identifying physicians at high risk of patient complaints and malpractice litigation.