Arthur Vleugels - Academia.edu (original) (raw)

Papers by Arthur Vleugels

Research paper thumbnail of Incidence and outcome of inappropriate in-hospital empiric antibiotics for severe infection: a systematic review and meta-analysis

Critical Care, 2015

The aims of this study were to explore the incidence of in-hospital inappropriate empiric antibio... more The aims of this study were to explore the incidence of in-hospital inappropriate empiric antibiotic use in patients with severe infection and to identify its relationship with patient outcomes. Methods: Medline (from 2004 to 2014) was systematically searched by using predefined inclusion criteria. Reference lists of retrieved articles were screened for additional relevant studies. The systematic review included original articles reporting a quantitative measure of the association between the use of (in)appropriate empiric antibiotics in patients with severe in-hospital infections and their outcomes. A meta-analysis, using a random-effects model, was conducted to quantify the effect on mortality by using risk ratios.

Research paper thumbnail of Validation of Hospital Administrative Dataset for adverse event screening

Quality & safety in health care, 2010

To assess whether the Belgian Hospital Discharge Dataset (B-HDDS) is a valid source for the detec... more To assess whether the Belgian Hospital Discharge Dataset (B-HDDS) is a valid source for the detection of adverse events in acute hospitals. Retrospective review of 1515 patient records in eight acute Belgian hospitals for the year 2005. Predictive value of the B-HDDS and medical record reviews and degree of correspondence between the B-HDDS and medical record reviews for five indicators: pressure ulcer, postoperative pulmonary embolism or deep vein thrombosis, postoperative sepsis, ventilator-associated pneumonia and postoperative wound infection. Postoperative wound infection received the highest positive predictive value (62.3%), whereas postoperative sepsis and ventilator-associated pneumonia were rated as only 44.2% and 29.9% respectively. Excluding present on admission from the screening substantially decreased the positive predictive value of pressure ulcer from 74.5% to 54.3%, as pressure ulcers present on admission were responsible for more B-HDDS-medical record mismatches t...

Research paper thumbnail of A quality improvement initiative to reduce ventilator-associated pneumonia at a large regional hospital

International Journal of Care Pathways, 2012

ABSTRACT Ventilator-associated pneumonia (VAP) is the leading cause of death among hospital-acqui... more ABSTRACT Ventilator-associated pneumonia (VAP) is the leading cause of death among hospital-acquired infections and prolongs time spent on the ventilator, length of intensive care unit (ICU) stay and length of hospital stay after discharge from the ICU. The ventilator bundle of the Institute of Healthcare Improvement includes five evidence-based guidelines which are proven to be effective in the prevention of VAP. The main purpose of this study is to determine the incidence of VAP at two intensive care units at the Jessa Hospital. In addition, compliance rates with the different elements of the VAP bundle are determined. From 1 January 2011 to 31 March 2011 an explorative study was conducted on a 18-bed surgical intensive care unit (SICU) and a six-bed medical intensive care unit (MICU). VAP was diagnosed using Johanson et al. criteria. Bedside observations and analysis of the electronic patient record were performed in order to determine compliance relative to the VAP bundle. At the SICU 10 VAPs were diagnosed resulting in an incidence of 38.46% and a VAP rate of 22.56. Three VAPs were diagnosed at the MICU. The incidence of VAP at the MICU was 18.75% resulting in a VAP rate of 18.75%. Compliance to all elements of the VAP bundle was observed in 0.52% (SICU) and 19.64% (MICU) of the observations. Compliance at the level of individual elements of the bundle varies between 1.03% and 99.48% (SICU) and 32.14% and 100% (MICU).

Research paper thumbnail of Management challenges in care pathways: conclusions of a qualitative study within 57 health-care organizations

International Journal of Care Pathways, 2010

ABSTRACT The objectives of this paper are to study the aim of care pathways, who has decisional p... more ABSTRACT The objectives of this paper are to study the aim of care pathways, who has decisional power concerning pathways, the actual follow-up, challenges in cross-boundary development and the support provided by information and communication technology (ICT). The study design included a qualitative study using semi-structured interviews with 88 care pathway coordinators and members of the executive board in 57 health-care organizations enrolled in the Belgian–Dutch Clinical Pathway Network. The study revealed that the most important objectives for introducing care pathways are more standardization and quality of care. In 76% of the interviewed organizations, pathways are discussed in a committee. There is a lack of continuous follow-up when care pathways are implemented. Pathways can facilitate cross-boundary care, but are a challenge because of the fragmentation within primary care. There is a need for more ICT support for care pathways. In conclusion, the executive board members and pathway coordinators state that clearly formulated objectives, a special steering committee, a clear follow-up to keep pathways alive, cross-boundary collaboration and ICT support are among the main challenges for the management of an organization.

Research paper thumbnail of Le Réseau Itinéraires Cliniques en Flandre et Aux Pays-Bas

Research paper thumbnail of Challenging patient safety culture: survey results

International Journal of Health Care Quality Assurance, 2007

The purpose of this paper is to measure patient safety culture in five Belgian general hospitals.... more The purpose of this paper is to measure patient safety culture in five Belgian general hospitals. Safety culture plays an important role in the approach towards greater patient safety in hospitals. The Patient Safety Culture Hospital questionnaire was distributed hospital-wide in five general hospitals. It evaluates ten patient safety culture dimensions and two outcomes. The scores were expressed as the percentage of positive answers towards patient safety for each dimension. The survey was conducted from March through November 2005. In total, 3,940 individuals responded (overall response rate = 77 per cent), including 2,813 nurses and assistants, 462 physicians, 397 physiotherapists, laboratory and radiology assistants, social workers and 64 pharmacists and pharmacy assistants. The dimensional positive scores were found to be low to average in all the hospitals. The lowest scores were "hospital management support for patient safety" (35 per cent), "non-punitive response to error" (36 per cent), "hospital transfers and transitions" (36 per cent), "staffing" (38 per cent), and "teamwork across hospital units" (40 per cent). The dimension "teamwork within hospital units" generated the highest score (70 per cent). Although the same dimensions were considered problematic in the different hospitals, important variations between the five hospitals were observed. A comprehensive and tailor-made plan to improve patient safety culture in these hospitals can now be developed. Results indicate that important aspects of the patient safety culture in these hospitals need improvement. This is an important challenge to all stakeholders wishing to improve patient safety.

Research paper thumbnail of The Global Trigger Tool shows that one out of seven patients suffers harm in Palestinian hospitals: challenges for launching a strategic safety plan

International Journal for Quality in Health Care, 2013

Objective. The aim of this study was to evaluate patient safety levels in Palestinian hospitals a... more Objective. The aim of this study was to evaluate patient safety levels in Palestinian hospitals and to provide guidance for policymakers involved in safety improvement efforts.

Research paper thumbnail of Use of diagnosis related groups for hospital management

Health Policy, 1989

This paper gives an overview on the use of Diagnosis Related Groups (DRGs) for internal hospital ... more This paper gives an overview on the use of Diagnosis Related Groups (DRGs) for internal hospital management. Some figures derived from a comparative study between 3 university hospitals in Belgium are used to illustrate specific points. Attention is given to cost accounting and cost control on the one hand, and utilization review and quality assurance testing on the other. Costs have been approximated by billed charges. It is concluded that DRGs can effectively be used for hospital management, in addition to hospital financing for which some pressure also exists in Europe.

Research paper thumbnail of Health Care Professionals as Second Victims after Adverse Events: A Systematic Review

Evaluation & the Health Professions, 2013

Adverse events within health care settings can lead to two victims. The first victim is the patie... more Adverse events within health care settings can lead to two victims. The first victim is the patient and family and the second victim is the involved health care professional. The latter is the focus of this review. The objectives are to determine definitions of this concept, research the prevalence and the impact of the adverse event on the second victim, and the used coping strategies. Therefore a literature research was performed by using a three-step search procedure. A total of 32 research articles and 9 nonresearch articles were identified. The second victim phenomenon was first described by Wu in 2000. In 2009, Scott et al. introduced a detailed definition of second victims. The prevalence of second victims after an adverse event varied from 10.4% up to 43.3%. Common reactions can be emotional, cognitive, and behavioral. The coping strategies used by second victims have an impact on their patients, colleagues, and themselves. After the adverse event, defensive as well as constructive changes have been reported in practice. The second victim phenomenon has a significant impact on clinicians, colleagues, and subsequent patients. Because of this broad impact it is important to offer support for second victims. When an adverse event occurs, it is critical that support networks are in place to protect both the patient and involved health care providers.

Research paper thumbnail of The Arabic version of the hospital survey on patient safety culture: a psychometric evaluation in a Palestinian sample

BMC Health Services Research, 2013

Background: A growing global interest in patient safety culture has increased the development of ... more Background: A growing global interest in patient safety culture has increased the development of validated instruments to asses this phenomenon. The aim of this study is to investigate the psychometric properties of the Hospital Survey on Patient Safety Culture (HSOPSC) and its appropriateness for Arab hospitals. Methods: The 7-step guideline of the Agency for Healthcare Research and Quality was used to translate and validate the HSOPSC. A panel of experts evaluated the face and content validity indexing of the Arabic version. Data were collected from 13 Palestinian hospitals including 2022 healthcare professionals who had direct or indirect interaction with patients, hospital supervisors, managers and administrators. Descriptive statistics and psychometric evaluation (a split-half validation technique) were then used to test and strengthen the validity and reliability of the instrument.

Research paper thumbnail of Onderzoek naar de toekomst van transmurale zorgpaden binnen Vlaanderen

Leuven: Centrum …, 2009

... Mevr. H. Alewaters Mevr. A. Glorieux Mevr. E. Van Gerven Prof. Em. Dr. J. Heyrman Prof. ... s... more ... Mevr. H. Alewaters Mevr. A. Glorieux Mevr. E. Van Gerven Prof. Em. Dr. J. Heyrman Prof. ... systeem waar de zorgkeuze (diagnostiek en therapie) in overleg tussen alle actoren genomen wordt en het verloop van het zorgproces door elke deelnemer kan gevolgd worden. ...

Research paper thumbnail of Do non-profit nursing homes separate governance roles?: The impact of size and ownership characteristics

Separation between operational responsibilities and those of oversight is an important point of d... more Separation between operational responsibilities and those of oversight is an important point of discussion in governance. Novel to the literature, this paper not only offers direct evidence on the degree of separation, but also shows its relationship with size (ceteris paribus efficiency prescribes that large organizations implement more separation) and ownership characteristics of non-profit institutions. Using a sample of Belgian

Research paper thumbnail of From Corporate Governance To Hospital Governance.: Authority, transparency and accountability of Belgian non-profit hospitals' board and management

As a result of multiple developments in health care and health care policy, hospital administrato... more As a result of multiple developments in health care and health care policy, hospital administrators, policy makers and researchers are increasingly challenged to reflect on the meaning of good hospital governance and how they can implement it in the hospital organisations.

Research paper thumbnail of Governance bij Belgische ziekenhuizen: een a(a)rtsmoeilijk probleem!

de oprichting van een Medische Raad waarvan de leden door de artsen worden verkozen. Dit orgaan h... more de oprichting van een Medische Raad waarvan de leden door de artsen worden verkozen. Dit orgaan heeft een adviesbevoegdheid naar het beheer toe alsook vetomacht omtrent voor artsen belangrijke aangelegenheden (afdrachten op honoraria, afzetting van artsen, aankoop van medische apparatuur, ...). Alzo functioneert deze Raad algauw als belangenverdediger van de artsen.

Research paper thumbnail of Quality of Care for Cardiac Surgery Patients in Belgian Acute Hospitals: An Illustration of Some Multilevel Modeling Issues

Revue d'Épidémiologie et de Santé Publique, 2008

KULeuven. ...

Research paper thumbnail of Governance in European Hospitals

Knowledge Management in E-Government, 2009

Research paper thumbnail of Validation of Hospital Administrative Dataset for adverse event screening

Quality & safety in health care, 2010

To assess whether the Belgian Hospital Discharge Dataset (B-HDDS) is a valid source for the detec... more To assess whether the Belgian Hospital Discharge Dataset (B-HDDS) is a valid source for the detection of adverse events in acute hospitals. Retrospective review of 1515 patient records in eight acute Belgian hospitals for the year 2005. Predictive value of the B-HDDS and medical record reviews and degree of correspondence between the B-HDDS and medical record reviews for five indicators: pressure ulcer, postoperative pulmonary embolism or deep vein thrombosis, postoperative sepsis, ventilator-associated pneumonia and postoperative wound infection. Postoperative wound infection received the highest positive predictive value (62.3%), whereas postoperative sepsis and ventilator-associated pneumonia were rated as only 44.2% and 29.9% respectively. Excluding present on admission from the screening substantially decreased the positive predictive value of pressure ulcer from 74.5% to 54.3%, as pressure ulcers present on admission were responsible for more B-HDDS-medical record mismatches t...

Research paper thumbnail of A quality improvement initiative to reduce ventilator-associated pneumonia at a large regional hospital

International Journal of Care Pathways, 2012

ABSTRACT Ventilator-associated pneumonia (VAP) is the leading cause of death among hospital-acqui... more ABSTRACT Ventilator-associated pneumonia (VAP) is the leading cause of death among hospital-acquired infections and prolongs time spent on the ventilator, length of intensive care unit (ICU) stay and length of hospital stay after discharge from the ICU. The ventilator bundle of the Institute of Healthcare Improvement includes five evidence-based guidelines which are proven to be effective in the prevention of VAP. The main purpose of this study is to determine the incidence of VAP at two intensive care units at the Jessa Hospital. In addition, compliance rates with the different elements of the VAP bundle are determined. From 1 January 2011 to 31 March 2011 an explorative study was conducted on a 18-bed surgical intensive care unit (SICU) and a six-bed medical intensive care unit (MICU). VAP was diagnosed using Johanson et al. criteria. Bedside observations and analysis of the electronic patient record were performed in order to determine compliance relative to the VAP bundle. At the SICU 10 VAPs were diagnosed resulting in an incidence of 38.46% and a VAP rate of 22.56. Three VAPs were diagnosed at the MICU. The incidence of VAP at the MICU was 18.75% resulting in a VAP rate of 18.75%. Compliance to all elements of the VAP bundle was observed in 0.52% (SICU) and 19.64% (MICU) of the observations. Compliance at the level of individual elements of the bundle varies between 1.03% and 99.48% (SICU) and 32.14% and 100% (MICU).

Research paper thumbnail of Management challenges in care pathways: conclusions of a qualitative study within 57 health-care organizations

International Journal of Care Pathways, 2010

ABSTRACT The objectives of this paper are to study the aim of care pathways, who has decisional p... more ABSTRACT The objectives of this paper are to study the aim of care pathways, who has decisional power concerning pathways, the actual follow-up, challenges in cross-boundary development and the support provided by information and communication technology (ICT). The study design included a qualitative study using semi-structured interviews with 88 care pathway coordinators and members of the executive board in 57 health-care organizations enrolled in the Belgian–Dutch Clinical Pathway Network. The study revealed that the most important objectives for introducing care pathways are more standardization and quality of care. In 76% of the interviewed organizations, pathways are discussed in a committee. There is a lack of continuous follow-up when care pathways are implemented. Pathways can facilitate cross-boundary care, but are a challenge because of the fragmentation within primary care. There is a need for more ICT support for care pathways. In conclusion, the executive board members and pathway coordinators state that clearly formulated objectives, a special steering committee, a clear follow-up to keep pathways alive, cross-boundary collaboration and ICT support are among the main challenges for the management of an organization.

Research paper thumbnail of Incidence and outcome of inappropriate in-hospital empiric antibiotics for severe infection: a systematic review and meta-analysis

Critical Care, 2015

The aims of this study were to explore the incidence of in-hospital inappropriate empiric antibio... more The aims of this study were to explore the incidence of in-hospital inappropriate empiric antibiotic use in patients with severe infection and to identify its relationship with patient outcomes. Medline (from 2004 to 2014) was systematically searched by using predefined inclusion criteria. Reference lists of retrieved articles were screened for additional relevant studies. The systematic review included original articles reporting a quantitative measure of the association between the use of (in)appropriate empiric antibiotics in patients with severe in-hospital infections and their outcomes. A meta-analysis, using a random-effects model, was conducted to quantify the effect on mortality by using risk ratios. In total, 27 individual articles fulfilled the inclusion criteria. The percentage of inappropriate empiric antibiotic use ranged from 14.1% to 78.9% (Q1-Q3: 28.1% to 57.8%); 13 of 27 studies (48.1%) described an incidence of 50% or more. A meta-analysis for 30-day mortality and in-hospital mortality showed risk ratios of 0.71 (95% confidence interval 0.62 to 0.82) and 0.67 (95% confidence interval 0.56 to 0.80), respectively. Studies with outcome parameter 28-day and 60-day mortality reported significantly (P ≤0.02) higher mortality rates in patients receiving inappropriate antibiotics. Two studies assessed the total costs, which were significantly higher in both studies (P ≤0.01). This systematic review with meta-analysis provides evidence that inappropriate use of empiric antibiotics increases 30-day and in-hospital mortality in patients with a severe infection.

Research paper thumbnail of Incidence and outcome of inappropriate in-hospital empiric antibiotics for severe infection: a systematic review and meta-analysis

Critical Care, 2015

The aims of this study were to explore the incidence of in-hospital inappropriate empiric antibio... more The aims of this study were to explore the incidence of in-hospital inappropriate empiric antibiotic use in patients with severe infection and to identify its relationship with patient outcomes. Methods: Medline (from 2004 to 2014) was systematically searched by using predefined inclusion criteria. Reference lists of retrieved articles were screened for additional relevant studies. The systematic review included original articles reporting a quantitative measure of the association between the use of (in)appropriate empiric antibiotics in patients with severe in-hospital infections and their outcomes. A meta-analysis, using a random-effects model, was conducted to quantify the effect on mortality by using risk ratios.

Research paper thumbnail of Validation of Hospital Administrative Dataset for adverse event screening

Quality & safety in health care, 2010

To assess whether the Belgian Hospital Discharge Dataset (B-HDDS) is a valid source for the detec... more To assess whether the Belgian Hospital Discharge Dataset (B-HDDS) is a valid source for the detection of adverse events in acute hospitals. Retrospective review of 1515 patient records in eight acute Belgian hospitals for the year 2005. Predictive value of the B-HDDS and medical record reviews and degree of correspondence between the B-HDDS and medical record reviews for five indicators: pressure ulcer, postoperative pulmonary embolism or deep vein thrombosis, postoperative sepsis, ventilator-associated pneumonia and postoperative wound infection. Postoperative wound infection received the highest positive predictive value (62.3%), whereas postoperative sepsis and ventilator-associated pneumonia were rated as only 44.2% and 29.9% respectively. Excluding present on admission from the screening substantially decreased the positive predictive value of pressure ulcer from 74.5% to 54.3%, as pressure ulcers present on admission were responsible for more B-HDDS-medical record mismatches t...

Research paper thumbnail of A quality improvement initiative to reduce ventilator-associated pneumonia at a large regional hospital

International Journal of Care Pathways, 2012

ABSTRACT Ventilator-associated pneumonia (VAP) is the leading cause of death among hospital-acqui... more ABSTRACT Ventilator-associated pneumonia (VAP) is the leading cause of death among hospital-acquired infections and prolongs time spent on the ventilator, length of intensive care unit (ICU) stay and length of hospital stay after discharge from the ICU. The ventilator bundle of the Institute of Healthcare Improvement includes five evidence-based guidelines which are proven to be effective in the prevention of VAP. The main purpose of this study is to determine the incidence of VAP at two intensive care units at the Jessa Hospital. In addition, compliance rates with the different elements of the VAP bundle are determined. From 1 January 2011 to 31 March 2011 an explorative study was conducted on a 18-bed surgical intensive care unit (SICU) and a six-bed medical intensive care unit (MICU). VAP was diagnosed using Johanson et al. criteria. Bedside observations and analysis of the electronic patient record were performed in order to determine compliance relative to the VAP bundle. At the SICU 10 VAPs were diagnosed resulting in an incidence of 38.46% and a VAP rate of 22.56. Three VAPs were diagnosed at the MICU. The incidence of VAP at the MICU was 18.75% resulting in a VAP rate of 18.75%. Compliance to all elements of the VAP bundle was observed in 0.52% (SICU) and 19.64% (MICU) of the observations. Compliance at the level of individual elements of the bundle varies between 1.03% and 99.48% (SICU) and 32.14% and 100% (MICU).

Research paper thumbnail of Management challenges in care pathways: conclusions of a qualitative study within 57 health-care organizations

International Journal of Care Pathways, 2010

ABSTRACT The objectives of this paper are to study the aim of care pathways, who has decisional p... more ABSTRACT The objectives of this paper are to study the aim of care pathways, who has decisional power concerning pathways, the actual follow-up, challenges in cross-boundary development and the support provided by information and communication technology (ICT). The study design included a qualitative study using semi-structured interviews with 88 care pathway coordinators and members of the executive board in 57 health-care organizations enrolled in the Belgian–Dutch Clinical Pathway Network. The study revealed that the most important objectives for introducing care pathways are more standardization and quality of care. In 76% of the interviewed organizations, pathways are discussed in a committee. There is a lack of continuous follow-up when care pathways are implemented. Pathways can facilitate cross-boundary care, but are a challenge because of the fragmentation within primary care. There is a need for more ICT support for care pathways. In conclusion, the executive board members and pathway coordinators state that clearly formulated objectives, a special steering committee, a clear follow-up to keep pathways alive, cross-boundary collaboration and ICT support are among the main challenges for the management of an organization.

Research paper thumbnail of Le Réseau Itinéraires Cliniques en Flandre et Aux Pays-Bas

Research paper thumbnail of Challenging patient safety culture: survey results

International Journal of Health Care Quality Assurance, 2007

The purpose of this paper is to measure patient safety culture in five Belgian general hospitals.... more The purpose of this paper is to measure patient safety culture in five Belgian general hospitals. Safety culture plays an important role in the approach towards greater patient safety in hospitals. The Patient Safety Culture Hospital questionnaire was distributed hospital-wide in five general hospitals. It evaluates ten patient safety culture dimensions and two outcomes. The scores were expressed as the percentage of positive answers towards patient safety for each dimension. The survey was conducted from March through November 2005. In total, 3,940 individuals responded (overall response rate = 77 per cent), including 2,813 nurses and assistants, 462 physicians, 397 physiotherapists, laboratory and radiology assistants, social workers and 64 pharmacists and pharmacy assistants. The dimensional positive scores were found to be low to average in all the hospitals. The lowest scores were "hospital management support for patient safety" (35 per cent), "non-punitive response to error" (36 per cent), "hospital transfers and transitions" (36 per cent), "staffing" (38 per cent), and "teamwork across hospital units" (40 per cent). The dimension "teamwork within hospital units" generated the highest score (70 per cent). Although the same dimensions were considered problematic in the different hospitals, important variations between the five hospitals were observed. A comprehensive and tailor-made plan to improve patient safety culture in these hospitals can now be developed. Results indicate that important aspects of the patient safety culture in these hospitals need improvement. This is an important challenge to all stakeholders wishing to improve patient safety.

Research paper thumbnail of The Global Trigger Tool shows that one out of seven patients suffers harm in Palestinian hospitals: challenges for launching a strategic safety plan

International Journal for Quality in Health Care, 2013

Objective. The aim of this study was to evaluate patient safety levels in Palestinian hospitals a... more Objective. The aim of this study was to evaluate patient safety levels in Palestinian hospitals and to provide guidance for policymakers involved in safety improvement efforts.

Research paper thumbnail of Use of diagnosis related groups for hospital management

Health Policy, 1989

This paper gives an overview on the use of Diagnosis Related Groups (DRGs) for internal hospital ... more This paper gives an overview on the use of Diagnosis Related Groups (DRGs) for internal hospital management. Some figures derived from a comparative study between 3 university hospitals in Belgium are used to illustrate specific points. Attention is given to cost accounting and cost control on the one hand, and utilization review and quality assurance testing on the other. Costs have been approximated by billed charges. It is concluded that DRGs can effectively be used for hospital management, in addition to hospital financing for which some pressure also exists in Europe.

Research paper thumbnail of Health Care Professionals as Second Victims after Adverse Events: A Systematic Review

Evaluation & the Health Professions, 2013

Adverse events within health care settings can lead to two victims. The first victim is the patie... more Adverse events within health care settings can lead to two victims. The first victim is the patient and family and the second victim is the involved health care professional. The latter is the focus of this review. The objectives are to determine definitions of this concept, research the prevalence and the impact of the adverse event on the second victim, and the used coping strategies. Therefore a literature research was performed by using a three-step search procedure. A total of 32 research articles and 9 nonresearch articles were identified. The second victim phenomenon was first described by Wu in 2000. In 2009, Scott et al. introduced a detailed definition of second victims. The prevalence of second victims after an adverse event varied from 10.4% up to 43.3%. Common reactions can be emotional, cognitive, and behavioral. The coping strategies used by second victims have an impact on their patients, colleagues, and themselves. After the adverse event, defensive as well as constructive changes have been reported in practice. The second victim phenomenon has a significant impact on clinicians, colleagues, and subsequent patients. Because of this broad impact it is important to offer support for second victims. When an adverse event occurs, it is critical that support networks are in place to protect both the patient and involved health care providers.

Research paper thumbnail of The Arabic version of the hospital survey on patient safety culture: a psychometric evaluation in a Palestinian sample

BMC Health Services Research, 2013

Background: A growing global interest in patient safety culture has increased the development of ... more Background: A growing global interest in patient safety culture has increased the development of validated instruments to asses this phenomenon. The aim of this study is to investigate the psychometric properties of the Hospital Survey on Patient Safety Culture (HSOPSC) and its appropriateness for Arab hospitals. Methods: The 7-step guideline of the Agency for Healthcare Research and Quality was used to translate and validate the HSOPSC. A panel of experts evaluated the face and content validity indexing of the Arabic version. Data were collected from 13 Palestinian hospitals including 2022 healthcare professionals who had direct or indirect interaction with patients, hospital supervisors, managers and administrators. Descriptive statistics and psychometric evaluation (a split-half validation technique) were then used to test and strengthen the validity and reliability of the instrument.

Research paper thumbnail of Onderzoek naar de toekomst van transmurale zorgpaden binnen Vlaanderen

Leuven: Centrum …, 2009

... Mevr. H. Alewaters Mevr. A. Glorieux Mevr. E. Van Gerven Prof. Em. Dr. J. Heyrman Prof. ... s... more ... Mevr. H. Alewaters Mevr. A. Glorieux Mevr. E. Van Gerven Prof. Em. Dr. J. Heyrman Prof. ... systeem waar de zorgkeuze (diagnostiek en therapie) in overleg tussen alle actoren genomen wordt en het verloop van het zorgproces door elke deelnemer kan gevolgd worden. ...

Research paper thumbnail of Do non-profit nursing homes separate governance roles?: The impact of size and ownership characteristics

Separation between operational responsibilities and those of oversight is an important point of d... more Separation between operational responsibilities and those of oversight is an important point of discussion in governance. Novel to the literature, this paper not only offers direct evidence on the degree of separation, but also shows its relationship with size (ceteris paribus efficiency prescribes that large organizations implement more separation) and ownership characteristics of non-profit institutions. Using a sample of Belgian

Research paper thumbnail of From Corporate Governance To Hospital Governance.: Authority, transparency and accountability of Belgian non-profit hospitals' board and management

As a result of multiple developments in health care and health care policy, hospital administrato... more As a result of multiple developments in health care and health care policy, hospital administrators, policy makers and researchers are increasingly challenged to reflect on the meaning of good hospital governance and how they can implement it in the hospital organisations.

Research paper thumbnail of Governance bij Belgische ziekenhuizen: een a(a)rtsmoeilijk probleem!

de oprichting van een Medische Raad waarvan de leden door de artsen worden verkozen. Dit orgaan h... more de oprichting van een Medische Raad waarvan de leden door de artsen worden verkozen. Dit orgaan heeft een adviesbevoegdheid naar het beheer toe alsook vetomacht omtrent voor artsen belangrijke aangelegenheden (afdrachten op honoraria, afzetting van artsen, aankoop van medische apparatuur, ...). Alzo functioneert deze Raad algauw als belangenverdediger van de artsen.

Research paper thumbnail of Quality of Care for Cardiac Surgery Patients in Belgian Acute Hospitals: An Illustration of Some Multilevel Modeling Issues

Revue d'Épidémiologie et de Santé Publique, 2008

KULeuven. ...

Research paper thumbnail of Governance in European Hospitals

Knowledge Management in E-Government, 2009

Research paper thumbnail of Validation of Hospital Administrative Dataset for adverse event screening

Quality & safety in health care, 2010

To assess whether the Belgian Hospital Discharge Dataset (B-HDDS) is a valid source for the detec... more To assess whether the Belgian Hospital Discharge Dataset (B-HDDS) is a valid source for the detection of adverse events in acute hospitals. Retrospective review of 1515 patient records in eight acute Belgian hospitals for the year 2005. Predictive value of the B-HDDS and medical record reviews and degree of correspondence between the B-HDDS and medical record reviews for five indicators: pressure ulcer, postoperative pulmonary embolism or deep vein thrombosis, postoperative sepsis, ventilator-associated pneumonia and postoperative wound infection. Postoperative wound infection received the highest positive predictive value (62.3%), whereas postoperative sepsis and ventilator-associated pneumonia were rated as only 44.2% and 29.9% respectively. Excluding present on admission from the screening substantially decreased the positive predictive value of pressure ulcer from 74.5% to 54.3%, as pressure ulcers present on admission were responsible for more B-HDDS-medical record mismatches t...

Research paper thumbnail of A quality improvement initiative to reduce ventilator-associated pneumonia at a large regional hospital

International Journal of Care Pathways, 2012

ABSTRACT Ventilator-associated pneumonia (VAP) is the leading cause of death among hospital-acqui... more ABSTRACT Ventilator-associated pneumonia (VAP) is the leading cause of death among hospital-acquired infections and prolongs time spent on the ventilator, length of intensive care unit (ICU) stay and length of hospital stay after discharge from the ICU. The ventilator bundle of the Institute of Healthcare Improvement includes five evidence-based guidelines which are proven to be effective in the prevention of VAP. The main purpose of this study is to determine the incidence of VAP at two intensive care units at the Jessa Hospital. In addition, compliance rates with the different elements of the VAP bundle are determined. From 1 January 2011 to 31 March 2011 an explorative study was conducted on a 18-bed surgical intensive care unit (SICU) and a six-bed medical intensive care unit (MICU). VAP was diagnosed using Johanson et al. criteria. Bedside observations and analysis of the electronic patient record were performed in order to determine compliance relative to the VAP bundle. At the SICU 10 VAPs were diagnosed resulting in an incidence of 38.46% and a VAP rate of 22.56. Three VAPs were diagnosed at the MICU. The incidence of VAP at the MICU was 18.75% resulting in a VAP rate of 18.75%. Compliance to all elements of the VAP bundle was observed in 0.52% (SICU) and 19.64% (MICU) of the observations. Compliance at the level of individual elements of the bundle varies between 1.03% and 99.48% (SICU) and 32.14% and 100% (MICU).

Research paper thumbnail of Management challenges in care pathways: conclusions of a qualitative study within 57 health-care organizations

International Journal of Care Pathways, 2010

ABSTRACT The objectives of this paper are to study the aim of care pathways, who has decisional p... more ABSTRACT The objectives of this paper are to study the aim of care pathways, who has decisional power concerning pathways, the actual follow-up, challenges in cross-boundary development and the support provided by information and communication technology (ICT). The study design included a qualitative study using semi-structured interviews with 88 care pathway coordinators and members of the executive board in 57 health-care organizations enrolled in the Belgian–Dutch Clinical Pathway Network. The study revealed that the most important objectives for introducing care pathways are more standardization and quality of care. In 76% of the interviewed organizations, pathways are discussed in a committee. There is a lack of continuous follow-up when care pathways are implemented. Pathways can facilitate cross-boundary care, but are a challenge because of the fragmentation within primary care. There is a need for more ICT support for care pathways. In conclusion, the executive board members and pathway coordinators state that clearly formulated objectives, a special steering committee, a clear follow-up to keep pathways alive, cross-boundary collaboration and ICT support are among the main challenges for the management of an organization.

Research paper thumbnail of Incidence and outcome of inappropriate in-hospital empiric antibiotics for severe infection: a systematic review and meta-analysis

Critical Care, 2015

The aims of this study were to explore the incidence of in-hospital inappropriate empiric antibio... more The aims of this study were to explore the incidence of in-hospital inappropriate empiric antibiotic use in patients with severe infection and to identify its relationship with patient outcomes. Medline (from 2004 to 2014) was systematically searched by using predefined inclusion criteria. Reference lists of retrieved articles were screened for additional relevant studies. The systematic review included original articles reporting a quantitative measure of the association between the use of (in)appropriate empiric antibiotics in patients with severe in-hospital infections and their outcomes. A meta-analysis, using a random-effects model, was conducted to quantify the effect on mortality by using risk ratios. In total, 27 individual articles fulfilled the inclusion criteria. The percentage of inappropriate empiric antibiotic use ranged from 14.1% to 78.9% (Q1-Q3: 28.1% to 57.8%); 13 of 27 studies (48.1%) described an incidence of 50% or more. A meta-analysis for 30-day mortality and in-hospital mortality showed risk ratios of 0.71 (95% confidence interval 0.62 to 0.82) and 0.67 (95% confidence interval 0.56 to 0.80), respectively. Studies with outcome parameter 28-day and 60-day mortality reported significantly (P ≤0.02) higher mortality rates in patients receiving inappropriate antibiotics. Two studies assessed the total costs, which were significantly higher in both studies (P ≤0.01). This systematic review with meta-analysis provides evidence that inappropriate use of empiric antibiotics increases 30-day and in-hospital mortality in patients with a severe infection.