Preface

Chapter 8 **Pressure Injury in the ICU: Major Reconstructive Surgery**

Chapter 10 **Patient Self-Harm in the Emergency Department: An Evidence-**

Ronya Silmi, Joshua Luster, Jacqueline Seoane, Stanislaw P. Stawicki, Thomas J. Papadimos, Farhad Sholevar and Christine

Chapter 9 **Wrong Blood Type: Transfusion Reaction 149** Holly Ringhauser and James Cipolla

**Required 109** Ashley Jordan

**VI** Contents

**Based Approach 157**

Marchionni

Since the late 1990s, a truly global movement to improve patient safety has evolved into the modern paradigm where safety and quality of care are enmeshed with virtually every as‐ pect of healthcare. This would not be possible without the early pioneers of patient safety, whose vision has evolved into a truly global movement that is helping to improve lives and outcomes of our patients around the world.

This work was conceived because of the continued need for a practical, easy-to-use, and at the same time comprehensive reference in the area of patient safety. The goal of this book cycle is to introduce the reader to key concepts in patient safety while providing clinically relevant context to each case vignette. Although there may be some conceptual overlap be‐ tween different chapters and volumes of the *Vignettes in Patient Safety*, this is done intention‐ ally to help reinforce the most critical concepts and patient safety processes while also allowing for different authors and teams to present their unique perspectives, experiences, and thoughts on these complex topics.

By embracing the case-based, practical approach to patient safety scenarios, we hope to sup‐ port the next phase of growth and development of the global healthcare quality and safety movement. Within this paradigm, the intent is to build on the foundations of the past two decades, to incorporate new evidence-based data, and to synthesize new knowledge that will rejuvenate the cycle of continuous healthcare self-improvement and further enmesh‐ ment of quality and safety into everyday practice of medicine. Moreover, by presenting cas‐ es, the authors can better convey to the readers that while such events are common in healthcare, many occurrences can be prevented using system-based approaches to solutions rather than accepting a defeatist perspective that adverse patient outcomes are inherently unavoidable. In essence, healthcare providers—at all levels—must continue to think beyond the events that occurred during their "shift work" to recognize that they are part of a larger continuum of care and that the fundamental guiding statement should always be "how can we all do better for our patients."

The editors would like to acknowledge the contribution and hard work of all the people who made this work possible. First and foremost, we thank our families and friends, with‐ out whom the time and effort required to complete this book cycle would simply not be feasible. Second, we would like to express our gratitude to all chapter contributors. Their effort is greatly appreciated, and we are confident that this work will help improve both safety and quality of care for patients around the world. Finally, we would like to acknowl‐ edge the generosity of all the departments and institutions for the support of contributing

authors and teams. Institutional embrace of the open access concept helps facilitate the unre‐ stricted, free availability of scientific knowledge contained in this and many other open ac‐ cess books. As such, we believe the open access paradigm to be the ultimate way of fostering scholarly pursuits and universal sharing of scientific information.

#### **Michael S. Firstenberg MD, FACC,**

**Chapter 1**

**Introductory Chapter: The Decades Long Quest**

Stanislaw P. Stawicki and Michael S. Firstenberg

Additional information is available at the end of the chapter

http://dx.doi.org/10.5772/intechopen.69354

didactic goal of each respective chapter.

**1. Introduction**

**Continues Toward Better, Safer Healthcare Systems**

As the Editors of *Vignettes in Patients Safety*, it is our pleasure to introduce the reader to this collection of problem-oriented, clinically focused chapters discussing various topics in one of the most important areas of healthcare. Each chapter in this collection will feature a clinical vignette, followed by an in-depth discussion of patient safety topics related to the corresponding clinical scenario. Vignettes described throughout this work constitute a blend of previously reported, publically available experiences related to actual patient safety events and carefully crafted, highly realistic scenarios that were designed specifically to fulfill the

The teachings of Hippocrates, a Greek physician, constitute the conceptual foundation of modern science, art, and practice of medicine [1]. For centuries, enhancements in patient safety were based on educational, technological and methodological progress combined with largely reactive, safety event-based response [2]. As the critical mass of available evidence irrefutably demonstrated the relationship between preventable iatrogenic harm and the associated morbidity and mortality, the medical community began to address the problem in a more organized, proactive fashion [2]. As the movement of patient safety and advocacy gained momentum, the way we understand and practice medicine began to slowly transition, with the parallel developments gradually morphing into a new synthetic state, including the emergence of institutional safety champions and evidence-based, peer-reviewed scientific contributions. In effect, the way we practice medicine and design our medical systems and institutions began to evolve so as to incorporate "patient safety thinking" as one of the fundamental and essential components of the overall paradigm [3]. No longer could physicians continue to practice in the "silos" of their specialty or individual practices and expect that if they performed at a level consistent with the standard of care, then an excellent outcome is to be expected. Everyone must be taught to recognize that they have active ownership in their patients' care and should be held accountable to that end. Additionally, with the growing emphasis on team-based

> © 2017 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Summa Health System, Cardiothoracic Surgery, Akron, OH, USA

**Stanislaw P. Stawicki MD, MBA, FACS,**

St. Luke's University Health Network, Department of Research and Innovation, Bethlehem, PA, USA
