Is targeting healthcares carbon footprint really the best we can do to help address the climate crisis?
I write this commentary as wildfires rage around the world, including in Greece, Italy, Siberia, Algeria and the USA. In my own country, Canada, fires have already consumed over 130 000 km21—the size of Greece—and the wildfire season has not yet ended. Recent months have also seen hundreds of millions of people suffering scorching heatwaves across Europe, China and North America. Residents of Phoenix, Arizona, endured temperatures over 43°C for 31 consecutive days this summer. In Italy, harsh heat in the south occurred at the same time as storms delivered hail the size of tennis balls in the country’s...
Source: BMJ Quality and Safety - February 19, 2024 Category: General Medicine Authors: Shojania, K. G. Tags: Viewpoints Source Type: research
Choosing Wisely and the climate crisis: a role for clinicians
There are growing calls for healthcare to confront it’s role in the climate crisis. Estimates suggest that carbon emissions from healthcare constitute 5% of net global emissions. To put this into context, emissions from all air travel are estimated at 3.5% of net global emissions.1 Health systems, organisations and clinicians have been called on to lead efforts to reduce emissions given that the climate crisis presents a major threat to human health. Ensuring appropriateness of care, and reducing overuse are central planks of strategies suggested in the literature and are increasingly being enacted by large healthcar...
Source: BMJ Quality and Safety - February 19, 2024 Category: General Medicine Authors: Born, K. B., Levinson, W., Vaux, E. Tags: Viewpoints Source Type: research
Systematic review of clinical debriefing tools: attributes and evidence for use
Conclusion
Recommendations for practice based on the findings are made. Future research should aim to further examine outcomes evidence of these tools in order to optimise the potential of CD tools for individuals, teams, healthcare systems and patients. (Source: BMJ Quality and Safety)
Source: BMJ Quality and Safety - February 19, 2024 Category: General Medicine Authors: Phillips, E. C., Smith, S. E., Tallentire, V., Blair, S. Tags: Systematic review Source Type: research
Identifying and mapping measures of medication safety during transfer of care in a digital era: a scoping literature review
Conclusion
The measures identified are insufficient for a comprehensive portfolio to assess safety of key medications during transfer of care. Further measures are required to reflect all components of transfers of care and capture the work system factors contributing to outcomes in order to support proactive intervention to reduce unwanted variation and prevent adverse outcomes. Advances in digital technology and its employment within integrated care provide opportunities for the development of such measures. (Source: BMJ Quality and Safety)
Source: BMJ Quality and Safety - February 19, 2024 Category: General Medicine Authors: Leon, C., Hogan, H., Jani, Y. H. Tags: Open access Systematic review Source Type: research
Talking about falls: a qualitative exploration of spoken communication of patients fall risks in hospitals and implications for multifactorial approaches to fall prevention
Conclusion
To support hospitals in implementing multifactorial, multidisciplinary fall prevention, we recommend: (1) focusing on patients’ individual risk factors and actions to address them (a ‘why?’ rather than a ‘who’ approach); (2) where not possible to avoid ‘high risk’ categorisations, employing ‘hybrid’ communication which emphasises actions to modify individual risk factors, as well as risk level; (3) challenging assumptions about generic interventions to identify what individual patients need; and (4) timing meetings to enable staff from different disciplines t...
Source: BMJ Quality and Safety - February 19, 2024 Category: General Medicine Authors: McVey, L., Alvarado, N., Healey, F., Montague, J., Todd, C., Zaman, H., Dowding, D., Lynch, A., Issa, B., Randell, R. Tags: Original research Source Type: research
What can Safety Cases offer for patient safety? A multisite case study
Conclusions
The Safety Case approach was recognised by those involved in the Safer Clinical Systems programme as having potential value. However, it is also fraught with challenge, highlighting the limitations of efforts to transfer safety management practices to healthcare from other sectors. (Source: BMJ Quality and Safety)
Source: BMJ Quality and Safety - February 19, 2024 Category: General Medicine Authors: Liberati, E. G., Martin, G. P., Lame, G., Waring, J., Tarrant, C., Willars, J., Dixon-Woods, M. Tags: Open access, Editor's choice Original research Source Type: research
Identifying patients with additional needs isnt enough to improve care: harnessing the benefits and avoiding the pitfalls of classification
Classification—the process of sorting people or things into groups according to shared qualities or characteristics—is increasingly used within healthcare as a means of identifying patients with particular needs and/or risks. This is important because receiving care in hospital can expose some particularly vulnerable groups of patients to increased risk of harm and poor outcomes, for example, the systemic safety inequities experienced by people with learning disabilities.1 Identifying and responding to patients with additional needs In order to deliver care that meets individual patients’ needs, health se...
Source: BMJ Quality and Safety - February 19, 2024 Category: General Medicine Authors: Armstrong, N., Sutton, E., Chew, S., Tarrant, C. Tags: Editorials Source Type: research
Using patient and carer perspectives to improve medication safety at transitions of care
It is widely known—among healthcare professionals as well as patient safety researchers—that transfers of care are a high-risk area in relation to patient safety.1 And even more importantly, the experience of patients and their families suggests likewise. For example, in a research priority setting exercise focusing on safe care for adults with complex health needs, 6 of the top 10 priorities related to transfers of care, either within or between organisations.2 While care transitions affect all elements of a person’s care, medication safety is a particular cause for concern, with a Cochrane review findin...
Source: BMJ Quality and Safety - February 19, 2024 Category: General Medicine Authors: Garfield, S., Etkind, M., Franklin, B. D. Tags: Editorials Source Type: research
Changing the patient safety mindset: can safety cases help?
Safety cases in industry In the UK and several other countries, including Norway, Australia and New Zealand, operators of safety-critical systems, such as nuclear power plants, public transportation systems and defence equipment, must develop a safety case to demonstrate that their systems are acceptably safe to operate.1 In these countries, the development, review and maintenance of safety cases are regulatory requirements. In the UK, this regulatory practice extends as of October 2023 to high-rise residential buildings following the Grenfell Tower fire in 2017, during which 72 people died. So, why are these countries pro...
Source: BMJ Quality and Safety - February 19, 2024 Category: General Medicine Authors: Sujan, M., Habli, I. Tags: Editorials Source Type: research
Our mission and how we hope to move the field forward: statement from the BMJ Quality & Safety senior editorial team 2023
The challenge Despite progress in many areas, the world continues to face significant and growing challenges to the delivery of high-quality healthcare. Consistently high levels of avoidable harm are reported internationally.1 Inequities in quality persist and solutions are in short supply.2 Implementing initiatives to increase the uptake of effective care and de-implement ineffective technologies has also proven difficult.3 4 Patient-centred care is on the ‘to do’ list for healthcare systems but in too many instances it is deprioritised by decisions that seem arbitrary and not connected to any clear ethical fr...
Source: BMJ Quality and Safety - February 19, 2024 Category: General Medicine Authors: Browne, J., Franklin, B. D., Thomas, E. J., Marang-van de Mheen, P. J. Tags: Editorials Source Type: research
Quality and safety in the literature: January 2024
Healthcare quality and safety span multiple topics across the spectrum of academic and clinical disciplines. Keeping abreast of the rapidly growing body of work can be challenging. In this series, we provide succinct summaries of selected relevant studies published in the last several months. Some articles will focus on a particular theme, whereas others will highlight unique publications from high-impact medical journals. Key points Among 210 132 pregnant or birthing persons from 78 hospitals across 4 African countries, use of a bundled care intervention (massage, uterotonic, tranexamic acid, IV fluids and examination) an...
Source: BMJ Quality and Safety - December 14, 2023 Category: General Medicine Authors: Vaid, S., Gupta, A., Houchens, N. Tags: Quality & amp; safety in the literature Source Type: research
Effect of implementing a heart failure admission care bundle on hospital readmission and mortality rates: interrupted time series study
This study aimed to evaluate the impact of developing and implementing a care bundle intervention to improve care for patients with acute heart failure admitted to a large London hospital. The intervention comprised three elements, targeted within 24 hours of admission: N-terminal pro-B-type natriuretic peptide (NT-proBNP) test, transthoracic Doppler two-dimensional echocardiography and specialist review by cardiology team. The SHIFT-Evidence approach to quality improvement was used. During implementation, July 2015–July 2017, 1169 patients received the intervention. An interrupted time series design was used to eval...
Source: BMJ Quality and Safety - December 14, 2023 Category: General Medicine Authors: Woodcock, T., Matthew, D., Palladino, R., Nakubulwa, M., Winn, T., Bethell, H., Hiles, S., Moggan, S., Dowell, J., Sullivan, P., Bell, D., Cowie, M. R. Tags: Open access Quality improvement reports Source Type: research
A realist synthesis of educational outreach visiting and integrated academic detailing to influence prescribing in ambulatory care: why relationships and dialogue matter
Conclusion
This realist synthesis elucidates that the quality of clinician-educational visitor interactions is pivotal to educational outreach visiting programmes. Building and sustaining relationships, and establishing an open dialogue are important; neglecting these undermines the impact of visits. Educational visitors can facilitate clinicians’ reflection on practice and influence their prescribing. Clinicians value the discussion of individualised, tailored information and advice they can translate into their practice.
PROSPERO registration number
CRD42021258199. (Source: BMJ Quality and Safety)
Source: BMJ Quality and Safety - December 14, 2023 Category: General Medicine Authors: Luetsch, K., Wong, G., Rowett, D. Tags: Open access Systematic review Source Type: research
Physician engagement in organisational patient safety through the implementation of a Medical Safety Huddle initiative: a qualitative study
Conclusion
The Medical Safety Huddle initiative supports physician engagement in quality and safety through intrinsic motivation. However, the huddles’ implementation must align with the organisation’s multipronged patient safety agenda to support multidisciplinary collaborative quality and safety efforts and leaders must ensure mechanisms to consistently address reported safety concerns for sustained physician engagement. (Source: BMJ Quality and Safety)
Source: BMJ Quality and Safety - December 14, 2023 Category: General Medicine Authors: Rotteau, L., Othman, D., Dunbar-Yaffe, R., Fortin, C., Go, K., Mayo, A., Pelc, J., Wolfstadt, J., Guo, M., Soong, C. Tags: Original research Source Type: research
Effects of ethical climate in association with tenure on work addiction, quality of care and staff retention: a cross-sectional study
Conclusion
Ethical climate in healthcare organisations has a significant and beneficial relationship with healthcare workers’ (HCWs) work addiction behaviours. In turn, this relationship is related to greater perceived quality of care and higher intention to remain, especially for HCWs with lower tenure. (Source: BMJ Quality and Safety)
Source: BMJ Quality and Safety - December 14, 2023 Category: General Medicine Authors: Maisonneuve, F., Groulx, P., Chenevert, D., Grady, C., Coderre-Ball, A. Tags: Original research Source Type: research
