The role of embedded research in quality improvement: a narrative review
Introduction The use of research evidence to facilitate improvements in healthcare quality continues to be a topic widely debated by scholars and practitioners.1 2 The concept of ‘knowledge mobilisation’ has been developed, with strategies to help bridge this gap.3 These strategies include the development of "a culture of partnership between academic researchers and decision-makers to assist in strengthening the development of policy, practice and social innovation, or the co-production of knowledge".3 4 It is based on the premise that knowledge that is collected and created ‘on the ground’, through...
Source: BMJ Quality and Safety - December 13, 2016 Category: Journals (General) Authors: Vindrola-Padros, C., Pape, T., Utley, M., Fulop, N. J. Tags: Open access Narrative review Source Type: research
Considering chance in quality and safety performance measures: an analysis of performance reports by boards in English NHS trusts
Conclusions
Hospital board members are expected to consider large amounts of information. Control charts can help board members distinguish signals from noise, but often boards are not using them. We discuss demand-side and supply-side barriers that could be overcome to increase use of control charts in healthcare. (Source: BMJ Quality and Safety)
Source: BMJ Quality and Safety - December 13, 2016 Category: Journals (General) Authors: Schmidtke, K. A., Poots, A. J., Carpio, J., Vlaev, I., Kandala, N.-B., Lilford, R. J. Tags: Original research Source Type: research
Reporting and design elements of audit and feedback interventions: a secondary review
Conclusions
Our process identified 17 A&F design elements, demonstrated gaps in reporting and helped understand the degree of variation in A&F interventions. (Source: BMJ Quality and Safety)
Source: BMJ Quality and Safety - December 13, 2016 Category: Journals (General) Authors: Colquhoun, H., Michie, S., Sales, A., Ivers, N., Grimshaw, J. M., Carroll, K., Chalifoux, M., Eva, K., Brehaut, J. Tags: Original research Source Type: research
How might health services capture patient-reported safety concerns in a hospital setting? An exploratory pilot study of three mechanisms
This study presents an exploratory pilot of three mechanisms for collecting data on safety concerns from patients during their hospital stay.
Method
Three mechanisms for capturing safety concerns were coproduced with healthcare professionals and patients, before being tested in an exploratory trial using cluster randomisation at the ward level. Nine wards participated, with each mechanism being tested over a 3-month study period. Patients were asked to feed back safety concerns via the mechanism on their ward (interviewing at their bedside, paper-based form or patient safety ‘hotline’). Safety concerns were su...
Source: BMJ Quality and Safety - December 13, 2016 Category: Journals (General) Authors: O'Hara, J. K., Armitage, G., Reynolds, C., Coulson, C., Thorp, L., Din, I., Watt, I., Wright, J. Tags: Original research Source Type: research
Understanding patient-centred readmission factors: a multi-site, mixed-methods study
Conclusion
Patients readmitted within 30 days reported understanding their discharge plans, but frequent difficulties in self-care and low anticipatory guidance for resolving these issues after discharge. (Source: BMJ Quality and Safety)
Source: BMJ Quality and Safety - December 13, 2016 Category: Journals (General) Authors: Greysen, S. R., Harrison, J. D., Kripalani, S., Vasilevskis, E., Robinson, E., Metlay, J., Schnipper, J. L., Meltzer, D., Sehgal, N., Ruhnke, G. W., Williams, M. V., Auerbach, A. D. Tags: Editor's choice Original research Source Type: research
Closing the loop: a process evaluation of inpatient care team communication
Introduction Interprofessional communication is a core component of healthcare delivery in inpatient settings and a key contributor to safe and efficient inpatient care. Communication is implicated in two-thirds of medical errors and accounts for a significant proportion of nurse and clinician time.1–4 Inpatient teams rely on multiple communication methods ranging from paging and stationary telephones to wireless mobile devices, but comparative evaluations of communication systems are largely limited to qualitative outcomes.5–10 With respect to safety and efficiency, key measures of communication system perform...
Source: BMJ Quality and Safety - December 13, 2016 Category: Journals (General) Authors: Kummerow Broman, K., Kensinger, C., Hart, H., Mathisen, J., Kripalani, S. Tags: Original research Source Type: research
Why do we still page each other? Examining the frequency, types and senders of pages in academic medical services
Conclusions
Paging remains widely used for communications within hospitals about patient care. Although the majority of pages were judged to be clinically relevant and important, they frequently required a response potentially leading to interruptions in workflow, and communication waste. Paging rate and volume has not decreased in 25 years despite significant penetration of newer technologies. For the majority of current uses of pages, we believe other approaches may now be more appropriate. Regionalisation significantly reduces the number and urgency of the pages. (Source: BMJ Quality and Safety)
Source: BMJ Quality and Safety - December 13, 2016 Category: Journals (General) Authors: Carlile, N., Rhatigan, J. J., Bates, D. W. Tags: BMJQS Noteworthy articles Original research Source Type: research
Do patients' disruptive behaviours influence the accuracy of a doctor's diagnosis? A randomised experiment
Conclusions
Disruptive behaviours displayed by patients seem to induce doctors to make diagnostic errors. Interestingly, the confrontation with difficult patients does however not cause the doctor to spend less time on such case. Time can therefore not be considered an intermediary between the way the patient is perceived, his or her likability and diagnostic performance. (Source: BMJ Quality and Safety)
Source: BMJ Quality and Safety - December 13, 2016 Category: Journals (General) Authors: Schmidt, H. G., van Gog, T., CE Schuit, S., Van den Berge, K., LA Van Daele, P., Bueving, H., Van der Zee, T., W Van den Broek, W., LCM Van Saase, J., Mamede, S. Tags: Press releases Original research Source Type: research
Why patients disruptive behaviours impair diagnostic reasoning: a randomised experiment
Conclusions
Difficult patients’ behaviours induce doctors to make diagnostic errors, apparently because doctors spend part of their mental resources on dealing with the difficult patients’ behaviours, impeding adequate processing of clinical findings. Efforts should be made to increase doctors’ awareness of the potential negative influence of difficult patients’ behaviours on diagnostic decisions and their ability to counteract such influence. (Source: BMJ Quality and Safety)
Source: BMJ Quality and Safety - December 13, 2016 Category: Journals (General) Authors: Mamede, S., Van Gog, T., Schuit, S. C. E., Van den Berge, K., Van Daele, P. L. A., Bueving, H., Van der Zee, T., Van den Broek, W. W., Van Saase, J. L. C. M., Schmidt, H. G. Tags: Press releases Original research Source Type: research
From stoplight reports to time series: equipping boards and leadership teams to drive better decisions
One of us was shown a letter received by a hospital infection control leader from the CEO congratulating her on an excellent monthly performance—for the previous month MRSA infections had decreased from 4 to 2 cases. A couple of months later the same CEO sent a letter expressing serious concern, asking for an explanation of why the monthly MRSA cases had doubled from 2 to 4. Implicit in the CEO's letter is an all too common misunderstanding when using point-to-point data comparisons that every data point is a signal of meaningful change. Absent any information about or understanding of the nature and extent of the un...
Source: BMJ Quality and Safety - December 13, 2016 Category: Journals (General) Authors: Mountford, J., Wakefield, D. Tags: Editorials Source Type: research
Self-care after hospital discharge: knowledge is not enough
In this issue of BMJ Quality and Safety, Greysen and colleagues present results of a large, multi-institutional interview study of readmitted patients’ perspectives of post-discharge care.1 Investigators interviewed over 1000 patients while they were readmitted to one of 12 academic medical centres and asked them a variety of questions about barriers to recovery after their previous discharge. More than half of patients reported difficulty carrying out the care plan given to them when they were first discharged from the hospital, even though the vast majority reported no difficulties understanding what they were supp...
Source: BMJ Quality and Safety - December 13, 2016 Category: Journals (General) Authors: Horwitz, L. I. Tags: Editorials Source Type: research
Turning the page on hospital communications slowly
In hospitals, breakdowns in communication has been found to be a major source of errors.1 Communication between clinicians can occur at scheduled times or rounds, through face-to-face meetings or may be facilitated through the use of communication tools such as pagers. For the latter, often urgent communication between clinicians about a patient is required. Problems in communication can result in a failure to rescue or result in poor coordination of care.2 In this issue of the journal, two articles describe the communication process within hospitals from different perspectives. Carlile et al3 looked at paging from the phy...
Source: BMJ Quality and Safety - December 13, 2016 Category: Journals (General) Authors: Wu, R. Tags: Editorials Source Type: research
A 'busy day effect on perinatal complications of delivery on weekends: a retrospective cohort study
Conclusions
Our findings suggest that weekend delivery is a consistent risk factor for a range of perinatal complications and there may be variability in how well hospitals handle surges in volume. (Source: BMJ Quality and Safety)
Source: BMJ Quality and Safety - December 13, 2016 Category: Journals (General) Authors: Snowden, J. M., Kozhimannil, K. B., Muoto, I., Caughey, A. B., McConnell, K. J. Tags: Open access Electronic page Source Type: research
Unwanted patients and unwanted diagnostic errors
Introduction Real people have real emotions that motivate their thinking. For example, the hopes of having a child can lead women with infertility to undergo courses of intense hormonal treatments and the fear of dying can lead men with prostate cancer to undergo surgical castration.1 Much of the attention towards advanced directives and discussions about goals of care are intended to document and legitimize a patient's emotions related to death and dying. Indeed, guidelines for physician-aided-dying suggest that a patient's emotions are sometimes more important than life itself.2 In contrast, the emotions of a physician a...
Source: BMJ Quality and Safety - December 13, 2016 Category: Journals (General) Authors: Redelmeier, D. A., Etchells, E. E. Tags: Press releases Editorials Source Type: research
Leveraging the electronic medical record to reduce the rate of hospital acquired clostridium difficile at an academic safety net hospital
Conclusions
Through the use of QI and leveraging changes in the eMAR improves appropriate testing and patient isolation reducing the risk of hospital acquired CDI.
Figure 1C.diff PCR order screen modification, advisory and demonstrated reduction in repeat testing.
Figure 2Laxative BPA reduction in test volume.
Figure 3New Order Panel and instructions to discontinue isolation if result negative.
Figure 4Outcome measure. (Source: BMJ Quality and Safety)
Source: BMJ Quality and Safety - November 17, 2016 Category: Journals (General) Authors: Gregson, D., Burke, R., Miller, N. S., Ostrander, T., Jawa, R., Phull, P., Scanlon, K., Fleming, K., Bradley, M., Steinke, J., Jung, Y., Pierre, C. Tags: Abstracts Source Type: research
