Perioperative diabetes care: development and validation of quality indicators throughout the entire hospital care pathway
Conclusion
We developed a face and content valid set of quality indicators for optimal perioperative diabetes care throughout the hospital care pathway, using a rigorous and systematic approach. The results from our practice test show that it is essential to subject indicators to a practice test before applying them for quality improvement purposes.
Trial registration number
ClinicalTrials.gov: NCT01610674. (Source: BMJ Quality and Safety)
Source: BMJ Quality and Safety - June 16, 2016 Category: Journals (General) Authors: Hommel, I., van Gurp, P. J., Tack, C. J., Wollersheim, H., Hulscher, M. E. Tags: Original research Source Type: research
Impact of an electronic alert notification system embedded in radiologists workflow on closed-loop communication of critical results: a time series analysis
Conclusions
A patient safety initiative with an alert notification system reduced the proportion of critical results among reports lacking documented communication between care providers. We observed no change in documented communication of non-critical results, suggesting the system did not promote overuse. Future studies are needed to evaluate whether such systems prevent subsequent patient harm. (Source: BMJ Quality and Safety)
Source: BMJ Quality and Safety - June 16, 2016 Category: Journals (General) Authors: Lacson, R., O'Connor, S. D., Sahni, V. A., Roy, C., Dalal, A., Desai, S., Khorasani, R. Tags: Original research Source Type: research
Coproduction of healthcare service
Efforts to ensure effective participation of patients in healthcare are called by many names—patient centredness, patient engagement, patient experience. Improvement initiatives in this domain often resemble the efforts of manufacturers to engage consumers in designing and marketing products. Services, however, are fundamentally different than products; unlike goods, services are always ‘coproduced’. Failure to recognise this unique character of a service and its implications may limit our success in partnering with patients to improve health care. We trace a partial history of the coproduction concept, p...
Source: BMJ Quality and Safety - June 16, 2016 Category: Journals (General) Authors: Batalden, M., Batalden, P., Margolis, P., Seid, M., Armstrong, G., Opipari-Arrigan, L., Hartung, H. Tags: Open access Original research Source Type: research
Work conditions, mental workload and patient care quality: a multisource study in the emergency department
Conclusions
Our investigation indicated that ED staff's capability to cope with demanding work conditions was associated with patient care quality. Our findings contribute to an improved understanding of the complex effects of interruptions and multitasking in the ED environment for creating safe and efficient ED work and care systems. (Source: BMJ Quality and Safety)
Source: BMJ Quality and Safety - June 16, 2016 Category: Journals (General) Authors: Weigl, M., Müller, A., Holland, S., Wedel, S., Woloshynowych, M. Tags: Original research Source Type: research
Are reductions in emergency department length of stay associated with improvements in quality of care? A difference-in-differences analysis
Conclusions
These results suggest that a policy approach that targets only reductions in ED LOS is not associated with broader improvements in selected quality measures. At the same time, there is no evidence that efforts to address crowding have a detrimental effect on quality of care. (Source: BMJ Quality and Safety)
Source: BMJ Quality and Safety - June 16, 2016 Category: Journals (General) Authors: Vermeulen, M. J., Guttmann, A., Stukel, T. A., Kachra, A., Sivilotti, M. L. A., Rowe, B. H., Dreyer, J., Bell, R., Schull, M. Tags: Open access Original research Source Type: research
Patient safety and the problem of many hands
Summary Healthcare worldwide is faced with a crisis of patient safety: Notwithstanding occasional successes in relation to specific harms, safety as a system characteristic has remained elusive. We propose that one neglected reason why the safety problem has proved so stubborn is that healthcare suffers from a pathology known in the public administration literature as the problem of many hands. It is a problem that arises in contexts where multiple actors—organisations, individuals, groups—each contribute to effects seen at system level, but it remains difficult to hold any single actor responsible for these ef...
Source: BMJ Quality and Safety - June 16, 2016 Category: Journals (General) Authors: Dixon-Woods, M., Pronovost, P. J. Tags: Viewpoints Source Type: research
Human factors in healthcare: welcome progress, but still scratching the surface
Introduction Calls to integrate human factors and ergonomics (HFE) within healthcare and patient safety have become increasingly frequent in the last few years.1 Judging by the number of recent articles in BMJ Quality and Safety that focus on HFE,2–4 we seem to be a step closer to achieving this goal. Within the USA and UK, groups such as the Human Factors and Ergonomics Society (HFES), the Chartered Institute of Human Factors and Ergonomics (CIEHF) and the Clinical Human Factors Group (CHFG) are also making significant progress in working with clinicians, healthcare managers and patients. Developments such as the UK...
Source: BMJ Quality and Safety - June 16, 2016 Category: Journals (General) Authors: Waterson, P., Catchpole, K. Tags: Viewpoints Source Type: research
Tip of the iceberg: patient safety incidents in primary care
Primary care in the US model is fraught with safety hazards. Visits are brief and infrequent, patients are largely self-managing, often with multiple comorbid conditions, the extent of healthcare teams varies widely, and the fragmentation of health systems and lack of interoperability among electronic health records (EHRs) means that primary care providers may not have timely, accurate data about patients.1 Despite these multiple vulnerabilities, significant gaps remain in our understanding of the safety of primary care.2–4 The patient safety movement began in acute-care settings, where adverse events resulting from ...
Source: BMJ Quality and Safety - June 16, 2016 Category: Journals (General) Authors: Sarkar, U. Tags: BMJQS Noteworthy articles Editorials Source Type: research
Authors response: hand washing is about respect for patients
To the editor, Cohen1 provides a thoughtful and heartfelt clinical anecdote that complements our review of the shortfalls around hand washing among physicians.2 We agree that hand washing shows care and diligence in patient treatment. It also conveys an image of being calm rather than rushed, humble rather than self-important and wanting contact rather than distance. Unfortunately, the metaphor of just-washed warm-hands may no longer apply to modern hand sanitisers that chill the skin from evaporation. We commend Cohen for his good intentions and yet a fundamental point in behavioural research is that intentions, no matter...
Source: BMJ Quality and Safety - May 18, 2016 Category: Journals (General) Authors: Redelmeier, D. A., Shafir, E. Tags: Correspondence Source Type: research
Hand washing is all about respect for patients
The paper by Redelmeier and Shafir1 resonated strongly with me because I have always believed that there are important factors that motivate some physicians to wash their hands while others behave differently. I agree completely that this is a more complex issue than has been previously noted. I always wash my hands in front of the patients and have done so for over 40 years. This has very little to do with the risks of healthcare-associated infections and much more to do with respect for the patients and a commitment to patient-centred care. I was a paediatric resident at the Boston Children's Hospital in the mid-197...
Source: BMJ Quality and Safety - May 18, 2016 Category: Journals (General) Authors: Cohen, D. L. Tags: Correspondence Source Type: research
Reducing the number and impact of outbreaks of nosocomial viral gastroenteritis: time-series analysis of a multidimensional quality improvement initiative
Conclusions
A multiyear QI programme, including use of real-time electronic identification of patients with norovirus-like symptoms, and an early robust response to suspected infection, resulted in virtual elimination of outbreaks. The ability to identify index cases of infection early facilitates prompt action to prevent ongoing transmission and appears to be a crucial intervention. (Source: BMJ Quality and Safety)
Source: BMJ Quality and Safety - May 18, 2016 Category: Journals (General) Authors: Mitchell, C., Meredith, P., Richardson, M., Greengross, P., Smith, G. B. Tags: Original research Source Type: research
The impact of interruptions on the duration of nursing interventions: a direct observation study in an academic emergency department
This study analyses the effect of interruptions to care provided by nurses and clinical technicians on the length of clinical procedures and interventions (excluding the length of the interruption).
Methods
An observational time study of the effect of interruptions on common nursing interventions in the emergency department (ED) of a large academic medical centre was conducted. This study used direct observations of nurses and clinical technicians while delivering care to patients.
Results
The average time spent on an uninterrupted intervention was 296.47 s (median:185.15, SD:319.05), while interrupted interventions...
Source: BMJ Quality and Safety - May 18, 2016 Category: Journals (General) Authors: Cole, G., Stefanus, D., Gardner, H., Levy, M. J., Klein, E. Y. Tags: Original research Source Type: research
Strengthening the afferent limb of rapid response systems: an educational intervention using web-based learning for early recognition and responding to deteriorating patients
Conclusions
A web-based educational programme developed for hospital nurses to strengthen the afferent limb of the RRS significantly increased their knowledge and performances in assessing, managing and reporting clinical deterioration. (Source: BMJ Quality and Safety)
Source: BMJ Quality and Safety - May 18, 2016 Category: Journals (General) Authors: Liaw, S. Y., Wong, L. F., Ang, S. B. L., Ho, J. T. Y., Siau, C., Ang, E. N. K. Tags: Original research Source Type: research
Physician and other healthcare personnel responses to hospital stroke quality of care performance feedback: a qualitative study
Discussion
Physicians and other healthcare personnel described hospital performance feedback on stroke quality of care measures to be broadly valuable but identified areas of concern related to the measurement process and public reporting. (Source: BMJ Quality and Safety)
Source: BMJ Quality and Safety - May 18, 2016 Category: Journals (General) Authors: Ross, J. S., Williams, L., Damush, T. M., Matthias, M. Tags: Original research Source Type: research
Access to primary care and the route of emergency admission to hospital: retrospective analysis of national hospital administrative data
Conclusions
Among hospital inpatients admitted as an emergency, patients registered to more accessible general practices were more likely to have been admitted via a GP (vs an A and E department). This furthers evidence suggesting that access to general practice is related to use of emergency hospital services in England. The relative merits of the two admission routes remain unclear. (Source: BMJ Quality and Safety)
Source: BMJ Quality and Safety - May 18, 2016 Category: Journals (General) Authors: Cowling, T. E., Harris, M., Watt, H., Soljak, M., Richards, E., Gunning, E., Bottle, A., Macinko, J., Majeed, A. Tags: Open access Original research Source Type: research
