Initial opioid prescription characteristics and risk of opioid misuse, poisoning and dependence: retrospective cohort study
Conclusions
Our study identifies riskier patterns of opioid prescription initiation for non-cancer indications, as well as patient subgroups with higher risk of misuse, poisoning and dependence. (Source: BMJ Quality and Safety)
Source: BMJ Quality and Safety - December 14, 2023 Category: General Medicine Authors: Garcia-Sempere, A., Hurtado, I., Robles, C., Llopis-Cardona, F., Sanchez-Saez, F., Rodriguez-Bernal, C., Peiro-Moreno, S., Sanfelix-Gimeno, G. Tags: Open access, Editor's choice Original research Source Type: research
Education and educational interventions: moving beyond information provision
Many of us will be familiar with educational outreach visits (EVs), which according to the Effective Practice and Organisation of Care taxonomy are defined as ‘personal visits by a trained person to health workers in their own settings, to provide information with the aim of changing practice’. But is merely providing information enough to achieve a change in practice, and through which mechanisms? In this issue of BMJ Quality & Safety, Luetsch and colleagues1 undertook a rigorous, transparent realist synthesis exploring how EVs work to influence prescribing behaviour in ambulatory care settings. Based on a...
Source: BMJ Quality and Safety - December 14, 2023 Category: General Medicine Authors: Mattick, K., Noble, C. Tags: Editorials Source Type: research
Medical safety huddles to engage frontline physicians in patient safety: calling physicians back to the table
It is broadly recognised that everyone has a role in making healthcare safe,1 yet hospitals continue to struggle with incorporating frontline physicians in quality improvement and patient safety work.2 One cornerstone of hospital-based quality improvement and patient safety work is multidisciplinary huddling. Multidisciplinary huddles—brief, focused, stand up meetings involving physicians, nurses, administrators, laboratory workers and other staff—can improve medical care by enabling collaborative and efficient information exchange and fostering a shared view of current clinical conditions.3 Huddles operational...
Source: BMJ Quality and Safety - December 14, 2023 Category: General Medicine Authors: Pimentel, C. B., Pimentel, M. P. T., Hartmann, C. W. Tags: Editorials Source Type: research
Work addiction and quality of care in healthcare: Working long hours should not be confused with addiction to work
Behavioural addictions are addictions that do not involve the ingestion of psychoactive substances and yet feature all the core features found in more traditional substance-based addictions (eg, withdrawal symptoms, mood modification, tolerance, salience, conflict and relapse).1 Although a couple of behavioural addictions have now been formally recognised in major psychiatric and medical diagnostic manuals such as the Diagnostic and Statistical Manual for Mental Disorders and the International Classification of Diseases (ie, addictions to gambling and gaming), all other types of behavioural addiction have not been formally...
Source: BMJ Quality and Safety - December 14, 2023 Category: General Medicine Authors: Griffiths, M. D. Tags: Editorials Source Type: research
Contextualising opioid-related risk factors before an initial opioid prescription
When asked about the similarities between the region of Valencia, Spain and the State of Oregon in the USA, an artificial-intelligence (AI)-driven chatbot poetically listed several common features, such as natural beauty, strong focus on agricultural industries including wine production, extensive outdoor activities and a shared commitment to sustainable practices. But are there similarities in healthcare delivery, considering vastly different systems and significant practice variability, particularly regarding the management of pain and the role of opioid analgesics? Here, the differences emerge. Oxycodone and hydrocodone...
Source: BMJ Quality and Safety - December 14, 2023 Category: General Medicine Authors: Weiner, S. G., Hoppe, J. A. Tags: Editorials Source Type: research
Factors that influence the implementation of (inter)nationally endorsed health and social care standards: a systematic review and meta-summary
Conclusions
The most frequently reported enablers related to available support tools, education and shared learning. The most frequently reported barriers related to a lack of knowledge of standards, staffing issues and insufficient funds. Incorporating these findings into the selection of implementation strategies will enhance the likelihood of effective implementation of standards and subsequently, improve safe, quality care for people using health and social care services. (Source: BMJ Quality and Safety)
Source: BMJ Quality and Safety - November 20, 2023 Category: General Medicine Authors: Kelly, Y., O'Rourke, N., Flynn, R., OConnor, L., Hegarty, J. Tags: Open access Systematic review Source Type: research
Handling missing values in the analysis of between-hospital differences in ordinal and dichotomous outcomes: a simulation study
Missing data are frequently encountered in registries that are used to compare performance across hospitals. The most appropriate method for handling missing data when analysing differences in outcomes between hospitals with a generalised linear mixed model is unclear. We aimed to compare methods for handling missing data when comparing hospitals on ordinal and dichotomous outcomes. We performed a simulation study using data from the Multicentre Randomised Controlled Trial of Endovascular Treatment for Acute Ischaemic Stroke in the Netherlands (MR CLEAN) Registry, a prospective cohort study in 17 hospitals performing endov...
Source: BMJ Quality and Safety - November 20, 2023 Category: General Medicine Authors: van Linschoten, R. C. A., Amini, M., van Leeuwen, N., Eijkenaar, F., den Hartog, S. J., Nederkoorn, P. J., Hofmeijer, J., Emmer, B. J., Postma, A. A., van Zwam, W., Roozenbeek, B., Dippel, D., Lingsma, H. F., MR CLEAN Registry Investigators Tags: Research and reporting methodology Source Type: research
Safety implications of remote assessments for suspected COVID-19: qualitative study in UK primary care
Conclusion
Lessons from the pandemic suggest three key strategies are needed to prevent avoidable deaths and inequalities in the next crisis: (1) strengthen system resilience (including improved resourcing and staffing; support of new tools and processes; and recognising primary care’s role as the ‘risk sink’ of the healthcare system); (2) develop evidence-based triage and scoring systems; and (3) address social vulnerability. (Source: BMJ Quality and Safety)
Source: BMJ Quality and Safety - November 20, 2023 Category: General Medicine Authors: Wieringa, S., Neves, A. L., Rushforth, A., Ladds, E., Husain, L., Finlay, T., Pope, C., Greenhalgh, T. Tags: Open access, COVID-19 Original research Source Type: research
Did the Acute Frailty Network improve outcomes for older people living with frailty? A staggered difference-in-difference panel event study
Conclusions
To realise its aims, the AFN might need to develop better resourced intervention and implementation strategies. (Source: BMJ Quality and Safety)
Source: BMJ Quality and Safety - November 20, 2023 Category: General Medicine Authors: Street, A., Maynou, L., Conroy, S. Tags: Original research Source Type: research
Unintended consequences of the 18-week referral to treatment standard in NHS England: a threshold analysis
Conclusion
We observed striking evidence of a threshold effect suggesting that while targets change behaviour, they do so in a selective way, focusing on the threshold rather than a pervasive improvement in practice. However, at the height of the pandemic, as almost no trusts could reach the target, the threshold effect disappeared. (Source: BMJ Quality and Safety)
Source: BMJ Quality and Safety - November 20, 2023 Category: General Medicine Authors: Quinn, L., Bird, P., Remsing, S., Reeves, K., Lilford, R. Tags: Open access, Press releases Original research Source Type: research
Patient safety and hospital visiting at the end of life during COVID-19 restrictions in Aotearoa New Zealand: a qualitative study
Conclusion
Visitor rights and visitor policy at the end of life require greater protection during a pandemic. Transparent, coherent, publicly available evidence-based guidelines that key stakeholders, including patients, families and ethicists, are included in producing, are urgently required. We want to avert a legacy of disenfranchised grief in future pandemics. (Source: BMJ Quality and Safety)
Source: BMJ Quality and Safety - November 20, 2023 Category: General Medicine Authors: Collier, A., Balmer, D., Gilder, E., Parke, R. Tags: Editor's choice, COVID-19 Original research Source Type: research
Its time for the field of geriatrics to invest in implementation science
Hospitalisation is one of the most vulnerable times in an older adult’s life, associated with increased risks of functional and cognitive decline and death.1 2 These risks are magnified for those with pre-existing cognitive or functional impairment.3 4 In response, the geriatrics research community has tested new care delivery models to improve hospital care for older adults and reduce these negative outcomes. Models such as Age-Friendly Health Systems,5 Acute Care for the Elderly units6 and the Hospital Elder Life Program (HELP)7 represent comprehensive assessment and intervention programmes with a robust evidence b...
Source: BMJ Quality and Safety - November 20, 2023 Category: General Medicine Authors: Prusaczyk, B., Burke, R. E. Tags: Editorials Source Type: research
Targets: unintended and unanticipated effects
Targets have assumed a central role in the management of healthcare and public services more generally in the UK over the last 25 years. They emerged from ideas of ‘new public management’ in the 1980s and of a strong performance management approach under prime minister Tony Blair from 1997.1 While targets can be effective2 and are an important part of public accountability, Quinn3 provides more evidence in this issue of the journal that they can also produce unintended or unanticipated consequences, some of which are unhelpful. They investigated the impact that an English NHS target has had on referral practice...
Source: BMJ Quality and Safety - November 20, 2023 Category: General Medicine Authors: Edwards, N., Black, S. Tags: Press releases Editorials Source Type: research
Meeting external demands to improve quality and safety of care: learning systematically from the literature
Practices that are known to be effective in improving patient safety are routinely either left unimplemented or not sustained in practice. Handwashing, checklists to reduce the risk of central line-associated blood stream infections and systems for medicine reconciliation all serve as examples of basic practices that fail too often. More complex practices or standards of care such as improving the management of chronic diseases like diabetes and hypertension can be even more challenging to implement and sustain. Because of these challenges, understanding the barriers and facilitators to implementation is critical to achiev...
Source: BMJ Quality and Safety - November 20, 2023 Category: General Medicine Authors: Needleman, J. Tags: Editorials Source Type: research
The Ethical Complexity of Restricting Visitors during the COVID-19 Pandemic
Background Across the globe, there were significant variations in government responses to the COVID-19 pandemic, with some countries putting in place public health measures which were criticised as too draconian, while elsewhere there were calls for a further tightening of restrictions to protect vulnerable members of society. As the pandemic unfolded, healthcare leaders responded rapidly to the urgent need to contain the spread of infection and to ration and reallocate resources. One of the most controversial and emotive issues arising from the critical phases of the pandemic was the imposition of restrictions on visitors...
Source: BMJ Quality and Safety - November 20, 2023 Category: General Medicine Authors: Campbell, L., Morley, G. Tags: Editorials Source Type: research
