Diagnostic error among vulnerable populations presenting to the emergency department with cardiovascular and cerebrovascular or neurological symptoms: a systematic review
Conclusions
This systematic review demonstrated consistent increased odds of missed AMI/ACS diagnosis among black patients presenting to the ED compared with white patients in most studies. No consistent associations between demographic groups and DE related to cerebrovascular/neurological diagnoses were identified. More standardised approaches to study design, measurement of DE and outcomes assessment are needed to understand this problem among vulnerable populations.
Trial registration number
The study protocol was registered in the International Prospective Register of Systematic Reviews PROSPERO 2020 CRD42020178885 an...
Source: BMJ Quality and Safety - October 19, 2023 Category: General Medicine Authors: Herasevich, S., Soleimani, J., Huang, C., Pinevich, Y., Dong, Y., Pickering, B. W., Murad, M. H., Barwise, A. K. Tags: Systematic review Source Type: research
Sustaining interventions in care homes initiated by quality improvement projects: a qualitative study
This study examined the sustainability of interventions initiated by such projects.
Method
This qualitative study explored the sustainability of seven interventions initiated by three QI projects between 2016 and 2018 in UK care homes and explored the perceived influences to the sustainability of interventions. QI projects were followed up in 2019. Staff leading QI projects (n=9) and care home (n=21, from 13 care homes) and healthcare (n=2) staff took part in semi-structured interviews. Interventions were classified as sustained if the intervention was continued at the point of the study. Thematic analysis of interview da...
Source: BMJ Quality and Safety - October 19, 2023 Category: General Medicine Authors: Devi, R., Martin, G. P., Banerjee, J., Gladman, J. R., Dening, T., Barat, A., Gordon, A. L. Tags: Open access Original research Source Type: research
Engagement and fidelity of a cardiovascular disease prevention-focused digital health intervention in cardiology outpatient waiting rooms: a mixed-methods study
Conclusion
The current analysis demonstrates that engagement with a digitally delivered clinic waiting room educational intervention was high, providing explanation for its efficacy in improving motivation to change cardiovascular risk behaviours. The high fidelity of delivery demonstrates potential for scaling of such interventions across waiting rooms. Recall bias and low response rate may bias self-reported engagement measures.
Trial registration number
ANZCTR12618001725257. (Source: BMJ Quality and Safety)
Source: BMJ Quality and Safety - October 19, 2023 Category: General Medicine Authors: Mcintyre, D., Chiang, J., Thiagalingam, A., Tong, A., Chow, C. K. Tags: Original research Source Type: research
Diagnostic error experiences of patients and families with limited English-language health literacy or disadvantaged socioeconomic position in a cross-sectional US population-based survey
Conclusions
Individuals with LEHL or dSEP identified unique and actionable contributing factors to diagnostic errors. Interpreter access should be viewed as a diagnostic safety imperative, social determinants affecting care access/affordability should be routinely addressed as part of the diagnostic process and patients/families should be encouraged to access and update their medical records. The frequent and disproportionate long-term impacts from self-reported diagnostic error among LEHL/dSEP patients/families raises urgency for greater prevention and supportive efforts. (Source: BMJ Quality and Safety)
Source: BMJ Quality and Safety - October 19, 2023 Category: General Medicine Authors: Bell, S. K., Dong, J., Ngo, L., McGaffigan, P., Thomas, E. J., Bourgeois, F. Tags: Original research Source Type: research
Addressing social determinants of health in primary care: a quasi-experimental study using unannounced standardised patients to evaluate the impact of audit/feedback on physicians' rates of identifying and responding to social needs
Conclusions
Results suggest that physicians may not be consistently screening for or responding to social needs but that receiving feedback on those practices, along with brief targeted education, can improve rates of SDOH screening and response. (Source: BMJ Quality and Safety)
Source: BMJ Quality and Safety - October 19, 2023 Category: General Medicine Authors: Gillespie, C., Wilhite, J. A., Hanley, K., Hardowar, K., Altshuler, L., Fisher, H., Porter, B., Wallach, A., Zabar, S. Tags: Original research Source Type: research
Reducing opioid use for chronic non-cancer pain in primary care using an evidence-based, theory-informed, multistrategic, multistakeholder approach: a single-arm time series with segmented regression
Conclusions
Our intervention addressed the cognitive, affective and sensory factors that contribute to pain and consequent opioid use, demonstrating it could be implemented at scale and was associated with a reduction in opioid use and increasing utilisation of psychologist services. (Source: BMJ Quality and Safety)
Source: BMJ Quality and Safety - October 19, 2023 Category: General Medicine Authors: Moffat, A. K., Apajee, J., Le Blanc, V. T., Westaway, K., Andrade, A. Q., Ramsay, E. N., Blacker, N., Pratt, N. L., Roughead, E. E. Tags: Open access, Editor's choice Original research Source Type: research
Moving upstream to address diagnostic disparities
Twenty years after the National Academy of Medicine report, Unequal Treatment, called attention to inequity in the diagnostic process, many communities continue to receive less accurate and less timely diagnosis.1 2 In this issue of BMJ Quality & Safety, Herasevich and colleagues examined 20 studies encompassing more than 7 million patients presenting to the emergency department with cardiovascular or neurologic symptoms.3 Among six studies looking at cardiovascular diagnoses, the authors found that Black patients were more likely than White patients to have their acute coronary syndrome diagnosis missed; there was no ...
Source: BMJ Quality and Safety - October 19, 2023 Category: General Medicine Authors: Connor, D. M., Dhaliwal, G. Tags: Editorials Source Type: research
The opioid prescribing problem: an opportunity to embed rigorous evaluation within initiatives to improve population healthcare
The Chinese use two brush strokes to write the word ‘crisis’. One brush stroke stands for danger; the other for opportunity. John F. Kennedy The USA and Canada are experiencing an ‘opioid crisis’, with an ongoing rise in related mortality.1 Other higher income countries risk going down the same road unless current prescription trends are reversed.1 The majority of prescribing in high-income countries happens in primary care, with marked variations in opioid prescribing among practices and practitioners, incompletely explained by patient and practice factors.2 3 Across different healthcare systems, b...
Source: BMJ Quality and Safety - October 19, 2023 Category: General Medicine Authors: Alderson, S., Ivers, N. M., Foy, R. Tags: Editorials Source Type: research
Successful quality improvement project to increase hydroxyurea prescriptions for children with sickle cell anaemia
Hydroxyurea (HU) is an effective but underused disease-modifying therapy for patients with sickle cell anaemia (SCA). EMBRACE SCD, a sickle cell disease treatment demonstration project, aimed to improve access to HU by increasing prescription (Rx) rates by at least 10% from baseline in children with SCA.
The Model for Improvement was used as the quality improvement framework. HU Rx was assessed from clinical databases in three paediatric haematology centres. Children aged 9 months–18 years with SCA not on chronic transfusions were eligible for HU treatment. The health belief model was the conceptual framework to disc...
Source: BMJ Quality and Safety - September 19, 2023 Category: General Medicine Authors: Alvarez, O. A., Rodriguez-Cortes, H., Clay, E. L. J., Echenique, S., Kanter, J., Strouse, J. J., Buitrago-Mogollon, T., Courtlandt, C., Noonan, L., Osunkwo, I. Tags: Quality improvement reports Source Type: research
Visual identifiers for people with dementia in hospitals: a qualitative study to unravel mechanisms of action for improving quality of care
Conclusion
Our research highlights the potential mechanisms of action of visual identifiers and their possible negative consequences. Optimising the use of identifiers requires consensus on the rules of classification and the symbols used, and closely coupled patient information. Organisations need to provide support, offer the right resources and training and engage meaningfully with carers and patients about the use of identifiers. (Source: BMJ Quality and Safety)
Source: BMJ Quality and Safety - September 19, 2023 Category: General Medicine Authors: Sutton, E., Armstrong, N., Locock, L., Conroy, S., Tarrant, C. Tags: Open access, Editor's choice Original research Source Type: research
Error disclosure in neonatal intensive care: a multicentre, prospective, observational study
Conclusion and relevance
In the particular context of the SEPREVEN randomised controlled trial of NICUs, staff did not disclose the majority of errors to parents, especially in the absence of moderate consequence for the infant.
Trial registration number
NCT02598609. (Source: BMJ Quality and Safety)
Source: BMJ Quality and Safety - September 19, 2023 Category: General Medicine Authors: Passini, L., Le Bouedec, S., Dassieu, G., Reynaud, A., Jung, C., Keller, M.-L., Lefebvre, A., Katty, T., Baleyte, J.-M., Layese, R., Audureau, E., Caeymaex, L., SEPREVEN Study Group, Astruc, Biran, Marcus, Beghin, Guillois, Remichi, Harbi, Durrmeyer, Casa Tags: Original research Source Type: research
Types and effects of feedback for emergency ambulance staff: a systematic mixed studies review and meta-analysis
Conclusion
This review demonstrated that the evidence base currently does not support a clear single point estimate of the pooled effect of feedback to EMS staff as a single intervention type due to study heterogeneity. Further research is needed to provide guidance and frameworks supporting better design and evaluation of feedback interventions within EMS.
PROSPERO registration number
CRD42020162600. (Source: BMJ Quality and Safety)
Source: BMJ Quality and Safety - September 19, 2023 Category: General Medicine Authors: Wilson, C., Janes, G., Lawton, R., Benn, J. Tags: Open access Systematic review Source Type: research
Moving the needle: using quality improvement to address gaps in sickle cell care
In 2008, the Sickle Cell Society of the UK published clinical standards for the care of adults with sickle cell disease (SCD).1 Over the subsequent decade, nations including France, Nigeria and the USA also published national guidelines for the management of SCD across the lifespan. However, studies have repeatedly demonstrated that patients are not consistently receiving this evidence-based care, and that up to a third of providers in the USA are unaware of the guidelines.2 The barriers to appropriate care of individuals with SCD are complex, given the wide range of manifestations of the disease,1 the scarcity of haematol...
Source: BMJ Quality and Safety - September 19, 2023 Category: General Medicine Authors: Jacob, S. A., Yui, J. C. Tags: Editorials Source Type: research
Five golden rules for successful measurement of improvement
Too often, seemingly simple interventions are implemented without fully considering how the intervention might achieve the desired results, whether it can cause harm, or whether a different intervention should be considered.1–3 The tendency to favour rapid cycle implementation over analysis and measurement represents a common pitfall in quality and safety studies.4 Quality improvement and patient safety (QIPS) studies often omit the critical details underlying the success (or lack thereof) of the intervention, in part due to the perception that simple interventions do not require rigorous measurement.3 4 Consequently...
Source: BMJ Quality and Safety - September 19, 2023 Category: General Medicine Authors: Etchells, E., Trbovich, P. Tags: Editorials Source Type: research
Progressing patient safety in the Emergency Medical Services
Introduction Patients are vulnerable during emergency episodes outside the formal care sector, for example, care provided by paramedics responding to a stroke or heart attack at home. Yet much less is known about the safety of Emergency Medical Services (EMS) as compared with primary or secondary healthcare.1 This relative lack of information is important given there are aspects of EMS care that create unique patient safety challenges. EMS staff are not surrounded by the usual safety infrastructure one finds in hospitals or community facilities. The episodic nature of each interaction means EMS staff lack the information o...
Source: BMJ Quality and Safety - September 19, 2023 Category: General Medicine Authors: Lydon, S., Masterson, S., Deasy, C., O'Connor, P. Tags: Editorials Source Type: research
