Disclosing medical errors: prioritising the needs of patients and families
A slow but significant change has occurred in how healthcare professionals and organisations are expected to respond when something has gone wrong in a patient’s care.1 In 2001, the US accreditation organisation The Joint Commission began to require that healthcare facilities disclose all outcomes of care, including ‘unanticipated outcomes’, to patients.2 Over time and across the world, the need to be transparent with patients and families when care has not gone well is now recognised as a key element of high-quality, safe and patient-centred healthcare. In 2020, the US National Steering Committee for Pat...
Source: BMJ Quality and Safety - September 19, 2023 Category: General Medicine Authors: Gallagher, T. H., Hemmelgarn, C., Benjamin, E. M. Tags: Editorials Source Type: research
Days alive and at home after hip fracture: a cross-sectional validation of a patient-centred outcome measure using routinely collected data
Conclusion
DAH has face, construct and predictive validity as a patient-centred outcome in patients with hip fracture, with an estimated MID of 11 days. Future research is required to include direct patient perspectives in confirming MID. (Source: BMJ Quality and Safety)
Source: BMJ Quality and Safety - August 17, 2023 Category: General Medicine Authors: McIsaac, D. I., Talarico, R., Jerath, A., Wijeysundera, D. N. Tags: Open access Original research Source Type: research
Patient-centred outcomes of imaging tests: recommendations for patients, clinicians and researchers
Conclusions
Using PCOs to inform healthcare decision-making will require ways of collating and presenting information on PCOs in ways that can inform patient–provider decision-making, and developing methods to determine the relative importance of outcomes (including test accuracy) to one another. (Source: BMJ Quality and Safety)
Source: BMJ Quality and Safety - August 17, 2023 Category: General Medicine Authors: Thompson, M. J., Suchsland, M. Z., Hardy, V., Lavallee, D. C., Lord, S., Devine, E. B., Jarvik, J. G., Findlay, S., Trikalinos, T. A., Walter, F. M., Chou, R., Green, B. B., Wernli, K. J., Fitzpatrick, A. L., Bossuyt, P. M. Tags: Open access Original research Source Type: research
Effect of a health system payment and quality improvement programme for tonsillectomy in Ontario, Canada: an interrupted time series analysis
Conclusions
The payment and quality improvement programme was associated with several improvements in quality of care. These findings may inform jurisdictions planning health system interventions to improve quality of care for tonsillectomy and other paediatric procedures. (Source: BMJ Quality and Safety)
Source: BMJ Quality and Safety - August 17, 2023 Category: General Medicine Authors: Mahant, S., Guan, J., Zhang, J., Gandhi, S., Propst, E. J., Guttmann, A. Tags: Original research Source Type: research
Repurposing the Ordering of Routine Laboratory Tests in Hospitalised Medical Patients (RePORT): results of a cluster randomised stepped-wedge quality improvement study
Conclusions
A multifaceted intervention bundle using education and facilitated multilevel social comparison was associated with a safe and effective reduction in use of routine daily laboratory testing in hospitals. Further research is needed to understand how system-level interventions may increase this effect and which intervention elements are necessary to sustain results. (Source: BMJ Quality and Safety)
Source: BMJ Quality and Safety - August 17, 2023 Category: General Medicine Authors: Ambasta, A., Omodon, O., Herring, A., Ferrie, L., Pokharel, S., Mehta, A., Liu, L., Hews-Girard, J., Tam, C., Taylor, S., Lonergan, K., Faris, P., Duncan, D., Woodhouse, D. Tags: Original research Source Type: research
Evaluating equity in performance of an electronic health record-based 6-month mortality risk model to trigger palliative care consultation: a retrospective model validation analysis
Conclusions
An EHR-based mortality risk model was less likely to identify some marginalised patients as potentially benefiting from palliative care, with younger age pinpointed as a possible mechanism. Evaluating predictive performance is a critical preliminary step in addressing algorithmic inequities in healthcare, which must also include evaluating clinical impact, and governance and regulatory structures for oversight, monitoring and accountability. (Source: BMJ Quality and Safety)
Source: BMJ Quality and Safety - August 17, 2023 Category: General Medicine Authors: Teeple, S., Chivers, C., Linn, K. A., Halpern, S. D., Eneanya, N., Draugelis, M., Courtright, K. Tags: Editor's choice Original research Source Type: research
How can we finally reduce repetitive routine laboratory tests for hospitalised patients?
Repeatedly performing routine laboratory tests on hospitalised patients is unnecessary and harmful. It causes discomfort, iatrogenic anaemia, biological waste, disrupted sleep, financial costs and spurious results that trigger cascades of further testing and interventions.1 Yet, every day in hospitals around the world, patients are awoken with a pre-dawn needle in the arm. Since at least the 1970s, medical educators have attempted various programmes to teach resident physicians to order fewer routine tests, nearly always observing that any effects quickly dissipated once the education was stopped.2 3 In one memorable examp...
Source: BMJ Quality and Safety - August 17, 2023 Category: General Medicine Authors: Moriates, C. Tags: Editorials Source Type: research
Clinical decision-making and algorithmic inequality
Decision support algorithms based on historical data will make recommendations that are influenced by past inequality. Detailed historical health data contain patterns that identify demographic factors, such as race,1 socioeconomic status or religion. These factors are linked to societal disadvantage and hence are indirectly correlated with unequal health outcomes. Machine learning or statistical models trained on such data will be able to identify these patterns and associate unequal outcomes with these disadvantaged groups even if the demographics are not explicitly recorded in the data.1 2 If the indirect associations l...
Source: BMJ Quality and Safety - August 17, 2023 Category: General Medicine Authors: Challen, R., Danon, L. Tags: Editorials Source Type: research
Indication documentation and indication-based prescribing within electronic prescribing systems: a systematic review and narrative synthesis
Conclusion
Indication documentation has the potential to improve appropriate prescribing and reduce prescribing errors. However, further benefits to the prescriber, multidisciplinary team and patient may only be realised by developing methods of indication documentation that integrate more efficiently with prescriber workflows.
PROSPERO registration number
CRD42021278495. (Source: BMJ Quality and Safety)
Source: BMJ Quality and Safety - May 18, 2023 Category: General Medicine Authors: Feather, C., Appelbaum, N., Darzi, A., Franklin, B. D. Tags: Open access Systematic review Source Type: research
Surgical implementation gap: an interrupted time series analysis with interviews examining the impact of surgical trials on surgical practice in England
Conclusion
While practice does not always change in the direction indicated by clinical trials, our results suggest that individuals, official committees and professional societies do assimilate trial evidence. Decision-makers seem to respond to the totality of evidence such that there are often plausible reasons for not adopting the evidence of any one trial in isolation. (Source: BMJ Quality and Safety)
Source: BMJ Quality and Safety - May 18, 2023 Category: General Medicine Authors: Schmidtke, K. A., Evison, F., Grove, A., Kudrna, L., Tucker, O., Metcalfe, A., Bradbury, A. W., Bhangu, A., Lilford, R. Tags: Open access, Editor's choice Original research Source Type: research
Impact of altering referral threshold from out-of-hours primary care to hospital on patient safety and further health service use: a cohort study
Conclusions
Out-of-hours patients whose referrals are affected by physician referral threshold contribute substantially to the use of health services. However, the referral seems protective by reducing the risk of death in the first 6 months after the referral. Thus, raising the threshold for referral to lower pressure on overcrowded emergency departments and hospitals should not be encouraged without ensuring the accuracy of the referral decisions, ideally through high-quality randomised controlled trial evidence. (Source: BMJ Quality and Safety)
Source: BMJ Quality and Safety - May 18, 2023 Category: General Medicine Authors: Svedahl, E. R., Pape, K., Austad, B., Vie, G. A., Sarheim Anthun, K., Carlsen, F., Davies, N. M., Bjorngaard, J. H. Tags: Original research Source Type: research
Approach to systematically examine the usefulness of quality measures in practice: Minnesotas nursing home quality indicators and scoring approach
Conclusion
We demonstrated a systematic approach for evaluating QIs in practice by arriving at parsimonious and relevant QIs, tailored scoring to different QI distributions and a meaningful domain structure. This approach could be applied in evaluating quality measures in other health or long-term care settings. (Source: BMJ Quality and Safety)
Source: BMJ Quality and Safety - May 18, 2023 Category: General Medicine Authors: Xu, D., Lewis, T., Rurka, M., Arling, G. Tags: Original research Source Type: research
Prescribing medications with indications: time to flip the script
Drug indications are the link between a drug and the patient. Indications link the evidence-based benefit of a drug for a specific population to a particular patient’s clinical condition. Unfortunately, in prescribing they are more often the ‘missing link’, with explicit documentation of the indication usually missing from the prescription, despite considerable evidence and recommendations (dare we say exhortations) that documenting the indication would make the entire medication use process safer.1–4 Patients want to, need to and have a right to know what each of their medications is for. This issu...
Source: BMJ Quality and Safety - May 18, 2023 Category: General Medicine Authors: Schiff, G. D., Lambert, B. L., Wright, A. Tags: Editorials Source Type: research
Making it happen: engaging the power of many in translating research into practice
Randomised controlled trials (RCTs) are considered the gold standard for the rigorous evaluation of healthcare interventions because, when feasible, they generate the least biased estimate of treatment effect. However, completion of a trial is not the end game; that is, the continuum of translating science into practice does not end with publication of the RCT. Rather, active efforts must be made to translate the research findings into general practice. Indeed, the science of implementation, defined holistically as the study of ways to promote, enhance and ensure the sustained integration of research evidence into frontlin...
Source: BMJ Quality and Safety - May 18, 2023 Category: General Medicine Authors: Kao, L. S., Ko, C. Y. Tags: Editorials Source Type: research
Understanding the consequences of GP referral thresholds: taking the instrumental approach
Trade-offs between patient safety and efficient use of healthcare services occur in clinical decisions across all forms of healthcare. In the case of acutely unwell older patients, decisions about referral to hospital involve trade-offs between the safety associated with inpatient hospital treatment and the burden on both the patient and health system associated with hospital admission. In many healthcare systems, these decisions are largely made by general practitioners (GPs), often without first-hand knowledge of the patient, especially when presentation is in an out-of-hours setting. This raises three questions: how muc...
Source: BMJ Quality and Safety - May 18, 2023 Category: General Medicine Authors: Lewis, J., Burton, C. Tags: Editorials Source Type: research
