Measuring what matters: refining our approach to quality indicators
Quality indicators are ubiquitous in healthcare and serve a variety of purposes for many different stakeholders. Few would question the value of monitoring the quality of care, but the increasing numbers of indicators and the resources consumed suggest that some reflection and refinement of approach may be required. For instance, the National Quality Forum catalogue in the USA lists 1167 indicators,1 and a recent study from the Netherlands showed that healthcare professionals from five clinical specialties collect data for 24 different stakeholders on 1380 different variables.2 Healthcare professionals in the latter study ...
Source: BMJ Quality and Safety - May 18, 2023 Category: General Medicine Authors: Marang-van de Mheen, P. J., Vincent, C. Tags: Editorials Source Type: research
Advancing equity, diversity and inclusion at BMJ Quality and Safety
The purpose of BMJ Quality and Safety is to encourage the science of improvement, debate and new thinking on improving the quality of healthcare.1 Equity is a key domain of healthcare quality—high quality, safe healthcare should be available to all who need it.2 However, systemic biases and barriers are widespread in healthcare,3 as well as more broadly, including within the processes around the publication of research.4 For example, lack of diversity among editors, reviewers and authors of published papers is likely to both reflect and exacerbate systemic sources of inequity among researchers but also among the inte...
Source: BMJ Quality and Safety - May 18, 2023 Category: General Medicine Authors: Franklin, B. D., Thomas, E. J., Soong, C. Tags: Editorials Source Type: research
Quality and safety in the literature: April 2023
Healthcare quality and safety span multiple topics across the spectrum of academic and clinical disciplines. Keeping abreast of the rapidly growing body of work can be challenging. In this series, we provide succinct summaries of selected relevant studies published in the last several months. Some articles will focus on a particular theme, whereas others will highlight unique publications from high-impact medical journals. Key points In older patients with diabetes mellitus and risk of cardiovascular events, the addition of a clinical decision support system to team-based care compared with team-based care alone resulted i...
Source: BMJ Quality and Safety - March 17, 2023 Category: General Medicine Authors: Maxey, J., Gupta, A., Houchens, N. Tags: Quality & amp; safety in the literature Source Type: research
Complex interplay between moral distress and other risk factors of burnout in ICU professionals: findings from a cross-sectional survey study
Conclusions
Understanding moral distress as a root cause of burnout is too simplified. There is an important interplay between moral distress and work–home imbalance. Interventions that support individual coping with moral distress and a work–home imbalance, and the support of direct supervisors, are paramount to prevent burnout in physicians and nurses. (Source: BMJ Quality and Safety)
Source: BMJ Quality and Safety - March 17, 2023 Category: General Medicine Authors: Kok, N., Van Gurp, J., van der Hoeven, J. G., Fuchs, M., Hoedemaekers, C., Zegers, M. Tags: Open access Original research Source Type: research
Medication-related Medical Emergency Team activations: a case review study of frequency and preventability
Conclusions
Medications contributed to almost a quarter of MET activations, often early in a patient’s admission. One in seven MET activations were due to potentially preventable adverse medication events. The most common of these were omission of beta-blockers and clinically inappropriate antihypertensive use. Strategies to prevent these events would increase patient safety and reduce burden on the MET. (Source: BMJ Quality and Safety)
Source: BMJ Quality and Safety - March 17, 2023 Category: General Medicine Authors: Levkovich, B. J., Orosz, J., Bingham, G., Cooper, D. J., Dooley, M., Kirkpatrick, C., Jones, D. A. Tags: Original research Source Type: research
Mortality before and after reconfiguration of the Danish hospital-based emergency healthcare system: a nationwide interrupted time series analysis
Conclusions
The Danish emergency care reconfiguration programme was not associated with an improvement in overall in-hospital mortality trends and was associated with a slight slowing of prior improvements in 30-day mortality trends. (Source: BMJ Quality and Safety)
Source: BMJ Quality and Safety - March 17, 2023 Category: General Medicine Authors: Flojstrup, M., Bogh, S. B. B., Bech, M., Henriksen, D. P., Johnsen, S. P., Brabrand, M. Tags: Open access Original research Source Type: research
Outcome differences between surgeons performing first and subsequent coronary artery bypass grafting procedures in a day: a retrospective comparative cohort study
Conclusions
For a technically challenging surgical procedure like off-pump CABG, prior workload adversely affected patient outcomes. (Source: BMJ Quality and Safety)
Source: BMJ Quality and Safety - March 17, 2023 Category: General Medicine Authors: Zhang, D., Gu, D., Rao, C., Zhang, H., Su, X., Chen, S., Ma, H., Zhao, Y., Feng, W., Sun, H., Zheng, Z. Tags: Editor's choice Original research Source Type: research
Adverse drug events leading to medical emergency team activation in hospitals: what can we learn?
Adverse drug events (ADEs) raise major concerns in hospital care by causing morbidity and mortality in patients despite active attention to medication safety.1–3 However, less attention has been paid to ADEs that lead to medication-related rapid response team (RRT) or medical emergency team (MET) activations, even though this kind of data can be very valuable for learning from incidents and understanding the variety of its contributing factors. In this issue of BMJ Quality & Safety, Levkovich4 estimated the incidence and preventability of medication-related MET activations and described the associated adverse med...
Source: BMJ Quality and Safety - March 17, 2023 Category: General Medicine Authors: Härkänen, M., Syyrilä, T., Schepel, L. Tags: Editorials Source Type: research
Reconfiguring emergency and acute services: time to pause and reflect
A dominant trend over the past few decades has been the reconfiguration of acute hospital services to provide more centralised and specialised care, particularly for complex conditions, resulting in fewer hospitals each serving a higher volume of patients. Centralisation is usually framed as a response to concerns about the safety of care in smaller hospitals. In this issue of the journal, Flojstrup and colleagues report on the impact of a hospital reconfiguration programme for emergency and acute care in Denmark.1 The ongoing programme, which began in 2008, involves closure of most small, rural hospitals and halving the n...
Source: BMJ Quality and Safety - March 17, 2023 Category: General Medicine Authors: Vaughan, L., Browne, J. Tags: Editorials Source Type: research
Surgeons and systems working together to drive safety and quality
Cardiac surgical outcomes are some of the most scrutinised results in medicine, both by the public as well as the surgeons themselves. This has resulted in an extraordinary push for quality, and the result has been improvement year over year.1 We now recognise that complex operations have high potential for error, and that no single individual should be relied on to ensure safe care. Indeed, even for high-quality cardiac surgery programmes with excellent outcomes errors still occur, and only about 10% of patients will experience zero error or near misses after open heart surgery.2 Creating the teams and care delivery syste...
Source: BMJ Quality and Safety - March 17, 2023 Category: General Medicine Authors: Hawkins, R. B., Nallamothu, B. K. Tags: Editorials Source Type: research
Grand rounds in methodology: when are realist reviews useful, and what does a 'good realist review look like?
Research in the quality and safety field often necessitates an approach that supports the development of an in-depth understanding of how a complex phenomenon occurs, or how an intervention works. Realist review is an increasingly popular form of evidence synthesis that provides a theory-driven, interpretive approach to secondary research. Realist reviews offer quality and safety researchers the opportunity to draw on diverse types of evidence to develop explanatory theory about how, when and for whom interventions ‘work’ or outcomes occur. The approach is flexible, iterative and practical, typically drawing on...
Source: BMJ Quality and Safety - February 28, 2023 Category: General Medicine Authors: Duddy, C., Wong, G. Tags: Research and reporting methodology Source Type: research
Helping healthcare teams to debrief effectively: associations of debriefers actions and participants reflections during team debriefings
Conclusion
When debriefers pair their observations and opinions with open-ended questions, paraphrase participants’ statements and ask specific questions, they help participants reflect during debriefings. (Source: BMJ Quality and Safety)
Source: BMJ Quality and Safety - February 28, 2023 Category: General Medicine Authors: Kolbe, M., Grande, B., Lehmann-Willenbrock, N., Seelandt, J. C. Tags: Original research Source Type: research
Negotiating the polypharmacy paradox: a video-reflexive ethnography study of polypharmacy and its practices in primary care
Conclusions
Supporting acceptable, feasible and meaningful progress towards addressing problematic polypharmacy may require shifts in how medication reviews are conceptualised. Responsible decision-making under conditions of such complexity and uncertainty depends crucially on the affective or emotional quality of the clinician-patient relationship. (Source: BMJ Quality and Safety)
Source: BMJ Quality and Safety - February 28, 2023 Category: General Medicine Authors: Swinglehurst, D., Hogger, L., Fudge, N. Tags: Open access, Editor's choice Original research Source Type: research
Incidence and characteristics of adverse events in paediatric inpatient care: a systematic review and meta-analysis
Conclusion
The reported incidence of AEs is highly variable in paediatric inpatient care research, and it is not possible to estimate a reliable single rate. Poor reporting standards and methodological differences hinder the comparison of study results. (Source: BMJ Quality and Safety)
Source: BMJ Quality and Safety - February 28, 2023 Category: General Medicine Authors: Dillner, P., Eggenschwiler, L. C., Rutjes, A. W. S., Berg, L., Musy, S. N., Simon, M., Moffa, G., Förberg, U., Unbeck, M. Tags: Open access Systematic review Source Type: research
Beyond the equity project: grounding equity in all quality improvement efforts
Significant racial and socioeconomic disparities in care quality and patient safety persist across and within countries. Recent evidence continues to show that a significant cause for the persistence of health disparities is grounded in systemic racism,1 that is, the way that the ideology of inferiority is embedded in health infrastructures, laws, policies and societal practices to perpetuate widespread unfair treatment of people of colour.2 These conditions undermine care quality and patient safety through the ways they are embedded in existing quality and safety infrastructure and their effects on patients and families. ...
Source: BMJ Quality and Safety - February 28, 2023 Category: General Medicine Authors: Glover, W., Vogus, T. Tags: Viewpoints Source Type: research
