The debrief imperative: building teaming competencies and team effectiveness
Healthcare providers are expected to communicate, coordinate and collaborate with people both within and outside their formal team on a regular basis, often with individuals from different professions, specialties or teams. Continuous ‘teaming’ is the norm. Almost everyone involved in the provision of healthcare must therefore possess teamwork competencies in addition to clinical expertise. Fortunately, research has matured to the point where the drivers of team effectiveness are increasingly clear. For example, in highly effective teams, team members possess shared mental models about roles, priorities and the...
Source: BMJ Quality and Safety - February 28, 2023 Category: General Medicine Authors: Tannenbaum, S. I., Greilich, P. E. Tags: Editorials Source Type: research
Polypharmacy and continuity of care: medicines optimisation in the era of multidisciplinary teams
Polypharmacy, and the negative effects that can arise from it, is increasingly recognised as an issue by healthcare systems globally. Although there is currently no consensus on the number of medicines that defines polypharmacy, it is generally understood as the concurrent use of multiple prescribed medicines. In England, the 2021 National Overprescribing Review estimated that 8.4 million people (around 15% of the population) are regularly prescribed five or more medicines.1 Rates are similar in other high-income countries, for example, in the USA around 20% of the population in community settings experience polypharmacy.2...
Source: BMJ Quality and Safety - February 28, 2023 Category: General Medicine Authors: Tarrant, C., Lewis, R., Armstrong, N. Tags: Editorials Source Type: research
Quality and safety in the literature: January 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 Use of a telemedicine-based model (with minimal in-person care) to provide medical abortion care in South Africa was non-inferior in efficacy and safety outcomes to standard, in-clinic care. L...
Source: BMJ Quality and Safety - December 22, 2022 Category: General Medicine Authors: Hunter, J., Houchens, N., Gupta, A. Tags: Quality & amp; safety in the literature Source Type: research
Grand rounds in methodology: four critical decision points in statistical process control evaluations of quality improvement initiatives
Quality improvement (QI) projects often employ statistical process control (SPC) charts to monitor process or outcome measures as part of ongoing feedback, to inform successive Plan-Do-Study-Act cycles and refine the intervention (formative evaluation). SPC charts can also be used to draw inferences on effectiveness and generalisability of improvement efforts (summative evaluation), but only if appropriately designed and meeting specific methodological requirements for generalisability. Inadequate design decreases the validity of results, which not only reduces the chance of publication but could also result in patient har...
Source: BMJ Quality and Safety - December 22, 2022 Category: General Medicine Authors: Marang-van de Mheen, P. J., Woodcock, T. Tags: Research and reporting methodology Source Type: research
Effectiveness of a multifaceted quality improvement intervention to improve patient outcomes after total hip and knee arthroplasty: a registry nested cluster randomised controlled trial
Conclusion
The multifaceted QI intervention including monthly feedback, education, and a toolbox to facilitate QII effectively improved patients achieving TO. The effect size was associated with the introduction of (evidence-based) QII, considered as the causal link to achieve better patient outcomes.
Trial registration number
NCT04055103. (Source: BMJ Quality and Safety)
Source: BMJ Quality and Safety - December 22, 2022 Category: General Medicine Authors: van Schie, P., van Bodegom-Vos, L., Zijdeman, T. M., Nelissen, R. G. H. H., Marang-van de Mheen, P. J., IQ Joint study group, van Steenbergen, Hokwerde, van Kampen, Buchholz, Schrier, de Graaf, Bouma, Hogervorst, Wolkenfelt, Vischjager, H van Kempen, Huit Tags: Original research Source Type: research
Effects of tall man lettering on the visual behaviour of critical care nurses while identifying syringe drug labels: a randomised in situ simulation
Conclusions
TML in drug names changes visual attention while identifying syringe labels and supports critical care nurses in preventing medication errors. (Source: BMJ Quality and Safety)
Source: BMJ Quality and Safety - December 22, 2022 Category: General Medicine Authors: Lohmeyer, Q., Schiess, C., Wendel Garcia, P. D., Petry, H., Strauch, E., Dietsche, A., Schuepbach, R. A., Buehler, P. K., Hofmaenner, D. A. Tags: Open access, Editor's choice Original research Source Type: research
Effect of clinical peer review on mortality in patients ventilated for more than 24 hours: a cluster randomised controlled trial
Conclusions
This study did not provide evidence for reductions in mortality in patients ventilated for more than 24 hours due to clinical peer review. A stronger focus on identification of structures and care processes related to mortality is required to improve the effectiveness of clinical peer review. (Source: BMJ Quality and Safety)
Source: BMJ Quality and Safety - December 22, 2022 Category: General Medicine Authors: Schmitt, J., Roessler, M., Scriba, P., Walther, F., Grählert, X., Eberlein-Gonska, M., Kuhlen, R., Schoffer, O. Tags: Open access Original research Source Type: research
Grand Rounds in Methodology: a new series to contribute to continuous improvement of methodology and scientific rigour in quality and safety
In clinical practice, ‘grand rounds’ are well known as a method for continuing medical education. In the early 1900s, grand rounds involved bedside teaching, but teaching sessions later moved to the auditorium when they gained popularity to accommodate a larger audience.1 Nowadays, grand rounds are generally targeted to a diverse audience and include topics that will have broad appeal but may also be organised for specific specialties, for example, medical,2 surgical,3 nursing4 or diagnostic5 grand rounds. Grand rounds are a way to help doctors and other healthcare professionals keep up to date in evolving area...
Source: BMJ Quality and Safety - December 22, 2022 Category: General Medicine Authors: Marang-van de Mheen, P. J., Browne, J. P., Thomas, E. J., Franklin, B. D. Tags: Editorials Source Type: research
'You cant do quality between surgical cases and tea time: barriers to surgeon engagement in quality improvement
Much has been written about the challenges of surgeon engagement in quality and safety improvement work. In Taitz and colleagues’ 2011 seminal work, one interviewee alluded to the difficulties in engaging surgeons in quality improvement by opining that ‘you can’t do quality between surgical cases and tea time’.1 There are several factors that may explain why surgeons have historically been difficult to engage in quality improvement work, including a lack of improvement culture, limited training and skills, inconvenience of timing of most daytime improvement work, lack of remuneration and inadequate ...
Source: BMJ Quality and Safety - December 22, 2022 Category: General Medicine Authors: Wolfstadt, J. I., Cohen-Rosenblum, A. Tags: Editorials Source Type: research
Beyond mixed case lettering: reducing the risk of wrong drug errors requires a multimodal response
Confusion between drug names that look and sound alike continues to occur and causes harm in all care settings, despite persistent prevention and mitigation efforts by industry, regulators, health systems, clinicians, patients and families. In this issue of BMJ Quality and Safety, Lohmeyer et al examined the effect of mixed case (often referred to as ‘tall man’) text enhancement on critical care nurses’ ability to correctly identify a specific syringe from an array of similarly labelled syringes.1 Here, we reflect on their study, summarising its key findings and commenting on its strengths as well as sugg...
Source: BMJ Quality and Safety - December 22, 2022 Category: General Medicine Authors: Lambert, B. L., Schroeder, S. R., Cohen, M. R., Paparella, S. Tags: Editorials Source Type: research
COP27 climate change conference: urgent action needed for Africa and the world
Wealthy nations must step up support for Africa and vulnerable countries in addressing past, present and future impacts of climate change The 2022 report of the Intergovernmental Panel on Climate Change paints a dark picture of the future of life on earth, characterised by ecosystem collapse, species extinction and climate hazards such as heatwaves and floods.1 These are all linked to physical and mental health problems, with direct and indirect consequences of increased morbidity and mortality. To avoid these catastrophic health effects across all regions of the globe, there is broad agreement—as 231 health journals...
Source: BMJ Quality and Safety - December 22, 2022 Category: General Medicine Authors: Zielinski, C., on behalf of the authorship group listed below Tags: Open access Editorials Source Type: research
Peer review of quality of care: methods and metrics
The privilege of professional self-regulation rests on clinical peer review, a long-established method for assuring quality of care, training, management and research. In clinical peer review, healthcare professionals evaluate each other’s clinical performance. Based originally on the personal experience and expertise (and prejudices and biases) of one’s peers, the process has gradually been formalised by the development of externally verifiable standards of practice, audit of care processes and outcomes and benchmarking of individual, group and organisational performance and patient outcomes. The spectrum of c...
Source: BMJ Quality and Safety - December 22, 2022 Category: General Medicine Authors: Bion, J., Alderman, J. E. Tags: Editorials Source Type: research
Effect on diagnostic accuracy of cognitive reasoning tools for the workplace setting: systematic review and meta-analysis
Conclusion
Cognitive reasoning tools resulted in small but clinically important improvements in diagnostic accuracy in medical students and professionals, although no factors could be distinguished that resulted in larger improvements. Cognitive reasoning tools could be routinely implemented to improve diagnosis in practice, but going forward, more large-scale studies and evaluations of these tools in practice are needed to determine how these tools can be effectively implemented.
PROSPERO registration number
CRD42020186994. (Source: BMJ Quality and Safety)
Source: BMJ Quality and Safety - November 17, 2022 Category: General Medicine Authors: Staal, J., Hooftman, J., Gunput, S. T. G., Mamede, S., Frens, M. A., Van den Broek, W. W., Alsma, J., Zwaan, L. Tags: Open access Systematic review Source Type: research
Experience of hospital-initiated medication changes in older people with multimorbidity: a multicentre mixed-methods study embedded in the OPtimising thERapy to prevent Avoidable hospital admissions in Multimorbid older people (OPERAM) trial
Conclusion
To meet patients’ needs, future medicines optimisation interventions should enhance information exchange, better prepare patients and clinicians for partnership in care and foster collaborative medication reviews across care settings. (Source: BMJ Quality and Safety)
Source: BMJ Quality and Safety - November 17, 2022 Category: General Medicine Authors: Thevelin, S., Petein, C., Metry, B., Adam, L., van Herksen, A., Murphy, K., Knol, W., O'Mahony, D., Rodondi, N., Spinewine, A., Dalleur, O. Tags: Open access Original research Source Type: research
Epidemiology of adverse drug events and medication errors in four nursing homes in Japan: the Japan Adverse Drug Events (JADE) Study
Conclusion
In Japan, ADEs and MEs are common among elderly residents of NHs. The assessment and appropriate adjustment of medication preadmission and postadmission to NHs are needed to improve medication safety, especially when a single physician is responsible for prescribing most medications for the residents, as is usually the case in Japan. (Source: BMJ Quality and Safety)
Source: BMJ Quality and Safety - November 17, 2022 Category: General Medicine Authors: Ayani, N., Oya, N., Kitaoka, R., Kuwahara, A., Morimoto, T., Sakuma, M., Narumoto, J. Tags: Open access Original research Source Type: research
