Antibiotic documentation: death by a thousand clicks
Bacteria and clinicians have one thing in common: resistance. As widespread antibiotic use has increased, antimicrobial resistance has risen.1 Despite this, many clinicians remain resistant to changing their antibiotic-prescribing habits.1 Antimicrobial stewardship—which focuses on interventions to help optimise antibiotic selection, dose and duration—has gained substantial public health interest while continuing to face frequent frontline clinician opposition.2 3 In this issue of BMJ Quality and Safety, Saini and colleagues’ findings support a seemingly simple antimicrobial stewardship tool: documentatio...
Source: BMJ Quality and Safety - October 19, 2022 Category: General Medicine Authors: Ciarkowski, C., Vaughn, V. M. Tags: Editorials Source Type: research
Correction: Effectiveness of a multifaceted quality improvement intervention to improve patient outcomes after total hip and knee arthroplasty: a registry nested cluster randomised controlled trial
van Schie P, van Bodegom-Vos L, Zijdeman TM, et al. Effectiveness of a multifaceted quality improvement intervention to improve patient outcomes after total hip and knee arthroplasty: a registry nested cluster randomised controlled trial. BMJ Qual Saf. Published Online First: 22 June 2022. doi:10.1136/bmjqs-2021-014472.
The IQ Joint study group has been added to the author list. In addition to this, blinded data in the methods section has been updated with the correct information. (Source: BMJ Quality and Safety)
Source: BMJ Quality and Safety - October 19, 2022 Category: General Medicine Tags: Corrections Source Type: research
Quality and safety in the literature: October 2022
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. (Source: BMJ Quality and Safety)
Source: BMJ Quality and Safety - September 19, 2022 Category: General Medicine Authors: Childers, S., Houchens, N., Gupta, A. Tags: Quality & amp; safety in the literature Source Type: research
Economic evaluations of audit and feedback interventions: a systematic review
Discussion
Results suggest that A&F interventions may have a high potential to be cost-effective. However, as is common in systematic reviews of economic evaluations, publication bias could have led to an overestimation of their economic value. (Source: BMJ Quality and Safety)
Source: BMJ Quality and Safety - September 19, 2022 Category: General Medicine Authors: Moore, L., Guertin, J. R., Tardif, P.-A., Ivers, N. M., Hoch, J., Conombo, B., Antony, J., Stelfox, H. T., Berthelot, S., Archambault, P., Turgeon, A., Gandhi, R., Grimshaw, J. Tags: Systematic review Source Type: research
A better way: training for direct observations in healthcare
Direct observation is valuable for identifying latent threats and elucidating system complexity in clinical environments. This approach facilitates prospective risk assessment and reveals workarounds, near-misses and recurrent safety problems difficult to diagnose retrospectively or via outcome data alone. As observers are an instrument of data collection, developing effective and comprehensive observer training is critical to ensuring the reliability of the data collection and reproducibility of the research. However, methodological rigour for ensuring these data collection properties remains a key challenge in direct obs...
Source: BMJ Quality and Safety - September 19, 2022 Category: General Medicine Authors: Alfred, M., Del Gaizo, J., Kanji, F., Lawton, S., Caron, A., Nemeth, L. S., Alekseyenko, A. V., Shouhed, D., Savage, S., Anger, J. T., Catchpole, K., Cohen, T. Tags: Research and reporting methodology Source Type: research
Use of e-triggers to identify diagnostic errors in the paediatric ED
Conclusion
An e-trigger coupled with manual screening enriched a cohort of patients at risk for DxEs. Fewer than 10% of DxEs were identified through existing surveillance systems, suggesting that they miss a large proportion of DxEs. Further study is required to identify specific clinical presentations at risk of DxEs. (Source: BMJ Quality and Safety)
Source: BMJ Quality and Safety - September 19, 2022 Category: General Medicine Authors: Lam, D., Dominguez, F., Leonard, J., Wiersma, A., Grubenhoff, J. A. Tags: Original research Source Type: research
A scoping review of real-time automated clinical deterioration alerts and evidence of impacts on hospitalised patient outcomes
Conclusions
Most studies in this review did not detect improvements in patient outcomes following the implementation of real-time deterioration alerts. Future implementation studies should consider: directly involving the patient’s physician or a dedicated surveillance nurse in structured response protocols for deteriorating patients; the workflow of alert recipients; and incorporating model features into the decision process to improve clinical utility. (Source: BMJ Quality and Safety)
Source: BMJ Quality and Safety - September 19, 2022 Category: General Medicine Authors: Blythe, R., Parsons, R., White, N. M., Cook, D., McPhail, S. Tags: Original research Source Type: research
Nursing implications of an early warning system implemented to reduce adverse events: a qualitative study
Conclusion
This qualitative study of nurses demonstrates the importance of earning user trust, ensuring timeliness and outlining actionable next steps when implementing an EWS. Careful attention to user workflow is required to maximise EWS impact on improving hospital quality and patient safety. (Source: BMJ Quality and Safety)
Source: BMJ Quality and Safety - September 19, 2022 Category: General Medicine Authors: Braun, E. J., Singh, S., Penlesky, A. C., Strong, E. A., Holt, J. M., Fletcher, K. E., Stadler, M. E., Nattinger, A. B., Crotty, B. H. Tags: Original research Source Type: research
Using a dark logic model to explore adverse effects in audit and feedback: a qualitative study of gaming in colonoscopy
Conclusion
Our dark logic model highlighted that A&F interventions may create both desired and adverse effects. Without a priori theorisation evaluations may disregard potential harms. In colonoscopy, improved patient experience measures may reduce harm. To address cognitive interference the motivation of feedback to support improvement should always be clear, with plans targeting specific behaviours and offering face-to-face support for confidence.
Trial registration number
ISRCTN11126923. (Source: BMJ Quality and Safety)
Source: BMJ Quality and Safety - September 19, 2022 Category: General Medicine Authors: Catlow, J., Bhardwaj-Gosling, R., Sharp, L., Rutter, M. D., Sniehotta, F. F. Tags: Open access, Editor's choice Original research Source Type: research
Diagnosing diagnostic errors: its time to evolve the patient safety research paradigm
Optimising patient safety in the hospital setting remains a significant challenge for modern healthcare. Substantial efforts have been made to eradicate patient harm events since the 1999 publication of To Err is Human: Building a Safer Health System.1 Nevertheless, a recent meta-analysis of 94 adult inpatient studies concluded that 8.6 hospital harm events occur for every 100 patient admissions, with over half (52.6%) judged to be preventable.2 Estimates in high-risk paediatric settings suggest a rate as high as 40 patient harm events per 100 admissions.3–5 Although patient harms within the subset known as hospital-...
Source: BMJ Quality and Safety - September 19, 2022 Category: General Medicine Authors: Stockwell, D. C., Sharek, P. Tags: Editorials Source Type: research
We dont talk about communication: why technology alone cannot save clinically deteriorating patients
When a hospitalised patient begins to deteriorate clinically, prompt detection and early intervention by trained clinicians is critical for preventing in-hospital cardiac arrest. This is a common event that affects nearly 300 000 patients annually in the USA1 and is associated with a high risk of death and neurological disability among survivors. A broad range of strategies have been proposed for the early detection and management of the deteriorating patient. Early warning systems (EWS) are an example of one strategy. EWS use clinical prediction models to identify patients who are likely to be deteriorating, with triggers...
Source: BMJ Quality and Safety - September 19, 2022 Category: General Medicine Authors: Manojlovich, M., Krein, S. L. Tags: Editorials Source Type: research
Channelling the force of audit and feedback: averting the dark side
Audit and feedback is a strategy used to improve healthcare delivery and promote the implementation of evidence-based practice.1 A recipient, at individual, team or unit level, is provided with summary data of their performance over a specified period of time to act as a stimulus for behaviour change and quality improvement. Audit and feedback is used across clinical conditions and settings around the world. When used correctly, it is effective, scalable and relatively inexpensive.1 However, every healthcare improvement strategy has the potential to have a ‘dark side’2; the potential for adverse effects to aris...
Source: BMJ Quality and Safety - September 19, 2022 Category: General Medicine Authors: Duncan, E. M., Ivers, N. M., Grimshaw, J. M. Tags: Editorials Source Type: research
Quality and Safety in the Literature: September 2022
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 Integration of a tablet computer-based delirium screening app into typical clinician workflow in two US hospitals was feasible, rapid and accurate and could be completed by certified nursing a...
Source: BMJ Quality and Safety - August 18, 2022 Category: General Medicine Authors: Burke, A., Gupta, A., Houchens, N. Tags: Quality & amp; safety in the literature Source Type: research
Impact of unacceptable behaviour between healthcare workers on clinical performance and patient outcomes: a systematic review
Conclusions
Despite the mixed quality of evidence and some inconsistencies in the strengths of associations reported, the overall weight of evidence shows that unacceptable behaviour negatively affects the clinical performance of HCWs, quality of care, workplace productivity and patient outcomes. Future research should focus on the evaluation and implementation of interventions that reduce the frequency of these behaviours. (Source: BMJ Quality and Safety)
Source: BMJ Quality and Safety - August 18, 2022 Category: General Medicine Authors: Guo, L., Ryan, B., Leditschke, I. A., Haines, K. J., Cook, K., Eriksson, L., Olusanya, O., Selak, T., Shekar, K., Ramanan, M. Tags: Systematic review Source Type: research
Examining the effect of quality improvement initiatives on decreasing racial disparities in maternal morbidity
The objective of this study was to evaluate the impact of quality improvement (QI) and patient safety initiatives and data disaggregation on racial disparities in severe maternal morbidity from hemorrhage (SMM-H).
Our hospital began monitoring and reporting on SMM-overall and SMM-H rates in 2018 using administrative data. In March 2019, we began stratifying data by race and ethnicity and noted a disparity in rates, with non-Hispanic Black women having the highest SMM rates. The data was presented as run charts at monthly department meetings. During this time, our hospital implemented several QI and patient safety initiativ...
Source: BMJ Quality and Safety - August 18, 2022 Category: General Medicine Authors: Davidson, C., Denning, S., Thorp, K., Tyer-Viola, L., Belfort, M., Sangi-Haghpeykar, H., Gandhi, M. Tags: Editor's choice Quality improvement reports Source Type: research
