Clinical summaries for hospitalised patients: time for higher standards
The average person remembers less than half of the information provided by healthcare professionals during a medical visit.1 The situation is arguably most challenging for patients leaving the hospital, where acute illness, sleep deprivation and delirium add to the challenge of learning and memory.2 3 Indeed, research has shown that after hospital discharge, only 59.6% of patients are able to accurately describe their discharge diagnoses, and 43.9% can accurately recall follow-up appointments.4 Approximately one-third of patients have difficulty understanding their discharge medication regimen.5 It is not the patients' fau...
Source: Quality and Safety in Health Care - April 18, 2017 Category: Health Management Authors: Kripalani, S. Tags: Editorials Source Type: research
Root-cause analysis: swatting at mosquitoes versus draining the swamp
Many healthcare systems recommend root-cause analysis (RCA) as a key method for investigating critical incidents and developing recommendations for preventing future events. In practice, however, RCAs vary widely in terms of their conduct and the utility of the recommendations they produce.1 2 RCAs often fail to explore deep system problems that contributed to safety events3 due to the limited methods used, constrained time and meagre financial/human resources to conduct RCAs.4 Furthermore, healthcare organisations often lack the mandate and authority required to develop and implement sophisticated and effective corrective...
Source: Quality and Safety in Health Care - April 18, 2017 Category: Health Management Authors: Trbovich, P., Shojania, K. G. Tags: Editorials Source Type: research
Extended opening hours in primary care: helpful for patients and--or--a distraction for health professionals?
WHO regards access to primary care as a priority for all health systems, because of the benefits for population health and because of the changing nature of populations (more older people with chronic conditions) and the growing expectations of the public.1 In most developed countries, progress has been made in enabling people to use primary care services during routine office hours, and policymakers have begun to ask "how much access is enough"? The two main drivers for extending access to general practices beyond traditional office hours are the possibility that longer opening hours would lead to reduced pressure on hosp...
Source: Quality and Safety in Health Care - April 18, 2017 Category: Health Management Authors: Baker, R., Walker, N. Tags: Editorials Source Type: research
Reducing hospital noise with sound acoustic panels and diffusion: a controlled study
Noise has been identified as a major stressor in hospitals,1 2 with ambient noise frequently exceeding recommended levels set by the WHO3 and reportedly as high as alarm clocks.4 5 Although hospitals frequently attempt to reduce noise through traditional methods such as shielding the patient (eg, closing doors), moving equipment or altering staff behaviours, these approaches disrupt workflow and ignore the realities of sound generation required in modern hospitals, which potentially limits their impact on quality and patient safety. An unexplored method of reducing hospital noise borrowed from other industries is to use so...
Source: Quality and Safety in Health Care - July 18, 2016 Category: Health Management Authors: Farrehi, P. M., Nallamothu, B. K., Navvab, M. Tags: Short reports Source Type: research
Rapid cycle development of a multifactorial intervention achieved sustained reductions in central line-associated bloodstream infections in haematology oncology units at a childrens hospital: a time series analysis
Conclusions
Stress to a complex system caring for high-risk patients can challenge CLABSI rates. Identifying key processes and executing them reliably can stabilise outcomes during times of system stress. (Source: Quality and Safety in Health Care)
Source: Quality and Safety in Health Care - July 18, 2016 Category: Health Management Authors: Dandoy, C. E., Hausfeld, J., Flesch, L., Hawkins, D., Demmel, K., Best, D., Osterkamp, E., Bracke, T., Nagarajan, R., Jodele, S., Holt, J., Giaccone, M. J., Davies, S. M., Kotagal, U., Simmons, J. Tags: Quality improvement reports Source Type: research
From tokenism to empowerment: progressing patient and public involvement in healthcare improvement
Conclusions
Current models of PPI are too narrow, and few organisations mention empowerment or address equality and diversity in their involvement strategies. These aspects of involvement should receive greater attention, as well as the adoption of models and frameworks that enable power and decision-making to be shared more equitably with patients and the public in designing, planning and co-producing healthcare. (Source: Quality and Safety in Health Care)
Source: Quality and Safety in Health Care - July 18, 2016 Category: Health Management Authors: Ocloo, J., Matthews, R. Tags: Open access Narrative review Source Type: research
Patients and families as teachers: a mixed methods assessment of a collaborative learning model for medical error disclosure and prevention
Conclusions
An educational paradigm that includes patients as teachers and collaborative learners with clinicians in patient safety is feasible, valued by clinicians and P/F and promising for P/F-centred medical error disclosure and prevention training. (Source: Quality and Safety in Health Care)
Source: Quality and Safety in Health Care - July 18, 2016 Category: Health Management Authors: Langer, T., Martinez, W., Browning, D. M., Varrin, P., Sarnoff Lee, B., Bell, S. K. Tags: Editor's choice Innovations in education Source Type: research
Development and testing of a text-mining approach to analyse patients comments on their experiences of colorectal cancer care
Conclusions
Learning-based text mining techniques were found useful and practical tools to identify specific free-text comments within a large dataset, facilitating resource-efficient qualitative analysis. This method should be considered for future PROM analysis to inform policy and practice. Study findings indicated that perceived care quality directly impacts on HRQoL (Source: Quality and Safety in Health Care)
Source: Quality and Safety in Health Care - July 18, 2016 Category: Health Management Authors: Wagland, R., Recio-Saucedo, A., Simon, M., Bracher, M., Hunt, K., Foster, C., Downing, A., Glaser, A., Corner, J. Tags: Original research Source Type: research
Radiologist-initiated double reading of abdominal CT: retrospective analysis of the clinical importance of changes to radiology reports
Conclusion
A 14% rate of clinically important changes made during double reading may justify quality assurance of radiological interpretation. Using expert second readers and a targeted selection of urgent cases and radiologists reading outside their specialty may increase the yield of discrepant cases. (Source: Quality and Safety in Health Care)
Source: Quality and Safety in Health Care - July 18, 2016 Category: Health Management Authors: Lauritzen, P. M., Andersen, J. G., Stokke, M. V., Tennstrand, A. L., Aamodt, R., Heggelund, T., Dahl, F. A., Sandbaek, G., Hurlen, P., Gulbrandsen, P. Tags: Open access, BMJQS Noteworthy articles Original research Source Type: research
Differing perceptions of safety culture across job roles in the ambulatory setting: analysis of the AHRQ Medical Office Survey on Patient Safety Culture
Conclusions
These findings suggest that managers need to pay attention to the training needs of office staff, since this was an area with one of the greatest gaps in perceptions. In addition, both office managers and physicians need to encourage more open communication. As medical offices innovate to improve value, efficiency and patient-centred care, it is important that they continue to foster shared perceptions about what organisational members need, understanding that those perceptions may differ systematically by job position. (Source: Quality and Safety in Health Care)
Source: Quality and Safety in Health Care - July 18, 2016 Category: Health Management Authors: Hickner, J., Smith, S. A., Yount, N., Sorra, J. Tags: Original research Source Type: research
Crew resource management training in the intensive care unit. A multisite controlled before-after study
Conclusions
We can conclude that CRM, as delivered in the present study, does not change behaviour or patient outcomes by itself, yet changes how participants think about errors and risks. This indicates that CRM requires a combination with other initiatives in order to improve clinical outcomes. (Source: Quality and Safety in Health Care)
Source: Quality and Safety in Health Care - July 18, 2016 Category: Health Management Authors: Kemper, P. F., de Bruijne, M., van Dyck, C., So, R. L., Tangkau, P., Wagner, C. Tags: Original research Source Type: research
Plans to accelerate innovation in health systems are less than IDEAL
The drive for innovation Across health systems there is a drive to roll out innovative models of care that will deliver better value for money and improve the quality of care. Innovation in service delivery has been defined as ‘a novel set of behaviours, routines, and ways of working that are discontinuous from previous practice, directed at improving health outcomes, administrative efficiency, cost effectiveness or users’ experience and that are implemented by planned and coordinated actions’.1 Undertaking this type of innovation at scale is increasingly viewed as crucial to the long-term sustainability ...
Source: Quality and Safety in Health Care - July 18, 2016 Category: Health Management Authors: Wilson, P. M., Boaden, R., Harvey, G. Tags: Open access Viewpoints Source Type: research
Radiology double reads
Diagnostic errors in radiology reports can result in patient harm, lead to unnecessary additional testing or interventions, or otherwise diminish the quality of care delivery.1 2 In this issue, Lauritzen et al retrospectively evaluated the impact of a quality assurance process using double reads on changes made to abdominal CT reports requested by referring surgeons.3 The authors address an important topic in this insightful study highlighting the challenges and opportunities related to improving radiology report quality. The authors analysed 1071 consecutive abdominal CT reports on patients referred by surgeons from five ...
Source: Quality and Safety in Health Care - July 18, 2016 Category: Health Management Authors: Sahni, V. A., Khorasani, R. Tags: Editorials Source Type: research
At a crossroads? Key challenges and future opportunities for patient involvement in patient safety
In 2002, Charles Vincent and Angela Coulter published what would become a seminal paper in the field of patient safety.1 Their argument was simple and compelling—that patient safety could be improved through the greater involvement of patients and their families. Over the past decade, the healthcare landscape has evolved, with patients and families now firmly placed at the centre of care design and delivery in both policy, and increasingly practice. However, as highlighted in two papers2 3 published in this issue of BMJ Quality & Safety, there remain significant challenges in the meaningful integration of the pat...
Source: Quality and Safety in Health Care - July 18, 2016 Category: Health Management Authors: O'Hara, J. K., Lawton, R. J. Tags: Editorials Source Type: research
Patient safety and rocket science
‘This safety stuff, it's not rocket science’. Many readers of this journal will undoubtedly have heard this sentiment expressed by their clinical colleagues. The article by Kemper et al1 shows just how widely this impression of patient safety misses the mark. This high-quality study confirms the trend of the recent literature by finding that teamwork training using the civil aviation Crew Resource Management (CRM) approach has no evident clinical benefit, although it does seem to change attitudes and enhance some aspects of the ‘non-technical’ skills involved with interacting with colleagues. In doi...
Source: Quality and Safety in Health Care - July 18, 2016 Category: Health Management Authors: McCulloch, P. Tags: BMJQS Noteworthy articles Editorials Source Type: research
