Between the guidelines: SQUIRE 2.0 and advances in healthcare improvement practice and reporting
The practice and reporting of healthcare improvement has matured significantly since its origin early this century. Most initial improvement reports were akin to management reports or case studies. They often lacked the specificity and details needed to communicate the design, performance and findings with enough precision, accuracy and thoroughness to allow readers to assess validity of the design and execution of the work. Prevention of central line-associated bloodstream infection (CLABSI) has yielded some of the field's most informative ‘foundation stories,’ illustrating the successes and challenges of iden...
Source: Quality and Safety in Health Care - July 18, 2016 Category: Health Management Authors: Mosher, H., Ogrinc, G. Tags: Editorials Source Type: research
Response to: 'Improving the care of patients with a hip fracture: a quality improvement report by Hawkes et al
I would like to commend Hawkes and colleagues on their work.1 Hip fracture is common and increasing, and the care of these patients occupies a significant amount of time and resources. Compared with other trauma cases, they often receive low priority in theatre scheduling, perhaps due to a subconscious perception of the limited benefit to society of early treatment. The patients are usually elderly and often lack a strong advocate for quality care. Thus, other drivers for improvement are required. Specific interventions have been identified that appear to improve outcome after hip fracture, and avoiding undue delay to surg...
Source: Quality and Safety in Health Care - March 17, 2016 Category: Health Management Authors: Lake, C. Tags: BMJQS Noteworthy articles Correspondence Source Type: research
Procedural instruction in invasive bedside procedures: a systematic review and meta-analysis of effective teaching approaches
Conclusions and relevance
This systematic review of bedside procedural skills demonstrates that the current literature is heterogeneous and of varying quality and rigour. Evidence is strongest for the use of simulation and competency-based paradigms in teaching procedures, and these approaches should be the mainstay of programmes that train physicians to perform procedures. Further research should clarify differences among instructional methods (eg, forms of hands-on training) rather than among educational modes (eg, lecture vs simulation). (Source: Quality and Safety in Health Care)
Source: Quality and Safety in Health Care - March 17, 2016 Category: Health Management Authors: Huang, G. C., McSparron, J. I., Balk, E. M., Richards, J. B., Smith, C. C., Whelan, J. S., Newman, L. R., Smetana, G. W. Tags: Systematic review Source Type: research
Developing a primary care patient measure of safety (PC PMOS): a modified Delphi process and face validity testing
Discussion
This is the first tool specifically designed for primary care settings, which allows patients to provide feedback about factors contributing to potential safety incidents. The PC PMOS provides a way for primary care organisations to learn about safety from the patient perspective and make service improvements with the aim of reducing harm in this setting. Future research will explore the reliability and construct validity of the PC PMOS. (Source: Quality and Safety in Health Care)
Source: Quality and Safety in Health Care - March 17, 2016 Category: Health Management Authors: Hernan, A. L., Giles, S. J., O'Hara, J. K., Fuller, J., Johnson, J. K., Dunbar, J. A. Tags: Original research Source Type: research
Findings from a novel approach to publication guideline revision: user road testing of a draft version of SQUIRE 2.0
Conclusions
User testing of a draft version of SQUIRE 2.0 revealed which items have poor concordance between developer intent and author usage, which will inform final editing of the Guideline and development of supporting supplementary materials. It also identified the items that require special attention when teaching about scholarly writing in healthcare improvement. (Source: Quality and Safety in Health Care)
Source: Quality and Safety in Health Care - March 17, 2016 Category: Health Management Authors: Davies, L., Donnelly, K. Z., Goodman, D. J., Ogrinc, G. Tags: Open access Original research Source Type: research
A cluster-randomised quality improvement study to improve two inpatient stroke quality indicators
Conclusion
Quality improvement training was associated with early DVT improvement, but the effect was not sustained over time and was not seen with dysphagia screening. External quality improvement programmes may quickly boost performance but their effect may vary by indicator and may not sustain over time. (Source: Quality and Safety in Health Care)
Source: Quality and Safety in Health Care - March 17, 2016 Category: Health Management Authors: Williams, L., Daggett, V., Slaven, J. E., Yu, Z., Sager, D., Myers, J., Plue, L., Woodward-Hagg, H., Damush, T. M. Tags: Original research Source Type: research
One size fits all? Mixed methods evaluation of the impact of 100% single-room accommodation on staff and patient experience, safety and costs
Conclusions
Staff needed to adapt their working practices significantly and felt unprepared for new ways of working with potentially significant implications for the nature of teamwork in the longer term. Staff preference remained for a mix of single rooms and bays. Patients preferred single rooms. (Source: Quality and Safety in Health Care)
Source: Quality and Safety in Health Care - March 17, 2016 Category: Health Management Authors: Maben, J., Griffiths, P., Penfold, C., Simon, M., Anderson, J. E., Robert, G., Pizzo, E., Hughes, J., Murrells, T., Barlow, J. Tags: Open access Original research Source Type: research
Tall Man lettering and potential prescription errors: a time series analysis of 42 children's hospitals in the USA over 9 years
Conclusions
Implementation of Tall Man lettering in 2007 was not associated with a reduction in the potential LA-SA error rate. Whether Tall Man lettering is effective in clinical practice warrants further study. (Source: Quality and Safety in Health Care)
Source: Quality and Safety in Health Care - March 17, 2016 Category: Health Management Authors: Zhong, W., Feinstein, J. A., Patel, N. S., Dai, D., Feudtner, C. Tags: BMJQS Noteworthy articles Original research Source Type: research
Measuring and improving patient safety through health information technology: The Health IT Safety Framework
Health information technology (health IT) has potential to improve patient safety but its implementation and use has led to unintended consequences and new safety concerns. A key challenge to improving safety in health IT-enabled healthcare systems is to develop valid, feasible strategies to measure safety concerns at the intersection of health IT and patient safety. In response to the fundamental conceptual and methodological gaps related to both defining and measuring health IT-related patient safety, we propose a new framework, the Health IT Safety (HITS) measurement framework, to provide a conceptual foundation for hea...
Source: Quality and Safety in Health Care - March 17, 2016 Category: Health Management Authors: Singh, H., Sittig, D. F. Tags: Open access Viewpoints Source Type: research
Why evaluate 'common sense quality and safety interventions?
At times, the decision to redesign a healthcare service may be driven by a sense that ‘something must be done’, for instance evidence of a significant failure within a hospital or national data indicating variable provision of evidence-based care. Under such circumstances, planners may look to their past experiences or let themselves be guided by research evidence; they may also turn to solutions perceived as self-evidently good ideas. Examples of such apparently ‘common sense’ interventions include the ongoing drives towards integration of various domains of care1 and 7-day working2: these are comm...
Source: Quality and Safety in Health Care - March 17, 2016 Category: Health Management Authors: Ramsay, A. I., Fulop, N. J. Tags: Editorials Source Type: research
To RCT or not to RCT? The ongoing saga of randomised trials in quality improvement
Williams et al1 describe a well-conducted cluster randomised trial of a stoke quality improvement (QI) initiative, which aimed to improve two inpatient stroke indicators with strong evidence linking them to improved patient outcomes. They randomised five hospitals to receive a QI intervention, and six to receive only indicator feedback. In aggregate, they found evidence of improvement in one indicator, in the intervention group, relative to the control, but this was not sustained once the intervention period ended. The design, execution and analysis of the study were textbook for a cluster randomised controlled trial (RCT)...
Source: Quality and Safety in Health Care - March 17, 2016 Category: Health Management Authors: Parry, G., Power, M. Tags: BMJQS Noteworthy articles Editorials Source Type: research
The health information technology safety framework: building great structures on vast voids
With their health information technology (HIT) safety framework, Drs Hardeep Singh and Dean Sittig offer many admirable suggestions to improve the safety of computerised provider order entry and electronic health records (EHRs).1 As I shall try to explain, however, I find their proposed framework less than the sum of its parts because: (1) some of its parts, in my opinion, are misdirected; (2) they make errors in their assumptions about what we can know about errors and HIT and (3) their key recommendations lack regulatory or legal teeth. Despite the authors’ fine intentions and several excellent insights and recomme...
Source: Quality and Safety in Health Care - March 17, 2016 Category: Health Management Authors: Koppel, R. Tags: Editorials Source Type: research
Does Tall Man lettering prevent drug name confusion errors? Incomplete and conflicting evidence suggest need for definitive study
Wrong-drug errors, thought to be caused primarily by drug names that look and/or sound alike, occur at a rate of about one error per thousand dispensed prescriptions in the outpatient setting and one per thousand orders in the inpatient setting.1 2 Most are relatively benign, but some cause severe or even fatal harm.3–5 One of the best known attempts to reduce drug name confusion has been the use of mixed case or ‘Tall Man’ lettering.6 The idea is to use capital letters to maximise the visual perceptual difference between two similar drug names. Thus, vinblastine and vincristine become vinBLAStine and vin...
Source: Quality and Safety in Health Care - March 17, 2016 Category: Health Management Authors: Lambert, B. L., Schroeder, S. R., Galanter, W. L. Tags: Editor's choice, BMJQS Noteworthy articles Editorials Source Type: research
Compromised communication: a qualitative study exploring Afghan families and health professionals experience of interpreting support in Australian maternity care
Conclusions
Improving identification of language needs at point of entry into healthcare, developing innovative ways to engage interpreters as integral members of multidisciplinary healthcare teams and building health professionals’ capacity to respond to language needs are critical to reducing social inequalities in maternal and child health outcomes for refugee and other migrant populations. (Source: Quality and Safety in Health Care)
Source: Quality and Safety in Health Care - March 17, 2016 Category: Health Management Authors: Yelland, J., Riggs, E., Szwarc, J., Casey, S., Duell-Piening, P., Chesters, D., Wahidi, S., Fouladi, F., Brown, S. Tags: Electronic page Source Type: research
Author response: from analysis to learning
Williams, Cooper and Carson-Stevens1 highlight some advanced approaches to analysing safety incident reports that can generate valuable insights into the causes of common events, and can help identify and prioritise topics for more focused conversations, investigations and improvement actions. However, in many healthcare settings, the focus on collecting and analysing large quantities of incident data continues to distract attention from the social, collaborative and participative work that is required to learn from safety incidents. Learning from safety incidents is by necessity a contact sport: it happens when people act...
Source: Quality and Safety in Health Care - January 18, 2016 Category: Health Management Authors: Macrae, C. Tags: BMJQS Noteworthy articles Correspondence Source Type: research
