A quality improvement project to improve early sepsis care in the emergency department
Conclusions
The new protocol demonstrates that early screening interventions can lead to expedited delivery of care to patients with sepsis in the ED and could serve as a model for other facilities. Mortality was not significantly improved by our intervention, which included patients with uncomplicated sepsis. (Source: Quality and Safety in Health Care)
Source: Quality and Safety in Health Care - November 19, 2015 Category: Health Management Authors: Gatewood, M. O., Wemple, M., Greco, S., Kritek, P. A., Durvasula, R. Tags: Quality improvement reports Source Type: research
Barriers and facilitators related to the implementation of surgical safety checklists: a systematic review of the qualitative evidence
Conclusions
The complex reality in which the checklist needs to be implemented requires an approach that includes more than eliminating barriers and supporting facilitating factors. Implementation leaders must facilitate team learning to foster the mutual understanding of perspectives and motivations, and the realignment of routines. This paper provides a pragmatic overview of the user-related barriers and facilitators upon which theories, hypothesising potential change strategies and interactions, can be developed and tested empirically. (Source: Quality and Safety in Health Care)
Source: Quality and Safety in Health Care - November 19, 2015 Category: Health Management Authors: Bergs, J., Lambrechts, F., Simons, P., Vlayen, A., Marneffe, W., Hellings, J., Cleemput, I., Vandijck, D. Tags: Systematic review Source Type: research
The SQUIRE Guidelines: an evaluation from the field, 5 years post release
Conclusions
The original SQUIRE Guidelines help with planning healthcare improvement work, but are perceived as complicated and unclear during writing. Key goals of the revision will be to clarify items where conflict was identified and outline the key components necessary for complete reporting of improvement work. (Source: Quality and Safety in Health Care)
Source: Quality and Safety in Health Care - November 19, 2015 Category: Health Management Authors: Davies, L., Batalden, P., Davidoff, F., Stevens, D., Ogrinc, G. Tags: Open access Original research Source Type: research
Expanding the scope of Critical Care Rapid Response Teams: a feasible approach to identify adverse events. A prospective observational cohort
Conclusions
Reviewing RRT consults identified a high proportion of AEs and preventable AEs. This methodology detected twice as many AEs as the hospital's safety reporting system. RRT clinicians provide a complementary and more sensitive mechanism than traditional safety reporting systems to identify possible AEs in hospitals. (Source: Quality and Safety in Health Care)
Source: Quality and Safety in Health Care - November 19, 2015 Category: Health Management Authors: Amaral, A. C. K.-B., McDonald, A., Coburn, N. G., Xiong, W., Shojania, K. G., Fowler, R. A., Chapman, M., Adhikari, N. K. J. Tags: Original research Source Type: research
Do pneumonia readmissions flagged as potentially preventable by the 3M PPR software have more process of care problems? A cross-sectional observational study
Conclusions
Among VA pneumonia readmissions, PPR categorisation did not produce the expected quality of care findings. Either PPR–yes cases are not more preventable, or preventability assessment requires other data collection methods to capture poorly documented processes (eg, direct observation). (Source: Quality and Safety in Health Care)
Source: Quality and Safety in Health Care - November 19, 2015 Category: Health Management Authors: Borzecki, A. M., Chen, Q., Restuccia, J., Mull, H. J., Shwartz, M., Gupta, K., Hanchate, A., Strymish, J., Rosen, A. Tags: Editor's choice, Press releases Original research Source Type: research
Statistical process control and interrupted time series: a golden opportunity for impact evaluation in quality improvement
Introduction Time series plots are widely used, across sectors and media, probably because many find them easy to understand. Figure 1 is a time series plot of how the readmission rate in a hospital changed over time (constructed data set). Statistical process control (SPC) and interrupted time series (ITS) designs are two closely related methodologies in the field of quality improvement. In both approaches, data are organised in time series and presented using time series plots. Both SPC and ITS use data to assess whether observed changes reflect random variation or ‘real’ change. SPC is a popular method ...
Source: Quality and Safety in Health Care - November 19, 2015 Category: Health Management Authors: Fretheim, A., Tomic, O. Tags: Open access Viewpoints Source Type: research
Why even good physicians do not wash their hands
Summary Lapses in hand hygiene are a persistent problem that has resisted a simple solution Behavioural decision science provides a framework for understanding some of the lapses Affective factors include a lack of positive reinforcement and a missing sense of certainty Cognitive factors include recurrent monotony, divided attention and faulty memory Social factors include insufficient prestige with inadequate enforcement of norms An awareness of behavioural factors helps explain past failures to improve hand hygiene Behavioural insights may lead to new technologies and to more effective solutions Introduction Hosp...
Source: Quality and Safety in Health Care - November 19, 2015 Category: Health Management Authors: Redelmeier, D. A., Shafir, E. Tags: Viewpoints Source Type: research
Identifying preventable readmissions: an achievable goal or waiting for Godot?
Hospital readmission rates have captured the attention of policymakers, administrators, researchers and healthcare providers over the last decade. This has been spurred in no small part by the Hospital Readmissions Reduction Program, which began in the USA in 2012 and requires the Centres for Medicare and Medicaid Services to reduce payments to acute care facilities with high rates of readmission within 30 days of discharge for selected conditions. After years of intense research to find an objective measure of preventable readmissions, it seems as imminent as the arrival of Godot. Whether preventable readmissions can...
Source: Quality and Safety in Health Care - November 19, 2015 Category: Health Management Authors: Soong, C., Bell, C. Tags: Press releases Editorials Source Type: research
Are we recording postoperative complications correctly? Comparison of NHS Hospital Episode Statistics with the American College of Surgeons National Surgical Quality Improvement Program
Conclusions
HES poorly registers postoperative complications. Suggested improvements include addition of dates when a condition is diagnosed, agreed criteria to identify postoperative complications, specifically trained coding staff for surgery and consistent use of the coding guidance. (Source: Quality and Safety in Health Care)
Source: Quality and Safety in Health Care - August 18, 2015 Category: Health Management Authors: Parthasarathy, M., Reid, V., Pyne, L., Groot-Wassink, T. Tags: Original research Source Type: research
Patient and carer identified factors which contribute to safety incidents in primary care: a qualitative study
Discussion
Patient and carer feedback of this type could help primary-care professionals better understand and identify potential safety concerns and make appropriate service improvements. The comprehensive range of factors identified provides the groundwork for developing tools that systematically capture the multiple contributory factors to patient safety. (Source: Quality and Safety in Health Care)
Source: Quality and Safety in Health Care - August 18, 2015 Category: Health Management Authors: Hernan, A. L., Giles, S. J., Fuller, J., Johnson, J. K., Walker, C., Dunbar, J. A. Tags: Original research Source Type: research
Exploring demographic and lifestyle associations with patient experience following telephone triage by a primary care doctor or nurse: secondary analyses from a cluster randomised controlled trial
Conclusions
Patient characteristics, such as age, ethnicity and ability to attend their practice during work hours, were associated with their experiences of care following a same-day consultation request in general practice. Telephone triage did not increase satisfaction among patients who were unable to attend their practice during working hours.
Trial registration number
ISCRTN20687662. (Source: Quality and Safety in Health Care)
Source: Quality and Safety in Health Care - August 18, 2015 Category: Health Management Authors: Warren, F. C., Calitri, R., Fletcher, E., Varley, A., Holt, T. A., Lattimer, V., Richards, D., Richards, S., Salisbury, C., Taylor, R. S., Campbell, J. L. Tags: Open access Original research Source Type: research
How effective are patient safety initiatives? A retrospective patient record review study of changes to patient safety over time
Conclusions
Our study shows some improvements in preventable AEs in the areas that were addressed during the comprehensive national safety programme. There are signs that such a programme has a positive impact on patient safety. (Source: Quality and Safety in Health Care)
Source: Quality and Safety in Health Care - August 18, 2015 Category: Health Management Authors: Baines, R., Langelaan, M., de Bruijne, M., Spreeuwenberg, P., Wagner, C. Tags: Open access, Editor's choice Original research Source Type: research
Lack of standardisation between specialties for human factors content in postgraduate training: an analysis of specialty curricula in the UK
Introduction It is well recognised that a significant proportion of errors involving trainee doctors result from failures of non-technical skills (NTS),1 which occur at least as frequently as knowledge and technical errors.2 Regardless of background, all trainees need generic skills of leadership, decision-making, team-working and resource management.3 It might, therefore, be expected that curricula for different specialties would use similar definitions and teaching methods to specify NTS standards. We have performed an analysis of medical training curricula to determine the extent to which different medical specialties s...
Source: Quality and Safety in Health Care - August 18, 2015 Category: Health Management Authors: Greig, P. R., Higham, H., Vaux, E. Tags: Short reports Source Type: research
Ranking hospitals on avoidable death rates derived from retrospective case record review: methodological observations and limitations
Reducing the number of avoidable deaths in hospital is the focus of many quality improvement initiatives worldwide.1 Comparing indicators of avoidable mortality between different hospitals could help to target improvement efforts, but optimally defining and measuring hospital deaths that could be deemed preventable remains a challenge.2 Unlike performance comparisons based on hospital standardised mortality ratio (HSMR), a new policy initiative announced by the UK Government will rank hospitals for avoidable mortality based on case reviews of 2000 deaths in English hospitals each year. Although this initiative aims to over...
Source: Quality and Safety in Health Care - August 18, 2015 Category: Health Management Authors: Abel, G., Lyratzopoulos, G. Tags: Open access Viewpoints Source Type: research
Emotional harm from disrespect: the neglected preventable harm
Introduction Consider these actual patient experiences:A patient is admitted to the hospital for a bowel obstruction from a known malignancy. She calls her cancer specialist about this complication, but he is unavailable. A covering provider reading from her file says ‘your cancer is untreatable’. This is the first time she has heard this. A patient dies in the hospital and the next day the funeral home collects a body from the hospital morgue. After embalming the body, the funeral home is notified by the hospital that they were given the wrong body. Because of this error, it may not be possible to process the...
Source: Quality and Safety in Health Care - August 18, 2015 Category: Health Management Authors: Sokol-Hessner, L., Folcarelli, P. H., Sands, K. E. F. Tags: Viewpoints Source Type: research
