The problem with checklists
‘The Problem with...’ series covers controversial topics related to efforts to improve healthcare quality, including widely recommended but deceptively difficult strategies for improvement and pervasive problems that seem to resist solution. Since the seminal studies by Gawande and colleagues1 and Pronovost et al,2 checklists have become the go-to solution for a vast range of patient safety and quality issues in healthcare. Some see them as a quick and obvious solution to a relatively straightforward problem. For others, they illustrate a failure to understand and address the complex challenges in patient saf...
Source: Quality and Safety in Health Care - August 18, 2015 Category: Health Management Authors: Catchpole, K., Russ, S. Tags: The problem with... Source Type: research
Temporal trends in patient safety in the Netherlands: reductions in preventable adverse events or the end of adverse events as a useful metric?
Two years ago, BMJ Quality & Safety published the first example of a longitudinal national adverse event (AE) study.1 That study included 400 admissions from each of 21 randomly selected hospitals in the Netherlands in 2004 and 200 admissions from 20 hospitals in 2008. The authors reported an increase in AEs (ie, harm from medical care) from 4.1% in 2004 to 6.2% in 2008. Reassuringly, the preventable AE rate did not change, leaving one to wonder if the increase in non-preventable AE rates reflected better documentation in medical records (or just a chance finding). The lack of improvement in patient safety over time in...
Source: Quality and Safety in Health Care - August 18, 2015 Category: Health Management Authors: Shojania, K. G., Marang-van de Mheen, P. J. Tags: Editorials Source Type: research
Safety in healthcare is a moving target
Safety in healthcare is a constantly moving target. As standards improve and concern for safety grows, we come to regard an increasing number of events as patient safety issues. In this respect, healthcare differs from almost all other safety-critical industries. What we regard as harm in, for instance, civil aviation remains the same whatever advances may occur in aviation technology or practice. In contrast, innovation and improving standards in healthcare alter our conceptions of both harm and preventability. In the 1950s, many complications of healthcare were recognised, at least by some, but largely viewed as the inev...
Source: Quality and Safety in Health Care - August 18, 2015 Category: Health Management Authors: Vincent, C., Amalberti, R. Tags: Editorials Source Type: research
Response to: 'Driven to distraction and driving for excellence in ward round practice' by Pucher and Aggarwal
We thank Pucher and Aggarwal1 for their interest in our paper and their kind words on how our research adds to the literature on this topic. We welcome the opportunity to share more detail about our study in response to their three specific questions. The first question related to how specific distractions used in the study were chosen. These were selected after discussion with a number of local clinical colleagues, ranging from relatively junior doctors through to experienced senior consultants. The results from these focus groups indicated six common workplace distractions. These were the doctor's pager, dealing with war...
Source: Quality and Safety in Health Care - March 18, 2015 Category: Health Management Authors: Thomas, I., Nicol, L., Regan, L., Cleland, J., Maliepaard, D., Clark, L., Walker, K., Duncan, J. Tags: Correspondence Source Type: research
'Driven to distraction' and driving for excellence in ward round practice
It is with great interest that we read the recent publication by Thomas et al1 investigating ward-based patient care. They describe a study in which 28 medical students were randomised to either control (no intervention) or intervention (performance feedback and error management training) groups, performing simulated ward rounds complicated by environmental distractors. Significant reductions in errors were seen in both groups from the first to the second ward round, with a significantly greater reduction seen in the intervention group. We thoroughly commend on their efforts to add to the body of literature for what is suc...
Source: Quality and Safety in Health Care - March 18, 2015 Category: Health Management Authors: Pucher, P., Aggarwal, R. Tags: Correspondence Source Type: research
Response to: 'working smarter, not harder' by Professor Iedema
We thank Professor Iedema for highlighting that a gap exists in providers having the skillset to ‘work smarter.’1 We agree that novel approaches to healthcare improvement that move beyond gadget-based solutions and that require a new set of skills of providers and provider organisations are required. The suggestion of videotaping one's performance to review how the system (and its participants) currently operates and to reflect on how to (re-) design their workflows is intriguing. It exemplifies the concept of ‘exnovation’ or ‘innovation from within’, meaning innovation arises from withi...
Source: Quality and Safety in Health Care - March 18, 2015 Category: Health Management Authors: Hayes, C. W., Batalden, P. B., Goldmann, D. Tags: Correspondence Source Type: research
Working smarter, not harder
The Hayes, Batalden and Goldmann piece is an important contribution to the debate about what exactly is practice improvement. Most practice improvement thinking is anchored in the ‘innovation’ paradigm, and this paradigm is predominantly ‘gadget thinking’. Others’ solutions are to be adopted here because they produce great outcomes elsewhere. Except now we have to figure out how we can get the gadget to work. Few commentators have been game to shift towards acknowledging that care practices are now too complex for ‘gadget thinking’. Hayes and colleagues are an exception. They propo...
Source: Quality and Safety in Health Care - March 18, 2015 Category: Health Management Authors: Iedema, R. Tags: Correspondence Source Type: research
Real-time information on preventable death provided by email from frontline intensivists: results in high response rates with useful information
Recently, Provenzano et al1 found that an electronic tool collecting real-time clinical information directly from frontline providers was both feasible and useful to evaluate inpatient deaths. These findings concur with our evaluation of the preventability of death using a simple electronic evaluation tool in our 46-bed adult intensive care unit (ICU). From September 2010 to September 2011, an email was sent to the attending intensivist each time a patient died in our intensive care including two questions: "Was this death preventable? If yes, what was the cause of preventability?" The definition of preventable mortality w...
Source: Quality and Safety in Health Care - March 18, 2015 Category: Health Management Authors: Dijkema, L. M., Keus, F., Dieperink, W., van der Horst, I. C. C., Zijlstra, J. G. Tags: Correspondence Source Type: research
Alarm system management: evidence-based guidance encouraging direct measurement of informativeness to improve alarm response
Although there are powerful incentives for creating alarm management programmes to reduce ‘alarm fatigue’, they do not provide guidance on how to reduce the likelihood that clinicians will disregard critical alarms. The literature cites numerous phenomena that contribute to alarm fatigue, although many of these, including total rate of alarms, are not supported in the literature as factors that directly impact alarm response. The contributor that is most frequently associated with alarm response is informativeness, which is defined as the proportion of total alarms that successfully conveys a specific event, an...
Source: Quality and Safety in Health Care - March 18, 2015 Category: Health Management Authors: Rayo, M. F., Moffatt-Bruce, S. D. Tags: Narrative review Source Type: research
Application of a trigger tool in near real time to inform quality improvement activities: a prospective study in a general medicine ward
Conclusions
Prospective application of an augmented trigger tool identified a wide range of factors contributing to AEs. However, the majority of contributing factors accounted for a small number of AEs, and more general categories were too heterogeneous to inform specific interventions. Successfully using trigger tools to stimulate quality improvement activities may require development of a framework that better classifies events that share contributing factors amenable to the same intervention. (Source: Quality and Safety in Health Care)
Source: Quality and Safety in Health Care - March 18, 2015 Category: Health Management Authors: Wong, B. M., Dyal, S., Etchells, E. E., Knowles, S., Gerard, L., Diamantouros, A., Mehta, R., Liu, B., Baker, G. R., Shojania, K. G. Tags: Original research Source Type: research
Computerised physician order entry-related medication errors: analysis of reported errors and vulnerability testing of current systems
Conclusions and relevance
Medication error reports provide valuable information for understanding CPOE-related errors. Reports were useful for developing taxonomy and identifying recurring errors to which current CPOE systems are vulnerable. Enhanced monitoring, reporting and testing of CPOE systems are important to improve CPOE safety. (Source: Quality and Safety in Health Care)
Source: Quality and Safety in Health Care - March 18, 2015 Category: Health Management Authors: Schiff, G. D., Amato, M. G., Eguale, T., Boehne, J. J., Wright, A., Koppel, R., Rashidee, A. H., Elson, R. B., Whitney, D. L., Thach, T.-T., Bates, D. W., Seger, A. C. Tags: Open access Original research Source Type: research
The quality of hospital work environments and missed nursing care is linked to heart failure readmissions: a cross-sectional study of US hospitals
Conclusions
Missed care is an independent predictor of heart failure readmissions. However, once adjusting for the quality of the nurse work environment, this relationship is attenuated. Improvements in nurses’ working conditions may be one strategy to reduce care omissions and improve patient outcomes. (Source: Quality and Safety in Health Care)
Source: Quality and Safety in Health Care - March 18, 2015 Category: Health Management Authors: Carthon, J. M. B., Lasater, K. B., Sloane, D. M., Kutney-Lee, A. Tags: Original research Source Type: research
Human factors and ergonomics and quality improvement science: integrating approaches for safety in healthcare
Introduction In this paper, we will address the important question of how quality improvement science (QIS) and human factors and ergonomics (HFE) can work together to produce safer solutions for healthcare. We suggest that there will be considerable advantages from an integrated approach between the two disciplines and professions which could be achieved in two phases. First, by identifying people trained in HFE and those trained in QIS who understand how to work together and second, by developing opportunities for integrated education and training. To develop this viewpoint we will:Discuss and explore how QIS and HFE cou...
Source: Quality and Safety in Health Care - March 18, 2015 Category: Health Management Authors: Hignett, S., Jones, E. L., Miller, D., Wolf, L., Modi, C., Shahzad, M. W., Buckle, P., Banerjee, J., Catchpole, K. Tags: Open access Viewpoints Source Type: research
'The problem with...': a new series on problematic improvements and problematic problems in healthcare quality and patient safety
Who has not attended an organisational meeting focused on some quality problem and not groaned in response to a suggestion of the type ‘We should just ...have a new policy’, ‘...send out performance reports’, ‘... create a checklist’, ‘go after the low-hanging fruit’, or any of a number of other commonly suggested strategies for dealing with quality-related problems. Whether the groan occurs audibly or just internally depends on one's self-control and role in the organisation. Following the groan, one may even launch into a short speech beginning with the phrase ‘The pr...
Source: Quality and Safety in Health Care - March 18, 2015 Category: Health Management Authors: Shojania, K. G., Catchpole, K. Tags: Viewpoints Source Type: research
The future of measuring patient safety: prospective clinical surveillance
Prospective clinical surveillance (PCS) is a safety measurement approach that fulfils many of the goals and principles of the latest thinking on measuring and improving safety.1 2 Compared with many current measurement practices, it may be more valid and reliable, with potential to facilitate learning and improvement and empower and draw upon the experience of front-line providers. It also has implications for external oversight of healthcare organisations. In the study by Wong et al,3 PCS involved a trained nurse who visited a clinical unit on weekdays. The nurse looked for triggers indicating a possible adverse event by ...
Source: Quality and Safety in Health Care - March 18, 2015 Category: Health Management Authors: Thomas, E. J. Tags: Editorials Source Type: research
