Nurse staffing matters: now what?
Brooks Carthon and colleagues1 assess the relationship between the quality of hospital work environments for registered nurses and ‘missed care’ reported by nurses. Similar to other authors, they define missed care as care that nurses regarded as necessary but left undone due to a lack of time.2–4 Brooks Carthon and colleagues1 also explore the relationship between both of these variables and hospital readmissions for heart failure. Their analysis represents an important step in moving beyond the literature describing relationships between nurse staffing and patient outcomes.5–7 For patients with he...
Source: Quality and Safety in Health Care - March 18, 2015 Category: Health Management Authors: Sales, A. Tags: Editorials Source Type: research
Electronic health records and patient safety: should we be discouraged?
For decades we have looked hopefully to electronic health records (EHRs) to aid efforts to make healthcare safer.1 Early research gave basis to this hope: automated alerts and reminders were shown to improve preventive and chronic illness care,2 electronic records could be better organised and more easily delivered where needed,3 automated computerised decision support (CDS) can help make diagnoses4 and plan treatments,5 and computerised practitioner order entry (CPOE) was shown to reduce risk for serious adverse drug events.6 Since 2009, the USA has joined other countries in broadly adopting EHRs.7 8 Through the meaningfu...
Source: Quality and Safety in Health Care - March 18, 2015 Category: Health Management Authors: Payne, T. H. Tags: Editorials Source Type: research
Demystifying theory and its use in improvement
The role and value of theory in improvement work in healthcare has been seriously underrecognised. We join others in proposing that more informed use of theory can strengthen improvement programmes and facilitate the evaluation of their effectiveness. Many professionals, including improvement practitioners, are unfortunately mystified—and alienated—by theory, which discourages them from using it in their work. In an effort to demystify theory we make the point in this paper that, far from being discretionary or superfluous, theory (‘reason-giving’), both informal and formal, is intimately woven into...
Source: Quality and Safety in Health Care - February 12, 2015 Category: Health Management Authors: Davidoff, F., Dixon-Woods, M., Leviton, L., Michie, S. Tags: Open access Research and reporting methodology Source Type: research
Influenza vaccination rates for hospitalised patients: a multiyear quality improvement effort
Conclusions
Although we are confident that our local efforts helped to improve the vaccination rate, external factors such as the 2009 H1N1 pandemic and universal vaccination may have primed our system to respond more readily to the implemented changes. Understanding all of the relevant factors that lead to vaccination uptake can be applied to future hospital influenza vaccination campaigns. In addition, our work demonstrates that an interprofessional approach is still required to apply the functionality of the EMR effectively. (Source: Quality and Safety in Health Care)
Source: Quality and Safety in Health Care - February 12, 2015 Category: Health Management Authors: Cohen, E. S., Ogrinc, G., Taylor, T., Brown, C., Geiling, J. Tags: Quality improvement reports Source Type: research
Clinically led performance management in secondary healthcare: evaluating the attitudes of medical and non-clinical managers
Conclusions
This study suggests that a performance-related HRM framework may facilitate the management of clinical performance in secondary healthcare, but is dependent on the design and methods of application used. Such approaches contrast with those currently proposed for clinicians in secondary healthcare in the UK and suggest that alternative strategies should be considered. (Source: Quality and Safety in Health Care)
Source: Quality and Safety in Health Care - February 12, 2015 Category: Health Management Authors: Trebble, T. M., Paul, M., Hockey, P. M., Heyworth, N., Humphrey, R., Powell, T., Clarke, N. Tags: Quality improvement reports Source Type: research
Developing and evaluating the success of a family activated medical emergency team: a quality improvement report
Conclusions
Family MET activations were uncommon and not a burden on responders. These calls recognised clinical deterioration and communication failures. Family activated METs should be tested and implemented in hospitals that care for children. (Source: Quality and Safety in Health Care)
Source: Quality and Safety in Health Care - February 12, 2015 Category: Health Management Authors: Brady, P. W., Zix, J., Brilli, R., Wheeler, D. S., Griffith, K., Giaccone, M. J., Dressman, K., Kotagal, U., Muething, S., Tegtmeyer, K. Tags: Editor's choice Quality improvement reports Source Type: research
Do patient-reported outcomes offer a more sensitive method for comparing the outcomes of consultants than mortality? A multilevel analysis of routine data
Conclusions
PROMs offer a more appropriate and sensitive method for comparing consultants’ outcomes. The influence of hospitals must be considered to ensure comparisons are meaningful. Improvements will be achieved by shifting the distribution of consultants rather than by reducing variation between them. (Source: Quality and Safety in Health Care)
Source: Quality and Safety in Health Care - February 12, 2015 Category: Health Management Authors: Varagunam, M., Hutchings, A., Black, N. Tags: Original research Source Type: research
Development and testing of an objective structured clinical exam (OSCE) to assess socio-cultural dimensions of patient safety competency
Conclusions
Results show (1) four OSCE stations evaluating socio-cultural dimensions of PS achieved variation in scores and (2) performance on this OSCE can be evaluated with high reliability, suggesting a single assessor per station would be sufficient. Differences between nursing and medical student performance are interesting; however, it is unclear what factors explain these differences. (Source: Quality and Safety in Health Care)
Source: Quality and Safety in Health Care - February 12, 2015 Category: Health Management Authors: Ginsburg, L. R., Tregunno, D., Norton, P. G., Smee, S., de Vries, I., Sebok, S. S., VanDenKerkhof, E. G., Luctkar-Flude, M., Medves, J. Tags: Open access Original research Source Type: research
But I told you she was ill! The role of families in preventing avoidable harm in children
"But I told you they were ill!" These are chilling words for any healthcare professional to hear if harm has occurred to a child following failure to recognise a serious illness. Failing to detect and act on a child who is deteriorating is an important form of avoidable harm that remains a significant issue both in and out of hospitals.1 2 Systems for tracking illness in children and triggering clinical response have been in use for some time, with a variety of Paediatric Early Warning Systems (PEWS) available.3 Typically, these systems use features common to clinical observations such as heart rate, respiratory rate and t...
Source: Quality and Safety in Health Care - February 12, 2015 Category: Health Management Authors: Roland, D. Tags: Editorials Source Type: research
New SQUIRE publication guidelines: supporting nuanced reporting and reflection on complex interventions
In 2008, the Standards for Quality Improvement Reporting Excellence (SQUIRE) guidelines were published to clarify the content and format for published scholarly reports of healthcare improvement (http://www.squire-statement.org).1 The guidelines were intended to increase the completeness, precision and transparency of those reports by establishing a level of rigour. The field has dramatically advanced even in the short time since their release, and the SQUIRE guidelines are being revised to align with those changes. As part of the development of SQUIRE 2.0—expected to release in Autumn 2015—Brady et al2 ‘...
Source: Quality and Safety in Health Care - February 12, 2015 Category: Health Management Authors: Davies, L., Ogrinc, G. Tags: Editorials Source Type: research
Parent-activated medical emergency teams: a parent's perspective
In 2008, I lost my baby son due to serious failures in his care at the hospital where he was born. Joshua’s mother collapsed shortly after the birth and was treated with antibiotics and fluids. She soon made a full recovery, but Joshua, we were told by staff on the ward, was fine. In the 24 h following Joshua’s birth, we were concerned about his condition. He was breathing quickly, seemed mucousy around his mouth and was struggling to maintain his body temperature. We raised repeated concerns with the midwifery staff that were looking after him. But each time, we were simply reassured he was ok. At 24 ...
Source: Quality and Safety in Health Care - February 12, 2015 Category: Health Management Authors: Titcombe, J. Tags: Editorials Source Type: research
Assessing patient safety competencies using Objective Structured Clinical Exams: a new twist on an old tool
Despite the widespread attention to patient safety over the past 15 years, the subject continues to receive relatively little attention in undergraduate training for health professionals (eg, in medical and nursing schools). Recent advances such as the WHO curriculum guide1 and the Canadian Patient Safety Institute competency framework1 2 help to guide our teaching and learning. Furthermore, some schools have implemented patient safety curricula.3 4 However, evaluating the degree to which students attain these competencies remains in its infancy (‘On a scale of 1–5, rate how well you did X’), with al...
Source: Quality and Safety in Health Care - February 12, 2015 Category: Health Management Authors: Stroud, L., Vidyarthi, A. R. Tags: Editorials Source Type: research
Learning from mistakes in clinical practice guidelines: the case of perioperative {beta}-blockade
Introduction For more than two decades, the role of β-blockers in preventing cardiac complications after surgery has been among the most hotly contested and controversial topics in medical practice. Based on two small randomised trials published in the late 1990s,1 2 leading physicians and experts in patient safety embraced preoperative β-blocker initiation as a therapeutic victory for high-risk surgical patients: an apparently simple and effective treatment that promised, for the first time, to prevent life-threatening postoperative cardiac events. Yet nearly as soon as preoperative β-blocker initiation had...
Source: Quality and Safety in Health Care - October 14, 2014 Category: Health Management Authors: Neuman, M. D., Bosk, C. L., Fleisher, L. A. Tags: History Source Type: research
Evaluation of hospital factors associated with hospital postoperative venous thromboembolism imaging utilisation practices
Conclusions
Hospital teaching status, resident-to-bed ratio, malpractice environment and local market factors drive hospital postoperative VTE imaging use, suggesting that non-clinical forces predominantly drive hospital VTE imaging practices. (Source: Quality and Safety in Health Care)
Source: Quality and Safety in Health Care - October 14, 2014 Category: Health Management Authors: Chung, J. W., Ju, M. H., Kinnier, C. V., Haut, E. R., Baker, D. W., Bilimoria, K. Y. Tags: Original research Source Type: research
The WHO surgical safety checklist: survey of patients' views
Conclusions
It is feasible and instructive to capture patients’ views of the delivery of safety improvements like the checklist. We have demonstrated strong support for the checklist in a sample of surgical patients, presenting a challenge to those resistant to its use. (Source: Quality and Safety in Health Care)
Source: Quality and Safety in Health Care - October 14, 2014 Category: Health Management Authors: Russ, S. J., Rout, S., Caris, J., Moorthy, K., Mayer, E., Darzi, A., Sevdalis, N., Vincent, C. Tags: Open access Original research Source Type: research
