How safe is the diagnostic process in healthcare?
The seminal report To Err is Human focused on a wide range of serious patient safety concerns; diagnostic error was mentioned only in passing.1 Very little data were available on the magnitude of harm related to diagnostic errors at that time, except for a back-of-the-napkin estimate that diagnostic error could be responsible for 40 000–80 000 in-hospital deaths annually.2 The problem finally received its due 15 years later, when the National Academy of Medicine asserted that "... most of us will experience at least one diagnostic error in our lifetime, sometimes with devastating consequences".3 In this context, the ...
Source: Quality and Safety in Health Care - January 19, 2024 Category: Health Management Authors: Marang-van de Mheen, P. J., Thomas, E. J., Graber, M. L. Tags: Editorials Source Type: research
Towards comprehensive fidelity evaluations: consideration of enactment measures in quality improvement interventions
Within healthcare services worldwide, there is a continual emphasis on innovation, including the development, evaluation and improvement of new and existing healthcare interventions and services to improve patient outcomes. In addition to evaluating efficacy, it is also important to evaluate how innovations are used in ‘real-world’ settings. A key part of this is process evaluation: understanding how interventions and services are implemented and engaged with. For example, recent Medical Research Council guidance on researching the effectiveness of complex interventions highlights the importance of measuring im...
Source: Quality and Safety in Health Care - January 19, 2024 Category: Health Management Authors: Walton, H. Tags: Editorials Source Type: research
Making lemonade out of lemons: an approach to combining variable race and ethnicity data from hospitals for quality and safety efforts
Equity is one of the six core healthcare quality domains in ‘Crossing the Quality Chasm’, published by the Institute of Medicine in 2001.1 While substantial quality measurement and improvement work has focused on improving safety, patient-centredness, timeliness, efficiency and efficacy (the other five domains), far less has focused on health equity measurement and improvement. This is in part due to limited adoption of standardised definitions of racial and ethnicities and therefore limited availability of high-quality data on race and ethnicity.2 Having accurate data is a key first step in addressing health i...
Source: Quality and Safety in Health Care - January 19, 2024 Category: Health Management Authors: Karvonen, K. L., Bardach, N. S. Tags: Editorials Source Type: research
Time to treat the climate and nature crisis as one indivisible global health emergency
Over 200 health journals call on the United Nations (UN), political leaders and health professionals to recognise that climate change and biodiversity loss are one indivisible crisis and must be tackled together to preserve health and avoid catastrophe. This overall environmental crisis is now so severe as to be a global health emergency. The world is currently responding to the climate crisis and the nature crisis as if they were separate challenges. This is a dangerous mistake. The 28th Conference of the Parties (COP) on climate change is about to be held in Dubai while the 16th COP on biodiversity is due to be held in T...
Source: Quality and Safety in Health Care - January 19, 2024 Category: Health Management Authors: Zielinski, C., on behalf of the authorship group listed below Tags: Open access Editorials Source Type: research
Reducing unnecessary diagnostic phlebotomy in intensive care: a prospective quality improvement intervention
Conclusion
Iterative improvement interventions targeting clinician test ordering behaviour can reduce ICU phlebotomy and may impact red cell transfusions. Frequent stakeholder consultation, incorporating stewardship into daily workflow, and audit and feedback are effective strategies. (Source: Quality and Safety in Health Care)
Source: Quality and Safety in Health Care - July 19, 2023 Category: Health Management Authors: Bodley, T., Levi, O., Chan, M., Friedrich, J. O., Hicks, L. K. Tags: Quality improvement reports Source Type: research
Impact of COVID-19 on opioid use in those awaiting hip and knee arthroplasty: a retrospective cohort study
Conclusion
The work provides evidence of potential for an emerging opioid problem associated with the influence of COVID-19 on elective arthroplasty services. Viable alternatives to opioid analgesia for those with end-stage arthritis should be explored, and prolonged waiting times for surgery ought to be avoided in the recovery from COVID-19 to prevent more widespread opioid use. (Source: Quality and Safety in Health Care)
Source: Quality and Safety in Health Care - July 19, 2023 Category: Health Management Authors: Farrow, L., Gardner, W. T., Tang, C. C., Low, R., Forget, P., Ashcroft, G. P. Tags: COVID-19 Original research Source Type: research
Measurement and Monitoring of Safety Framework: a qualitative study of implementation through a Canadian learning collaborative
Conclusion
The MMSF requires a dramatic departure from traditional safety strategies that focus on discrete problems and emphasise measurement. MMSF implementation requires extensive discussion, coaching and experimentation. Future implementation should consider engaging local leaders and coaches and an organisation or system approach to enable broader reach and systemic change. (Source: Quality and Safety in Health Care)
Source: Quality and Safety in Health Care - July 19, 2023 Category: Health Management Authors: Goldman, J., Rotteau, L., Flintoft, V., Jeffs, L., Baker, G. R. Tags: Editor's choice Original research Source Type: research
What works in medication reconciliation: an on-treatment and site analysis of the MARQUIS2 study
Conclusion and relevance
Patient-level interventions most associated with reductions in discrepancies were receipt of a BPMH of admitted patients in the ED and admission and discharge medication reconciliation by a trained clinician. System-level interventions were associated with modest reduction in discrepancies for the average patient but are likely important to support patient-level interventions and may reach more patients. These findings can be used to help hospitals and health systems prioritise interventions to improve medication safety during care transitions. (Source: Quality and Safety in Health Care)
Source: Quality and Safety in Health Care - July 19, 2023 Category: Health Management Authors: Schnipper, J. L., Reyes Nieva, H., Yoon, C., Mallouk, M., Mixon, A. S., Rennke, S., Chu, E. S., Mueller, S. K., Smith, G. R., Williams, M. V., Wetterneck, T. B., Stein, J., Dalal, A. K., Labonville, S., Sridharan, A., Stolldorf, D. P., Orav, E. J., Gresha Tags: Original research Source Type: research
Mixed-methods study examining family carers perceptions of the relationship between intrahospital transitions and patient readiness for discharge
Conclusions
IHTs often represent disruptive events that may influence carers’ understanding of patient readiness for discharge to home and, thus, their own preparation for discharge. Further consideration is needed regarding how to support carers during IHT to facilitate high-quality discharge planning. (Source: Quality and Safety in Health Care)
Source: Quality and Safety in Health Care - July 19, 2023 Category: Health Management Authors: Bristol, A. A., Elmore, C. E., Weiss, M. E., Barry, L. A., Iacob, E., Johnson, E. P., Wallace, A. S. Tags: Original research Source Type: research
Choosing Wisely for quality improvement: more is not always better
It is not an entirely original observation that critical care medicine can be divided into two eras: a ‘maximalist’ era and a ‘minimalist’ era. From its founding as a specialty in 1952, critical care practice and research focused on increasingly invasive interventions to support patients’ failing organs. The reflex response to a problem was generally a new intervention. However, since the early 2000s, there is a growing weight of evidence suggesting that excessive and burdensome interventions are not good for patients (or staff). High volume ventilation,1 unsuitably invasive haemodynamic monit...
Source: Quality and Safety in Health Care - July 19, 2023 Category: Health Management Authors: Stephens, T. J., Thomson, W. R. Tags: Editorials Source Type: research
Measurement and Monitoring of Safety Framework (MMSF): learning from its implementation in Canada
The Measurement and Monitoring of Safety Framework (MMSF) is a conceptual model to guide organisations in assessing safety. Developed from a synthesis of research literature and case studies from healthcare and other industries,1 2 the MMSF comprises five dimensions of safety, each with an accompanying fundamental safety question (see table 1). The MMSF is a departure from prescriptive and top-down patient safety interventions; it encourages discussion, reflection and learning to improve patient safety. The MMSF tells us there is no one single measure of safety, and that safety measurement and monitoring is complex and mul...
Source: Quality and Safety in Health Care - July 19, 2023 Category: Health Management Authors: Carthey, J. Tags: Editorials Source Type: research
Learning how and why complex improvement interventions work: insights from implementation science
Many quality improvement (QI) interventions can be complex, comprising multiple inter-related components that target a range of factors which may lead to change. Some of these components can be focused on the nature of the improvement planned, the place where the change is to occur, the people who are involved and/or the structures and processes within the organisation itself.1 Understanding how the multiple components of such interventions work together to drive an improvement or in those instances where they fail to do so can be challenging. Without adequate assessment of the underlying processes and mechanisms through w...
Source: Quality and Safety in Health Care - July 19, 2023 Category: Health Management Authors: Wilson, P., Kislov, R. Tags: Editorials Source Type: research
Embracing carers: when will adult hospitals fully adopt the same practices as childrens hospitals?
Everyday, in children’s hospitals across the world, medical teams meet with hospitalised children and their family members on rounds. Why did this become routine in paediatics? Parents demanding involvement in their child’s care and paediatricians’ willingness to listen and collaborate with families certainly contributed. Moreover, national organisations asserted that this should be the standard of care in children’s hospitals. For example, the American Academy of Pediatrics and the Institute for Patient- and Family-Centered Care formally defined patient-centred and family centred care in 2012, reco...
Source: Quality and Safety in Health Care - July 19, 2023 Category: Health Management Authors: Williams, M. V., Li, J. Tags: Editorials Source Type: research
Imperfection in adverse event detection: is this the opportunity to mature our focus on preventing harm in paediatrics?
In a recent issue of BMJ Quality and Safety, Dillner and colleagues aim to estimate the incidence of paediatric adverse events (AEs).1 The authors provide a thorough examination of inpatient paediatric AEs through a much-needed systematic review and meta-analysis to characterise the incidence rate. A previous systematic review was published more than 10 years ago and reported a surprisingly low AE incidence but was based on only nine studies with samples of at least 1000 patients.2 Dillner and colleagues included studies regardless of sample size and identified more than 30 000 paediatric admissions and 8000 AEs from 32 st...
Source: Quality and Safety in Health Care - July 19, 2023 Category: Health Management Authors: Wong, C., Macias, C., Miller, M. Tags: Editorials Source Type: research
Quality and safety in the literature: July 2023
Healthcare quality and safety span multiple topics across the spectrum of academic and clinical disciplines. Keeping abreast of the rapidly growing body of work can be challenging. In this series, we provide succinct summaries of selected relevant studies published in the last several months. Some articles will focus on a particular theme, whereas others will highlight unique publications from high-impact medical journals. Key points Despite increased attention to patient safety over the last several decades, adverse events continue to be common in hospitalised patients, occurring in 23.6% of admissions studied. N Engl J M...
Source: Quality and Safety in Health Care - June 19, 2023 Category: Health Management Authors: Youssef, C., Houchens, N., Gupta, A. Tags: Quality & amp; safety in the literature Source Type: research
