Cost-effectiveness of a quality improvement project, including simulation-based training, on reducing door-to-needle times in stroke thrombolysis
Conclusions
We have shown that a QI project aiming to improve stroke thrombolysis treatment at our centre can be implemented and sustained at a relatively low cost with increasing cost-effectiveness over time. Our work builds on the emerging theory and practice for economic evaluations in QI projects and simulation-based training. The presented cost-effectiveness data might help guide healthcare leaders planning similar interventions. (Source: Quality and Safety in Health Care)
Source: Quality and Safety in Health Care - July 19, 2022 Category: Health Management Authors: Ajmi, S. C., Kurz, M. W., Ersdal, H., Lindner, T., Goyal, M., Issenberg, S. B., Vossius, C. Tags: Original research Source Type: research
Transition of care from adult intensive care settings - implementing interventions to improve medication safety and patient outcomes
On admission to an intensive care unit (ICU), patients’ regular long-term medications may be withheld while they are being stabilised. Such medications are sometimes not restarted during the rest of their hospital stay, even when transferred to a lower acuity ward or discharged from hospital.1 This puts patients discharged from an ICU at higher risk of unintentional medication discontinuation, which could lead to future exacerbation of chronic conditions. Additionally, ICU patients may have medications commenced in the acute stage of their ICU admission (eg, gastric acid secretion inhibitors) that might inadvertently...
Source: Quality and Safety in Health Care - July 19, 2022 Category: Health Management Authors: McCarthy, S., Laaksonen, R., Silvari, V. Tags: Editorials Source Type: research
Inequalities exacerbated: an all-too-familiar story
The direct effects of COVID-19—at least in terms of cases, hospitalisations and deaths—have been well documented in almost real time throughout the pandemic. Researchers, policymakers, clinicians and the public are now increasingly able to reflect on the multiple indirect effects of the pandemic and associated policy responses. In this issue of BMJ Quality & Safety, Warner and colleagues add to this literature, highlighting socioeconomic and ethnicity inequalities in disruptions to non-COVID-19 hospital activity.1 While the inequalities that Warner and colleagues highlight constitute the core of their artic...
Source: Quality and Safety in Health Care - July 19, 2022 Category: Health Management Authors: Stokes, J. Tags: Editorials Source Type: research
Urgent referral to specialist services for patients with cancer symptoms: a cause for concern or oversimplifying a complex issue?
Prompt diagnosis of cancer is crucial, as it saves lives. In some primary healthcare systems, such as New Zealand (NZ) or the UK, patients with suspicious symptoms or signs normally require a referral from their general practitioner (GP) before accessing diagnostic services.1 Thus, primary care in such systems has a key role in facilitating early diagnosis of cancer and reducing diagnostic delay.2–4 Early diagnosis of cancer in primary care is difficult because most presenting symptoms are common and overlap with other, benign, conditions. The GP’s task is to assess the diagnostic probability of cancer and deci...
Source: Quality and Safety in Health Care - July 19, 2022 Category: Health Management Authors: Keenan, R., Lawrenson, R., Stokes, T. Tags: Editorials Source Type: research
The Evolving Economics of Implementation
Decision makers in healthcare systems strive to implement evidence-based, high-quality care. A lack of economic data is often cited as a barrier to implementation, especially when decision makers are asked to allocate finite resources and face competing demands.1–3 Studies that evaluate the cost of implementation strategies remain rare, and often these studies only estimate the implementation costs without connecting those investments to patient outcomes. In this issue of BMJ Quality & Safety, in a cost-effectiveness evaluation of a quality improvement project to improve thrombolysis door-to-needle times in a lar...
Source: Quality and Safety in Health Care - July 19, 2022 Category: Health Management Authors: Knocke, K., Wagner, T. W. Tags: Open access Editorials Source Type: research
Optimising GPs communication of advice to facilitate patients self-care and prompt follow-up when the diagnosis is uncertain: a realist review of 'safety-netting in primary care
Conclusions
We present 15 recommendations to enhance communication of safety-netting advice and map these onto established consultation models. Effective safety-netting communication relies on understanding the information needs of the patient, barriers to acceptance and explanation of the reasons why the advice is being given. Reduced continuity of care, increasing multimorbidity and remote consultations represent threats to safety-netting communication. (Source: Quality and Safety in Health Care)
Source: Quality and Safety in Health Care - June 20, 2022 Category: Health Management Authors: Friedemann Smith, C., Lunn, H., Wong, G., Nicholson, B. D. Tags: Open access Systematic review Source Type: research
Filling a gap in safety metrics: development of a patient-centred framework to identify and categorise patient-reported breakdowns related to the diagnostic process in ambulatory care
Conclusions
The PRDB framework, developed in partnership with patients/families, can help organisations identify and reliably categorise PRDBs, including some that are invisible to clinicians; guide interventions to engage patients and families as diagnostic partners; and inform whole organisational learning. (Source: Quality and Safety in Health Care)
Source: Quality and Safety in Health Care - June 20, 2022 Category: Health Management Authors: Bell, S. K., Bourgeois, F., DesRoches, C. M., Dong, J., Harcourt, K., Liu, S. K., Lowe, E., McGaffigan, P., Ngo, L. H., Novack, S. A., Ralston, J. D., Salmi, L., Schrandt, S., Sheridan, S., Sokol-Hessner, L., Thomas, G., Thomas, E. J. Tags: Original research Source Type: research
Outcomes for surgical procedures funded by the English health service but carried out in public versus independent hospitals: a database study
Conclusion
Elective surgery in an ISHP is associated with shorter lengths of stay and lower readmission rates than treatment in NHS hospitals across 18 operation types. The data were matched on observable covariates, but we cannot exclude selection bias due to unobserved confounders. (Source: Quality and Safety in Health Care)
Source: Quality and Safety in Health Care - June 20, 2022 Category: Health Management Authors: Crothers, H., Liaqat, A., Reeves, K., Watson, S. I., Gallier, S., Khunti, K., Bird, P., Lilford, R. Tags: Open access, Press releases Original research Source Type: research
Impact of COVID-19 restrictions on diabetes health checks and prescribing for people with type 2 diabetes: a UK-wide cohort study involving 618 161 people in primary care
Conclusions
Over the coming months, healthcare services will need to manage this backlog of testing and prescribing. We recommend effective communications to ensure patient engagement with diabetes services, monitoring and opportunities for prescribing, and when appropriate use of home monitoring, remote consultations and other innovations in care. (Source: Quality and Safety in Health Care)
Source: Quality and Safety in Health Care - June 20, 2022 Category: Health Management Authors: Carr, M. J., Wright, A. K., Leelarathna, L., Thabit, H., Milne, N., Kanumilli, N., Ashcroft, D. M., Rutter, M. K. Tags: Open access, Editor's choice, COVID-19 Original research Source Type: research
Development and pilot testing of survey items to assess the culture of value and efficiency in hospitals and medical offices
Conclusion
We developed psychometrically sound survey items measuring value and efficiency culture. When added to the Agency for Healthcare Research and Quality Surveys on Patient Safety Culture, the item sets extend those surveys by assessing additional dimensions of organisational culture that affect care delivery. Healthcare organisations can use these item sets to assess how well their organisational culture supports value and efficiency and identify areas for improvement. (Source: Quality and Safety in Health Care)
Source: Quality and Safety in Health Care - June 20, 2022 Category: Health Management Authors: Sorra, J., Zebrak, K., Yount, N., Famolaro, T., Gray, L., Franklin, M., Smith, S. A., Streagle, S. Tags: Open access Original research Source Type: research
Adding value to the diagnostic process
In 2010, Porter introduced the concept of value-based healthcare in an attempt to shift the focus from volume of services to value created for patients.1 Value was defined based on important health outcomes achieved for patients relative to costs, rather than being based on the input in terms of volume of delivered services. Since multiple professionals and organisational units are involved in healthcare, the idea was that all stakeholders should work towards a shared goal of creating value in improving health outcomes that meet the needs of the patient. Besides health outcomes, Porter included time to achieve recovery and...
Source: Quality and Safety in Health Care - June 20, 2022 Category: Health Management Authors: Kuhrij, L., Marang-van de Mheen, P. J. Tags: Editorials Source Type: research
Outsourcing care to the private sector: some reassuring evidence on patient outcomes
Many countries have a mixed healthcare economy, with a private sector (either for profit or non-profit) making up a varying proportion of capacity, depending on the financing model. The outsourcing of routine elective care to the private sector by the National Health Service (NHS) in England has become well established over the last two decades. Introduced in 2003 to cut waiting times for high-volume surgical and diagnostic procedures, a range of privately owned healthcare providers were contracted to provide services that are free at the point of access to NHS patients. The scale of capacity boost is modest, accounting fo...
Source: Quality and Safety in Health Care - June 20, 2022 Category: Health Management Authors: Bottle, A., Browne, J. Tags: Editorials Source Type: research
Indirect effects of the COVID-19 pandemic on people with type 2 diabetes: time to urgently move into a recovery phase
While the direct risks of the COVID-19 on people with type 2 diabetes (T2D) are well established,1 the indirect effects of the COVID-19 response on their management are less well understood. It is estimated that 4.7 million people have diabetes in the UK with T2D accounting for 90% of all diabetes cases, with primary care being at the forefront of delivering diabetes care.2 Besides the disproportionately high immediate direct effects of the COVID-19 pandemic on people with T2D, it has also exerted indirect effects through severe disruptions in the routine care of patients.3 During the first wave of the pandemic, efforts we...
Source: Quality and Safety in Health Care - June 20, 2022 Category: Health Management Authors: Vamos, E. P., Khunti, K. Tags: COVID-19 Editorials Source Type: research
Value of a value culture survey for improving healthcare quality
The article by Sorra and colleagues in this issue of BMJ Quality and Safety1 reflects a subtle but important shift in national efforts to enhance quality in healthcare. Since 2000 and the publication of To Err is Human,2 there has been widespread recognition of the need to address patient safety issues at a systems level. This and subsequent discourse directed attention to organisational culture as a key lever for ensuring safety and quality. The follow-on Crossing the Quality Chasm report acknowledged the multidimensionality of the cultural challenge by recommending redesign of the American healthcare system including six...
Source: Quality and Safety in Health Care - June 20, 2022 Category: Health Management Authors: Singer, S. J. Tags: Editorials Source Type: research
Effect of the surgical safety checklist on provider and patient outcomes: a systematic review
Conclusion
There is a scarcity of research that examines how the SSC is completed and how this influences safety outcomes. Examining how a checklist is completed is critical for understanding why the checklist is successful in some instances and not others. (Source: Quality and Safety in Health Care)
Source: Quality and Safety in Health Care - May 23, 2022 Category: Health Management Authors: Armstrong, B. A., Dutescu, I. A., Nemoy, L., Bhavsar, E., Carter, D. N., Ng, K.-D., Boet, S., Trbovich, P., Palter, V. Tags: Systematic review Source Type: research
