Determining the skills needed by frontline NHS staff to deliver quality improvement: findings from six case studies
Conclusion
Our case studies provide a nuanced understanding of the skills used by healthcare staff. While technical skills are important, the ability to judge when and how to use wider skills was paramount. The provision of QI training and fidelity to the improvement programme may be less of a priority than the deployment of SOFFT skills used to overcome barriers. QI projects will fail if such skills and resources are not accessed. (Source: Quality and Safety in Health Care)
Source: Quality and Safety in Health Care - May 23, 2022 Category: Health Management Authors: Wright, D., Gabbay, J., Le May, A. Tags: Open access Original research Source Type: research
Association between acute psychiatric bed availability in the Veterans Health Administration and veteran suicide risk: a retrospective cohort study
Conclusions
High VHA hospital occupancy (>95%) was associated with a 10% increased suicide risk for veterans whereas absolute number of beds was not, suggesting occupancy is an important access measure. Future work should clarify optimal bed occupancy to meet acute psychiatric needs and ensure adequate bed distribution. (Source: Quality and Safety in Health Care)
Source: Quality and Safety in Health Care - May 23, 2022 Category: Health Management Authors: Kaboli, P. J., Augustine, M. R., Haraldsson, B., Mohr, N. M., Howren, M. B., Jones, M. P., Trivedi, R. Tags: Original research Source Type: research
National cross-sectional cohort study of the relationship between quality of mental healthcare and death by suicide
Conclusion
There was no correlation between overall quality of outpatient mental healthcare and rates of suicide in a national healthcare system. Although it is possible that quality was not high enough anywhere to prevent suicide at the population level or that we were unable to adequately measure quality, this examination of core mental health services in a well-resourced system raises doubts that a quality-based approach alone can lower population-level suicide rates. (Source: Quality and Safety in Health Care)
Source: Quality and Safety in Health Care - May 23, 2022 Category: Health Management Authors: Shiner, B., Gottlieb, D. J., Levis, M., Peltzman, T., Riblet, N. B., Cornelius, S. L., Russ, C. J., Watts, B. V. Tags: Original research Source Type: research
Should electronic differential diagnosis support be used early or late in the diagnostic process? A multicentre experimental study of Isabel
Conclusions and relevance
EDS increased the number of diagnostic hypotheses and the likelihood of the correct diagnosis appearing in the differential, and these effects persisted irrespective of whether EDS was used early or late in the diagnostic process. (Source: Quality and Safety in Health Care)
Source: Quality and Safety in Health Care - May 23, 2022 Category: Health Management Authors: Sibbald, M., Monteiro, S., Sherbino, J., LoGiudice, A., Friedman, C., Norman, G. Tags: Open access, Editor's choice Original research Source Type: research
Beyond improvement skills: what do clinicians, managers, patients and others need to do to make improvement happen?
In this issue of the journal, Wright et al offer an in-depth examination of the implementation of six improvement projects in three English hospitals to elucidate the work that matters most to those directly involved. The framework they inductively derive from their analysis—a set of ‘socio-organisational functional and facilitative tasks’, or SOFFTs—gives substance to the activities undertaken by practitioners at the sharp end of improvement projects, beyond the technical skills involved in delivering quality improvement methods.1 The notion that this class of activity may be important to the succe...
Source: Quality and Safety in Health Care - May 23, 2022 Category: Health Management Authors: Martin, G. P. Tags: Editorials Source Type: research
Mental health services: quality, safety and suicide
Suicide is a major global challenge with an estimated 700 000 people taking their lives each year.1 Each of these deaths is an individual tragedy affecting families, friends, communities and health and social care teams. As clinicians and researchers working in suicide prevention, we are sometimes contacted by people whose loved ones have died by suicide while under the care of mental health services. Although we hear about examples of high-quality care, there are also accounts of poor continuity, failed communication, diagnostic or therapeutic errors, poorly trained or resourced clinical teams or a lack of family involvem...
Source: Quality and Safety in Health Care - May 23, 2022 Category: Health Management Authors: Kapur, N., Gorman, L. S., Quinlivan, L., Webb, R. T. Tags: Editorials Source Type: research
Reaching 95%: decision support tools are the surest way to improve diagnosis now
Rory Staunton, a 12 year-old boy, presented with fever, vomiting and mottled skin. Was this gastroenteritis? Thomas Duncan’s symptoms were headache, dizziness, nausea, abdominal pain and fever after recent travel from West Africa. Was this sinusitis? These two classic cases of diagnostic error beg the question of why the correct diagnosis was missed, and in his classic paper, George Bordage provided a very plausible answer: ‘I just didn’t think of it.’1 That is where clinical decision support tools for diagnosis (CDS-Dx), the so-called ‘symptom checkers’, come in. They work, and would li...
Source: Quality and Safety in Health Care - May 23, 2022 Category: Health Management Authors: Graber, M. L. Tags: Editorials Source Type: research
Quality and Safety in the Literature: May 2022
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 Use of an automated text messaging service for home monitoring of symptoms results in decreased 30-day all-cause mortality in outpatients diagnosed with COVID-19. Ann Intern Med. 16 November 2...
Source: Quality and Safety in Health Care - April 19, 2022 Category: Health Management Authors: Emery, A., Houchens, N., Gupta, A. Tags: Quality & amp; safety in the literature Source Type: research
The problem with making Safety-II work in healthcare
‘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. Introduction Patient safety is typically assessed by the frequency of adverse events or incidents, which means we seek to determine safety by its absence rather than its presence.1 The Safety-II perspective aspires to overcome this paradox by bringing into focus situations where safety is actually present, that is, in everyday work that usually goes well.2 Central to Safet...
Source: Quality and Safety in Health Care - April 19, 2022 Category: Health Management Authors: Verhagen, M. J., de Vos, M. S., Sujan, M., Hamming, J. F. Tags: The problem with... Source Type: research
Barriers and enablers to monitoring and deprescribing opioid analgesics for chronic non-cancer pain: a systematic review with qualitative evidence synthesis using the Theoretical Domains Framework
Conclusion
Future implementation interventions aimed at monitoring and deprescribing opioids should target the patient and HCP barriers and enablers identified in this synthesis.
PROSPERO registration number
CRD42019140784. (Source: Quality and Safety in Health Care)
Source: Quality and Safety in Health Care - April 19, 2022 Category: Health Management Authors: Cross, A. J., Buchbinder, R., Mathieson, S., Bourne, A., Maher, C. G., Lin, C.-W. C., O'Connor, D. A. Tags: Systematic review Source Type: research
Overdiagnosis of urinary tract infection linked to overdiagnosis of pneumonia: a multihospital cohort study
In conclusion, we found overdiagnosis of UTI and CAP to be correlated at the hospital level. Reducing overdiagnosis of these two common infections may benefit from systematic interventions. (Source: Quality and Safety in Health Care)
Source: Quality and Safety in Health Care - April 19, 2022 Category: Health Management Authors: Gupta, A., Petty, L., Gandhi, T., Flanders, S., Hsaiky, L., Basu, T., Zhang, Q., Horowitz, J., Masood, Z., Chopra, V., Vaughn, V. M. Tags: Short reports Source Type: research
Impact of the COVID-19 pandemic on the incidence and mortality of hospital-onset bloodstream infection: a cohort study
The COVID-19 pandemic burdens hospitals, but consequences for quality of care outcomes such as healthcare-associated infections are largely unknown. This cohort included all adult hospital episodes (n=186 945) at an academic centre between January 2018 and January 2021. Data were collected from the hospitals’ electronic health record data repository. Hospital-onset bloodstream infection (HOB) was defined as any positive blood culture obtained ≥48 hours after admission classified based on microbiological and hospital administrative data. Subgroup analyses were performed with exclusion of potential contaminant bacte...
Source: Quality and Safety in Health Care - April 19, 2022 Category: Health Management Authors: Valik, J. K., Hedberg, P., Holmberg, F., van der Werff, S. D., Naucler, P. Tags: Short reports Source Type: research
Evaluating the safety of mental health-related prescribing in UK primary care: a cross-sectional study using the Clinical Practice Research Datalink (CPRD)
Conclusion
Potentially hazardous prescribing and inadequate medication monitoring commonly affect patients with mental illness in primary care, with marked between-practice variation for some indicators. These findings support health providers to identify improvement targets and inform development of improvement efforts to reduce medication-related harm. (Source: Quality and Safety in Health Care)
Source: Quality and Safety in Health Care - April 19, 2022 Category: Health Management Authors: Khawagi, W. Y., Steinke, D., Carr, M. J., Wright, A. K., Ashcroft, D. M., Avery, A., Keers, R. N. Tags: Open access, Editor's choice Original research Source Type: research
Implementation challenges to patient safety in Guatemala: a mixed methods evaluation
Conclusion
Implementation of safety programmes in low-resource settings requires recognition of facilitators such as staff receptivity and patient-centredness as well as barriers such as lack of training in patient safety and poor organisational incentives. Embedding an implementation analysis during programme deployment allows for programme modification to enhance successful implementation. (Source: Quality and Safety in Health Care)
Source: Quality and Safety in Health Care - April 19, 2022 Category: Health Management Authors: Hall, B. J., Puente, M., Aguilar, A., Sico, I., Orozco Barrios, M., Mendez, S., Baumgartner, J. N., Boyd, D., Calgua, E., Lou-Meda, R., Ramirez, C. C., Diez, A., Tello, A., Sexton, J. B., Rice, H. Tags: Open access Original research Source Type: research
Association of clinical competence, specialty and physician country of origin with opioid prescribing for chronic pain: a cohort study
Conclusions
Clinical competence at entry into US graduate training, physician gender, specialty and country of origin play a role in opioid prescribing practices. (Source: Quality and Safety in Health Care)
Source: Quality and Safety in Health Care - April 19, 2022 Category: Health Management Authors: Tamblyn, R., Girard, N., Boulet, J., Dauphinee, D., Habib, B. Tags: Open access Original research Source Type: research
