Why do homeless women in New York state experience fewer hospital revisits after childbirth than housed women?
Homelessness is a major public health challenge faced by many countries, and in many places, it has been aggravated by the economic downturn associated with the COVID-19 pandemic. Even in wealthy countries, homelessness remains a major social and public health issue. For example, in the USA, which is one of the wealthiest countries in the world, an estimated 600 000 individuals are homeless on any given night.1 Homelessness is defined as the lack of ‘a fixed, regular, and adequate night time residence’ by the US Department of Housing and Urban Development.2 Studies have found that homeless individuals are more ...
Source: Quality and Safety in Health Care - March 17, 2022 Category: Health Management Authors: Miyawaki, A., Tsugawa, Y. Tags: Editorials Source Type: research
Quality and Safety in the Literature: March 2022
Key points Replacing peripheral intravenous catheters only when clinically indicated is associated with more bloodstream infections as compared with routine replacement. JAMA Intern Med 17 September 2021. Penalties levied by the End-Stage Renal Disease Quality Incentive Program pay-for-performance programme do not improve performance scores of dialysis facilities. Ann Intern Med August 2021. Point-of-care procalcitonin testing for acute respiratory tract infection in the outpatient setting leads to reduced antibiotic prescribing without affecting safety. BMJ 21 September 2021. Healthcare quality and safety span multiple to...
Source: Quality and Safety in Health Care - March 3, 2022 Category: Health Management Authors: Khurana, I., Gupta, A., Houchens, N. Tags: Quality & amp; safety in the literature Source Type: research
The problem with ... using stories as a source of evidence and learning
Since time immemorial, stories have played a central role in teaching us about life.1 Stories have also thrown light on complex aspects of contemporary care, such as doctors’ reasoning,2 patients’ experiences,3 clinical training4 and care practices.5 This is an acknowledgement of stories’ significance for acculturating us into social norms and sanctioned practices, and teaching us about risks, challenges and incidents. The power of stories to teach us about these matters lies in their ability to affect us at multiple levels. ‘Little stories’ nurture and ground our individual self and our ident...
Source: Quality and Safety in Health Care - March 3, 2022 Category: Health Management Authors: Iedema, R. Tags: The problem with... Source Type: research
Were all in this together: how COVID-19 revealed the co-construction of mindful organising and organisational reliability
The pursuit of highly reliable performance has been a priority of patient safety policy-makers, practitioners and researchers alike for the past two decades. Aside from narrow examples of sustained reliability (eg, central-line bloodstream infections in the USA1), it has largely been elusive despite considerable effort.2 Prior work has argued that high reliability remains difficult and fragile because our approaches to pursuing it in both practice and research are insufficiently systemic3 or have failed to identify and create behavioural habits of high-reliability organising.4 On this brittle foundation, as it has with so ...
Source: Quality and Safety in Health Care - March 3, 2022 Category: Health Management Authors: Vogus, T. J., Wilson, A. D., Randall, K., Sitterding, M. C. Tags: COVID-19 Viewpoints Source Type: research
Primary care physicians (PCP) perceived value of patient-reported outcomes (PROs) in clinical practice: a mixed methods study
Conclusions
Most PCPs regularly use PRO data though there are mixed opinions about their clinical relevance. An adaptable, user-friendly PRO system has the potential to have meaningful clinical applications in primary care. (Source: Quality and Safety in Health Care)
Source: Quality and Safety in Health Care - March 3, 2022 Category: Health Management Authors: Mou, D., Horn, D. M., Heng, M., Castillo-Angeles, M., Ladin, K., Frendl, D., Kaur, M., del Carmen, M., Sequist, T. D., Sisodia, R. C. Tags: Editor's choice Original research Source Type: research
Patient-level and hospital-level variation and related time trends in COVID-19 case fatality rates during the first pandemic wave in England: multilevel modelling analysis of routine data
Conclusions
There was modest variation in mortality following admission for COVID-19 between English hospitals after adjustment for risk and random variation, in marked contrast to early media reports. Early-period mortality did not predict late-period mortality. (Source: Quality and Safety in Health Care)
Source: Quality and Safety in Health Care - March 3, 2022 Category: Health Management Authors: Bottle, A., Faitna, P., Aylin, P. P. Tags: COVID-19 Original research Source Type: research
Understanding decisions about antibiotic prescribing in ICU: an application of the Necessity Concerns Framework
Conclusion
Efforts to improve antibiotic stewardship should consider clinicians’ desire to protect with a prescription. Rapid molecular microbiology, with appropriate communication, may diminish clinicians’ fears of not prescribing or of using narrower-spectrum antibiotics. (Source: Quality and Safety in Health Care)
Source: Quality and Safety in Health Care - March 3, 2022 Category: Health Management Authors: Pandolfo, A. M., Horne, R., Jani, Y., Reader, T. W., Bidad, N., Brealey, D., Enne, V. I., Livermore, D. M., Gant, V., Brett, S. J., INHALE WP2 Study Group, Barber, Shallcross, Cuesta, Peters, Klein, Moondi, OGrady, High, Russell, Turner, Singh Tags: Open access Original research Source Type: research
Patient-centred care delivered by general practitioners: a qualitative investigation of the experiences and perceptions of patients and providers
Conclusion
Patient advocates’ and GPs’ understanding of PCC are diverse, which can hinder strategies to implement and sustain PCC improvements. Future research should explore novel interventions that expose GPs to unique feedback from patients, assess the patient-centeredness of the environment and promote GP self-reflection on PCC. (Source: Quality and Safety in Health Care)
Source: Quality and Safety in Health Care - March 3, 2022 Category: Health Management Authors: Brickley, B., Williams, L. T., Morgan, M., Ross, A., Trigger, K., Ball, L. Tags: Original research Source Type: research
Influence of drug safety advisories on drug utilisation: an international interrupted time series and meta-analysis
Conclusions
Among safety advisories issued on a wide range of drugs during 2009–2015 in 4 countries (Canada, Denmark, the UK and the USA), the association of advisories with changes in drug utilisation was variable, and the average association was modest. (Source: Quality and Safety in Health Care)
Source: Quality and Safety in Health Care - March 3, 2022 Category: Health Management Authors: Morrow, R. L., Mintzes, B., Souverein, P. C., De Bruin, M. L., Roughead, E. E., Lexchin, J., Kemp-Casey, A., Puil, L., Sketris, I., Mangin, D., Hallgreen, C. E., Pearson, S.-A., Lopert, R., Bero, L., Ofori-Asenso, R., Gnjidic, D., Sarpatwari, A., Perry, L Tags: Open access Original research Source Type: research
Understanding the complexities of collecting and using PRO data in a primary care context
Patient-reported outcomes (PROs) were originally introduced to primary care as screening instruments to assist primary care practitioners to diagnose and manage depression, on the assumption that standardised tools offered a more systematic and comprehensive assessment of symptoms.1 2 Since then, in both England and the USA, for instance, primary care has seen a move towards integrated care systems with collaboration across primary and secondary care and social services with the aim of better supporting patients to self-manage long-term conditions.3 In this context, PROs are envisaged to enable practitioners to identify pa...
Source: Quality and Safety in Health Care - March 3, 2022 Category: Health Management Authors: Greenhalgh, J. Tags: Editorials Source Type: research
Have we forgotten the moral justification for patient-centred care?
Patient-centred care has attracted intense attention over the last 50 years. First articulated in the late 1960s, and inspired by Roger’s Client-Centred Therapy1 and Balint’s concept of the therapeutic relationship,2 its early focus was on the relationship between a patient and their physician.3 Over the last couple of decades, patient-centred care has become a foundation for health professional education,4 a guiding principle for health disciplines5 and an explicit focus of the patient-centred medical home.6 It has been increasingly incorporated into the design of healthcare organisations and the systems in wh...
Source: Quality and Safety in Health Care - March 3, 2022 Category: Health Management Authors: Russell, G. Tags: Editorials Source Type: research
Deconstructing improvements and hospital variation in COVID-19 mortality rates during the early pandemic wave: the effects of wave evolution and advances in testing, treatment, and hospital care quality
The COVID-19 pandemic has contributed to millions of deaths around the world and placed unprecedented strains on healthcare systems. Several studies early in the pandemic demonstrated substantial variation in COVID-19-associated mortality rates among hospitalised patients across and within countries, suggesting that hospital factors such as bed capacity, adequacy of staffing, supplies of ventilators and other critical equipment, and/or quality of care had a major impact on patient outcomes.1–3 These analyses have been difficult to interpret, however, because variation in outcomes may also reflect community-based fact...
Source: Quality and Safety in Health Care - March 3, 2022 Category: Health Management Authors: Rhee, C. Tags: COVID-19 Editorials Source Type: research
Antibiotic overuse: managing uncertainty and mitigating against overtreatment
Diagnostic uncertainty drives antibiotic overuse Antibiotic overuse contributes to the growing threat of antimicrobial resistance (AMR). Despite local, national and global initiatives to target the problem, reducing overuse is challenging. Levels of antibiotic prescribing in hospitals in the UK are still rising year on year.1 Pandolfo et al’s2 study in this issue of BMJ Quality & Safety provides new insights into this problem by studying clinician decision-making about antibiotic prescribing in intensive care units, using a framework from psychology: the Necessity Concerns Framework. They explored how clinicians ...
Source: Quality and Safety in Health Care - March 3, 2022 Category: Health Management Authors: Tarrant, C., Krockow, E. M. Tags: Editorials Source Type: research
Impact of Statewide Prevention and Reduction of Clostridioides difficile (SPARC), a Maryland public health-academic collaborative: an evaluation of a quality improvement intervention
To evaluate changes in Clostridioides difficile incidence rates for Maryland hospitals that participated in the Statewide Prevention and Reduction of C. difficile (SPARC) collaborative. Pre-post, difference-in-difference analysis of non-randomised intervention using four quarters of preintervention and six quarters of postintervention National Healthcare Safety Network data for SPARC hospitals (April 2017 to March 2020) and 10 quarters for control hospitals (October 2017 to March 2020). Mixed-effects negative binomial models were used to assess changes over time. Process evaluation using hospital intervention implementatio...
Source: Quality and Safety in Health Care - January 19, 2022 Category: Health Management Authors: Rock, C., Perlmutter, R., Blythe, D., Bork, J., Claeys, K., Cosgrove, S. E., Dzintars, K., Fabre, V., Harris, A. D., Heil, E., Hsu, Y.-J., Keller, S., Maragakis, L. L., Milstone, A. M., Morgan, D. J., Dullabh, P., Ubri, P. S., Rotondo, C., Brooks, R., Lee Tags: Open access Quality improvement reports Source Type: research
Looking back on the history of patient safety: an opportunity to reflect and ponder future challenges
The publication of To Err is Human1 by the US Institute of Medicine (IOM) helped launch not just the field of patient safety but the broader interest in healthcare quality. The report’s estimates of 44 000–98 000 annual deaths from medical error in US hospitals—eye-catchingly equated to a jumbo jet crashing every day and a half—captured headlines and widespread attention. The IOM (now the National Academy of Medicine, NAM) followed up this success with Crossing the Quality Chasm,2 which notably defined quality in terms of six distinct dimensions, including not just safety, but also effectiveness, pa...
Source: Quality and Safety in Health Care - January 19, 2022 Category: Health Management Authors: Schiff, G., Shojania, K. G. Tags: Open access Viewpoints Source Type: research
