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BMJ Quality & Safety

Sigall K Bell, Stephanie D Roche, Ariel Mueller, Erica Dente, Kristin O'Reilly, Barbara Sarnoff Lee, Kenneth Sands, Daniel Talmor, Samuel M Brown
BACKGROUND: Little is known about patient/family comfort voicing care concerns in real time, especially in the intensive care unit (ICU) where stakes are high and time is compressed. Experts advocate patient and family engagement in safety, which will require that patients/families be able to voice concerns. Data on patient/family attitudes and experiences regarding speaking up are sparse, and mostly include reporting events retrospectively, rather than pre-emptively, to try to prevent harm...
July 12, 2018: BMJ Quality & Safety
Carien W Alingh, Jeroen D H van Wijngaarden, Karina van de Voorde, Jaap Paauwe, Robbert Huijsman
BACKGROUND: Speaking up is important for patient safety, but healthcare professionals often hesitate to voice their concerns. Direct supervisors have an important role in influencing speaking up. However, good insight into the relationship between managers' behaviour and employees' perceptions about whether speaking up is safe and worthwhile is still lacking. AIM: To explore the relationships between control-based and commitment-based safety management, climate for safety, psychological safety and nurses' willingness to speak up...
June 28, 2018: BMJ Quality & Safety
Lauren Clack, Walter Zingg, Sanjay Saint, Alejandra Casillas, Sylvie Touveneau, Fabricio da Liberdade Jantarada, Ursina Willi, Tjallie van der Kooi, Laura J Damschroder, Jane H Forman, Molly Harrod, Sarah Krein, Didier Pittet, Hugo Sax
OBJECTIVE: The Prevention of Hospital Infections by Intervention and Training (PROHIBIT) project included a cluster-randomised, stepped wedge, controlled study to evaluate multiple strategies to prevent catheter-related bloodstream infection. We report an in-depth investigation of the main barriers, facilitators and contextual factors relevant to successfully implementing these strategies in European acute care hospitals. METHODS: Qualitative comparative case study in 6 of the 14 European PROHIBIT hospitals...
June 27, 2018: BMJ Quality & Safety
Anne Marie J W M Weggelaar-Jansen, Damien S E Broekharst, Martine de Bruijne
BACKGROUND: Several countries have national policies and programmes requiring hospitals to use quality and safety (QS) indicators. To present an overview of these indicators, hospital-wide QS (HWQS) dashboards are designed. There is little evidence how these dashboards are developed. The challenges faced to develop these dashboards in Dutch hospitals were retrospectively studied. METHODS: 24 focus group interviews were conducted: 12 with hospital managers (n=25; 39...
June 27, 2018: BMJ Quality & Safety
Cecilia Vindrola-Padros, Laura Eyre, Helen Baxter, Helen Cramer, Bethan George, Lesley Wye, Naomi J Fulop, Martin Utley, Natasha Phillips, Peter Brindle, Martin Marshall
The concept of knowledge co-production is used in health services research to describe partnerships (which can involve researchers, practitioners, managers, commissioners or service users) with the purpose of creating, sharing and negotiating different knowledge types used to make improvements in health services. Several knowledge co-production models have been proposed to date, some involving intermediary roles. This paper explores one such model, researchers-in-residence (also known as 'embedded researchers')...
June 4, 2018: BMJ Quality & Safety
Eddie Donaghy, Lisa Salisbury, Nazir I Lone, Robert Lee, Pamela Ramsey, Janice E Rattray, Timothy Simon Walsh
BACKGROUND: Many intensive care (ICU) survivors experience early unplanned hospital readmission, but the reasons and potential prevention strategies are poorly understood. We aimed to understand contributors to readmissions from the patient/carer perspective. METHODS: This is a mixed methods study with qualitative data taking precedence. Fifty-eight ICU survivors and carers who experienced early unplanned rehospitalisation were interviewed. Thematic analysis was used to identify factors contributing to readmissions, and supplemented with questionnaire data measuring patient comorbidity and carer strain, and importance rating scales for factors that contribute to readmissions in other patient groups...
May 31, 2018: BMJ Quality & Safety
Mahsa Sadeghi, Jerome A Leis, Claude Laflamme, Darrel Sparkes, Wendy Ditrani, Aaron Watamaniuk, Ru Taggar, Fatema Jinnah, Melisa Avaness, Mary Vearncombe, Avery B Nathens
BACKGROUND: Prevention of healthcare-associated urinary tract infection (UTI) has been the focus of a national effort, yet appropriate indications for insertion and removal of urinary catheters (UC) among surgical patients remain poorly defined. METHODS: We developed and implemented a standardised approach to perioperative UC use to reduce postsurgical UTI including standard criteria for catheter insertion, training of staff to insert UC using sterile technique and standardised removal in the operating room and surgical unit using a nurse-initiated medical directive...
May 29, 2018: BMJ Quality & Safety
Marc Reeson, Alan Forster, Carl van Walraven
BACKGROUND: Central line associated pneumothorax (CLAP) could be a good quality of care indicator because they are objectively measured, clearly undesirable and possibly avoidable. We measured the incidence and trends of CLAP using radiograph report text search with manual review and compared them with measures using routinely collected health administrative data. METHODS: For each hospitalisation to a tertiary care teaching hospital between 2002 and 2015, we searched all chest radiography reports for a central line with a sensitive computer algorithm...
May 25, 2018: BMJ Quality & Safety
Kevin J O'Leary, Abra L Fant, Jessica Thurk, Karl Y Bilimoria, Aashish K Didwania, Kristine M Gleason, Matthew Groth, Jane L Holl, Claire A Knoten, Gary J Martin, Patricia O'Sullivan, Mark Schumacher, Donna M Woods
BACKGROUND: Although many studies of quality improvement (QI) education programmes report improvement in learners' knowledge and confidence, the impact on learners' future engagement in QI activities is largely unknown and few studies report project measures beyond completion of the programme. METHOD: We developed the Academy for Quality and Safety Improvement (AQSI) to prepare individuals, across multiple departments and professions, to lead QI. The 7-month programme consisted of class work and team-based project work...
May 22, 2018: BMJ Quality & Safety
Stefanie N Hofstede, Iris E Ceyisakar, Hester F Lingsma, Dionne S Kringos, Perla J Marang-van de Mheen
BACKGROUND: Despite widespread use of quality indicators, it remains unclear to what extent they can reliably distinguish hospitals on true differences in performance. Rankability measures what part of variation in performance reflects 'true' hospital differences in outcomes versus random noise. OBJECTIVE: This study sought to assess whether combining data into composites or including data from multiple years improves the reliability of ranking quality indicators for hospital care...
May 22, 2018: BMJ Quality & Safety
Vikas N O'Reilly-Shah, George S Easton, Craig S Jabaley, Grant C Lynde
BACKGROUND: Identifying mechanisms to improve provider compliance with quality metrics is a common goal across medical disciplines. Nudge interventions are minimally invasive strategies that can influence behavioural changes and are increasingly used within healthcare settings. We hypothesised that nudge interventions may improve provider compliance with lung-protective ventilation (LPV) strategies during general anaesthesia. METHODS: We developed an audit and feedback dashboard that included information on both provider-level and department-level compliance with LPV strategies in two academic hospitals, two non-academic hospitals and two academic surgery centres affiliated with a single healthcare system...
May 18, 2018: BMJ Quality & Safety
Jane K O'Hara, Karina Aase, Justin Waring
No abstract text is available yet for this article.
May 15, 2018: BMJ Quality & Safety
Elizabeth Cecil, Alex Bottle, Aneez Esmail, Samantha Wilkinson, Charles Vincent, Paul P Aylin
OBJECTIVE: To investigate the association between alerts from a national hospital mortality surveillance system and subsequent trends in relative risk of mortality. BACKGROUND: There is increasing interest in performance monitoring in the NHS. Since 2007, Imperial College London has generated monthly mortality alerts, based on statistical process control charts and using routinely collected hospital administrative data, for all English acute NHS hospital trusts...
May 4, 2018: BMJ Quality & Safety
Viet-Thi Tran, Eugene Messou, Mariam Mama Djima, Philippe Ravaud, Didier K Ekouevi
OBJECTIVE: Patients living with HIV infection (PLWH) in sub-Saharan Africa face an important burden of treatment related to everything they do to take care of their health: doctor visits, tests, regular refills, travels, and so on. In this study, we involved PLWH in proposing ideas on how to decrease their burden of treatment and assessed to what extent these propositions could be implemented in care. METHODS: Adult PLWH recruited in three HIV care centres in Côte d'Ivoire participated in qualitative interviews starting with ' What do you believe are the most important things to change in your care to improve your burden of treatment? ' Two independent investigators conducted a thematic analysis to identify and classify patients' propositions to decrease their burden of treatment...
April 29, 2018: BMJ Quality & Safety
Adi Hirshberg, Katheryne Downes, Sindhu Srinivas
BACKGROUND: Monitoring blood pressure at 72 hours and 7-10 days post partum in women with hypertensive disorders is recommended to decrease morbidity. However, there are no recommendations as to how to achieve this. OBJECTIVE: To compare the effectiveness of text-based blood pressure monitoring to in-person visits for women with hypertensive disorders of pregnancy in the immediate postpartum period. METHODS: Randomised clinical trial among 206 postpartum women with pregnancy-related hypertension diagnosed during the delivery admission between August 2016 and January 2017...
April 27, 2018: BMJ Quality & Safety
Melissa M Garrido, Austin B Frakt
No abstract text is available yet for this article.
April 19, 2018: BMJ Quality & Safety
Ketan K Mane, Kevin B Rubenstein, Najlla Nassery, Adam L Sharp, Ejaz A Shamim, Navdeep S Sangha, Ahmed Hassoon, Mehdi Fanai, Zheyu Wang, David E Newman-Toker
No abstract text is available yet for this article.
July 2018: BMJ Quality & Safety
Gurpreet Dhaliwal, Kaveh G Shojania
No abstract text is available yet for this article.
July 2018: BMJ Quality & Safety
Dawn Goodwin, Jessica Mesman, Marian Verkerk, Suzanne Grant
No abstract text is available yet for this article.
June 2018: BMJ Quality & Safety
Noah M Ivers, Jon Barrett
No abstract text is available yet for this article.
June 2018: BMJ Quality & Safety
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