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BMJ Quality & Safety

Rocco Friebel, Adam Steventon
No abstract text is available yet for this article.
September 17, 2018: BMJ Quality & Safety
John T Ratelle, Adam P Sawatsky, Deanne T Kashiwagi, Will M Schouten, Patricia J Erwin, Jed D Gonzalo, Thomas J Beckman, Colin P West
BACKGROUND: Bedside rounds (BR) have been proposed as an ideal method to promote patient-centred hospital care, but there is substantial variation in their implementation and effects. Our objectives were to describe the implementation of BR in hospital settings and determine their effect on patient-centred outcomes. METHODS: Data sources included Ovid MEDLINE, Ovid Embase, Scopus and Ovid Cochrane Central Registry of Clinical Trials from database inception through 28 July 2017...
September 17, 2018: BMJ Quality & Safety
Anjali Joseph, Amin Khoshkenar, Kevin M Taaffe, Ken Catchpole, Herminia Machry, Sara Bayramzadeh
BACKGROUND: Studies in operating rooms (OR) show that minor disruptions tend to group together to result in serious adverse events such as surgical errors. Understanding the characteristics of these minor flow disruptions (FD) that impact major events is important in order to proactively design safer systems OBJECTIVE: The purpose of this study is to use a systems approach to investigate the aetiology of minor and major FDs in ORs in terms of the people involved, tasks performed and OR traffic, as well as the location of FDs and other environmental characteristics of the OR that may contribute to these disruptions...
August 29, 2018: BMJ Quality & Safety
Isaac Barker, Adam Steventon, Robert Williamson, Sarah R Deeny
OBJECTIVE: To quantify the association between patient self-management capability measured using the Patient Activation Measure (PAM) and healthcare utilisation across a whole health economy. RESULTS: 12 270 PAM questionnaires were returned from 9348 patients. In the adjusted analyses, compared with the least activated group, highly activated patients (level 4) had the lowest rate of contact with a general practitioner (rate ratio: 0.82, 95% CI 0.79 to 0.86), emergency department attendances (rate ratio: 0...
August 23, 2018: BMJ Quality & Safety
Jeffrey L Schnipper, Amanda Mixon, Jason Stein, Tosha B Wetterneck, Peter J Kaboli, Stephanie Mueller, Stephanie Labonville, Jacquelyn A Minahan, Elisabeth Burdick, Endel John Orav, Jenna Goldstein, Nyryan V Nolido, Sunil Kripalani
BACKGROUND: Unintentional discrepancies across care settings are a common form of medication error and can contribute to patient harm. Medication reconciliation can reduce discrepancies; however, effective implementation in real-world settings is challenging. METHODS: We conducted a pragmatic quality improvement (QI) study at five US hospitals, two of which included concurrent controls. The intervention consisted of local implementation of medication reconciliation best practices, utilising an evidence-based toolkit with 11 intervention components...
August 20, 2018: BMJ Quality & Safety
Sarah Burm, Kaitlyn Boese, Lisa Faden, Sandy DeLuca, Noureen Huda, Kathy Hibbert, Mark Goldszmidt
BACKGROUND: While the concept of collaboration is highly touted in the literature, most descriptions of effective collaboration highlight formal collaborative events; largely ignored are the informal collaborative events and none focusing on the frequent, 'seemingly' by chance communication events that arise and their role in supporting patient safety and quality care. OBJECTIVE: To identify the types of informal communication events that exist in the inpatient setting and better understand the barriers contributing to their necessity...
August 18, 2018: BMJ Quality & Safety
JoAnna K Leyenaar, Christine B Andrews, Emily R Tyksinski, Eric Biondi, Kavita Parikh, Shawn Ralston
BACKGROUND: Emergency medicine and paediatric hospital medicine physicians each provide a portion of the initial clinical care for the majority of hospitalised children in the USA. While these disciplines share goals to increase quality of care, there are scant data describing their collaboration. Our national, multihospital learning collaborative, which aimed to increase narrow-spectrum antibiotic prescribing for paediatric community-acquired pneumonia, provided an opportunity to examine factors influencing the success of quality improvement efforts across these two clinical departments...
August 12, 2018: BMJ Quality & Safety
Matthew Barclay, Mary Dixon-Woods, Georgios Lyratzopoulos
'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.
August 12, 2018: BMJ Quality & Safety
Jennifer Meddings, Ted A Skolarus, Karen E Fowler, Steven J Bernstein, Justin B Dimick, Jason D Mann, Sanjay Saint
BACKGROUND: Indwelling urinary catheters are commonly used for patients undergoing general and orthopaedic surgery. Despite infectious and non-infectious harms of urinary catheters, there is limited guidance available to surgery teams regarding appropriate perioperative catheter use. OBJECTIVE: Using the RAND Corporation/University of California Los Angeles (RAND/UCLA) Appropriateness Method, we assessed the appropriateness of indwelling urinary catheter placement and different timings of catheter removal for routine general and orthopaedic surgery procedures...
August 12, 2018: BMJ Quality & Safety
William V Padula, Peter J Pronovost, Mary Beth F Makic, Heidi L Wald, Dane Moran, Manish K Mishra, David O Meltzer
OBJECTIVE: Hospital-acquired pressure injuries are localised skin injuries that cause significant mortality and are costly. Nursing best practices prevent pressure injuries, including time-consuming, complex tasks that lack payment incentives. The Braden Scale is an evidence-based stratification tool nurses use daily to assess pressure-injury risk. Our objective was to analyse the cost-utility of performing repeated risk-assessment for pressure-injury prevention in all patients or high-risk groups...
August 10, 2018: BMJ Quality & Safety
Tim Badgery-Parker, Sallie-Anne Pearson, Kelsey Chalmers, Jonathan Brett, Ian A Scott, Susan Dunn, Neville Onley, Adam G Elshaug
OBJECTIVE: To examine 27 low-value procedures, as defined by international recommendations, in New South Wales public hospitals. DESIGN: Analysis of admitted patient data for financial years 2010-2011 to 2016-2017. MAIN OUTCOME MEASURES: Number and proportion of episodes identified as low value by two definitions (narrower and broader), associated costs and bed-days, and variation between hospitals in financial year 2016-2017; trends in numbers of low-value episodes from 2010-2011 to 2016-2017...
August 6, 2018: BMJ Quality & Safety
Suhas Gondi, Derek Soled, Ashish Jha
'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.
July 30, 2018: BMJ Quality & Safety
Noah M Ivers, Monica Taljaard, Vasily Giannakeas, Catherine Reis, Evelyn Williams, Susan Bronskill
BACKGROUND: Although sometimes appropriate, antipsychotic medications are associated with increased risk of significant adverse events. In 2014, a series of newspaper articles describing high prescribing rates in nursing homes in Ontario, Canada, garnered substantial interest. Subsequently, an online public reporting initiative with home-level data was launched. We examined the impact of these public reporting interventions on antipsychotic prescribing in nursing homes. METHODS: Time series analysis of all nursing home residents in Ontario, Canada, between 1 October 2013 and 31 March 2016...
July 30, 2018: BMJ Quality & Safety
Valerie M Vaughn, Sanjay Saint, Sarah L Krein, Jane H Forman, Jennifer Meddings, Jessica Ameling, Suzanne Winter, Whitney Townsend, Vineet Chopra
BACKGROUND: Identifying characteristics associated with struggling healthcare organisations may help inform improvement. Thus, we systematically reviewed the literature to: (1) Identify organisational factors associated with struggling healthcare organisations and (2) Summarise these factors into actionable domains. METHODS: Systematic review of qualitative studies that evaluated organisational characteristics of healthcare organisations that were struggling as defined by below-average patient outcomes (eg, mortality) or quality of care metrics (eg, Patient Safety Indicators)...
July 25, 2018: BMJ Quality & Safety
Marit S de Vos, Jaap F Hamming, Jolanda J C Chua-Hendriks, Perla J Marang-van de Mheen
BACKGROUND AND OBJECTIVE: Incident, adverse event (AE) and complaint data are typically used separately, but may be related at the patient level with one event triggering a cascade of events, ultimately resulting in a complaint. This study examined relations between incidents, AEs and complaints that co-occurred in admissions. METHODS: Independently and routinely collected incident, AE and complaint data were retrospectively linked for surgical admissions in an academic centre (2008-2014)...
July 21, 2018: BMJ Quality & Safety
Tormod Rogne, Trond Nordseth, Gudmund Marhaug, Einar Marcus Berg, Arve Tromsdal, Ola Sæther, Sven Gisvold, Peter Hatlen, Helen Hogan, Erik Solligård
BACKGROUND: The proportion of avoidable hospital deaths is challenging to estimate, but has great implications for quality improvement and health policy. Many studies and monitoring tools are based on selected high-risk populations, which may overestimate the proportion. Mandatory reporting systems, however, under-report. We hypothesise that a review of an unselected sample of hospital deaths will provide an estimate of avoidability in-between the estimates from these methods. METHODS: A retrospective case record review of an unselected population of 1000 consecutive non-psychiatric hospital deaths in a Norwegian hospital trust was conducted...
July 19, 2018: BMJ Quality & Safety
Lisa Nordan, Lorrie Blanchfield, Shehzad Niazi, Juliet Sattar, Courtney Elizabeth Coakes, Ryan Uitti, Michael Vizzini, James M Naessens, Aaron Spaulding
No abstract text is available yet for this article.
July 18, 2018: BMJ Quality & Safety
Tejal K Gandhi, Gary S Kaplan, Lucian Leape, Donald M Berwick, Susan Edgman-Levitan, Amy Edmondson, Gregg S Meyer, David Michaels, Julianne M Morath, Charles Vincent, Robert Wachter
In 2009, the National Patient Safety Foundation's Lucian Leape Institute (LLI) published a paper identifying five areas of healthcare that require system-level attention and action to advance patient safety.The authors argued that to truly transform the safety of healthcare, there was a need to address medical education reform; care integration; restoring joy and meaning in work and ensuring the safety of the healthcare workforce; consumer engagement in healthcare and transparency across the continuum of care...
July 17, 2018: BMJ Quality & Safety
Alicia I Arbaje, Ashley Hughes, Nicole Werner, Kimberly Carl, Dawn Hohl, Kate Jones, Kathryn H Bowles, Kitty Chan, Bruce Leff, Ayse P Gurses
BACKGROUND: Middle-aged and older adults requiring skilled home healthcare ('home health') services following hospital discharge are at high risk of experiencing suboptimal outcomes. Information management (IM) needed to organise and communicate care plans is critical to ensure safety. Little is known about IM during this transition. OBJECTIVES: (1) Describe the current IM process (activity goals, subactivities, information required, information sources/targets and modes of communication) from home health providers' perspectives and (2) Identify IM-related process failures...
July 17, 2018: BMJ Quality & Safety
Julia E Szymczak
No abstract text is available yet for this article.
July 14, 2018: BMJ Quality & Safety
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