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BMJ Quality & Safety

Su-Yin Hor, Claire Hooker, Rick Iedema, Mary Wyer, Gwendolyn L Gilbert, Christine Jorm, Matthew Vincent Neil O'Sullivan
BACKGROUND: Hospital-acquired infections are the most common adverse event for inpatients worldwide. Efforts to prevent microbial cross-contamination currently focus on hand hygiene and use of personal protective equipment (PPE), with variable success. Better understanding is needed of infection prevention and control (IPC) in routine clinical practice. METHODS: We report on an interventionist video-reflexive ethnography study that explored how healthcare workers performed IPC in three wards in two hospitals in New South Wales, Australia: an intensive care unit and two general surgical wards...
November 30, 2016: BMJ Quality & Safety
Benjamin D Bray, Adam Steventon
No abstract text is available yet for this article.
November 30, 2016: BMJ Quality & Safety
Carl Macrae
No abstract text is available yet for this article.
November 18, 2016: BMJ Quality & Safety
Reshma Gupta, Christopher Moriates, James D Harrison, Victoria Valencia, Michael Ong, Robin Clarke, Neil Steers, Ron D Hays, Clarence H Braddock, Robert Wachter
BACKGROUND: Organisational culture affects physician behaviours. Patient safety culture surveys have previously been used to drive care improvements, but no comparable survey of high-value care culture currently exists. We aimed to develop a High-Value Care Culture Survey (HVCCS) for use by healthcare leaders and training programmes to target future improvements in value-based care. METHODS: We conducted a two-phase national modified Delphi process among 28 physicians and nurse experts with diverse backgrounds...
October 26, 2016: BMJ Quality & Safety
Laura Anselmi, Rachel Meacock, Søren Rud Kristensen, Tim Doran, Matt Sutton
BACKGROUND: Studies finding higher mortality rates for patients admitted to hospital at weekends rely on routine administrative data to adjust for risk of death, but these data may not adequately capture severity of illness. We examined how rates of patient arrival at accident and emergency (A&E) departments by ambulance-a marker of illness severity-were associated with in-hospital mortality by day and time of attendance. METHODS: Retrospective observational study of 3 027 946 admissions to 140 non-specialist hospital trusts in England between April 2013 and February 2014...
October 18, 2016: BMJ Quality & Safety
Kaveh G Shojania, Mary Dixon-Woods
No abstract text is available yet for this article.
October 12, 2016: BMJ Quality & Safety
George Larcos, Mirela Prgomet, Andrew Georgiou, Johanna Westbrook
BACKGROUND: Errors by nuclear medicine technologists during the preparation of radiopharmaceuticals or at other times can cause patient harm and may reflect the impact of interruptions, busy work environments and deficient systems or processes. We aimed to: (a) characterise the rate and nature of interruptions technologists experience and (b) identify strategies that support safety. METHODS: We performed 100 hours of observation of 11 technologists at a major public hospital and measured the proportions of time spent in eight categories of work tasks, location of task, interruption rate and type and multitasking (tasks conducted in parallel)...
October 5, 2016: BMJ Quality & Safety
Ashley N D Meyer, Hardeep Singh
No abstract text is available yet for this article.
September 26, 2016: BMJ Quality & Safety
Marleen Kunneman, Victor M Montori
No abstract text is available yet for this article.
September 26, 2016: BMJ Quality & Safety
Darlene Tad-Y, Heidi L Wald
No abstract text is available yet for this article.
September 21, 2016: BMJ Quality & Safety
Jessica Sheringham, Rachel Sequeira, Jonathan Myles, William Hamilton, Joe McDonnell, Judith Offman, Stephen Duffy, Rosalind Raine
INTRODUCTION: Lung cancer survival is low and comparatively poor in the UK. Patients with symptoms suggestive of lung cancer commonly consult primary care, but it is unclear how general practitioners (GPs) distinguish which patients require further investigation. This study examined how patients' clinical and sociodemographic characteristics influence GPs' decisions to initiate lung cancer investigations. METHODS: A factorial experiment was conducted among a national sample of 227 English GPs using vignettes presented as simulated consultations...
September 20, 2016: BMJ Quality & Safety
Ann-Marie Howell, Elaine M Burns, Louise Hull, Erik Mayer, Nick Sevdalis, Ara Darzi
No abstract text is available yet for this article.
September 12, 2016: BMJ Quality & Safety
Christine M Bond
No abstract text is available yet for this article.
October 2016: BMJ Quality & Safety
Laura C Leviton, Lori Melichar
Quality improvement (QI) efforts affect a broader range of people than we often assume. These are the potential stakeholders for QI and its evaluation, and they have valuable perspectives to offer when they are consulted in planning, conducting and interpreting evaluations. QI practitioners are accustomed to consulting stakeholders to assess unintended consequences or assess patient experiences of care, but in many cases there are additional benefits to a broad inclusion of stakeholders. These benefits are better adherence to ethical standards, to assure that all legitimate interests take part, more useful and relevant evaluation information and better political buy-in to improve impact...
October 2016: BMJ Quality & Safety
Kathryn Ann Lambe, Gary O'Reilly, Brendan D Kelly, Sarah Curristan
BACKGROUND: Diagnostic error incurs enormous human and economic costs. The dual-process model reasoning provides a framework for understanding the diagnostic process and attributes certain errors to faulty cognitive shortcuts (heuristics). The literature contains many suggestions to counteract these and to enhance analytical and non-analytical modes of reasoning. AIMS: To identify, describe and appraise studies that have empirically investigated interventions to enhance analytical and non-analytical reasoning among medical trainees and doctors, and to assess their effectiveness...
October 2016: BMJ Quality & Safety
Imogen Lyons, Nicholas Barber, David K Raynor, Li Wei
AIM: To test the effectiveness of a tailored, pharmacist-led centralised advice service to improve adherence to patients on established medications. METHODS: A parallel group randomised controlled trial was conducted. Patients prescribed at least one oral medication for type 2 diabetes and/or lipid regulation were eligible to participate. 677 patients of a mail-order pharmacy were recruited and randomised (340 intervention, 337 control). The intervention comprised two tailored telephone consultations with a pharmacist, 4-6 weeks apart, plus a written summary of the discussion and a medicines reminder chart...
October 2016: BMJ Quality & Safety
Alan F Merry, Simon J Mitchell
No abstract text is available yet for this article.
October 2016: BMJ Quality & Safety
Rachel Ann Elliott, Matthew J Boyd, Nde-Eshimuni Salema, James Davies, Nicholas Barber, Rajnikant Laxmishanker Mehta, Lukasz Tanajewski, Justin Waring, Asam Latif, Georgios Gkountouras, A J Avery, Antony Chuter, Christopher Craig
OBJECTIVE: To examine the effectiveness of the New Medicine Service (NMS), a national community pharmacy service to support medicines-taking in people starting a new medicine for a long-term condition, compared with normal practice. METHODS: Pragmatic patient-level parallel randomised controlled trial, in 46 community pharmacies in England. Patients 1:1 block randomisation stratified by drug/disease group within each pharmacy. 504 participants (NMS: 251) aged 14 years and over, identified in the pharmacy on presentation of a prescription for asthma/chronic obstructive pulmonary disease, hypertension, type 2 diabetes or an anticoagulant/antiplatelet agent...
October 2016: BMJ Quality & Safety
Daniel A Devcich, Jennifer Weller, Simon J Mitchell, Scott McLaughlin, Lauren Barker, Jenny W Rudolph, Daniel B Raemer, Martin Zammert, Sara J Singer, Jane Torrie, Chris Ma Frampton, Alan F Merry
BACKGROUND: Realising the full potential of the WHO Surgical Safety Checklist (SSC) to reduce perioperative harm requires the constructive engagement of all operating room (OR) team members during its administration. To facilitate research on SSC implementation, a valid and reliable instrument is needed for measuring OR team behaviours during its administration. We developed a behaviourally anchored rating scale (BARS) for this purpose. METHODS: We used a modified Delphi process, involving 16 subject matter experts, to compile a BARS with behavioural domains applicable to all three phases of the SSC...
October 2016: BMJ Quality & Safety
Douglas Wetmore, Andrew Goldberg, Nishant Gandhi, John Spivack, Patrick McCormick, Samuel DeMaria
BACKGROUND: Anaesthesiologists work in a high stress, high consequence environment in which missed steps in preparation may lead to medical errors and potential patient harm. The pre-anaesthetic induction period has been identified as a time in which medical errors can occur. The Anesthesia Patient Safety Foundation has developed a Pre-Anesthetic Induction Patient Safety (PIPS) checklist. We conducted this study to test the effectiveness of this checklist, when embedded in our institutional Anesthesia Information Management System (AIMS), on resident performance in a simulated environment...
October 2016: BMJ Quality & Safety
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