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Improving medication safety in both adults and children: what will it take? BMJ Qual. Saf. (IF 5.6) Pub Date : 2024-10-01 David W Bates, Mio Sakuma
Medications continue to represent a major cause of harm, both in inpatients and outpatients and in adults and children. In a recent large study, medications were the leading cause of harm in inpatient adults, and the same was true for adult outpatients.1 2 Medications were also the most frequent cause of harm in a large paediatric inpatient study.3 Despite these and other data, the magnitude of this
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Measuring gist-based perceptions of medication benefit-to-harm ratios BMJ Qual. Saf. (IF 5.6) Pub Date : 2024-10-01 Olga Kostopoulou
In this issue of the journal, Wegwarth et al report on a study that sought to identify general practitioner (GP) characteristics that predicted prescribing of potentially hazardous medications or, as the authors put it, ‘too much medicine’.1 An online survey of 304 English GPs measured their risk literacy, conflicts of interest, and perceived benefit-to-harm ratio in low-value prescribing scenarios
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Paediatric medication incident reporting: a multicentre comparison study of medication errors identified at audit, detected by staff and reported to an incident system BMJ Qual. Saf. (IF 5.6) Pub Date : 2024-10-01 Ling Li, Tim Badgery-Parker, Alison Merchant, Erin Fitzpatrick, Magdalena Z Raban, Virginia Mumford, Najwa-Joelle Metri, Peter Damian Hibbert, Cheryl Mccullagh, Michael Dickinson, Johanna I Westbrook
Objectives To compare medication errors identified at audit and via direct observation with medication errors reported to an incident reporting system at paediatric hospitals and to investigate differences in types and severity of errors detected and reported by staff. Methods This is a comparison study at two tertiary referral paediatric hospitals between 2016 and 2020 in Australia. Prescribing errors
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General practitioners’ risk literacy and real-world prescribing of potentially hazardous drugs: a cross-sectional study BMJ Qual. Saf. (IF 5.6) Pub Date : 2024-10-01 Odette Wegwarth, Tammy C Hoffmann, Ben Goldacre, Claudia Spies, Helge A Giese
Background Overuse of medical care is a pervasive problem. Studies using hypothetical scenarios suggest that physicians’ risk literacy influences medical decisions; real-world correlations, however, are lacking. We sought to determine the association between physicians’ risk literacy and their real-world prescriptions of potentially hazardous drugs, accounting for conflicts of interest and perceptions
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Common contributing factors of diagnostic error: A retrospective analysis of 109 serious adverse event reports from Dutch hospitals BMJ Qual. Saf. (IF 5.6) Pub Date : 2024-10-01 Jacky Hooftman, Aart Cornelis Dijkstra, Ilse Suurmeijer, Akke van der Bij, Ellen Paap, Laura Zwaan
Introduction Although diagnostic errors have gained renewed focus within the patient safety domain, measuring them remains a challenge. They are often measured using methods that lack information on decision-making processes given by involved physicians (eg, record reviews). The current study analyses serious adverse event (SAE) reports from Dutch hospitals to identify common contributing factors of
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Surgical informed consent practices and influencing factors in sub-Saharan Africa: a scoping review of the literature BMJ Qual. Saf. (IF 5.6) Pub Date : 2024-10-01 Chiara Pittalis, Cherie Sackey, Paul Okeny, Bip Nandi, Jakub Gajewski
Introduction Current international standards in consent to surgery practices are usually derived from health systems in Western countries, while little attention has been given to other contexts such as sub-Saharan Africa (SSA), despite this region facing the highest burdens of disease amenable to surgery globally. The aim of this study was to examine how the concept of informed consent for surgery
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Diagnostic error in mental health: a review BMJ Qual. Saf. (IF 5.6) Pub Date : 2024-10-01 Andrea Bradford, Ashley N D Meyer, Sundas Khan, Traber D Giardina, Hardeep Singh
Diagnostic errors are associated with patient harm and suboptimal outcomes. Despite national scientific efforts to advance definition, measurement and interventions for diagnostic error, diagnosis in mental health is not well represented in this ongoing work. We aimed to summarise the current state of research on diagnostic errors in mental health and identify opportunities to align future research
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Checking all the boxes: a checklist for when and how to use checklists effectively BMJ Qual. Saf. (IF 5.6) Pub Date : 2024-10-01 Myrtede Alfred, Laura H Barg-Walkow, Joseph R Keebler, Alex Chaparro
Checklists are a type of cognitive aid used to guide task performance; they have been adopted as an important safety intervention throughout many high-risk industries. They have become an ubiquitous tool in many medical settings due to being easily accessible and perceived as easy to design and implement. However, there is a lack of understanding for when to use checklists and how to design them, leading
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Raising the barcode: improving medication safety behaviours through a behavioural science-informed feedback intervention. A quality improvement project and difference-in-difference analysis BMJ Qual. Saf. (IF 5.6) Pub Date : 2024-10-01 Kate Grailey, Alix Brazier, Bryony Dean Franklin, Clare McCrudden, Roberto Fernandez Crespo, Helen Brown, James Bird, Amish Acharya, Alice Gregory, Ara Darzi, Sarah Huf
Barcode medication administration (BCMA) technology can improve patient safety by using scanning technology to ensure the right drug and dose are given to the right patient. Implementation can be challenging, requiring adoption of different workflows by nursing staff. In one London National Health Service trust scanning rates were lower than desired at around 0–20% of doses per ward. Our objective
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Development of the Patient-Reported Indicator Surveys (PaRIS) conceptual framework to monitor and improve the performance of primary care for people living with chronic conditions BMJ Qual. Saf. (IF 5.6) Pub Date : 2024-09-05 Jose M Valderas, Ian Porter, Jimmy Martin-Delgado, Mieke Rijken, Judith de Jong, Oliver Groene, Janika Bloemeke-Cammin, Rosa Sunol, Rachel Williams, Marta Ballester, Katherine de Bienassis, Candan Kendir, Frederico Guanais, Dolf de Boer, Michael van den Berg
The Organisation for Economic Co-operation and Development (OECD) Patient-Reported Indicator Surveys (PaRIS) initiative aims to support countries in improving care for people living with chronic conditions by collecting information on how people experience the quality and performance of primary and (generalist) ambulatory care services. This paper presents the development of the conceptual framework
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Role of communicating diagnostic uncertainty in the safety-netting process: insights from a vignette study BMJ Qual. Saf. (IF 5.6) Pub Date : 2024-09-04 Caitríona Cox, Thea Hatfield, Zoë Fritz
Background Safety-netting is intended to protect against harm from uncertainty in diagnosis/disease trajectory. Despite recommendations to communicate diagnostic uncertainty when safety-netting, this is not always done. Aims To explore how and why doctors safety-netted in response to several clinical scenarios, within the broader context of exploring how doctors communicate diagnostic uncertainty.
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Cluster randomised evaluation of a training intervention to increase the use of statistical process control charts for hospitals in England: making data count BMJ Qual. Saf. (IF 5.6) Pub Date : 2024-09-04 Kelly Ann Schmidtke, Laura Kudrna, Laura Quinn, Paul Bird, Karla Hemming, Zoe Venable, Richard Lilford
Background The way that data are presented can influence quality and safety initiatives. Time-series charts highlight changes but do not clarify whether data lie outside expected variation. Statistical process control (SPC) charts make this distinction and have been demonstrated to be effective in supporting hospital initiatives. To improve the uptake of the SPC methodology by hospitals in England
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Integration and connection: the key to effectiveness of large-scale pharmacist-led medication reviews? BMJ Qual. Saf. (IF 5.6) Pub Date : 2024-08-30 Andrew Husband, Anna Robinson-Barella
Our population is ageing and with increased age, comes more frequent presentation of people living with multiple long-term conditions (MLTCs), who are likely to experience polypharmacy and the risk that accompanies taking multiple medications. These risks disproportionately affect the most socioeconomically deprived people in our communities, including those from minority ethnic groups, among whom
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Reducing administrative burden by implementing a core set of quality indicators in the ICU: a multicentre longitudinal intervention study BMJ Qual. Saf. (IF 5.6) Pub Date : 2024-08-30 Gijs Hesselink, Rutger Verhage, Brigitte Westerhof, Eva Verweij, Malaika Fuchs, Inge Janssen, Catrien van der Meer, Iwan C C van der Horst, Paul de Jong, Johannes G van der Hoeven, Marieke Zegers
Background The number of quality indicators for which clinicians need to record data is increasing. For many indicators, there are concerns about their efficacy. This study aimed to determine whether working with only a consensus-based core set of quality indicators in the intensive care unit (ICU) reduces the time spent on documenting performance data and administrative burden of ICU professionals
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Sex, drugs and rock ‘n’ roll: the only reasons for regulators to target individuals BMJ Qual. Saf. (IF 5.6) Pub Date : 2024-08-23 Siri Wiig, Catherine Jane Calderwood, Bent Høie, Jeffrey Braithwaite
Healthcare regulators are having trouble keeping up. There is always a lag between regulators getting on top of things and fast-paced changes in health systems. Care is continuously becoming more complex.1 Rapid technological shifts (eg, new-generation drugs, artificial intelligence (AI) and advances in genomics) are accelerating. This confers new opportunities for better care, but it also implies
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Assessing patient work system factors for medication management during transition of care among older adults: an observational study BMJ Qual. Saf. (IF 5.6) Pub Date : 2024-08-23 Yan Xiao, Yea-Jen Hsu, Susan M Hannum, Ephrem Abebe, Melinda E Kantsiper, Ivonne Marie Pena, Andrea M Wessell, Sydney M Dy, Eric E Howell, Ayse P Gurses
Objective To develop and evaluate measures of patient work system factors in medication management that may be modifiable for improvement during the care transition from hospital to home among older adults. Design, settings and participants Measures were developed and evaluated in a multisite prospective observational study of older adults (≥65 years) discharged home from medical units of two US hospitals
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Strategies for adapting under pressure: an interview study in intensive care units BMJ Qual. Saf. (IF 5.6) Pub Date : 2024-08-23 Bethan Page, Dulcie Irving, Jane Carthey, John Welch, Helen Higham, Charles Vincent
Background Healthcare systems are operating under substantial pressures. Clinicians and managers are constantly having to make adaptations, which are typically improvised, highly variable and not coordinated across teams. This study aimed to identify and describe the types of everyday pressures in intensive care and the adaptive strategies staff use to respond, with the longer-term aim of developing
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Equity in Choosing Wisely and beyond: the effect of health literacy on healthcare decision-making and methods to support conversations about overuse BMJ Qual. Saf. (IF 5.6) Pub Date : 2024-08-22 Danielle M Muscat, Erin Cvejic, Jenna Smith, Rachel Thompson, Edward Chang, Marguerite Tracy, Joshua Zadro, Robyn Linder, Kirsten McCaffery
Objective To (a) examine whether the effect of the Choosing Wisely consumer questions on question-asking and shared decision-making (SDM) outcomes differs based on individuals’ health literacy and (b) explore the relationship between health literacy, question-asking and other decision-making outcomes in the context of low value care. Methods Preplanned analysis of randomised trial data comparing: the
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Aiming for equity in children with chronic conditions: introducing a new population health management system BMJ Qual. Saf. (IF 5.6) Pub Date : 2024-08-22 Persijn Honkoop
The widely known United Nations sustainable development goals indicate that good quality healthcare should be available to all those who need it.1 Unfortunately, the availability of good care tends to vary inversely with the actual need for it. This is not a new issue and had already been dubbed ‘the inverse care law’ as far back as 1971.2 In response, those working in healthcare strived to make changes
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Impact of a financial incentive on early rehabilitation and outcomes in ICU patients: a retrospective database study in Japan BMJ Qual. Saf. (IF 5.6) Pub Date : 2024-08-22 Yudai Honda, Jung-ho Shin, Susumu Kunisawa, Kiyohide Fushimi, Yuichi Imanaka
Background Early mobilisation of intensive care unit (ICU) patients has been recommended in clinical practice guidelines. Therefore, the Japanese universal health insurance system introduced an additional fee for early mobilisation and/or rehabilitation, which can be claimed by hospitals when starting rehabilitation of ICU patients within 48 hours after their ICU admission. However, the effect of this
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‘This time is different’: physician knowledge in the age of artificial intelligence BMJ Qual. Saf. (IF 5.6) Pub Date : 2024-09-01 Gurpreet Dhaliwal
Great diagnosticians are often portrayed as recognising rare diseases that evade the efforts of mere mortals. This makes for great TV and local legends, but does not reflect daily practice, where the most common diagnostic challenge is discriminating between common conditions like pneumonia and heart failure or appendicitis and gastroenteritis. Questions about how to train the brain to make those distinctions
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Examining telehealth through the Institute of Medicine quality domains: unanswered questions and research agenda BMJ Qual. Saf. (IF 5.6) Pub Date : 2024-09-01 Timothy C Guetterman, Lorraine R Buis
Telehealth has been in use for decades, yet prompted by the COVID-19 pandemic, its adoption rapidly expanded globally, including Australia, India, Europe and North America.1–4 Telehealth is a broad term for healthcare that can be delivered or supported remotely by a variety of clinicians and healthcare professionals. Through telehealth, patients and clinicians do not need to be colocated within the
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Direct-to-consumer telemedicine: navigating the implications for quality and safety of care BMJ Qual. Saf. (IF 5.6) Pub Date : 2024-09-01 Ana Luisa Neves
Patients are increasingly seeking more accessible, simpler and more streamlined experiences across healthcare. These evolving expectations offer healthcare providers new opportunities to engage with service users, through a growing wave of direct-to-consumer care solutions. The advent of home diagnostics, online pharmacies and, importantly, telemedicine are some key examples of this emerging trend
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What’s in a name? On the rhetorical harm of ‘never events’ BMJ Qual. Saf. (IF 5.6) Pub Date : 2024-09-01 Julia Szymczak
It has been 22 years since the introduction of ‘never event’ to the discourse surrounding patient safety. Originally coined by then-CEO of the National Quality Forum (NQF) Kenneth Kizer, MD,1 the term refers to errors so egregious that they are intolerable, and thus, should never happen.2 Although interventions and regulatory muscle have been directed at eliminating them, never events continue to occur
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Role of knowledge and reasoning processes as predictors of resident physicians’ susceptibility to anchoring bias in diagnostic reasoning: a randomised controlled experiment BMJ Qual. Saf. (IF 5.6) Pub Date : 2024-09-01 Sílvia Mamede, Adrienne Zandbergen, Marco Antonio de Carvalho-Filho, Goda Choi, Marco Goeijenbier, Joost van Ginkel, Laura Zwaan, Fred Paas, Henk G Schmidt
Background Diagnostic errors have been attributed to reasoning flaws caused by cognitive biases. While experiments have shown bias to cause errors, physicians of similar expertise differed in susceptibility to bias. Resisting bias is often said to depend on engaging analytical reasoning, disregarding the influence of knowledge. We examined the role of knowledge and reasoning mode, indicated by diagnosis
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Patient safety in remote primary care encounters: multimethod qualitative study combining Safety I and Safety II analysis BMJ Qual. Saf. (IF 5.6) Pub Date : 2024-09-01 Rebecca Payne, Aileen Clarke, Nadia Swann, Jackie van Dael, Natassia Brenman, Rebecca Rosen, Adam Mackridge, Lucy Moore, Asli Kalin, Emma Ladds, Nina Hemmings, Sarah Rybczynska-Bunt, Stuart Faulkner, Isabel Hanson, Sophie Spitters, Sietse Wieringa, Francesca H Dakin, Sara E Shaw, Joseph Wherton, Richard Byng, Laiba Husain, Trisha Greenhalgh
Background Triage and clinical consultations increasingly occur remotely. We aimed to learn why safety incidents occur in remote encounters and how to prevent them. Setting and sample UK primary care. 95 safety incidents (complaints, settled indemnity claims and reports) involving remote interactions. Separately, 12 general practices followed 2021–2023. Methods Multimethod qualitative study. We explored
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Temporal structures that determine consistency and quality of care: a case study in hyperacute stroke services BMJ Qual. Saf. (IF 5.6) Pub Date : 2024-09-01 Georgia B Black, Angus I G Ramsay, Robert Simister, Abigail Baim-Lance, Jeannie Eng, Mariya Melnychuk, Naomi J Fulop
Background Temporal structuring is determined by practices and social norms and affects the quality and timing of care . In this case study of hyperacute stroke wards which provide initial stroke investigation, treatment and care, we explored temporal structuring patterns to explain how these may affect quality of care. Methods This paper presents a thematic analysis of qualitative interviews with
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Patient and family contributions to improve the diagnostic process through the OurDX electronic health record tool: a mixed method analysis BMJ Qual. Saf. (IF 5.6) Pub Date : 2024-09-01 Sigall K Bell, Kendall Harcourt, Joe Dong, Catherine DesRoches, Nicholas J Hart, Stephen K Liu, Long Ngo, Eric J Thomas, Fabienne C. Bourgeois
Background Accurate and timely diagnosis relies on sharing perspectives among team members and avoiding information asymmetries. Patients/Families hold unique diagnostic process (DxP) information, including knowledge of diagnostic safety blindspots—information that patients/families know, but may be invisible to clinicians. To improve information sharing, we co-developed with patients/families an online
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Assessing quality of direct-to-consumer telemedicine in China: a cross-sectional study using unannounced standardised patients BMJ Qual. Saf. (IF 5.6) Pub Date : 2024-09-01 Zhen Zeng, Dong (Roman) Xu, Yiyuan Cai, Wenjie Gong
Direct-to-onsumer telemedicine (DTCT) has become popular as an alternative to traditional care. However, uncertainties about the potential risks associated with the lack of comprehensive quality evaluation could influence its long-term development. This study aimed to assess the quality of care provided by DTCT platforms in China using unannounced standardised patients (USP) between July 2021 and January
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The problem with ‘never events’ BMJ Qual. Saf. (IF 5.6) Pub Date : 2024-09-01 Joanna Zaslow, Jacqueline Fortier, Gary Garber
‘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. The series is overseen by Ken Catchpole (Guest Editor) and Kaveh Shojania. The concept of ‘never events’ (NEs), introduced in 2002, is used to classify patient
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An anthropologist’s insight into healthcare data – multiple and rich of contradictions BMJ Qual. Saf. (IF 5.6) Pub Date : 2024-09-01 Valentina Lichtner
Readers of this journal will be familiar with the power of data to inform healthcare decisions, processes, policies and investments, with the goal of better patient care. They may also know first-hand how these data are always limited, partial, political and context-dependent,1–3 yet useful and necessary nonetheless. This is one of the data paradoxes recounted in the book by the same name,4 by Professor
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Optimising antibacterial utilisation in Argentine intensive care units: a quality improvement collaborative BMJ Qual. Saf. (IF 5.6) Pub Date : 2024-08-15 Facundo Jorro-Baron, Cecilia Inés Loudet, Wanda Cornistein, Inés Suarez-Anzorena, Pilar Arias-Lopez, Carina Balasini, Laura Cabana, Eleonora Cunto, Pablo Rodrigo Jorge Corral, Luz Gibbons, Marina Guglielmino, Gabriela Izzo, Marianela Lescano, Claudia Meregalli, Cristina Orlandi, Fernando Perre, Maria Elena Ratto, Mariano Rivet, Ana Paula Rodriguez, Viviana Monica Rodriguez, Jacqueline Vilca Becerra
Background There is limited evidence from antimicrobial stewardship programmes in less-resourced settings. This study aimed to improve the quality of antibacterial prescriptions by mitigating overuse and promoting the use of narrow-spectrum agents in intensive care units (ICUs) in a middle-income country. Methods We established a quality improvement collaborative (QIC) model involving nine Argentine
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Decoding behaviour change techniques in opioid deprescribing strategies following major surgery: a systematic review of interventions to reduce postoperative opioid use BMJ Qual. Saf. (IF 5.6) Pub Date : 2024-08-08 Neetu Bansal, Christopher J Armitage, Rhiannon E Hawkes, Sarah Tinsley, Darren M Ashcroft, Li-Chia Chen
Methods A structured search strategy encompassing databases including MEDLINE, Embase, CINAHL Plus, PsycINFO and Cochrane Library was implemented from inception to October 2023. Included studies focused on interventions targeting opioid reduction in adults following major surgeries. The risk of bias was evaluated using Cochrane risk-of-bias tool V.2 (RoB 2) and non-randomised studies of interventions
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Preventing urinary tract infection in older people living in care homes: the ‘StOP UTI’ realist synthesis BMJ Qual. Saf. (IF 5.6) Pub Date : 2024-08-08 Jacqui Prieto, Jennie Wilson, Alison Tingle, Emily Cooper, Melanie Handley, Jo Rycroft Malone, Jennifer Bostock, Heather Loveday
Background Urinary tract infection (UTI) is the most diagnosed infection in older people living in care homes. Objective To identify interventions for recognising and preventing UTI in older people living in care homes in the UK and explain the mechanisms by which they work, for whom and under what circumstances. Methods A realist synthesis of evidence was undertaken to develop programme theory underlying
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Understanding the challenges and successes of implementing ‘hybrid’ interventions in healthcare settings: findings from a process evaluation of a patient involvement trial BMJ Qual. Saf. (IF 5.6) Pub Date : 2024-08-06 Sarah Hampton, Jenni Murray, Rebecca Lawton, Laura Sheard
Introduction ‘Hybrid’ interventions in which some intervention components are fixed across sites and others are flexible (locally created) are thought to allow for adaptation to the local context while maintaining fidelity. However, there is little evidence regarding the challenges and facilitators of implementing hybrid interventions. This paper reports on a process evaluation of a patient safety
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Role of remediation in cases of serious misconduct before UK healthcare regulators: a qualitative study BMJ Qual. Saf. (IF 5.6) Pub Date : 2024-08-06 Tristan Price, Ellie Reynolds, Tim O’Brien, Thomas Gale, Oliver Quick, Marie Bryce
Background The raison d’etre of healthcare profession regulators across the globe is to protect patients and the public from the risk of harm. In cases of serious misconduct, remediation is deemed to be an important factor when considering the risk of harm from a practitioner under investigation. Yet, we know very little about how regulators account for remediation in their decision-making, and whether
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Why a sociotechnical framework is necessary to address diagnostic error BMJ Qual. Saf. (IF 5.6) Pub Date : 2024-08-03 Meagan M Ladell, Sarah Yale, Brett J Bordini, Matthew C Scanlon, Nancy Jacobson, Elizabeth Lerner Papautsky
Failures in the diagnostic process are thought to affect at least 15% of patient encounters, cause 34% of adverse events in hospitals, are a leading cause in major malpractice claims and payouts and are recognised as a top priority in patient safety research.1–3 The National Academies of Science, Engineering and Medicine defines diagnostic error as a failure to establish an accurate and timely explanation
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General practitioners retiring or relocating and its association with healthcare use and mortality: a cohort study using Norwegian national data BMJ Qual. Saf. (IF 5.6) Pub Date : 2024-07-26 Kristin Hestmann Vinjerui, Andreas Asheim, Kjartan Sarheim Anthun, Fredrik Carlsen, Bente Prytz Mjølstad, Sara Marie Nilsen, Kristine Pape, Johan Håkon Bjørngaard
Background Continuity in the general practitioner (GP)-patient relationship is associated with better healthcare outcomes. However, few studies have examined the impact of permanent discontinuities on all listed patients when a GP retires or relocates. Aim To investigate changes in the Norwegian population’s overall healthcare use and mortality after discontinuity due to Regular GPs retiring or relocating
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Generative artificial intelligence, patient safety and healthcare quality: a review BMJ Qual. Saf. (IF 5.6) Pub Date : 2024-07-24 Michael D Howell
The capabilities of artificial intelligence (AI) have accelerated over the past year, and they are beginning to impact healthcare in a significant way. Could this new technology help address issues that have been difficult and recalcitrant problems for quality and safety for decades? While we are early in the journey, it is clear that we are in the midst of a fundamental shift in AI capabilities. It
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Is hospital-onset bacteraemia and fungaemia an actionable quality measure? BMJ Qual. Saf. (IF 5.6) Pub Date : 2024-08-01 Chanu Rhee, Payal Patel, Julia Szymczak
Healthcare-associated infections (HAIs) are one of the most common complications of hospital care and a leading cause of death worldwide.1 Many countries have therefore implemented surveillance systems for HAIs and multifaceted infection prevention and control programmes to reduce their burden. In the USA, regulators have made HAI prevention a national priority by requiring hospitals to report key
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Time for a rebalance: psychological and emotional well-being in the healthcare workforce as the foundation for patient safety BMJ Qual. Saf. (IF 5.6) Pub Date : 2024-08-01 Kate Kirk
The COVID-19 pandemic shone a light on the work and needs of the healthcare workforce like never before, resulting in an increased focus of workforce well-being research, policy and within mainstream media. Despite this recent attention, the relevance of workforce well-being for healthcare delivery and efficiency is not a new phenomenon. The National Health Service (NHS) in England employs around 1
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Evaluation of hospital-onset bacteraemia and fungaemia in the USA as a potential healthcare quality measure: a cross-sectional study BMJ Qual. Saf. (IF 5.6) Pub Date : 2024-08-01 Surbhi Leekha, Gwen L Robinson, Jesse T Jacob, Scott Fridkin, Andi Shane, Anna Sick-Samuels, Aaron M Milstone, Rajeshwari Nair, Eli Perencevich, Mireia Puig-Asensio, Takaaki Kobayashi, Jeanmarie Mayer, Julia Lewis, Susan Bleasdale, Eric Wenzler, Alfredo J Mena Lora, Jonathan Baghdadi, Gregory M Schrank, Eli Wilber, Amalia A Aldredge, Joseph Sharp, Kelly E Dyer, Lea Kendrick, Viraj Ambalam, Scott Borgetti
Background Hospital-onset bacteraemia and fungaemia (HOB) is being explored as a surveillance and quality metric. The objectives of the current study were to determine sources and preventability of HOB in hospitalised patients in the USA and to identify factors associated with perceived preventability. Methods We conducted a cross-sectional study of HOB events at 10 academic and three community hospitals
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Comparing secondary prevention for patients with coronary heart disease and stroke attending Australian general practices: a cross-sectional study using nationwide electronic database BMJ Qual. Saf. (IF 5.6) Pub Date : 2024-08-01 Jason Yue, Samia Kazi, Tu Nguyen, Clara Kayei Chow
Objectives To compare secondary prevention care for patients with coronary heart disease (CHD) and stroke, exploring particularly the influences due to frequency and regularity of primary care visits. Setting Secondary prevention for patients (≥18 years) in the National Prescription Service administrative electronic health record database collated from 458 Australian general practice sites across all
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Consent and refusal of procedures during labour and birth: a survey among 11 418 women in the Netherlands BMJ Qual. Saf. (IF 5.6) Pub Date : 2024-08-01 Marit Sophia Gerardina van der Pijl, Margot Klein Essink, Tineke van der Linden, Rachel Verweij, Elselijn Kingma, Martine H Hollander, Ank de Jonge, Corine J Verhoeven
Background Informed consent for medical interventions is ethically and legally required; an important aspect of quality and safety in healthcare; and essential to person-centred care. During labour and birth, respecting consent requirements, including respecting refusal, can contribute to a higher sense of choice and control for labouring women. This study examines (1) to what extent and for which
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Care Under Pressure 2: a realist synthesis of causes and interventions to mitigate psychological ill health in nurses, midwives and paramedics BMJ Qual. Saf. (IF 5.6) Pub Date : 2024-08-01 Cath Taylor, Jill Maben, Justin Jagosh, Daniele Carrieri, Simon Briscoe, Naomi Klepacz, Karen Mattick
Background Nurses, midwives and paramedics comprise over half of the clinical workforce in the UK National Health Service and have some of the highest prevalence of psychological ill health. This study explored why psychological ill health is a growing problem and how we might change this. Methods A realist synthesis involved iterative searches within MEDLINE, CINAHL and HMIC, and supplementary handsearching
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Fixing patient safety: Are we nearly there yet? BMJ Qual. Saf. (IF 5.6) Pub Date : 2024-08-01 Peter McCulloch
Reducing harm in hospital care using Human Factors and Quality Improvement approaches has proved harder than expected: better evaluation of our efforts, a more realistic understanding of the challenges we face and an intense focus on engaging staff are the key elements needed for progress. Patient safety was not a recognised term in medical research parlance until the 1990s. Prior to this, avoidable
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Patient safety for clinical practice BMJ Qual. Saf. (IF 5.6) Pub Date : 2024-08-01 Persijn J Honkoop
Recent studies still show high numbers of patient harm in healthcare, with 1 in 10 being harmed and around 3 million deaths annually due to unsafe care. Numbers such as these stress the importance of the concept of patient safety, defined by the WHO as ‘the absence of preventable harm to a patient and reduction of risk of unnecessary harm associated with healthcare to an acceptable minimum’. Most readers
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Quality and safety in the literature: August 2024 BMJ Qual. Saf. (IF 5.6) Pub Date : 2024-08-01 Abiola Alaka, Ashwin Gupta, Nathan Houchens
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
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Longitudinal cohort study of discrepancies between prescribed and administered polypharmacy rates: implications for National Aged Care Quality Indicator Programs BMJ Qual. Saf. (IF 5.6) Pub Date : 2024-07-16 Nasir Wabe, Rachel Urwin, Karla Seaman, Johanna I Westbrook
Background Polypharmacy is frequently used as a quality indicator for older adults in Residential Aged Care Facilities (RACFs) and is measured using a range of definitions. The impact of data source choice on polypharmacy rates and the implications for monitoring and benchmarking remain unclear. We aimed to determine polypharmacy rates (≥9 concurrent medicines) by using prescribed and administered
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Components of pharmacist-led medication reviews and their relationship to outcomes: a systematic review and narrative synthesis BMJ Qual. Saf. (IF 5.6) Pub Date : 2024-07-16 Miriam E. Craske, Wendy Hardeman, Nicholas Steel, Michael J Twigg
Introduction Pharmacist-led medication reviews are an established intervention to support patients prescribed multiple medicines or with complex medication regimes. For this systematic review, a medication review was defined as ‘a consultation between a pharmacist and a patient to review the patient’s total medicines use with a view to improve patient health outcomes and minimise medicines-related
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Investigating a novel population health management system to increase access to healthcare for children: a nested cross-sectional study within a cluster randomised controlled trial BMJ Qual. Saf. (IF 5.6) Pub Date : 2024-07-11 Elizabeth Cecil, Julia Forman, James Newham, Nan Hu, Raghu Lingam, Ingrid Wolfe
Background Early intervention for unmet needs is essential to improve health. Clear inequalities in healthcare use and outcomes exist. The Children and Young People’s Health Partnership (CYPHP) model of care uses population health management methods to (1) identify and proactively reach children with asthma, eczema and constipation (tracer conditions); (2) engage these families, with CYPHP, by sending
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Patient and caregiver perspectives on causes and prevention of ambulatory adverse events: multilingual qualitative study BMJ Qual. Saf. (IF 5.6) Pub Date : 2024-07-11 Anjana E Sharma, Amber S Tran, Marika Dy, Adriana L. Najmabadi, Kristan Olazo, Beatrice Huang, Urmimala Sarkar
Context Ambulatory adverse events (AEs) affect up to 25% of the global population and cause over 7 million preventable hospital admissions around the world. Though patients and caregivers are key actors in promoting and monitoring their own ambulatory safety, healthcare teams do not traditionally partner with patients in safety efforts. We sought to identify what patients and caregivers contribute
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Frequency and preventability of adverse drug events in the outpatient setting BMJ Qual. Saf. (IF 5.6) Pub Date : 2024-07-09 Rachel L Wasserman, Heba H Edrees, Mary G Amato, Diane L Seger, Michelle L Frits, Andrew Y Hwang, Christine Iannaccone, David W Bates
Background Limited data exist regarding adverse drug events (ADEs) in the outpatient setting. The objective of this study was to determine the incidence, severity, and preventability of ADEs in the outpatient setting and identify potential prevention strategies. Methods We conducted an analysis of ADEs identified in a retrospective electronic health records review of outpatient encounters in 2018 at
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Quantifying the cost savings and health impacts of improving colonoscopy quality: an economic evaluation BMJ Qual. Saf. (IF 5.6) Pub Date : 2024-06-26 Stephen McCarthy, Matthew David Rutter, Peter McMeekin, Jamie Catlow, Linda Sharp, Matthew Brookes, Roland Valori, Rashmi Bhardwaj-Gosling, Tom Lee, Richard McNally, Andrew McCarthy, Joanne Gray
Objective To estimate and quantify the cost implications and health impacts of improving the performance of English endoscopy services to the optimum quality as defined by postcolonoscopy colorectal cancer (PCCRC) rates. Design A semi-Markov state-transition model was constructed, following the logical treatment pathway of individuals who could potentially undergo a diagnostic colonoscopy. The model
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Need to systematically identify and mitigate risks upon hospitalisation for patients with chronic health conditions BMJ Qual. Saf. (IF 5.6) Pub Date : 2024-06-24 Peter J Pronovost, Eboné M Carrington
To date, most safety and quality improvement efforts to mitigate harm have focused on the single diagnosis for which the patient was admitted to the hospital. Most often, the objective has been to ensure patients receive the appropriate evidence-based therapies for their diagnosis using guidelines, checklists, learning from defect tools1 or other interventions. However, people often have multiple morbidities
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Understanding the enablers and barriers to implementing a patient-led escalation system: a qualitative study BMJ Qual. Saf. (IF 5.6) Pub Date : 2024-06-20 Elizabeth Sutton, Mudathir Ibrahim, William Plath, Lesley Booth, Mark Sujan, Peter McCulloch, Nicola Mackintosh
Background The management of acute deterioration following surgery remains highly variable. Patients and families can play an important role in identifying early signs of deterioration but effective contribution to escalation of care can be practically difficult to achieve. This paper reports the enablers and barriers to the implementation of patient-led escalation systems found during a process evaluation
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Factors associated with proximal femoral fractures in older adults during hospital stay: a cross-sectional study BMJ Qual. Saf. (IF 5.6) Pub Date : 2024-06-20 Mutsuko Moriwaki, Asuka Takae, Mikayo Toba, Miki Sasaki, Yasuko Ogata, Satoshi Obayashi, Masayuki Kakehashi, Kiyohide Fushimi
Background Proximal femoral fractures in older adults affect prognosis, quality of life and medical expenses. Therefore, identifying patients with an elevated risk for proximal femoral fractures and implementing preventive measures to mitigate their occurrence are crucial. Objective This study aimed to develop an accurate in-hospital fracture prediction model that considers patients’ daily conditions
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Can virtual reality simulations improve macrocognition? BMJ Qual. Saf. (IF 5.6) Pub Date : 2024-07-01 Michelle Aebersold, Laura Gonzalez
Simulation studies provide a unique opportunity to develop a deeper understanding of how healthcare workers manage risk in everyday care. In this issue of the journal, Mumma and colleagues1 use a simulation design to analyse how nurses think during infection prevention and control practices and identify the cognitive skills that are associated with high performance. Most nurse educators are familiar
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Variation in quality of care between hospitals: how to identify learning opportunities BMJ Qual. Saf. (IF 5.6) Pub Date : 2024-07-01 Alex Bottle, Pia Kjær Kristensen
In healthcare, as in life, the adage ‘variety is the spice of life’ often holds true. Variation can represent individual patient preferences, but when it comes to the quality of healthcare, variation can also be unwanted and harmful. Analysis of variation in a quality-of-care indicator assumes that finding only limited variation is a good thing, suggesting consistently high compliance with evidence-based
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Understanding linguistic inequities in healthcare: moving from the technical to the social BMJ Qual. Saf. (IF 5.6) Pub Date : 2024-07-01 Christina Reppas-Rindlisbacher, Shail Rawal
When patients and clinicians do not speak the same language, the quality and safety concerns that can arise seem evident. However, the literature on the association between language and a host of health outcomes is vast and varied. In this issue of BMJQS , Chu et al share the results of their well-conducted systematic review and meta-analysis of the relationship between a patient’s spoken language