MedWorm.com provides a medical RSS filtering service. Over 6000 RSS medical sources are combined and output via different filters. This feed contains the latest items from the 'Quality and Safety in Health Care' source. Thu, 09 Feb 2012 10:13:04 +0100 http://www.medworm.com/index.php?rid=5615736&cid=s_31292_51_f&fid=31292&url=http%3A%2F%2Fqualitysafety.bmj.com%2Fcgi%2Fcontent%2Fshort%2F21%2F2%2F171%3Frss%3D1 Conclusion This project has delivered sustained improvement in hand hygiene compliance by establishing a framework of multimodal evidence-based strategies. (Source: Quality and Safety in Health Care) Quality and Safety in Health Care journals http://www.medworm.com/rss/comments.php?id=5615736 Thu, 19 Jan 2012 05:00:00 +0100 5615736 http://www.medworm.com/index.php?rid=5615735&cid=s_31292_51_f&fid=31292&url=http%3A%2F%2Fqualitysafety.bmj.com%2Fcgi%2Fcontent%2Fshort%2F21%2F2%2F160%3Frss%3D1 Conclusions Despite a number of suggested interventions in the literature, few empirical studies in the past decade have tested interventions to reduce diagnostic errors. Advancing the science of diagnostic error prevention will require more robust study designs and rigorous definitions of diagnostic processes and outcomes to measure intervention effects. (Source: Quality and Safety in Health Care) Quality and Safety in Health Care journals http://www.medworm.com/rss/comments.php?id=5615735 Thu, 19 Jan 2012 05:00:00 +0100 5615735 http://www.medworm.com/index.php?rid=5615734&cid=s_31292_51_f&fid=31292&url=http%3A%2F%2Fqualitysafety.bmj.com%2Fcgi%2Fcontent%2Fshort%2F21%2F2%2F152%3Frss%3D1 Conclusion In a single centre experience, implementation of an IL-MET did not reduce the rate of in-hospital death or lengths of stay. (Source: Quality and Safety in Health Care) Quality and Safety in Health Care journals http://www.medworm.com/rss/comments.php?id=5615734 Thu, 19 Jan 2012 05:00:00 +0100 5615734 http://www.medworm.com/index.php?rid=5615733&cid=s_31292_51_f&fid=31292&url=http%3A%2F%2Fqualitysafety.bmj.com%2Fcgi%2Fcontent%2Fshort%2F21%2F2%2F145%3Frss%3D1 Conclusions Several elements of hospital organisational culture were associated with regular use of DIS in US hospitals. These findings emphasise the importance of combining specific administrative approaches with strategies to encourage receptivity to change among bedside clinicians in order to successfully implement complex evidence-based practices in the intensive care setting. (Source: Quality and Safety in Health Care) Quality and Safety in Health Care journals http://www.medworm.com/rss/comments.php?id=5615733 Thu, 19 Jan 2012 05:00:00 +0100 5615733 http://www.medworm.com/index.php?rid=5615732&cid=s_31292_51_f&fid=31292&url=http%3A%2F%2Fqualitysafety.bmj.com%2Fcgi%2Fcontent%2Fshort%2F21%2F2%2F135%3Frss%3D1 Conclusion Locating a RRS within a pathway of care for the acutely ill patient illustrates the role of these safety strategies within the social organisation of clinical work. There is a need to broaden the focus of inquiry from detection and initiation of escalation (where the strategies are principally directed) towards team response behaviour and towards those medical response practices which to date have escaped scrutiny and monitoring. (Source: Quality and Safety in Health Care) Quality and Safety in Health Care journals http://www.medworm.com/rss/comments.php?id=5615732 Thu, 19 Jan 2012 05:00:00 +0100 5615732 http://www.medworm.com/index.php?rid=5615731&cid=s_31292_51_f&fid=31292&url=http%3A%2F%2Fqualitysafety.bmj.com%2Fcgi%2Fcontent%2Fshort%2F21%2F2%2F127%3Frss%3D1 Conclusions The Lazio and Tuscany programmes appeared to have a positive impact on quality of care for older patients admitted with hip fracture without having a negative impact on other orthopaedic interventions. The results highlight the need for continuous quality improvement by repeating the evaluation process and by combining the performance system with a management strategy. (Source: Quality and Safety in Health Care) Quality and Safety in Health Care journals http://www.medworm.com/rss/comments.php?id=5615731 Thu, 19 Jan 2012 05:00:00 +0100 5615731 http://www.medworm.com/index.php?rid=5615730&cid=s_31292_51_f&fid=31292&url=http%3A%2F%2Fqualitysafety.bmj.com%2Fcgi%2Fcontent%2Fshort%2F21%2F2%2F118%3Frss%3D1 Conclusions Efforts to simultaneously improve caregivers' ability to troubleshoot care and enhance communication may improve patients' perception of team functions, but may also increase patients' perception of safety gaps. (Source: Quality and Safety in Health Care) Quality and Safety in Health Care journals http://www.medworm.com/rss/comments.php?id=5615730 Thu, 19 Jan 2012 05:00:00 +0100 5615730 http://www.medworm.com/index.php?rid=5615729&cid=s_31292_51_f&fid=31292&url=http%3A%2F%2Fqualitysafety.bmj.com%2Fcgi%2Fcontent%2Fshort%2F21%2F2%2F112%3Frss%3D1 Conclusion Perceptions of safety such as communication and responsiveness were similar to those found in previous studies. Mapping these perceptions onto the Swiss-Cheese model of safety identifies how further defences, barriers and safeguards can be constructed to make people feel safer by reinforcing communication and responsiveness. Traditional risks are widely published, but the identification by patients reinforces the role they can play in identifying and reporting these risks. (Source: Quality and Safety in Health Care) Quality and Safety in Health Care journals http://www.medworm.com/rss/comments.php?id=5615729 Thu, 19 Jan 2012 05:00:00 +0100 5615729 http://www.medworm.com/index.php?rid=5615728&cid=s_31292_51_f&fid=31292&url=http%3A%2F%2Fqualitysafety.bmj.com%2Fcgi%2Fcontent%2Fshort%2F21%2F2%2F101%3Frss%3D1 Conclusions Safety climate was associated with both patient and nurse injuries, suggesting that patient and nurse safety may actually be linked outcomes. The findings also indicate that increased unit turnover should be considered a risk factor for nurse and patient injuries. (Source: Quality and Safety in Health Care) Quality and Safety in Health Care journals http://www.medworm.com/rss/comments.php?id=5615728 Thu, 19 Jan 2012 05:00:00 +0100 5615728 http://www.medworm.com/index.php?rid=5615727&cid=s_31292_51_f&fid=31292&url=http%3A%2F%2Fqualitysafety.bmj.com%2Fcgi%2Fcontent%2Fshort%2F21%2F2%2F93%3Frss%3D1 Conclusions While physician agreement on diagnostic error remains low, an EHR-facilitated surveillance methodology could be useful for gaining insight into the origin of these errors. (Source: Quality and Safety in Health Care) Quality and Safety in Health Care journals http://www.medworm.com/rss/comments.php?id=5615727 Thu, 19 Jan 2012 05:00:00 +0100 5615727 http://www.medworm.com/index.php?rid=5615726&cid=s_31292_51_f&fid=31292&url=http%3A%2F%2Fqualitysafety.bmj.com%2Fcgi%2Fcontent%2Fshort%2F21%2F2%2F89%3Frss%3D1 Imagine conferring with your clinician colleagues and being handed a plateful of all of your missed and delayed diagnoses. But, imagine further that, rather than a nightmare of ghosts returning to haunt you in the form of malpractice claims, sanctions by regulatory boards, insurers pouncing on needless expenditures or hordes (yes, there would be large numbers) of angry finger-pointing patients and families, the experience would instead bring a dream of supportive feedback and learning. Imagine the ways such an idealised non-threatening consultation and conference might be designed to minimise defensiveness and maximise introspection, learn lessons, and rethink habits and standard practices. Rather than prompting incredulous exclamations of "you missed that?!" or "what were you thinking?!",... Quality and Safety in Health Care journals http://www.medworm.com/rss/comments.php?id=5615726 Thu, 19 Jan 2012 05:00:00 +0100 5615726 http://www.medworm.com/index.php?rid=5510814&cid=s_31292_51_f&fid=31292&url=http%3A%2F%2Fqualitysafety.bmj.com%2Fcgi%2Fcontent%2Fshort%2F21%2F1%2F84%3Frss%3D1 Communication breakdown is a factor contributing to most cases of patient harm, and this harm continues to occur at unacceptable levels. Responding to this evidence, the Metro South District of Queensland Health (Australia) has developed a communication skills training programme titled ‘Communication and Patient Safety’. The three modules, each lasting 31/2 h, cover both staff-to-patient and staff-to-staff communication issues, and an unusual feature is that clinical and non-clinical staff attend together. Following positive evaluation data from our initial pilot programme (involving 350 staff in a single hospital), the programme was expanded to all five hospitals in the district, and has now been completed by over 3000 staff. The results show that despite the significant time ... Quality and Safety in Health Care journals http://www.medworm.com/rss/comments.php?id=5510814 Thu, 15 Dec 2011 05:00:00 +0100 5510814 http://www.medworm.com/index.php?rid=5510813&cid=s_31292_51_f&fid=31292&url=http%3A%2F%2Fqualitysafety.bmj.com%2Fcgi%2Fcontent%2Fshort%2F21%2F1%2F78%3Frss%3D1 Conclusions The results from this study indicate that the GAOTP would be a sufficient assessment tool for obstetrical team performance using simulation provided that it is used to assess teams with at least eight raters to ensure a sufficiently stable score. This could allow the quantitative evaluation of an educational intervention. (Source: Quality and Safety in Health Care) Quality and Safety in Health Care journals http://www.medworm.com/rss/comments.php?id=5510813 Thu, 15 Dec 2011 05:00:00 +0100 5510813 http://www.medworm.com/index.php?rid=5510812&cid=s_31292_51_f&fid=31292&url=http%3A%2F%2Fqualitysafety.bmj.com%2Fcgi%2Fcontent%2Fshort%2F21%2F1%2F70%3Frss%3D1 Conclusions The 2009 survey confirmed improvement needs identified by the 2005 survey for hospitals' event reporting processes, while finding signs of progress. Optimising the use of surveys to assess the effects of national patient-safety initiatives such as PSQIA will require decreasing within-hospital variations in reporting rates. (Source: Quality and Safety in Health Care) Quality and Safety in Health Care journals http://www.medworm.com/rss/comments.php?id=5510812 Thu, 15 Dec 2011 05:00:00 +0100 5510812 http://www.medworm.com/index.php?rid=5510811&cid=s_31292_51_f&fid=31292&url=http%3A%2F%2Fqualitysafety.bmj.com%2Fcgi%2Fcontent%2Fshort%2F21%2F1%2F63%3Frss%3D1 Conclusion Lean thinking transformation of the unsedated UGI endoscopy pathway results in reduced waiting times, reduced staffing requirements and improved patient flow and can form the basis of a pathway template which may be successfully transferred into alternative endoscopy environments with high levels of patient satisfaction. (Source: Quality and Safety in Health Care) Quality and Safety in Health Care journals http://www.medworm.com/rss/comments.php?id=5510811 Thu, 15 Dec 2011 05:00:00 +0100 5510811 http://www.medworm.com/index.php?rid=5510810&cid=s_31292_51_f&fid=31292&url=http%3A%2F%2Fqualitysafety.bmj.com%2Fcgi%2Fcontent%2Fshort%2F21%2F1%2F54%3Frss%3D1 Conclusions These data suggest that clinical leadership and institution-focused efforts to standardise preventive practices can help reduce the incidence of CI-AKI. (Source: Quality and Safety in Health Care) Quality and Safety in Health Care journals http://www.medworm.com/rss/comments.php?id=5510810 Thu, 15 Dec 2011 05:00:00 +0100 5510810 http://www.medworm.com/index.php?rid=5510809&cid=s_31292_51_f&fid=31292&url=http%3A%2F%2Fqualitysafety.bmj.com%2Fcgi%2Fcontent%2Fshort%2F21%2F1%2F47%3Frss%3D1 Conclusions The task list presented here is a tool that will help clinics study their workflows so they can plan for changes that will take place because of EHR implementation and/or transformation to a patient centered medical home. (Source: Quality and Safety in Health Care) Quality and Safety in Health Care journals http://www.medworm.com/rss/comments.php?id=5510809 Thu, 15 Dec 2011 05:00:00 +0100 5510809 http://www.medworm.com/index.php?rid=5510808&cid=s_31292_51_f&fid=31292&url=http%3A%2F%2Fqualitysafety.bmj.com%2Fcgi%2Fcontent%2Fshort%2F21%2F1%2F39%3Frss%3D1 Conclusions The study showed that both fulfilment of expectations and patient-reported experiences are distinct from but related to overall patient satisfaction. The most important predictors for overall patient satisfaction with hospitals are patient-reported experiences and fulfilment of expectations. (Source: Quality and Safety in Health Care) Quality and Safety in Health Care journals http://www.medworm.com/rss/comments.php?id=5510808 Thu, 15 Dec 2011 05:00:00 +0100 5510808 http://www.medworm.com/index.php?rid=5510807&cid=s_31292_51_f&fid=31292&url=http%3A%2F%2Fqualitysafety.bmj.com%2Fcgi%2Fcontent%2Fshort%2F21%2F1%2F30%3Frss%3D1 Conclusions A framework of SA can help analyse and understand diagnostic errors in primary care settings that use EHRs. (Source: Quality and Safety in Health Care) Quality and Safety in Health Care journals http://www.medworm.com/rss/comments.php?id=5510807 Thu, 15 Dec 2011 05:00:00 +0100 5510807 http://www.medworm.com/index.php?rid=5510806&cid=s_31292_51_f&fid=31292&url=http%3A%2F%2Fqualitysafety.bmj.com%2Fcgi%2Fcontent%2Fshort%2F21%2F1%2F21%3Frss%3D1 Conclusion Substantial ethnic differences in patient experience exist in a national healthcare system providing universal coverage. Improving the experience of patients in low-scoring practices would not only improve the quality of care provided to their White patients but it would also substantially reduce ethnic group differences in patient experience. There were large variations in the experiences reported by ethnic minority patients in different practices: practices with high patient experience scores from ethnic minority patients could be studied as models for quality improvement. (Source: Quality and Safety in Health Care) Quality and Safety in Health Care journals http://www.medworm.com/rss/comments.php?id=5510806 Thu, 15 Dec 2011 05:00:00 +0100 5510806 http://www.medworm.com/index.php?rid=5510805&cid=s_31292_51_f&fid=31292&url=http%3A%2F%2Fqualitysafety.bmj.com%2Fcgi%2Fcontent%2Fshort%2F21%2F1%2F13%3Frss%3D1 Conclusions The MUSIQ framework has the potential to guide the application of QI methods in healthcare and focus research. The specificity of MUSIQ and the explicit delineation of relationships among factors allows a deeper understanding of the mechanism of action by which context influences QI success. MUSIQ also provides a foundation to support further studies to test and refine the theory and advance the field of QI science. (Source: Quality and Safety in Health Care) Quality and Safety in Health Care journals http://www.medworm.com/rss/comments.php?id=5510805 Thu, 15 Dec 2011 05:00:00 +0100 5510805 http://www.medworm.com/index.php?rid=5510804&cid=s_31292_51_f&fid=31292&url=http%3A%2F%2Fqualitysafety.bmj.com%2Fcgi%2Fcontent%2Fshort%2F21%2F1%2F3%3Frss%3D1 Conclusions The results of this study validate the role of prospective observational research methods in unveiling critical factors that contribute to deviation in expected length of operation. These results have the potential to inform evidence-based interventions aimed at ameliorating the effects of miscommunications, hence improve patient safety. (Source: Quality and Safety in Health Care) Quality and Safety in Health Care journals http://www.medworm.com/rss/comments.php?id=5510804 Thu, 15 Dec 2011 05:00:00 +0100 5510804 http://www.medworm.com/index.php?rid=5510803&cid=s_31292_51_f&fid=31292&url=http%3A%2F%2Fqualitysafety.bmj.com%2Fcgi%2Fcontent%2Fshort%2F21%2F1%2F1%3Frss%3D1 Gillespie and colleagues have reported on their structured observations in operating rooms to help us understand which factors (interruptions, communication failures, team familiarity and the unpredictability of unplanned cases) prolong the length of an operation and lead to inefficiency and increased costs. All of us feel intuitively that a well-orchestrated operation is best for everyone involved—the patient, the surgeon, the anaesthesiologist, the nurse and the hospital's bottom line. Communication failures have been identified by Makary and others to cause the majority of errors in the operating room as reviewed retrospectively.1–3 This paper is one of the very first to observe communication failures in real time and connect those communication failures to a longer than exp... Quality and Safety in Health Care journals http://www.medworm.com/rss/comments.php?id=5510803 Thu, 15 Dec 2011 05:00:00 +0100 5510803 http://www.medworm.com/index.php?rid=5446476&cid=s_31292_51_f&fid=31292&url=http%3A%2F%2Fqualitysafety.bmj.com%2Fcgi%2Fcontent%2Fshort%2F20%2F12%2F1082%3Frss%3D1 Problem In hospitals in rural, resource-limited settings, there is an acute need for simple, practical strategies to improve healthcare quality. Setting A district hospital in remote western Nepal. Key measures for improvement To provide a mechanism for systems-level reflection so that staff can identify targets for quality improvement in healthcare delivery. Strategies for change To develop a morbidity and mortality conference (M&M) quality improvement initiative that aims to facilitate structured analysis of patient care and identify barriers to providing quality care, which can subsequently be improved. Design The authors designed an M&M involving clinical and non-clinical staff in conducting root-cause analyses of healthcare delivery at their hospital. Weekly conferences fo... Quality and Safety in Health Care journals http://www.medworm.com/rss/comments.php?id=5446476 Wed, 23 Nov 2011 05:00:00 +0100 5446476 http://www.medworm.com/index.php?rid=5446475&cid=s_31292_51_f&fid=31292&url=http%3A%2F%2Fqualitysafety.bmj.com%2Fcgi%2Fcontent%2Fshort%2F20%2F12%2F1075%3Frss%3D1 This study proved that modelling the scheduling process can contribute to optimising the scheduling strategy, which can lead to a reduction in access times for imaging facilities such as MRI scanners. (Source: Quality and Safety in Health Care) Quality and Safety in Health Care journals http://www.medworm.com/rss/comments.php?id=5446475 Wed, 23 Nov 2011 05:00:00 +0100 5446475 http://www.medworm.com/index.php?rid=5446474&cid=s_31292_51_f&fid=31292&url=http%3A%2F%2Fqualitysafety.bmj.com%2Fcgi%2Fcontent%2Fshort%2F20%2F12%2F1069%3Frss%3D1 Conclusion The authors' findings offer some support for recommendations to concentrate arthroscopy and knee replacement in surgical departments with more than 50 procedures and hip replacement in departments with more than 100 procedures per year in order to reduce SSI. (Source: Quality and Safety in Health Care) Quality and Safety in Health Care journals http://www.medworm.com/rss/comments.php?id=5446474 Wed, 23 Nov 2011 05:00:00 +0100 5446474 http://www.medworm.com/index.php?rid=5446473&cid=s_31292_51_f&fid=31292&url=http%3A%2F%2Fqualitysafety.bmj.com%2Fcgi%2Fcontent%2Fshort%2F20%2F12%2F1062%3Frss%3D1 Conclusions The safety climate in community pharmacies is influenced by perceptions of job characteristics, such as the level of job demands and the resources available to meet these demands. Hence, any efforts to improve safety should take into consideration the effect of the psychosocial work environment on safety climate. In addition, there is a need to address the presence of work-related stressors, which have the potential to cause direct or indirect harm to staff and service users. The findings of the current study provide a basis for future research to improve the safety climate and well-being, both in the pharmacy profession and in other healthcare settings. (Source: Quality and Safety in Health Care) Quality and Safety in Health Care journals http://www.medworm.com/rss/comments.php?id=5446473 Wed, 23 Nov 2011 05:00:00 +0100 5446473 http://www.medworm.com/index.php?rid=5446472&cid=s_31292_51_f&fid=31292&url=http%3A%2F%2Fqualitysafety.bmj.com%2Fcgi%2Fcontent%2Fshort%2F20%2F12%2F1057%3Frss%3D1 Conclusions It is important to identify concerns and experiences about unintended consequences of indicators at an early stage when there is time to remove or adapt problem indicators. Since the UK government currently spends over £1 billion each year on QOF, the £150 000 spent on each piloting cohort (0.0005% of the total QOF budget) appears to be good value for money. (Source: Quality and Safety in Health Care) Quality and Safety in Health Care journals http://www.medworm.com/rss/comments.php?id=5446472 Wed, 23 Nov 2011 05:00:00 +0100 5446472 http://www.medworm.com/index.php?rid=5446471&cid=s_31292_51_f&fid=31292&url=http%3A%2F%2Fqualitysafety.bmj.com%2Fcgi%2Fcontent%2Fshort%2F20%2F12%2F1052%3Frss%3D1 Conclusion Patients with cancer are at risk of injury from cancer treatment procedures and as a consequence of problems related to administrative processes and communication. Types of identified events varied according to the methods used, and each method added new information. Further research on patient safety in cancer care and safety-enhancing activities is needed. (Source: Quality and Safety in Health Care) Quality and Safety in Health Care journals http://www.medworm.com/rss/comments.php?id=5446471 Wed, 23 Nov 2011 05:00:00 +0100 5446471 http://www.medworm.com/index.php?rid=5446470&cid=s_31292_51_f&fid=31292&url=http%3A%2F%2Fqualitysafety.bmj.com%2Fcgi%2Fcontent%2Fshort%2F20%2F12%2F1043%3Frss%3D1 Conclusions The high rate of prevalent AE found suggests that PS may represent an important public-health issue in the participating hospitals. While new studies may be needed to confirm these results, these may already be useful to inspire new PS-improvement policies in those settings. (Source: Quality and Safety in Health Care) Quality and Safety in Health Care journals http://www.medworm.com/rss/comments.php?id=5446470 Wed, 23 Nov 2011 05:00:00 +0100 5446470 http://www.medworm.com/index.php?rid=5446469&cid=s_31292_51_f&fid=31292&url=http%3A%2F%2Fqualitysafety.bmj.com%2Fcgi%2Fcontent%2Fshort%2F20%2F12%2F1035%3Frss%3D1 Conclusions A new method for measuring team SA during the ICU round was successfully employed. A number of areas for future research were identified, including refinement of the situation awareness and teamwork measures. (Source: Quality and Safety in Health Care) Quality and Safety in Health Care journals http://www.medworm.com/rss/comments.php?id=5446469 Wed, 23 Nov 2011 05:00:00 +0100 5446469 http://www.medworm.com/index.php?rid=5446468&cid=s_31292_51_f&fid=31292&url=http%3A%2F%2Fqualitysafety.bmj.com%2Fcgi%2Fcontent%2Fshort%2F20%2F12%2F1027%3Frss%3D1 Conclusions Intravenous administrations have a higher risk and severity of error than other medication administrations. A significant proportion of errors suggest skill and knowledge deficiencies, with errors and severity reducing as clinical experience increases. A proportion of errors are also associated with routine violations which are likely to be learnt workplace behaviours. Both areas suggest specific targets for intervention. (Source: Quality and Safety in Health Care) Quality and Safety in Health Care journals http://www.medworm.com/rss/comments.php?id=5446468 Wed, 23 Nov 2011 05:00:00 +0100 5446468 http://www.medworm.com/index.php?rid=5446467&cid=s_31292_51_f&fid=31292&url=http%3A%2F%2Fqualitysafety.bmj.com%2Fcgi%2Fcontent%2Fshort%2F20%2F12%2F1020%3Frss%3D1 Conclusions When designing funnel plots for comparisons of provider performance based on highly skewed data, the use of simulated control limits should be considered. (Source: Quality and Safety in Health Care) Quality and Safety in Health Care journals http://www.medworm.com/rss/comments.php?id=5446467 Wed, 23 Nov 2011 05:00:00 +0100 5446467 http://www.medworm.com/index.php?rid=5446466&cid=s_31292_51_f&fid=31292&url=http%3A%2F%2Fqualitysafety.bmj.com%2Fcgi%2Fcontent%2Fshort%2F20%2F12%2F1011%3Frss%3D1 Conclusions We conclude that CQI features can be extracted from QII articles with reasonable reliability, but only a small proportion of QII articles include all features. Further consensus development is needed to support meaningful use of the term CQI for scientific communication. (Source: Quality and Safety in Health Care) Quality and Safety in Health Care journals http://www.medworm.com/rss/comments.php?id=5446466 Wed, 23 Nov 2011 05:00:00 +0100 5446466 http://www.medworm.com/index.php?rid=5446465&cid=s_31292_51_f&fid=31292&url=http%3A%2F%2Fqualitysafety.bmj.com%2Fcgi%2Fcontent%2Fshort%2F20%2F12%2F1005%3Frss%3D1 Conclusion MSCP has developed and implemented the first safety learning system in Canada for family practice. All clinic members were encouraged to submit reports, but most of the incidents were reported by physicians. The vast majority of incidents reported were preventable with limited severity. The most frequently reported types of incidents fell into the categories of documentation and medication. The low reporting rates suggest that for family practices incident reporting may not be the most effective method to determine the types and frequency of incidents in family medicine. (Source: Quality and Safety in Health Care) Quality and Safety in Health Care journals http://www.medworm.com/rss/comments.php?id=5446465 Wed, 23 Nov 2011 05:00:00 +0100 5446465 http://www.medworm.com/index.php?rid=5446464&cid=s_31292_51_f&fid=31292&url=http%3A%2F%2Fqualitysafety.bmj.com%2Fcgi%2Fcontent%2Fshort%2F20%2F12%2F1001%3Frss%3D1 As in most other areas of human experience, fashions in healthcare and in healthcare research come and go. They come about because a good idea is articulated, often as a sound bite that makes intrinsic sense, and they go because a few intrepid researchers are prepared to investigate the substance behind the sound bite and they come to realise that the logic is not supported by the reality. The original logic is supplanted. Over the last 20–30 years, there have been some notable fashions in healthcare that have lit up the globe like a comet and then died. Just as there have been passing fashions in surgery (eg, routine tonsillectomies) and medications (eg, hormone replacement therapy), so also have there been passing fashions in quality improvement (QI) and QI research. Kieran Wa... Quality and Safety in Health Care journals http://www.medworm.com/rss/comments.php?id=5446464 Wed, 23 Nov 2011 05:00:00 +0100 5446464 http://www.medworm.com/index.php?rid=5353815&cid=s_31292_51_f&fid=31292&url=http%3A%2F%2Fqualitysafety.bmj.com%2Fcgi%2Fcontent%2Fshort%2F20%2F11%2F991%3Frss%3D1 Conclusions There are many tools designed to assess the safety competencies of healthcare professionals. However, a reliable and valid toolbox for summative testing that covers all patient safety domains at Miller's four competency levels cannot yet be constructed. Many tools, however, are useful for formative feedback. (Source: Quality and Safety in Health Care) Quality and Safety in Health Care journals http://www.medworm.com/rss/comments.php?id=5353815 Tue, 25 Oct 2011 04:00:00 +0100 5353815 http://www.medworm.com/index.php?rid=5353814&cid=s_31292_51_f&fid=31292&url=http%3A%2F%2Fqualitysafety.bmj.com%2Fcgi%2Fcontent%2Fshort%2F20%2F11%2F986%3Frss%3D1 A noted French ethnographer describes his care in a French private hospital for a hip replacement. He recounts a number of events that are probably typical of many patients' hospital experiences, but which clinicians often do not perceive. The observations are probably similar to those patients might make after exposure to any modern healthcare system, except that they offer a level of detail few would provide. The account focuses on the contradiction between excellent technical operations and the absence of compassionate patient care, basic civility and the needs of patient safety. It addresses marketing of hospital services, staffing levels, conflicts between private enterprise and medical need, fragmented billing, disconnected after-care, and the absence of a coherent view of a patient'... Quality and Safety in Health Care journals http://www.medworm.com/rss/comments.php?id=5353814 Tue, 25 Oct 2011 04:00:00 +0100 5353814 http://www.medworm.com/index.php?rid=5353813&cid=s_31292_51_f&fid=31292&url=http%3A%2F%2Fqualitysafety.bmj.com%2Fcgi%2Fcontent%2Fshort%2F20%2F11%2F983%3Frss%3D1 People who are sick are often the most vulnerable in society. They frequently rely on caring and competent healthcare professionals and should and do have expectations of a safe and caring environment. In a recent unexpected adventure through the healthcare system, the organisation, professionalism, caring and compassion associated with healthcare provision were in very short supply. A lack of basic dignity and humanity were among the most concerning deficits. Any form of dehumanisation of the national health service that leads to unsafe, undignified and degrading treatment not only infringes patients' and clients' human rights but should not be acceptable or excused as a by-product of economic pressures. (Source: Quality and Safety in Health Care) Quality and Safety in Health Care journals http://www.medworm.com/rss/comments.php?id=5353813 Tue, 25 Oct 2011 04:00:00 +0100 5353813 http://www.medworm.com/index.php?rid=5353812&cid=s_31292_51_f&fid=31292&url=http%3A%2F%2Fqualitysafety.bmj.com%2Fcgi%2Fcontent%2Fshort%2F20%2F11%2F974%3Frss%3D1 Discussion Implementing a non-monetary recognition award that was tied to specific improvement goals greatly improved the timeliness and quality of the RCA reports in the Veterans Health Administration System. (Source: Quality and Safety in Health Care) Quality and Safety in Health Care journals http://www.medworm.com/rss/comments.php?id=5353812 Tue, 25 Oct 2011 04:00:00 +0100 5353812 http://www.medworm.com/index.php?rid=5353811&cid=s_31292_51_f&fid=31292&url=http%3A%2F%2Fqualitysafety.bmj.com%2Fcgi%2Fcontent%2Fshort%2F20%2F11%2F967%3Frss%3D1 Conclusions A multifaceted intervention can be highly effective for improving discharge communication from the ICU. (Source: Quality and Safety in Health Care) Quality and Safety in Health Care journals http://www.medworm.com/rss/comments.php?id=5353811 Tue, 25 Oct 2011 04:00:00 +0100 5353811 http://www.medworm.com/index.php?rid=5353810&cid=s_31292_51_f&fid=31292&url=http%3A%2F%2Fqualitysafety.bmj.com%2Fcgi%2Fcontent%2Fshort%2F20%2F11%2F959%3Frss%3D1 Conclusion While clinicians think it is important to ask patients about their expectations, they often fail to do so and consequently may not respond adequately. These results identify a ‘blind spot’ in clinicians' approach when attempting to address patient expectations and improve patient satisfaction, suggesting that healthcare organisations should take a more active role in increasing clinicians' awareness and initiating structured training programmes to cope with patient expectations. (Source: Quality and Safety in Health Care) Quality and Safety in Health Care journals http://www.medworm.com/rss/comments.php?id=5353810 Tue, 25 Oct 2011 04:00:00 +0100 5353810 http://www.medworm.com/index.php?rid=5353809&cid=s_31292_51_f&fid=31292&url=http%3A%2F%2Fqualitysafety.bmj.com%2Fcgi%2Fcontent%2Fshort%2F20%2F11%2F953%3Frss%3D1 Conclusions Performance as indicated by the quality and outcomes framework did not predict rates of attendance at emergency departments, but satisfaction with telephone access did. Consideration should be given to improving access to some general practices to contain the use of emergency departments. (Source: Quality and Safety in Health Care) Quality and Safety in Health Care journals http://www.medworm.com/rss/comments.php?id=5353809 Tue, 25 Oct 2011 04:00:00 +0100 5353809 http://www.medworm.com/index.php?rid=5353808&cid=s_31292_51_f&fid=31292&url=http%3A%2F%2Fqualitysafety.bmj.com%2Fcgi%2Fcontent%2Fshort%2F20%2F11%2F947%3Frss%3D1 Conclusion The CGDI offers a simple method for measuring the extent to which a healthcare organisation is working to develop clinical governance. Its use in New Zealand provides a baseline for tracking clinical governance over time. The CGDI could be easily adapted for use in other healthcare systems. (Source: Quality and Safety in Health Care) Quality and Safety in Health Care journals http://www.medworm.com/rss/comments.php?id=5353808 Tue, 25 Oct 2011 04:00:00 +0100 5353808 http://www.medworm.com/index.php?rid=5353807&cid=s_31292_51_f&fid=31292&url=http%3A%2F%2Fqualitysafety.bmj.com%2Fcgi%2Fcontent%2Fshort%2F20%2F11%2F941%3Frss%3D1 Conclusions For many hospitals, successfully improving communication will require overcoming organisational barriers such as cultures not conducive to change and lack of resources and infrastructure. Creating a culture that values communication at discharge may help improve outcomes following hospitalisation, but changes in healthcare delivery in the past few decades may necessitate new strategies or changes at the systems level to address barriers to effective communication. (Source: Quality and Safety in Health Care) Quality and Safety in Health Care journals http://www.medworm.com/rss/comments.php?id=5353807 Tue, 25 Oct 2011 04:00:00 +0100 5353807 http://www.medworm.com/index.php?rid=5353806&cid=s_31292_51_f&fid=31292&url=http%3A%2F%2Fqualitysafety.bmj.com%2Fcgi%2Fcontent%2Fshort%2F20%2F11%2F932%3Frss%3D1 Background Computerised provider order entry (CPOE) is an important patient safety intervention that has encountered significant barriers to implementation. The usability of a CPOE system plays a significant role in its acceptance. The authors conducted a heuristic evaluation of a CPOE order set system to uncover existing usability issues prior to implementation. Methods A heuristic evaluation methodology was used to evaluate the usability of a CPOE test order set system. There are 10 heuristic principles, such as error prevention, to help users identify and recover from errors. Evaluators included a staff physician with extensive clinical experience, and three engineers with expertise in heuristic evaluation methodology. The results of the heuristic evaluation were used to create a user ... Quality and Safety in Health Care journals http://www.medworm.com/rss/comments.php?id=5353806 Tue, 25 Oct 2011 04:00:00 +0100 5353806 http://www.medworm.com/index.php?rid=5353805&cid=s_31292_51_f&fid=31292&url=http%3A%2F%2Fqualitysafety.bmj.com%2Fcgi%2Fcontent%2Fshort%2F20%2F11%2F924%3Frss%3D1 Conclusions The provision of real-time clinical alerts and decision support for critical laboratory abnormalities did not improve clinical management or decrease adverse events. (Source: Quality and Safety in Health Care) Quality and Safety in Health Care journals http://www.medworm.com/rss/comments.php?id=5353805 Tue, 25 Oct 2011 04:00:00 +0100 5353805 http://www.medworm.com/index.php?rid=5353804&cid=s_31292_51_f&fid=31292&url=http%3A%2F%2Fqualitysafety.bmj.com%2Fcgi%2Fcontent%2Fshort%2F20%2F11%2F914%3Frss%3D1 Conclusion Actively developing a transparent and positive safety culture at the unit level can improve medication safety. System-level mechanisms to promote medication safety are likely important factors that enable safety culture to translate into better outcomes, but may be independently ineffective in the face of poor safety culture. (Source: Quality and Safety in Health Care) Quality and Safety in Health Care journals http://www.medworm.com/rss/comments.php?id=5353804 Tue, 25 Oct 2011 04:00:00 +0100 5353804 http://www.medworm.com/index.php?rid=5353803&cid=s_31292_51_f&fid=31292&url=http%3A%2F%2Fqualitysafety.bmj.com%2Fcgi%2Fcontent%2Fshort%2F20%2F11%2F911%3Frss%3D1 In this issue of the journal, two patients narrate stories about their disappointments with a healthcare system that did not seem to care about them as people. Michel Villette, a sociologist in France, tells the story of his hip surgery in an ‘elite’ French orthopaedic hospital.1 Melissa McCullough, a bioethicist and attorney, relates the story of her more prolonged ordeal with an uncommon neurological diagnosis in the National Health System in the UK.2 Despite these differences—undergoing a routine orthopaedic procedure in an exclusive private care setting versus diagnosing and managing a far from routine neurological problem in a public health system—these two stories share fundamental features. Both recount numerous failures of the system to deliver patient-centr... Quality and Safety in Health Care journals http://www.medworm.com/rss/comments.php?id=5353803 Tue, 25 Oct 2011 04:00:00 +0100 5353803 http://www.medworm.com/index.php?rid=5244812&cid=s_31292_51_f&fid=31292&url=http%3A%2F%2Fqualitysafety.bmj.com%2Fcgi%2Fcontent%2Fshort%2F20%2F10%2F903%3Frss%3D1 Problem A significant proportion of patients with diabetes mellitus do not get the benefit of treatment that would reduce their risk of progressive kidney disease and reach a nephrologist once significant loss of kidney function has already occurred. Design Systematic disease management of patients with diabetes and kidney disease. Setting Diverse population (approximately 800 000) in and around Birmingham, West Midlands, UK. Key measures for improvement Number of outpatient appointments, estimated glomerular filtration rate (eGFR) at first contact with nephrologist, number of patients starting kidney replacement therapy (KRT) and mode of KRT at start. Strategy for change Identification of patients with low or deteriorating trend in eGFR from weekly database review, specialist diabetes... Quality and Safety in Health Care journals http://www.medworm.com/rss/comments.php?id=5244812 Wed, 21 Sep 2011 04:00:00 +0100 5244812 http://www.medworm.com/index.php?rid=5244811&cid=s_31292_51_f&fid=31292&url=http%3A%2F%2Fqualitysafety.bmj.com%2Fcgi%2Fcontent%2Fshort%2F20%2F10%2F895%3Frss%3D1 Conclusions Opioid-related oversedation events decreased over the course of the study. Because the perioperative period is an especially likely time for opioid oversedation events, strict opioid prescribing practices, while maintaining adequate pain control and improved sedation assessment during the perioperative period, were emphasised. The restructured pain service and increased visits by pain team experts were also associated with the reduction in oversedation events. (Source: Quality and Safety in Health Care) Quality and Safety in Health Care journals http://www.medworm.com/rss/comments.php?id=5244811 Wed, 21 Sep 2011 04:00:00 +0100 5244811 http://www.medworm.com/index.php?rid=5244810&cid=s_31292_51_f&fid=31292&url=http%3A%2F%2Fqualitysafety.bmj.com%2Fcgi%2Fcontent%2Fshort%2F20%2F10%2F885%3Frss%3D1 Conclusion Using a patient-reported questionnaire of doctors' communication skills, favourable assessments of doctors by patients were mostly discordant with the views of expert observers. Only very poor performance identified by patients was in agreement with the views of expert observers. The results suggest that patient reports alone may not be sufficient to identify all doctors whose communication skills need improvement training. (Source: Quality and Safety in Health Care) Quality and Safety in Health Care journals http://www.medworm.com/rss/comments.php?id=5244810 Wed, 21 Sep 2011 04:00:00 +0100 5244810 http://www.medworm.com/index.php?rid=5244809&cid=s_31292_51_f&fid=31292&url=http%3A%2F%2Fqualitysafety.bmj.com%2Fcgi%2Fcontent%2Fshort%2F20%2F10%2F875%3Frss%3D1 Conclusion Prospectively identifying older persons receiving PIMs or with adherence issues and providing feasible interventions may prevent adverse drug events. (Source: Quality and Safety in Health Care) Quality and Safety in Health Care journals http://www.medworm.com/rss/comments.php?id=5244809 Wed, 21 Sep 2011 04:00:00 +0100 5244809 http://www.medworm.com/index.php?rid=5244808&cid=s_31292_51_f&fid=31292&url=http%3A%2F%2Fqualitysafety.bmj.com%2Fcgi%2Fcontent%2Fshort%2F20%2F10%2F869%3Frss%3D1 Conclusion The currently used Dutch outcome indicators are not suitable for ranking hospitals. When judging hospital quality the influence of random variation must be accounted for to avoid overinterpretation of the numbers in the quest for more transparency in healthcare. Adequate sample size is a prerequisite in attempting reliable ranking. (Source: Quality and Safety in Health Care) Quality and Safety in Health Care journals http://www.medworm.com/rss/comments.php?id=5244808 Wed, 21 Sep 2011 04:00:00 +0100 5244808 http://www.medworm.com/index.php?rid=5244807&cid=s_31292_51_f&fid=31292&url=http%3A%2F%2Fqualitysafety.bmj.com%2Fcgi%2Fcontent%2Fshort%2F20%2F10%2F863%3Frss%3D1 Conclusion Adverse events in pre-PICU hospital care were common in children who subsequently died in PICU. CIs occurred throughout the patient journey. Interventional studies of healthcare organisation and delivery are necessary to identify appropriate strategies to improve patient safety. (Source: Quality and Safety in Health Care) Quality and Safety in Health Care journals http://www.medworm.com/rss/comments.php?id=5244807 Wed, 21 Sep 2011 04:00:00 +0100 5244807 http://www.medworm.com/index.php?rid=5244806&cid=s_31292_51_f&fid=31292&url=http%3A%2F%2Fqualitysafety.bmj.com%2Fcgi%2Fcontent%2Fshort%2F20%2F10%2F857%3Frss%3D1 Conclusions GP trainees rated highly by their faculty voluntarily reported incidents in the delivery of clinical care when given a safe, blame-free, and confidential reporting process. Most incidents were not found to be directly related to the inexperience of the trainee, but were caused by failing organisational processes in the healthcare delivery system. Moreover, the trainees who tended to report these incidents were those whose performance was highly evaluated in the domain of clinical expertise. (Source: Quality and Safety in Health Care) Quality and Safety in Health Care journals http://www.medworm.com/rss/comments.php?id=5244806 Wed, 21 Sep 2011 04:00:00 +0100 5244806 http://www.medworm.com/index.php?rid=5244805&cid=s_31292_51_f&fid=31292&url=http%3A%2F%2Fqualitysafety.bmj.com%2Fcgi%2Fcontent%2Fshort%2F20%2F10%2F849%3Frss%3D1 Conclusions Scientific observational metrics can be reliably used by medical and non-medical observers in cancer MDTs. Such robust assessment tools provide part of a toolkit for team evaluation and enhancement. (Source: Quality and Safety in Health Care) Quality and Safety in Health Care journals http://www.medworm.com/rss/comments.php?id=5244805 Wed, 21 Sep 2011 04:00:00 +0100 5244805 http://www.medworm.com/index.php?rid=5244804&cid=s_31292_51_f&fid=31292&url=http%3A%2F%2Fqualitysafety.bmj.com%2Fcgi%2Fcontent%2Fshort%2F20%2F10%2F842%3Frss%3D1 Conclusions This study provided evidence that the original 12-factor structure of the Hospital Survey on Patient Safety Culture scale has been replicated in this Scottish sample. Therefore, no modifications are required to the original 12-factor model, which is suggested for use, since it would allow researchers the possibility of cross-national comparisons. (Source: Quality and Safety in Health Care) Quality and Safety in Health Care journals http://www.medworm.com/rss/comments.php?id=5244804 Wed, 21 Sep 2011 04:00:00 +0100 5244804 http://www.medworm.com/index.php?rid=5244803&cid=s_31292_51_f&fid=31292&url=http%3A%2F%2Fqualitysafety.bmj.com%2Fcgi%2Fcontent%2Fshort%2F20%2F10%2F832%3Frss%3D1 Conclusions The value of a guideline using alternative evidence-based methods seems to at least equal that of a guideline composed in multiple sessions, that is, for topics with a monodisciplinary character and a relatively small number of conducted trials. In addition, the presented alternatives were more time- and cost-efficient. (Source: Quality and Safety in Health Care) Quality and Safety in Health Care journals http://www.medworm.com/rss/comments.php?id=5244803 Wed, 21 Sep 2011 04:00:00 +0100 5244803 http://www.medworm.com/index.php?rid=5244802&cid=s_31292_51_f&fid=31292&url=http%3A%2F%2Fqualitysafety.bmj.com%2Fcgi%2Fcontent%2Fshort%2F20%2F10%2F826%3Frss%3D1 Conclusion Attention to broader domains of social policy may be helpful in accomplishing improvements in health envisioned by advocates of healthcare reform. (Source: Quality and Safety in Health Care) Quality and Safety in Health Care journals http://www.medworm.com/rss/comments.php?id=5244802 Wed, 21 Sep 2011 04:00:00 +0100 5244802 http://www.medworm.com/index.php?rid=5244801&cid=s_31292_51_f&fid=31292&url=http%3A%2F%2Fqualitysafety.bmj.com%2Fcgi%2Fcontent%2Fshort%2F20%2F10%2F823%3Frss%3D1 The Institute of Medicine identifies patient-centred care as one of the essential elements of high quality care.1 They define patient-centred care as ‘respecting and responding to patients’ wants, needs and preferences, so that patients can make choices in their care that best fit their individual circumstances'. Studies demonstrate that patient-centred care is associated with improved healthcare outcomes, particularly in patients with chronic diseases.2–8 It seems as if it would be both important and easy to deliver this kind of care. But, in fact, it is very difficult to do well. Patient-centred care requires physicians and other healthcare providers to have the communication skills to elicit patients' true wishes and to recognise and respond to both their needs and the... Quality and Safety in Health Care journals http://www.medworm.com/rss/comments.php?id=5244801 Wed, 21 Sep 2011 04:00:00 +0100 5244801 http://www.medworm.com/index.php?rid=5153562&cid=s_31292_51_f&fid=31292&url=http%3A%2F%2Fqualitysafety.bmj.com%2Fcgi%2Fcontent%2Fshort%2F20%2F9%2F818%3Frss%3D1 Conclusion Following consultation with staff and patients, the authors managed to institute and sustain the performance of a surgical safety checklist for elective cases in obstetric theatres. While significant progress has been made, the authors recognise that further work is required in order to further evaluate and optimise this process. (Source: Quality and Safety in Health Care) Quality and Safety in Health Care journals http://www.medworm.com/rss/comments.php?id=5153562 Sun, 21 Aug 2011 23:00:00 +0100 5153562 http://www.medworm.com/index.php?rid=5153561&cid=s_31292_51_f&fid=31292&url=http%3A%2F%2Fqualitysafety.bmj.com%2Fcgi%2Fcontent%2Fshort%2F20%2F9%2F811%3Frss%3D1 Conclusions Salient cues to drive provider behaviour towards best practice are helpful to sustain process improvement, and cessation of such cues should be approached warily. Initial education, year-long habit formation, and effective early implementation demonstrated no appreciable effect on the VAP rate during the checklist washout period. (Source: Quality and Safety in Health Care) Quality and Safety in Health Care journals http://www.medworm.com/rss/comments.php?id=5153561 Sun, 21 Aug 2011 23:00:00 +0100 5153561 http://www.medworm.com/index.php?rid=5153560&cid=s_31292_51_f&fid=31292&url=http%3A%2F%2Fqualitysafety.bmj.com%2Fcgi%2Fcontent%2Fshort%2F20%2F9%2F806%3Frss%3D1 In the wake of adverse events, injured patients and their families have a complex range of needs and wants. The tort system, even when operating at its best, will inevitably fall far short of addressing them. In Australia and New Zealand, government-run health complaints commissions take a more flexible and expansive approach to providing remedies for patients injured by or disgruntled with care. Unfortunately, survey research has shown that many patients in these systems are dissatisfied with their experience. We hypothesised that an important explanation for this dissatisfaction is an ‘expectations gap’; discordance between what complainants want and what they eventually get out of the process. Analysing a sample of complaints relating to informed consent from the Commission ... Quality and Safety in Health Care journals http://www.medworm.com/rss/comments.php?id=5153560 Sun, 21 Aug 2011 23:00:00 +0100 5153560 http://www.medworm.com/index.php?rid=5153559&cid=s_31292_51_f&fid=31292&url=http%3A%2F%2Fqualitysafety.bmj.com%2Fcgi%2Fcontent%2Fshort%2F20%2F9%2F797%3Frss%3D1 Conclusions This study demonstrates the development of a patient safety climate instrument. The questionnaire displays established features of safety climate and additionally contains features that might be specific to small-scale general practices. (Source: Quality and Safety in Health Care) Quality and Safety in Health Care journals http://www.medworm.com/rss/comments.php?id=5153559 Sun, 21 Aug 2011 23:00:00 +0100 5153559 http://www.medworm.com/index.php?rid=5153558&cid=s_31292_51_f&fid=31292&url=http%3A%2F%2Fqualitysafety.bmj.com%2Fcgi%2Fcontent%2Fshort%2F20%2F9%2F791%3Frss%3D1 Conclusion The introduction of a new observation chart, and education regarding its use and importance, was associated with a major improvement in the recording of respiratory rate and other vital signs. (Source: Quality and Safety in Health Care) Quality and Safety in Health Care journals http://www.medworm.com/rss/comments.php?id=5153558 Sun, 21 Aug 2011 23:00:00 +0100 5153558 http://www.medworm.com/index.php?rid=5153557&cid=s_31292_51_f&fid=31292&url=http%3A%2F%2Fqualitysafety.bmj.com%2Fcgi%2Fcontent%2Fshort%2F20%2F9%2F785%3Frss%3D1 Discussion Substantial effort has been made in the last decade to improve patient safety. The actual improvement in safety has been fairly modest, which is understandable because most hospitals currently have fairly unreliable processes in place. Using the framework presented here, hospitals can gauge the reliability of their processes and practices. Recognisable characteristics provide insights into where improvement is needed and possible. In addition, this framework provides a way to view the relationship between different patient safety building blocks and a means to link them conceptually. An integrated approach is needed for hospitals to achieve a higher reliability level with particular attention to the interconnected elements that affect patient safety. (Source: Quality and Safety ... Quality and Safety in Health Care journals http://www.medworm.com/rss/comments.php?id=5153557 Sun, 21 Aug 2011 23:00:00 +0100 5153557 http://www.medworm.com/index.php?rid=5153556&cid=s_31292_51_f&fid=31292&url=http%3A%2F%2Fqualitysafety.bmj.com%2Fcgi%2Fcontent%2Fshort%2F20%2F9%2F779%3Frss%3D1 Conclusions The authors' strategy allows for patient-oriented CPG development, but it requires appropriate training and knowledge of qualitative research techniques (primary research and systematic review of qualitative evidence) for developers. It is also crucial to have specific support for patients, previously selected with eligibility criteria, to facilitate an effective engagement, providing clear guidance on their roles and ensuring opportunities to attend training events. (Source: Quality and Safety in Health Care) Quality and Safety in Health Care journals http://www.medworm.com/rss/comments.php?id=5153556 Sun, 21 Aug 2011 23:00:00 +0100 5153556 http://www.medworm.com/index.php?rid=5153555&cid=s_31292_51_f&fid=31292&url=http%3A%2F%2Fqualitysafety.bmj.com%2Fcgi%2Fcontent%2Fshort%2F20%2F9%2F773%3Frss%3D1 Conclusions Documentation of discharge process components in the medical record may not reflect actual discharge process activities. Alternatively, mandated discharge processes are ineffective in preventing readmission. The observed absence of an association between discharge documentation and readmission indicates that discharge quality improvement initiatives should target metrics of discharge process quality beyond improving rates of documentation. (Source: Quality and Safety in Health Care) Quality and Safety in Health Care journals http://www.medworm.com/rss/comments.php?id=5153555 Sun, 21 Aug 2011 23:00:00 +0100 5153555 http://www.medworm.com/index.php?rid=5153554&cid=s_31292_51_f&fid=31292&url=http%3A%2F%2Fqualitysafety.bmj.com%2Fcgi%2Fcontent%2Fshort%2F20%2F9%2F764%3Frss%3D1 Conclusion All proposed disease-specific quality indicators for outpatient antibiotic prescribing have face validity and are potentially applicable. They could be used to better describe antibiotic use and assess the quality of antibiotic prescribing patterns in ambulatory care. (Source: Quality and Safety in Health Care) Quality and Safety in Health Care journals http://www.medworm.com/rss/comments.php?id=5153554 Sun, 21 Aug 2011 23:00:00 +0100 5153554 http://www.medworm.com/index.php?rid=5153553&cid=s_31292_51_f&fid=31292&url=http%3A%2F%2Fqualitysafety.bmj.com%2Fcgi%2Fcontent%2Fshort%2F20%2F9%2F756%3Frss%3D1 Conclusions Using clinical surveillance, the authors identified a high risk of AE and significant variation in AE risks and subtypes between services. These findings suggest that institutions will need to evaluate service-specific safety problems to set priorities and design improvement strategies. (Source: Quality and Safety in Health Care) Quality and Safety in Health Care journals http://www.medworm.com/rss/comments.php?id=5153553 Sun, 21 Aug 2011 23:00:00 +0100 5153553 http://www.medworm.com/index.php?rid=5153552&cid=s_31292_51_f&fid=31292&url=http%3A%2F%2Fqualitysafety.bmj.com%2Fcgi%2Fcontent%2Fshort%2F20%2F9%2F747%3Frss%3D1 Conclusions There is no relationship between the rigour of development score and the recommendations in guidelines on ice for acute ankle sprains. The guidelines suffered from methodological problems which were not captured by the AGREE instrument. (Source: Quality and Safety in Health Care) Quality and Safety in Health Care journals http://www.medworm.com/rss/comments.php?id=5153552 Sun, 21 Aug 2011 23:00:00 +0100 5153552 http://www.medworm.com/index.php?rid=5153551&cid=s_31292_51_f&fid=31292&url=http%3A%2F%2Fqualitysafety.bmj.com%2Fcgi%2Fcontent%2Fshort%2F20%2F9%2F738%3Frss%3D1 Conclusion A clinical pharmacist service during inpatient care may improve quality of prescribing and patients' HRQL. Trial registration clinicaltrials.gov Identifier: NCT01016301. (Source: Quality and Safety in Health Care) Quality and Safety in Health Care journals http://www.medworm.com/rss/comments.php?id=5153551 Sun, 21 Aug 2011 23:00:00 +0100 5153551 http://www.medworm.com/index.php?rid=5153550&cid=s_31292_51_f&fid=31292&url=http%3A%2F%2Fqualitysafety.bmj.com%2Fcgi%2Fcontent%2Fshort%2F20%2F9%2F735%3Frss%3D1 Almost no one is happy with malpractice liability, the traditional Anglo–American system for dealing with complaints about medical injury. To its more trenchant critics it is inefficient, ineffective, inaccurate and, what matters most, it is structurally inconsistent with the fundaments of quality improvement and future patient safety.1 It is, in all, something only a trial lawyer could love.2 3 Efforts at reform are in place almost everywhere. New Zealand has effectively barred malpractice litigation entirely4; Australia has curbed it by offering parallel, commission-based procedures5; Canada and England have relatively lower claiming rates due to disincentives built into law and insurance practices6; while in the USA the process remains troublesome. Many hospitals and some liabilit... Quality and Safety in Health Care journals http://www.medworm.com/rss/comments.php?id=5153550 Sun, 21 Aug 2011 23:00:00 +0100 5153550 http://www.medworm.com/index.php?rid=5056623&cid=s_31292_51_f&fid=31292&url=http%3A%2F%2Fqualitysafety.bmj.com%2Fcgi%2Fcontent%2Fshort%2F20%2F8%2F733-b%3Frss%3D1 Mitchell and Morrison have raised some important concerns in relation to the creation and transmission of electronic discharge summaries.1 We agree that while electronic summaries hold the potential to improve information transfer across care settings, they can be disruptive to the workflow of doctors and are not necessarily of a higher quality than manual discharge summaries.2 Barriers to the use of electronic discharge summaries centre around technological and workplace issues including speed and functionality of discharge summary software, poor interoperability between systems within hospitals and externally, time pressures and interruptions on those completing discharge summaries, the emphasis on administrative requirements for timely completion of summaries as opposed to clinical need... Quality and Safety in Health Care journals http://www.medworm.com/rss/comments.php?id=5056623 Wed, 20 Jul 2011 23:00:00 +0100 5056623 http://www.medworm.com/index.php?rid=5056622&cid=s_31292_51_f&fid=31292&url=http%3A%2F%2Fqualitysafety.bmj.com%2Fcgi%2Fcontent%2Fshort%2F20%2F8%2F733-a%3Frss%3D1 In their recent article, Callen et al1 suggest that electronic discharge summary (DS) systems might ameliorate issues associated with missed test results for hospitalised patients. In fact, the use of information technology (IT) has long been proposed as a tool for enhancing the quality of DSs and, by extension, continuity of care.2–6 Simply switching to electronic DS systems will not be a panacea, however, unless the underlying factors that affect the quality and utility of DSs are addressed. These include the work practices of their authors, who are most commonly junior medical officers (JMOs).7–9 In Australia, two recent workshops considered barriers to the creation and transmission of high-quality electronic DSs. Attended by JMOs from across the country, the workshops ident... Quality and Safety in Health Care journals http://www.medworm.com/rss/comments.php?id=5056622 Wed, 20 Jul 2011 23:00:00 +0100 5056622 http://www.medworm.com/index.php?rid=5056621&cid=s_31292_51_f&fid=31292&url=http%3A%2F%2Fqualitysafety.bmj.com%2Fcgi%2Fcontent%2Fshort%2F20%2F8%2F725%3Frss%3D1 Conclusion Capitalising on a large healthcare system, VA IPEC used strategies applicable to non-federal healthcare systems and communities. Such tactics included measurement through information technology, leadership, learning tools and mentoring. (Source: Quality and Safety in Health Care) Quality and Safety in Health Care journals http://www.medworm.com/rss/comments.php?id=5056621 Wed, 20 Jul 2011 23:00:00 +0100 5056621 http://www.medworm.com/index.php?rid=5056620&cid=s_31292_51_f&fid=31292&url=http%3A%2F%2Fqualitysafety.bmj.com%2Fcgi%2Fcontent%2Fshort%2F20%2F8%2F718%3Frss%3D1 Discussions with key stakeholders were held to identify their needs from an acute oncology service. Strategies for change A new patient pathway was developed, and a new online referral process was implemented. The publicity and education campaign was repeatedly aimed at referring physicians at consultant and junior level, and took the form of emails and presentations with handouts at all teaching sessions, multidisciplinary team meetings, the Consultants Committee and Junior Doctors' induction. Effects of change The new system was piloted for 6 months. 12/18 patients were referred via the new pathway. 15/18 patients were referred via the new online system. Length of stay, endoscopies, biopsies and blood tests were all statistically significantly reduced during the study period compa... Quality and Safety in Health Care journals http://www.medworm.com/rss/comments.php?id=5056620 Wed, 20 Jul 2011 23:00:00 +0100 5056620 http://www.medworm.com/index.php?rid=5056619&cid=s_31292_51_f&fid=31292&url=http%3A%2F%2Fqualitysafety.bmj.com%2Fcgi%2Fcontent%2Fshort%2F20%2F8%2F711%3Frss%3D1 Conclusions The study reports a powerful link between briefing practices and attitudes towards safety. Findings build on previous work by reporting on the relationship between briefings and safety climate within a 4-year period. Briefings, however, remain difficult to establish in local contexts without appropriate team-based patient safety education. Success in establishing a safety culture, with associated practices, may depend on first establishing unidirectional, positive change in attitudes to create a safety climate. (Source: Quality and Safety in Health Care) Quality and Safety in Health Care journals http://www.medworm.com/rss/comments.php?id=5056619 Wed, 20 Jul 2011 23:00:00 +0100 5056619 http://www.medworm.com/index.php?rid=5056618&cid=s_31292_51_f&fid=31292&url=http%3A%2F%2Fqualitysafety.bmj.com%2Fcgi%2Fcontent%2Fshort%2F20%2F8%2F704%3Frss%3D1 Conclusion QI efforts may be more effective if they foster both specific individual attitudes and capabilities, as well as improve practice-level systems. (Source: Quality and Safety in Health Care) Quality and Safety in Health Care journals http://www.medworm.com/rss/comments.php?id=5056618 Wed, 20 Jul 2011 23:00:00 +0100 5056618 http://www.medworm.com/index.php?rid=5056617&cid=s_31292_51_f&fid=31292&url=http%3A%2F%2Fqualitysafety.bmj.com%2Fcgi%2Fcontent%2Fshort%2F20%2F8%2F698%3Frss%3D1 The objectives were the achievement of a global risk mapping related to the whole process of sterilising medical devices, and second, the implementation of corrective measures to reduce identified risks. Methods A multidisciplinary team, formed in January 2008, validated results at each step of the study. During the analysis, 416 hazardous situations were identified, among which 81 were quoted first in priority and led to the description of 141 risk scenarios. The PRA team assessed 42 scenarios with risk ranking assessed as ‘acceptable under control’ or ‘unacceptable.’ They adopted 23 follow-up actions measures and 13 safety parameters. Results and discussion The PRA constitutes an appropriate tool for assessing quality-improvement policy and safety in healthcare ... Quality and Safety in Health Care journals http://www.medworm.com/rss/comments.php?id=5056617 Wed, 20 Jul 2011 23:00:00 +0100 5056617 http://www.medworm.com/index.php?rid=5056616&cid=s_31292_51_f&fid=31292&url=http%3A%2F%2Fqualitysafety.bmj.com%2Fcgi%2Fcontent%2Fshort%2F20%2F8%2F692%3Frss%3D1 Conclusions A limited set of communication elements is suitable for a brief communication template in communication from paediatric PCPs to specialists. The use of such a template may add value to interphysician communication. (Source: Quality and Safety in Health Care) Quality and Safety in Health Care journals http://www.medworm.com/rss/comments.php?id=5056616 Wed, 20 Jul 2011 23:00:00 +0100 5056616 http://www.medworm.com/index.php?rid=5056615&cid=s_31292_51_f&fid=31292&url=http%3A%2F%2Fqualitysafety.bmj.com%2Fcgi%2Fcontent%2Fshort%2F20%2F8%2F680%3Frss%3D1 Conclusions No single best hospital-wide intervention could be identified using strict methodological criteria. However, several interventions had positive results, and may be used in hospital practice. Since strict methodological designs are not optimal for evaluating highly complex interventions and settings, the authors recommend studying hospital-wide interventions for older persons using adapted quality and research criteria. (Source: Quality and Safety in Health Care) Quality and Safety in Health Care journals http://www.medworm.com/rss/comments.php?id=5056615 Wed, 20 Jul 2011 23:00:00 +0100 5056615 http://www.medworm.com/index.php?rid=5056614&cid=s_31292_51_f&fid=31292&url=http%3A%2F%2Fqualitysafety.bmj.com%2Fcgi%2Fcontent%2Fshort%2F20%2F8%2F672%3Frss%3D1 Conclusion Process variation was in part induced by systemised risk mitigation. IT-based process support for monitoring processes such as that studied here should aim to ensure resilience and further mitigate risk to enhance patient safety. (Source: Quality and Safety in Health Care) Quality and Safety in Health Care journals http://www.medworm.com/rss/comments.php?id=5056614 Wed, 20 Jul 2011 23:00:00 +0100 5056614 http://www.medworm.com/index.php?rid=5056613&cid=s_31292_51_f&fid=31292&url=http%3A%2F%2Fqualitysafety.bmj.com%2Fcgi%2Fcontent%2Fshort%2F20%2F8%2F666%3Frss%3D1 Conclusions A set of 42 quality indicators was developed for community pharmacy care. It is expected that this will have a positive impact on quality and safety of community pharmacy care in the Netherlands. (Source: Quality and Safety in Health Care) Quality and Safety in Health Care journals http://www.medworm.com/rss/comments.php?id=5056613 Wed, 20 Jul 2011 23:00:00 +0100 5056613 http://www.medworm.com/index.php?rid=5056612&cid=s_31292_51_f&fid=31292&url=http%3A%2F%2Fqualitysafety.bmj.com%2Fcgi%2Fcontent%2Fshort%2F20%2F8%2F658%3Frss%3D1 Conclusion Collaborative improvement can produce significant, sustained gains in compliance with standards and outcomes in less-developed settings and merits wider application as a strategy for health systems strengthening. (Source: Quality and Safety in Health Care) Quality and Safety in Health Care journals http://www.medworm.com/rss/comments.php?id=5056612 Wed, 20 Jul 2011 23:00:00 +0100 5056612 http://www.medworm.com/index.php?rid=5056611&cid=s_31292_51_f&fid=31292&url=http%3A%2F%2Fqualitysafety.bmj.com%2Fcgi%2Fcontent%2Fshort%2F20%2F8%2F651%3Frss%3D1 Conclusion Despite statistically significant differences between hospitals, random variation is a crucial factor that must be taken into account when judging individual hospitals. The funnel plot provides easily interpretable information on hospital performance, including the influence of random variation. (Source: Quality and Safety in Health Care) Quality and Safety in Health Care journals http://www.medworm.com/rss/comments.php?id=5056611 Wed, 20 Jul 2011 23:00:00 +0100 5056611 http://www.medworm.com/index.php?rid=5056610&cid=s_31292_51_f&fid=31292&url=http%3A%2F%2Fqualitysafety.bmj.com%2Fcgi%2Fcontent%2Fshort%2F20%2F8%2F647%3Frss%3D1 My grandfather was a general practitioner in a small town in the USA in the mid-20th century. His medical team consisted of himself and a nurse (who was also my grandmother). He even served as his own pharmacist. In stark contrast, the team in my primary care practice consists of my physician partners, several trainees, nurses, medical assistants, referral coordinators, pharmacists, the subspecialists and their teams, home health nurses and therapists, and more. Such large and disconnected teams can provide comprehensive care for complex and chronic illnesses, but when they malfunction, they can harm patients.1 Teams are larger and more dispersed in time and space, and there are now many more types of teams. They vary from teams whose members repeatedly work together over many years (eg, h... Quality and Safety in Health Care journals http://www.medworm.com/rss/comments.php?id=5056610 Wed, 20 Jul 2011 23:00:00 +0100 5056610 http://www.medworm.com/index.php?rid=4943446&cid=s_31292_51_f&fid=31292&url=http%3A%2F%2Fqualitysafety.bmj.com%2Fcgi%2Fcontent%2Fshort%2F20%2F7%2F645-b%3Frss%3D1 As with all approaches to assessing and improving the quality of healthcare, it is important that we establish, as rigorously as possible, their impact and cost-effectiveness. Just as we rightly expect healthcare practice and policy to be informed by research evidence, we should expect the same for quality assessment and improvement activities that consume resources that could otherwise be spent on care. Without rigorous evaluation, we cannot know how best to improve the quality of healthcare. With this goal in mind, we undertook a long overdue review of the research evidence of the impact of national confidential enquiries (NCEs), an approach to assessing the safety of care that has changed little since its inception about 50 years ago. We concluded by pointing out the need for more ... Quality and Safety in Health Care journals http://www.medworm.com/rss/comments.php?id=4943446 Fri, 17 Jun 2011 23:00:00 +0100 4943446 http://www.medworm.com/index.php?rid=4943445&cid=s_31292_51_f&fid=31292&url=http%3A%2F%2Fqualitysafety.bmj.com%2Fcgi%2Fcontent%2Fshort%2F20%2F7%2F645-a%3Frss%3D1 Angelow and Black1 mount a series of scathing criticisms of the national confidential enquiries (NCEs). They suggest ‘nesting’ NCEs within prospective National Clinical Audits. The competing interest declared by one of the authors is that he chairs the National Clinical Audit Advisory Group. He was also a member of the group convened by the National Patient Safety Agency (NPSA) that advised on the future of the NCEs. The criticisms are without merit, and I deal with them in turn. First, it is alleged that the research evidence of the impact of the recommendations is poor, with no time series analysis or experimental studies and is restricted to considering their impact on the structure and process rather than the outcome of care. The role of the NCE is to enable the profession ... Quality and Safety in Health Care journals http://www.medworm.com/rss/comments.php?id=4943445 Fri, 17 Jun 2011 23:00:00 +0100 4943445 http://www.medworm.com/index.php?rid=4943444&cid=s_31292_51_f&fid=31292&url=http%3A%2F%2Fqualitysafety.bmj.com%2Fcgi%2Fcontent%2Fshort%2F20%2F7%2F637%3Frss%3D1 Conclusion A structured validation process was successful in reducing incorrect prescription and administration of high-dose insulin and has reduced the risk of associated fatalities or significant patient harm. Consideration should be given to adopting this process in any setting where insulin is prescribed and administered. (Source: Quality and Safety in Health Care) Quality and Safety in Health Care journals http://www.medworm.com/rss/comments.php?id=4943444 Fri, 17 Jun 2011 23:00:00 +0100 4943444 http://www.medworm.com/index.php?rid=4943443&cid=s_31292_51_f&fid=31292&url=http%3A%2F%2Fqualitysafety.bmj.com%2Fcgi%2Fcontent%2Fshort%2F20%2F7%2F631%3Frss%3D1 Conclusion In order to reduce the risk of acquiring healthcare-associated infections and to increase patient safety, a continuous, systematic effort involving continual measurement and review is necessary. (Source: Quality and Safety in Health Care) Quality and Safety in Health Care journals http://www.medworm.com/rss/comments.php?id=4943443 Fri, 17 Jun 2011 23:00:00 +0100 4943443 http://www.medworm.com/index.php?rid=4943442&cid=s_31292_51_f&fid=31292&url=http%3A%2F%2Fqualitysafety.bmj.com%2Fcgi%2Fcontent%2Fshort%2F20%2F7%2F625%3Frss%3D1 Prescribing errors cause substantial potentially avoidable patient harm. There is increasing evidence that the implementation of clinical decision support systems to support prescribing may reduce the risk of such errors. Efforts have thus far concentrated on the implementation of these systems within local health communities. However, considerable potential benefit exists in sharing the content of these prescribing decision support systems across geographical boundaries, including the sharing of experiences and expertise and cost reduction, which could in turn potentially increase accessibility to low resource settings. Technical, commercial and regulatory issues would however first need to be overcome in order to facilitate such a development. In this paper, the authors reflect on some o... Quality and Safety in Health Care journals http://www.medworm.com/rss/comments.php?id=4943442 Fri, 17 Jun 2011 23:00:00 +0100 4943442 http://www.medworm.com/index.php?rid=4943441&cid=s_31292_51_f&fid=31292&url=http%3A%2F%2Fqualitysafety.bmj.com%2Fcgi%2Fcontent%2Fshort%2F20%2F7%2F618%3Frss%3D1 Conclusion This framework offers a way to classify and compare PSPs, and thereby to interpret the patient-safety literature. Further research is needed to develop understanding of these dimensions, how they evolve as the patient safety field matures, and their relative utilities in describing, evaluating and implementing PSPs. (Source: Quality and Safety in Health Care) Quality and Safety in Health Care journals http://www.medworm.com/rss/comments.php?id=4943441 Fri, 17 Jun 2011 23:00:00 +0100 4943441 http://www.medworm.com/index.php?rid=4943440&cid=s_31292_51_f&fid=31292&url=http%3A%2F%2Fqualitysafety.bmj.com%2Fcgi%2Fcontent%2Fshort%2F20%2F7%2F611%3Frss%3D1 Conclusion This work can guide research commissioners and evaluators on the contextual features of PSP implementations that are important to report or evaluate. It represents a first step towards developing guidelines on contexts in PSP implementation evaluations. However, the science of context measurement needs maturing. (Source: Quality and Safety in Health Care) Quality and Safety in Health Care journals http://www.medworm.com/rss/comments.php?id=4943440 Fri, 17 Jun 2011 23:00:00 +0100 4943440 http://www.medworm.com/index.php?rid=4943439&cid=s_31292_51_f&fid=31292&url=http%3A%2F%2Fqualitysafety.bmj.com%2Fcgi%2Fcontent%2Fshort%2F20%2F7%2F604%3Frss%3D1 Conclusions The paper suggests that significant gaps in research exist and makes proposals for future research better to inform decision-making. (Source: Quality and Safety in Health Care) Quality and Safety in Health Care journals http://www.medworm.com/rss/comments.php?id=4943439 Fri, 17 Jun 2011 23:00:00 +0100 4943439 http://www.medworm.com/index.php?rid=4943438&cid=s_31292_51_f&fid=31292&url=http%3A%2F%2Fqualitysafety.bmj.com%2Fcgi%2Fcontent%2Fshort%2F20%2F7%2F599%3Frss%3D1 Conclusions Structured observation of effective teamwork in the operating room can identify substantive deficiencies in the system and conduct of procedures, even in otherwise successful operations. High performing teams are more resilient displaying effective teamwork when operations become more difficult. (Source: Quality and Safety in Health Care) Quality and Safety in Health Care journals http://www.medworm.com/rss/comments.php?id=4943438 Fri, 17 Jun 2011 23:00:00 +0100 4943438 http://www.medworm.com/index.php?rid=4943437&cid=s_31292_51_f&fid=31292&url=http%3A%2F%2Fqualitysafety.bmj.com%2Fcgi%2Fcontent%2Fshort%2F20%2F7%2F592%3Frss%3D1 Conclusion The work carried out with a view to certification has confirmed the possibility that facilities spread across different hospitals can actually share common processes and standardise the activities for the care of end-of-life patients with cancer at home as if they were one single service provider. (Source: Quality and Safety in Health Care) Quality and Safety in Health Care journals http://www.medworm.com/rss/comments.php?id=4943437 Fri, 17 Jun 2011 23:00:00 +0100 4943437 http://www.medworm.com/index.php?rid=4943436&cid=s_31292_51_f&fid=31292&url=http%3A%2F%2Fqualitysafety.bmj.com%2Fcgi%2Fcontent%2Fshort%2F20%2F7%2F587%3Frss%3D1 Conclusions New Zealand's no-fault treatment injury claims database provides information about primary care patient safety events from an unusual ‘no-fault’ perspective. This analysis reinforces previous research identifying medication as a high-risk primary care activity and further identifies other primary care activities (dental care, injections, venepuncture, cryotherapy and ear syringing) as carrying important risks for patient harm. (Source: Quality and Safety in Health Care) Quality and Safety in Health Care journals http://www.medworm.com/rss/comments.php?id=4943436 Fri, 17 Jun 2011 23:00:00 +0100 4943436 http://www.medworm.com/index.php?rid=4943435&cid=s_31292_51_f&fid=31292&url=http%3A%2F%2Fqualitysafety.bmj.com%2Fcgi%2Fcontent%2Fshort%2F20%2F7%2F580%3Frss%3D1 Conclusions and discussion Surgical safety practices in ORs across the WRHA are consistent with the guidelines established by the WHO in 2007, but most are not monitored or enforced. The use of a checklist in the preoperative briefing period may improve adherence to these guidelines and facilitate surgical team interaction, resulting in standardisation of practice and improvements in team communication. Student interprofessional team observers are an effective tool for monitoring safety and teamwork. (Source: Quality and Safety in Health Care) Quality and Safety in Health Care journals http://www.medworm.com/rss/comments.php?id=4943435 Fri, 17 Jun 2011 23:00:00 +0100 4943435 http://www.medworm.com/index.php?rid=4943434&cid=s_31292_51_f&fid=31292&url=http%3A%2F%2Fqualitysafety.bmj.com%2Fcgi%2Fcontent%2Fshort%2F20%2F7%2F570%3Frss%3D1 Conclusions Ten relevant articles were identified and organised by method of investigation into (i) observation, (ii) questionnaire and (iii) interview studies. This review summarises the limited literature on surgeons' intraoperative leadership, and proposes a preliminary theoretically based structure for intraoperative leadership behaviours. This structure comprises seven categories with corresponding leadership components and covers two overarching themes related to task- and team-focus. Selected leadership theories which may be applicable to the operating room environment are also discussed. Further research is required to determine effective intraoperative leadership behaviours for safe surgical practice. (Source: Quality and Safety in Health Care) Quality and Safety in Health Care journals http://www.medworm.com/rss/comments.php?id=4943434 Fri, 17 Jun 2011 23:00:00 +0100 4943434 http://www.medworm.com/index.php?rid=4943433&cid=s_31292_51_f&fid=31292&url=http%3A%2F%2Fqualitysafety.bmj.com%2Fcgi%2Fcontent%2Fshort%2F20%2F7%2F564%3Frss%3D1 Objective Patient safety studies have identified older adults as a high-risk group for adverse events (AEs). As frequent users of the emergency department (ED), they are vulnerable to the negative consequences of ED crowding. The study objective was to determine whether a prolonged ED stay is associated with an increased risk for the occurrence of AEs for older patients admitted to hospital. Methods This retrospective cohort study was conducted at the largest adult tertiary care facility in Atlantic Canada (1 July 2005–31 March 2006). All community-dwelling persons 65 years and older admitted to an acute inpatient unit from the ED were eligible. The exposure of interest was total length of stay (LOS) in the ED. The primary outcome was the occurrence of an AE in-hospital. AEs we... Quality and Safety in Health Care journals http://www.medworm.com/rss/comments.php?id=4943433 Fri, 17 Jun 2011 23:00:00 +0100 4943433 http://www.medworm.com/index.php?rid=4943432&cid=s_31292_51_f&fid=31292&url=http%3A%2F%2Fqualitysafety.bmj.com%2Fcgi%2Fcontent%2Fshort%2F20%2F7%2F560%3Frss%3D1 Many quality improvement (QI) projects often fail to achieve their goals. Some fail for technical reasons, such as invalid measures, inattention to key contextual factors that determine the intervention's effectiveness, or not pilot testing the effort to identify and remove implementation barriers. But, an even larger number of projects fail because of adaptive challenges. ‘Adaptive challenges can only be addressed through changes in people's priorities, beliefs, habits, and loyalties.’1 2 A challenge for leaders is engaging people in deciding the change is needed, while also accepting that there may be things people want to preserve. For example, convincing physicians to include nurses during patient rounds, but letting them work out the logistics. Technical challenges are iss... Quality and Safety in Health Care journals http://www.medworm.com/rss/comments.php?id=4943432 Fri, 17 Jun 2011 23:00:00 +0100 4943432 http://www.medworm.com/index.php?rid=4943431&cid=s_31292_51_f&fid=31292&url=http%3A%2F%2Fqualitysafety.bmj.com%2Fcgi%2Fcontent%2Fshort%2F20%2F7%2F557%3Frss%3D1 The scholarly publication of patient safety initiatives must contribute more to accelerating reliable, safe patient care. Reports of safety initiatives generally describe specific safety practices and the resulting clinical outcomes. So why is progress so slow to make patients safer?1–3 Do the reported safety practices in such reports in fact lack convincing and plausible supporting evidence?4 Or, do the patient safety practices work, but require more explicit attention to implementation strategies? We suggest "Yes"—to both questions. Moreover, context lies at the heart of the answers to both. The lack of useful focus on context has led to heterogeneity in both evaluation of effective patient safety practices and successful implementation strategies.5–7 In this issue of B... Quality and Safety in Health Care journals http://www.medworm.com/rss/comments.php?id=4943431 Fri, 17 Jun 2011 23:00:00 +0100 4943431 http://www.medworm.com/index.php?rid=4860090&cid=s_31292_51_f&fid=31292&url=http%3A%2F%2Fqualitysafety.bmj.com%2Fcgi%2Fcontent%2Fshort%2F20%2F6%2F549%3Frss%3D1 Conclusion A system for identifying and monitoring organisational processes that give rise to latent conditions that may contribute to failures was prototyped at the dispensary at Hereford Hospital. This contributes to the organisation's efforts towards creating a proactive safety culture. (Source: Quality and Safety in Health Care) Quality and Safety in Health Care journals http://www.medworm.com/rss/comments.php?id=4860090 Mon, 23 May 2011 23:00:00 +0100 4860090 http://www.medworm.com/index.php?rid=4860089&cid=s_31292_51_f&fid=31292&url=http%3A%2F%2Fqualitysafety.bmj.com%2Fcgi%2Fcontent%2Fshort%2F20%2F6%2F539%3Frss%3D1 Conclusion Internally led compared with externally led redesign led to superior and sustained improvements in ED access block as a result of major structural reforms that were driven by committed clinicians and managers and cut across departmental boundaries. (Source: Quality and Safety in Health Care) Quality and Safety in Health Care journals http://www.medworm.com/rss/comments.php?id=4860089 Mon, 23 May 2011 23:00:00 +0100 4860089 http://www.medworm.com/index.php?rid=4860088&cid=s_31292_51_f&fid=31292&url=http%3A%2F%2Fqualitysafety.bmj.com%2Fcgi%2Fcontent%2Fshort%2F20%2F6%2F534%3Frss%3D1 Healthcare costs are unsustainable. The authors propose a solution to control costs without rationing (deliberate withholding of effective care) or payment reductions to doctors and hospitals. Three physician-led strategies comprise this solution: reduce (1) overuse of health services, (2) preventable complications and (3) waste within healthcare processes. These challenges know no borders. (Source: Quality and Safety in Health Care) Quality and Safety in Health Care journals http://www.medworm.com/rss/comments.php?id=4860088 Mon, 23 May 2011 23:00:00 +0100 4860088 http://www.medworm.com/index.php?rid=4860087&cid=s_31292_51_f&fid=31292&url=http%3A%2F%2Fqualitysafety.bmj.com%2Fcgi%2Fcontent%2Fshort%2F20%2F6%2F527%3Frss%3D1 Conclusions To facilitate implementation of complex healthcare innovations such as ADE-TIDS, staff in adopting organisations should give high priority to innovation implementation; allocate sufficient resources; effectively communicate with and involve local champions and users; and align innovations with workflows and information systems. In addition, they should monitor local factors, such as changes in organisational priorities and IT, availability of implementation staff and champions, and external regulations and constraints that may pose barriers to innovation implementation and sustainability. (Source: Quality and Safety in Health Care) Quality and Safety in Health Care journals http://www.medworm.com/rss/comments.php?id=4860087 Mon, 23 May 2011 23:00:00 +0100 4860087 http://www.medworm.com/index.php?rid=4860086&cid=s_31292_51_f&fid=31292&url=http%3A%2F%2Fqualitysafety.bmj.com%2Fcgi%2Fcontent%2Fshort%2F20%2F6%2F522%3Frss%3D1 Conclusion Internal evidence and peer-group opinion are strong determinants for clinical decisions. A self-conducted practice test, together with self-reflection in a peer group, strongly supports the process of change. (Source: Quality and Safety in Health Care) Quality and Safety in Health Care journals http://www.medworm.com/rss/comments.php?id=4860086 Mon, 23 May 2011 23:00:00 +0100 4860086 http://www.medworm.com/index.php?rid=4860085&cid=s_31292_51_f&fid=31292&url=http%3A%2F%2Fqualitysafety.bmj.com%2Fcgi%2Fcontent%2Fshort%2F20%2F6%2F515%3Frss%3D1 Discussion The context of care may influence both how professional values are expressed and the extent to which behaviours are in line with stated values. Doctors have an important responsibility to develop their healthcare systems in ways which will support good professional behaviour. (Source: Quality and Safety in Health Care) Quality and Safety in Health Care journals http://www.medworm.com/rss/comments.php?id=4860085 Mon, 23 May 2011 23:00:00 +0100 4860085 http://www.medworm.com/index.php?rid=4860084&cid=s_31292_51_f&fid=31292&url=http%3A%2F%2Fqualitysafety.bmj.com%2Fcgi%2Fcontent%2Fshort%2F20%2F6%2F508%3Frss%3D1 Conclusions The correlation between non-physician team member satisfaction and patient satisfaction was higher than the correlation between satisfaction of physicians and patients. Patients seem to be sensitive to aspects of practice structure. (Source: Quality and Safety in Health Care) Quality and Safety in Health Care journals http://www.medworm.com/rss/comments.php?id=4860084 Mon, 23 May 2011 23:00:00 +0100 4860084 http://www.medworm.com/index.php?rid=4860083&cid=s_31292_51_f&fid=31292&url=http%3A%2F%2Fqualitysafety.bmj.com%2Fcgi%2Fcontent%2Fshort%2F20%2F6%2F498%3Frss%3D1 Conclusion Lessons relevant to non-VA institutions include the: (1) need for ongoing data validation, (2) essential involvement of leadership at multiple levels, (3) supplementation of electronic data when key elements are absent, (4) utility of a good but not perfect electronic indicator to move practice while improving data elements and (5) value of a dashboard. (Source: Quality and Safety in Health Care) Quality and Safety in Health Care journals http://www.medworm.com/rss/comments.php?id=4860083 Mon, 23 May 2011 23:00:00 +0100 4860083 http://www.medworm.com/index.php?rid=4860082&cid=s_31292_51_f&fid=31292&url=http%3A%2F%2Fqualitysafety.bmj.com%2Fcgi%2Fcontent%2Fshort%2F20%2F6%2F491%3Frss%3D1 Conclusion The present method may be useful for quantifying and distinguishing sources of hospital doctors' workflow interruptions and useful in raising awareness of organisational circumstances. (Source: Quality and Safety in Health Care) Quality and Safety in Health Care journals http://www.medworm.com/rss/comments.php?id=4860082 Mon, 23 May 2011 23:00:00 +0100 4860082 http://www.medworm.com/index.php?rid=4860081&cid=s_31292_51_f&fid=31292&url=http%3A%2F%2Fqualitysafety.bmj.com%2Fcgi%2Fcontent%2Fshort%2F20%2F6%2F483%3Frss%3D1 Conclusions We have identified a preliminary set of safety skills, which with further refinement could form the template for the development of a formal taxonomy of the qualities and attributes of the safe practitioner. Experts and practitioners agree about the importance of the individual skills. The fact that the majority of these were felt by experienced cross-speciality clinicians to be trainable is encouraging in terms of the possibility of developing generic safety curricula. (Source: Quality and Safety in Health Care) Quality and Safety in Health Care journals http://www.medworm.com/rss/comments.php?id=4860081 Mon, 23 May 2011 23:00:00 +0100 4860081 http://www.medworm.com/index.php?rid=4860080&cid=s_31292_51_f&fid=31292&url=http%3A%2F%2Fqualitysafety.bmj.com%2Fcgi%2Fcontent%2Fshort%2F20%2F6%2F475%3Frss%3D1 Conclusions Use of a preoperative team checklist briefing was associated with improved physician compliance with antibiotic administration guidelines. Based on the results, recommendations to enhance timely antibiotic therapy are provided. (Source: Quality and Safety in Health Care) Quality and Safety in Health Care journals http://www.medworm.com/rss/comments.php?id=4860080 Mon, 23 May 2011 23:00:00 +0100 4860080 http://www.medworm.com/index.php?rid=4860079&cid=s_31292_51_f&fid=31292&url=http%3A%2F%2Fqualitysafety.bmj.com%2Fcgi%2Fcontent%2Fshort%2F20%2F6%2F469%3Frss%3D1 Conclusion The RA-EWMA chart is a direct and intuitive way to display information about an indicator while accounting for differences in case mix. (Source: Quality and Safety in Health Care) Quality and Safety in Health Care journals http://www.medworm.com/rss/comments.php?id=4860079 Mon, 23 May 2011 23:00:00 +0100 4860079 http://www.medworm.com/index.php?rid=4740661&cid=s_31292_51_f&fid=31292&url=http%3A%2F%2Fqualitysafety.bmj.com%2Fcgi%2Fcontent%2Fshort%2F20%2F5%2F465%3Frss%3D1 The Baldrige Award criteria are an excellent example of the practical application of Quality Improvement theory and are named for Malcolm Baldrige (1922 to 1987). They are the all-industry quality prize of the USA and are analogous to the Deming Prize of Japan, which was started in 1951. This award is a central feature of what is now called the Baldrige Performance Excellence Program. Howard Malcolm ‘Mac’ Baldrige, Jr (4 October 1922 to 25 July 1987) Malcolm Baldrige was born in Omaha, Nebraska in 1922. His father was H Malcolm Baldrige, a Nebraska lawyer and congressman. He was educated at Yale University, and received a bachelor's degree in 1944. In 1945, he fought in World War II at the battle of Okinawa. He married Margaret T Murrary in 1951, and they went on to have two da... Quality and Safety in Health Care journals http://www.medworm.com/rss/comments.php?id=4740661 Tue, 19 Apr 2011 23:00:00 +0100 4740661 http://www.medworm.com/index.php?rid=4740660&cid=s_31292_51_f&fid=31292&url=http%3A%2F%2Fqualitysafety.bmj.com%2Fcgi%2Fcontent%2Fshort%2F20%2F5%2F460%3Frss%3D1 Conclusion In conclusion, the most effective means of achieving VTE guideline adherence is to establish a thromboprophylaxis culture. This can be accomplished through a multiple intervention and continuous feedback approach. However, it is essential to ensure that a comprehensive VTE risk assessment is carried out to ensure that those not requiring treatment do not receive it unnecessarily. (Source: Quality and Safety in Health Care) Quality and Safety in Health Care journals http://www.medworm.com/rss/comments.php?id=4740660 Tue, 19 Apr 2011 23:00:00 +0100 4740660 http://www.medworm.com/index.php?rid=4740659&cid=s_31292_51_f&fid=31292&url=http%3A%2F%2Fqualitysafety.bmj.com%2Fcgi%2Fcontent%2Fshort%2F20%2F5%2F453%3Frss%3D1 Theories provide a way of understanding and predicting the effects of patient safety practices (PSPs), interventions intended to prevent or mitigate harm caused by healthcare or risks of such harm. Yet most published evaluations make little or no explicit reference to theory, thereby hindering efforts to generalise findings from one context to another. Theories from a wide range of disciplines are potentially relevant to research on PSPs. Theory can be used in research to explain clinical and organisational behaviour, to guide the development and selection of PSPs, and in evaluating their implementation and mechanisms of action. One key recommendation from an expert consensus process is that researchers should describe the theoretical basis for chosen intervention components or provide an ... Quality and Safety in Health Care journals http://www.medworm.com/rss/comments.php?id=4740659 Tue, 19 Apr 2011 23:00:00 +0100 4740659 http://www.medworm.com/index.php?rid=4740658&cid=s_31292_51_f&fid=31292&url=http%3A%2F%2Fqualitysafety.bmj.com%2Fcgi%2Fcontent%2Fshort%2F20%2F5%2F449%3Frss%3D1 While the complaints process is intended to improve healthcare, some doctors appear to practise defensive medicine after receiving a complaint. This response occurs in countries that use a tort-based medicolegal system as well as in countries with less professional liability. Defensive medicine is based on avoiding malpractice liability rather than considering a risk–benefit analysis for both investigations and treatment. There is also evidence that this style of practice is low quality in terms of decision-making, cost and patient outcomes. Western medical practice is based on biomedicine: determining medical failure using the underlying, taken-for-granted assumptions of biomedicine can potentially contribute to a response of shame after an adverse outcome or a complaint. Shame is i... Quality and Safety in Health Care journals http://www.medworm.com/rss/comments.php?id=4740658 Tue, 19 Apr 2011 23:00:00 +0100 4740658 http://www.medworm.com/index.php?rid=4740657&cid=s_31292_51_f&fid=31292&url=http%3A%2F%2Fqualitysafety.bmj.com%2Fcgi%2Fcontent%2Fshort%2F20%2F5%2F440%3Frss%3D1 Conclusions The findings highlight the complexity of the problem and the value of the approach used to increase our understanding of the issues considering the perspectives of patients, staff and family members. The results are being used to construct context-specific interventions to reduce the rates of falls. (Source: Quality and Safety in Health Care) Quality and Safety in Health Care journals http://www.medworm.com/rss/comments.php?id=4740657 Tue, 19 Apr 2011 23:00:00 +0100 4740657 http://www.medworm.com/index.php?rid=4740656&cid=s_31292_51_f&fid=31292&url=http%3A%2F%2Fqualitysafety.bmj.com%2Fcgi%2Fcontent%2Fshort%2F20%2F5%2F432%3Frss%3D1 Conclusions Although guidelines and systematic reviews on flu and pneumococcal vaccination in HIV-infected children came from authoritative institutions, their overall quality is poor, with the weakest fields being the methodological domains. (Source: Quality and Safety in Health Care) Quality and Safety in Health Care journals http://www.medworm.com/rss/comments.php?id=4740656 Tue, 19 Apr 2011 23:00:00 +0100 4740656 http://www.medworm.com/index.php?rid=4740655&cid=s_31292_51_f&fid=31292&url=http%3A%2F%2Fqualitysafety.bmj.com%2Fcgi%2Fcontent%2Fshort%2F20%2F5%2F424%3Frss%3D1 Introduction Methods for improving patient safety are predicated on cooperation between healthcare groups, but are the views of health professionals involved in promoting safety shared by other healthcare workforce staff and managers? Aim To compare patient-safety suggestions from health workforce managerial and staff groups with those of patient-safety specialists. Method Samples of managers (424) and staff (1214) in the South Australian state health system and 131 Australian patient-safety specialists were asked to write suggestions for improving patient safety. Group responses were content analysed and compared. Results Patient-safety specialists (83.2%) were more likely to make suggestions than were workforce managers (57.8%) or staff (44.1%). Workforce members from clinical profess... Quality and Safety in Health Care journals http://www.medworm.com/rss/comments.php?id=4740655 Tue, 19 Apr 2011 23:00:00 +0100 4740655 http://www.medworm.com/index.php?rid=4740654&cid=s_31292_51_f&fid=31292&url=http%3A%2F%2Fqualitysafety.bmj.com%2Fcgi%2Fcontent%2Fshort%2F20%2F5%2F416%3Frss%3D1 Conclusions The CPTT is the first validated, comprehensive trigger tool available to detect AEs in children hospitalised in acute care facilities. (Source: Quality and Safety in Health Care) Quality and Safety in Health Care journals http://www.medworm.com/rss/comments.php?id=4740654 Tue, 19 Apr 2011 23:00:00 +0100 4740654 http://www.medworm.com/index.php?rid=4740653&cid=s_31292_51_f&fid=31292&url=http%3A%2F%2Fqualitysafety.bmj.com%2Fcgi%2Fcontent%2Fshort%2F20%2F5%2F403%3Frss%3D1 Conclusions Computer-enabled discharge communications appear beneficial with respect to a number of important secondary outcomes. Primary outcomes of mortality and readmission are less commonly reported in this literature and require further study. (Source: Quality and Safety in Health Care) Quality and Safety in Health Care journals http://www.medworm.com/rss/comments.php?id=4740653 Tue, 19 Apr 2011 23:00:00 +0100 4740653 http://www.medworm.com/index.php?rid=4740652&cid=s_31292_51_f&fid=31292&url=http%3A%2F%2Fqualitysafety.bmj.com%2Fcgi%2Fcontent%2Fshort%2F20%2F5%2F397%3Frss%3D1 Conclusions Inhalers and liquid medicines were associated with significantly increased odds of administration errors. Training of staff in safe administration of these formulations needs implementing. Although there was some evidence that MDS reduced the odds of an administration error, the use of MDS impacts on other aspects of medicines management. Because of this, and as the primary topic of our study was not MDS, a prospective trial specifically designed to evaluate the overall impact of MDS on medicine management in care homes is needed. (Source: Quality and Safety in Health Care) Quality and Safety in Health Care journals http://www.medworm.com/rss/comments.php?id=4740652 Tue, 19 Apr 2011 23:00:00 +0100 4740652 http://www.medworm.com/index.php?rid=4740651&cid=s_31292_51_f&fid=31292&url=http%3A%2F%2Fqualitysafety.bmj.com%2Fcgi%2Fcontent%2Fshort%2F20%2F5%2F396-b%3Frss%3D1 Snijders C, van der Schaaf T W, Klip H, et al. Feasibility and reliability of PRISMA-Medical for specialty-based incident analysis. Qual Saf Health Care 2009;18:486–91. The authors names were incorrectly cited in this paper. The author list should have been as follows; C Snijders, T W van der Schaaf, H Klip, R A van Lingen, W P F Fetter, A Molendijk. (Source: Quality and Safety in Health Care) Quality and Safety in Health Care journals http://www.medworm.com/rss/comments.php?id=4740651 Tue, 19 Apr 2011 23:00:00 +0100 4740651 http://www.medworm.com/index.php?rid=4740649&cid=s_31292_51_f&fid=31292&url=http%3A%2F%2Fqualitysafety.bmj.com%2Fcgi%2Fcontent%2Fshort%2F20%2F5%2F390%3Frss%3D1 Conclusion Correct classification of acute and non-urgent cases among nurses was quite high. Work experience and employment percentage did not affect triage decision. The intrarater agreement was good and about the same as in previous studies performed in other countries. Kappa increased significantly with increasing employment percentage. (Source: Quality and Safety in Health Care) Quality and Safety in Health Care journals http://www.medworm.com/rss/comments.php?id=4740649 Tue, 19 Apr 2011 23:00:00 +0100 4740649 http://www.medworm.com/index.php?rid=4740648&cid=s_31292_51_f&fid=31292&url=http%3A%2F%2Fqualitysafety.bmj.com%2Fcgi%2Fcontent%2Fshort%2F20%2F5%2F381%3Frss%3D1 Conclusions DVT prophylaxis in a surgical setting is fraught with socio-political agendas, cognitive dissonance and misaligned expectations. These must be sought and articulated if organisations are to respond to internal resistance to change. This case study demonstrates that QI teams using information technology must understand the clinical context, even in mature electronic health record environments, in order to implement sustainable systems. (Source: Quality and Safety in Health Care) Quality and Safety in Health Care journals http://www.medworm.com/rss/comments.php?id=4740648 Tue, 19 Apr 2011 23:00:00 +0100 4740648 http://www.medworm.com/index.php?rid=4640358&cid=s_31292_51_f&fid=31292&url=http%3A%2F%2Fqualitysafety.bmj.com%2Fcgi%2Fcontent%2Fshort%2F20%2F4%2F372%3Frss%3D1 Conclusions Through the use of improvement methods and reliability science, a sustainable process for medical reconciliation completion at admission was successfully achieved at a large, busy academic children's hospital. (Source: Quality and Safety in Health Care) Quality and Safety in Health Care journals http://www.medworm.com/rss/comments.php?id=4640358 Sun, 27 Mar 2011 23:00:00 +0100 4640358 http://www.medworm.com/index.php?rid=4640357&cid=s_31292_51_f&fid=31292&url=http%3A%2F%2Fqualitysafety.bmj.com%2Fcgi%2Fcontent%2Fshort%2F20%2F4%2F366%3Frss%3D1 Discussion At The Children's Hospital at Westmead, the authors take the view supported by others that ethical review is necessary and so have developed a process which utilises the unique skills available in the Clinical Governance Unit to ensure improvement activities are reviewed for ethical considerations in an effective and efficient manner and implemented a database to approve, monitor and report on improvement activities. This has resulted in staff being increasingly satisfied with the turnaround time for approval of improvement activities they are undertaking as well as for the methodological support provided. The authors have experienced a dramatic increase in the number of improvement activities being recorded and ethically reviewed. (Source: Quality and Safety in Health Care) Quality and Safety in Health Care journals http://www.medworm.com/rss/comments.php?id=4640357 Sun, 27 Mar 2011 23:00:00 +0100 4640357 http://www.medworm.com/index.php?rid=4640356&cid=s_31292_51_f&fid=31292&url=http%3A%2F%2Fqualitysafety.bmj.com%2Fcgi%2Fcontent%2Fshort%2F20%2F4%2F360%3Frss%3D1 Conclusion Medication alerts issued by the NPSA have stimulated significant work to improve medication safety and are believed to have had an important impact on patient safety. (Source: Quality and Safety in Health Care) Quality and Safety in Health Care journals http://www.medworm.com/rss/comments.php?id=4640356 Sun, 27 Mar 2011 23:00:00 +0100 4640356 http://www.medworm.com/index.php?rid=4640355&cid=s_31292_51_f&fid=31292&url=http%3A%2F%2Fqualitysafety.bmj.com%2Fcgi%2Fcontent%2Fshort%2F20%2F4%2F351%3Frss%3D1 This study consisted of screening interviews with 30 organisations. Staff and an expert advisory committee developed criteria to select 10 organisations for further study. The authors then conducted in-depth interviews with two leaders from each of the 10 organisations. Results and discussion Qualitative analysis revealed several key findings, including diversity in the language that organisations used regarding professionalism, and the professional behaviours that they chose to promote. Despite this diversity, all organisations shared a common strategy of clearly articulating their values and reinforcing these values. This reinforcement occurred through the provision of aligned organisational systems and structures, and the cultivation of strong interpersonal relationships... Quality and Safety in Health Care journals http://www.medworm.com/rss/comments.php?id=4640355 Sun, 27 Mar 2011 23:00:00 +0100 4640355 http://www.medworm.com/index.php?rid=4640354&cid=s_31292_51_f&fid=31292&url=http%3A%2F%2Fqualitysafety.bmj.com%2Fcgi%2Fcontent%2Fshort%2F20%2F4%2F344%3Frss%3D1 Conclusions The effectiveness of a QIC is associated with the efforts of programme managers to create conditions that provide insight into which changes in processes of care and in client outcomes have been made. Measurability is not an inherent property of the improvement topic. Rather, creating measurability and formulating challenging and achievable targets is one of the crucial tasks for programme managers of QICs. (Source: Quality and Safety in Health Care) Quality and Safety in Health Care journals http://www.medworm.com/rss/comments.php?id=4640354 Sun, 27 Mar 2011 23:00:00 +0100 4640354 http://www.medworm.com/index.php?rid=4640353&cid=s_31292_51_f&fid=31292&url=http%3A%2F%2Fqualitysafety.bmj.com%2Fcgi%2Fcontent%2Fshort%2F20%2F4%2F338%3Frss%3D1 Discussion Most studies utilise quantitative surveys to measure safety culture, and propose improvements in safety by implementing multifaceted interventions targeting several dimensions. Conversely, very few studies made their theoretical underpinnings explicit. Moving forward, a common set of definitions and dimensions will enable researchers to better share information and strategies to improve safety culture in healthcare, building momentum in this rapidly expanding field. Advancing the measurement of safety culture to include both quantitative and qualitative methods should be further explored. Using the expertise of traditional culture experts, anthropologists, more in-depth observational and longitudinal research is needed to move research in this area forward. (Source: Quality and ... Quality and Safety in Health Care journals http://www.medworm.com/rss/comments.php?id=4640353 Sun, 27 Mar 2011 23:00:00 +0100 4640353 http://www.medworm.com/index.php?rid=4640352&cid=s_31292_51_f&fid=31292&url=http%3A%2F%2Fqualitysafety.bmj.com%2Fcgi%2Fcontent%2Fshort%2F20%2F4%2F332%3Frss%3D1 Conclusions Improvement initiatives are necessary for improved quality of care and patient safety but are difficult to implement and sustain. The factors identified to develop them are constantly under challenge in health services. Improving healthcare quality will, in part, depend upon the ability to provide more flexible and supportive social contexts. (Source: Quality and Safety in Health Care) Quality and Safety in Health Care journals http://www.medworm.com/rss/comments.php?id=4640352 Sun, 27 Mar 2011 23:00:00 +0100 4640352 http://www.medworm.com/index.php?rid=4640351&cid=s_31292_51_f&fid=31292&url=http%3A%2F%2Fqualitysafety.bmj.com%2Fcgi%2Fcontent%2Fshort%2F20%2F4%2F326%3Frss%3D1 Discussion Improving process and structure aspects of healthcare is most likely to increase patients' overall evaluation of the quality of care as expressed in a global rating. A more sophisticated method of patient reported outcome measurement, with pre- and post-treatment questionnaires and the inclusion of quality-of-life criteria, might lead to higher associations between outcome and the overall evaluation of the received care. (Source: Quality and Safety in Health Care) Quality and Safety in Health Care journals http://www.medworm.com/rss/comments.php?id=4640351 Sun, 27 Mar 2011 23:00:00 +0100 4640351 http://www.medworm.com/index.php?rid=4640350&cid=s_31292_51_f&fid=31292&url=http%3A%2F%2Fqualitysafety.bmj.com%2Fcgi%2Fcontent%2Fshort%2F20%2F4%2F319%3Frss%3D1 Conclusions An active learning curriculum integrated into a clinical clerkship can change learners' attitudes towards patient safety. Students found the curriculum relevant and recommended its continuation. (Source: Quality and Safety in Health Care) Quality and Safety in Health Care journals http://www.medworm.com/rss/comments.php?id=4640350 Sun, 27 Mar 2011 23:00:00 +0100 4640350 http://www.medworm.com/index.php?rid=4640349&cid=s_31292_51_f&fid=31292&url=http%3A%2F%2Fqualitysafety.bmj.com%2Fcgi%2Fcontent%2Fshort%2F20%2F4%2F314%3Frss%3D1 Conclusions Evidence-based standards and a (electronic) format for record keeping are necessary for standardisation of recording patient information. This will improve the completeness, readability, accessibility, accuracy and exchange of patient information between healthcare providers and institutions. Better registration of patient information will benefit the quality of the healthcare process and will reduce the risk of AEs. (Source: Quality and Safety in Health Care) Quality and Safety in Health Care journals http://www.medworm.com/rss/comments.php?id=4640349 Sun, 27 Mar 2011 23:00:00 +0100 4640349 http://www.medworm.com/index.php?rid=4640348&cid=s_31292_51_f&fid=31292&url=http%3A%2F%2Fqualitysafety.bmj.com%2Fcgi%2Fcontent%2Fshort%2F20%2F4%2F307%3Frss%3D1 Conclusions The proposed five-factor structure was confirmed in the QLO, which makes it a promising instrument to assess learning capacity in teams. The Systems Thinking and the Mental Models scales have to be revised. Future research should be aimed at testing criterion and discriminatory validity. (Source: Quality and Safety in Health Care) Quality and Safety in Health Care journals http://www.medworm.com/rss/comments.php?id=4640348 Sun, 27 Mar 2011 23:00:00 +0100 4640348 http://www.medworm.com/index.php?rid=4640347&cid=s_31292_51_f&fid=31292&url=http%3A%2F%2Fqualitysafety.bmj.com%2Fcgi%2Fcontent%2Fshort%2F20%2F4%2F297%3Frss%3D1 Conclusion The authors found no evidence to show that two common pressure-ulcer risk-assessment tools are superior to clinical judgement to prevent pressure injury. Resources associated with use of these tools might be better spent on careful daily skin inspection and improving management targetted at specific risks. Study registration The trial was registered with the Australian and New Zealand Clinicat Trials Registry (ACTRN 12608000541303). (Source: Quality and Safety in Health Care) Quality and Safety in Health Care journals http://www.medworm.com/rss/comments.php?id=4640347 Sun, 27 Mar 2011 23:00:00 +0100 4640347 http://www.medworm.com/index.php?rid=4640346&cid=s_31292_51_f&fid=31292&url=http%3A%2F%2Fqualitysafety.bmj.com%2Fcgi%2Fcontent%2Fshort%2F20%2F4%2F293%3Frss%3D1 (Source: Quality and Safety in Health Care) Quality and Safety in Health Care journals http://www.medworm.com/rss/comments.php?id=4640346 Sun, 27 Mar 2011 23:00:00 +0100 4640346 http://www.medworm.com/index.php?rid=4640345&cid=s_31292_51_f&fid=31292&url=http%3A%2F%2Fqualitysafety.bmj.com%2Fcgi%2Fcontent%2Fshort%2F20%2F4%2F291%3Frss%3D1 (Source: Quality and Safety in Health Care) Quality and Safety in Health Care journals http://www.medworm.com/rss/comments.php?id=4640345 Sun, 27 Mar 2011 23:00:00 +0100 4640345 http://www.medworm.com/index.php?rid=4564654&cid=s_31292_51_f&fid=31292&url=http%3A%2F%2Fqualitysafety.bmj.com%2Fcgi%2Fcontent%2Fshort%2F20%2F3%2F282%3Frss%3D1 Conclusions Clear information marketed to general practitioners improved the quality of laboratory test ordering for patients in New Zealand. (Source: Quality and Safety in Health Care) Quality and Safety in Health Care journals http://www.medworm.com/rss/comments.php?id=4564654 Wed, 09 Mar 2011 00:00:00 +0100 4564654 http://www.medworm.com/index.php?rid=4564653&cid=s_31292_51_f&fid=31292&url=http%3A%2F%2Fqualitysafety.bmj.com%2Fcgi%2Fcontent%2Fshort%2F20%2F3%2F275%3Frss%3D1 Conclusions The authors question the validity of the full list of PIMs as an indicator of safety of medicines in older people because one-third of the population is exposed with little practice variation and no significant impact on mortality. Future studies should focus on management of a shorter list of genuinely high-risk medicines. (Source: Quality and Safety in Health Care) Quality and Safety in Health Care journals http://www.medworm.com/rss/comments.php?id=4564653 Wed, 09 Mar 2011 00:00:00 +0100 4564653 http://www.medworm.com/index.php?rid=4564652&cid=s_31292_51_f&fid=31292&url=http%3A%2F%2Fqualitysafety.bmj.com%2Fcgi%2Fcontent%2Fshort%2F20%2F3%2F268%3Frss%3D1 Conclusion With the risk of bias in mind, it is concluded that more than half of the RCARs described erroneous verbal communication between staff members as root causes of or contributing factors of severe patient safety incidents. The RCARs rich descriptions of the incidents revealed the organisational factors and needs related to these errors. (Source: Quality and Safety in Health Care) Quality and Safety in Health Care journals http://www.medworm.com/rss/comments.php?id=4564652 Wed, 09 Mar 2011 00:00:00 +0100 4564652 http://www.medworm.com/index.php?rid=4564651&cid=s_31292_51_f&fid=31292&url=http%3A%2F%2Fqualitysafety.bmj.com%2Fcgi%2Fcontent%2Fshort%2F20%2F3%2F260%3Frss%3D1 Introduction The development of a pressure ulcer is an adverse event and is often avoidable if adequate preventive measures are applied. No large-scale data, based on direct patient observations, are available regarding the pressure ulcer preventive interventions used in hospitals. Purpose The aim of this study was to obtain insight into the adequacy of interventions used to prevent pressure ulcers in Belgian hospitals. Methods A cross-sectional, multi-centre pressure ulcer prevalence study was performed in Belgian hospitals. The methodology used to measure pressure ulcer prevalence was developed by the European Pressure Ulcer Advisory Panel. The data collection instrument includes five categories of data: general data, patient data, risk assessment, skin observation and prevention. Res... Quality and Safety in Health Care journals http://www.medworm.com/rss/comments.php?id=4564651 Wed, 09 Mar 2011 00:00:00 +0100 4564651 http://www.medworm.com/index.php?rid=4564650&cid=s_31292_51_f&fid=31292&url=http%3A%2F%2Fqualitysafety.bmj.com%2Fcgi%2Fcontent%2Fshort%2F20%2F3%2F251%3Frss%3D1 Conclusion A pattern of three success factors for CQI emerges: (1) continuous and reliable information, including measurement, about best and current practice; (2) engagement of everybody in all phases of the improvement work: the patient and family, the leadership, the professional environment and the staff; and (3) an infrastructure based on improvement knowledge, with multidisciplinary teams, available coaching, learning systems and sustainability systems. (Source: Quality and Safety in Health Care) Quality and Safety in Health Care journals http://www.medworm.com/rss/comments.php?id=4564650 Wed, 09 Mar 2011 00:00:00 +0100 4564650 http://www.medworm.com/index.php?rid=4564649&cid=s_31292_51_f&fid=31292&url=http%3A%2F%2Fqualitysafety.bmj.com%2Fcgi%2Fcontent%2Fshort%2F20%2F3%2F243%3Frss%3D1 Conclusions LT patients with post-operative complications prompting MET activation had higher morbidity and mortality compared with controls; however, the MET may have been under-utilised and/or delayed. Further prospective multi-centre investigation is warranted. (Source: Quality and Safety in Health Care) Quality and Safety in Health Care journals http://www.medworm.com/rss/comments.php?id=4564649 Wed, 09 Mar 2011 00:00:00 +0100 4564649