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BMJ Quality & Safety

Jessica Reszel, Sandra I Dunn, Ann E Sprague, Ian D Graham, Jeremy M Grimshaw, Wendy E Peterson, Holly Ockenden, Jodi Wilding, Ashley Quosdorf, Elizabeth K Darling, Deshayne B Fell, JoAnn Harrold, Andrea Lanes, Graeme N Smith, Monica Taljaard, Deborah Weiss, Mark C Walker
BACKGROUND: As part of a larger study examining the effectiveness of the Maternal Newborn Dashboard, an electronic audit and feedback system to improve maternal-newborn care practices and outcomes, the purpose of this study was to increase our understanding of factors explaining variability in performance after implementation of the Dashboard in Ontario, Canada. METHODS: A collective case study. A maximum variation sampling approach was used to invite hospitals reflecting different criteria to participate in a 1-day to 2-day site visit by the research team...
February 16, 2019: BMJ Quality & Safety
Ruth Baxter, Natalie Taylor, Ian Kellar, Rebecca Lawton
BACKGROUND: The positive deviance approach seeks to identify and learn from those who demonstrate exceptional performance. This study sought to explore how multidisciplinary teams deliver exceptionally safe care on medical wards for older people. METHODS: A qualitative positive deviance study was conducted on four positively deviant and four slightly-above-average matched comparator wards, which had been identified using routinely collected NHS Safety Thermometer data...
February 13, 2019: BMJ Quality & Safety
Anish N Bhuva, Patricia Feuchter, Angela Hawkins, Lizette Cash, Redha Boubertakh, Jane Evanson, Richard Schilling, Martin Lowe, James C Moon, Charlotte H Manisty
BACKGROUND: Patients with cardiac pacemakers and defibrillators are disadvantaged because of poor access to MRI scans, leading to late and misdiagnosis particularly for cancer and neurological disease. New technology allied to tested protocols now allows safe MRI scanning of such patients; however, logistical barriers persist. AIM: To deliver a streamlined sustainable service that provides timely MRI scans to patients with cardiac implantable electronic devices (CIEDs)...
February 13, 2019: BMJ Quality & Safety
Rebecca Lawton, Olivia Robinson, Rebecca Harrison, Suzanne Mason, Mark Conner, Brad Wilson
BACKGROUND: Risk aversion among junior doctors that manifests as greater intervention (ordering of tests, diagnostic procedures and so on) has been proposed as one of the possible causes for increased pressure in emergency departments (EDs). Here we tested the prediction that doctors with more experience would be more tolerant of uncertainty and therefore less risk-averse in decision making. METHODS: In this cross-sectional, vignette-based study, doctors working in three EDs were asked to complete a questionnaire measuring experience (length of service in EDs), reactions to uncertainty (Gerrity et al , 1995) and risk aversion (responses about the appropriateness of patient management decisions)...
February 6, 2019: BMJ Quality & Safety
Laura Zwaan, Wolf E Hautz
No abstract text is available yet for this article.
February 6, 2019: BMJ Quality & Safety
Kiran Gupta, Sarah Lisker, Natalie A Rivadeneira, Christina Mangurian, Eleni Linos, Urmimala Sarkar
BACKGROUND: The second victim effect is defined as emotional distress experienced by providers involved in mistakes. This study characterises events contributing to the second victim effect among a diverse sample of physician mothers, describes the impact on both provider and patient and seeks to determine the association between experiencing a mistake and burnout. METHODS: In this mixed-methods study, an anonymous, cross-sectional survey was posted to an online network of over 65 000 physician mothers on 17 June 2016...
February 4, 2019: BMJ Quality & Safety
Sarah L Krein, Sanjay Saint, Barbara W Trautner, Latoya Kuhn, John Colozzi, David Ratz, Erica Lescinskas, Vineet Chopra
OBJECTIVE: Peripherally inserted central catheters (PICC) are frequently used to deliver medical therapies, but our knowledge regarding PICC-related complications remains incomplete. The objective of this study was to systematically elicit and characterise PICC-related complications as experienced by patients during and after hospitalisation. DESIGN: Prospective cohort study. SETTING: Inpatient medical units at four US hospitals in two states...
January 25, 2019: BMJ Quality & Safety
Douglas A Wiegmann, Thoralf M Sundt
No abstract text is available yet for this article.
January 25, 2019: BMJ Quality & Safety
Andrew J Graham, Wrechelle Ocampo, Danielle A Southern, Anthony Falvi, Dina Sotiropoulos, Bruce Wang, Kevin Lonergan, Biraboneye Vito, William A Ghali, Sean Daniel Patrick McFadden
BACKGROUND: The reporting of adverse events (AE) remains an important part of quality improvement in thoracic surgery. The best methodology for AE reporting in surgery is unclear. An AE reporting system using an electronic discharge summary with embedded data collection fields, specifying surgical procedure and complications, was developed. The data are automatically transferred daily to a web-based reporting system. METHODS: We determined the accuracy and sustainability of this electronic real time data collection system (ERD) by comparing the completeness of record capture on procedures and complications with coded discharge data (administrative data), and with the standard of chart audit at two intervals...
January 18, 2019: BMJ Quality & Safety
Rachel O'Hara, Lindsey Bishop-Edwards, Emma Knowles, Alicia O'Cathain
BACKGROUND: An emergency ambulance is not always the appropriate response for emergency medical service patients. Telephone advice aims to resolve low acuity calls over the phone, without sending an ambulance. In England, variation in rates of telephone advice and patient recontact between services raises concerns about inequities in care. To understand this variation, this study aimed to explore operational factors influencing the provision of telephone advice. METHODS: This is a multimethod qualitative study in three emergency medical services in England with different rates of telephone advice and recontact...
January 12, 2019: BMJ Quality & Safety
Lekshmi Santhosh, Patrick G Lyons, Juan C Rojas, Thomas M Ciesielski, Shire Beach, Jeanne M Farnan, Vineet Arora
BACKGROUND: There is limited literature about physician handoffs between the intensive care unit (ICU) and the ward, and best practices have not been described. These patients are uniquely vulnerable given their medical complexity, diagnostic uncertainty and reduced monitoring intensity. We aimed to characterise the structure, perceptions and processes of ICU-ward handoffs across three teaching hospitals using multimodal methods: by identifying the handoff components involved in communication failures and describing common processes of patient transfer...
January 12, 2019: BMJ Quality & Safety
Robert Challen, Joshua Denny, Martin Pitt, Luke Gompels, Tom Edwards, Krasimira Tsaneva-Atanasova
No abstract text is available yet for this article.
January 12, 2019: BMJ Quality & Safety
Rachael L Morton, John F Thompson
No abstract text is available yet for this article.
January 3, 2019: BMJ Quality & Safety
Sei J Lee
No abstract text is available yet for this article.
January 3, 2019: BMJ Quality & Safety
Tim Badgery-Parker, Sallie-Anne Pearson, Ian A Scott, Adam G Elshaug
No abstract text is available yet for this article.
January 3, 2019: BMJ Quality & Safety
Sheree R Schwartz, Stefan Baral
No abstract text is available yet for this article.
December 27, 2018: BMJ Quality & Safety
Ashwin Gupta, Nathan Houchens, Jennifer Meddings
No abstract text is available yet for this article.
December 18, 2018: BMJ Quality & Safety
Paula Chatterjee, Karen Joynt Maddox
BACKGROUND: Publicly reported quality data can help consumers make informed choices about where to seek medical care. The Centers for Medicare and Medicaid Services developed a composite Hospital Compare Overall Star Rating for US acute-care hospitals in 2016. However, patterns of performance and improvement have not been previously described. OBJECTIVE: To characterise high-quality and low-quality hospitals as assessed by Star Ratings. DESIGN: We performed a retrospective cross-sectional study of 3429 US acute-care hospitals assigned Overall Star Ratings in both 2016 and 2017...
December 8, 2018: BMJ Quality & Safety
Peter Griffiths, Antonello Maruotti, Alejandra Recio Saucedo, Oliver C Redfern, Jane E Ball, Jim Briggs, Chiara Dall'Ora, Paul E Schmidt, Gary B Smith
OBJECTIVE: To determine the association between daily levels of registered nurse (RN) and nursing assistant staffing and hospital mortality. DESIGN: This is a retrospective longitudinal observational study using routinely collected data. We used multilevel/hierarchical mixed-effects regression models to explore the association between patient outcomes and daily variation in RN and nursing assistant staffing, measured as hours per patient per day relative to ward mean...
December 4, 2018: BMJ Quality & Safety
Kathryn Elizabeth Engelhardt, Richard S Matulewicz, John O DeLancey, Ryan P Merkow, Christopher M Quinn, Lindsey Kreutzer, Karl Y Bilimoria
No abstract text is available yet for this article.
November 28, 2018: BMJ Quality & Safety
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