BMJ quality & safety
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BMJ quality & safety · Jun 2014
Governance of quality of care: a qualitative study of health service boards in Victoria, Australia.
To describe the engagement of health service boards with quality-of-care issues and to identify factors that influence boards' activities in this area. ⋯ Although health service boards are eager to establish quality of care as a governance priority, several obstacles are blocking progress. The result is a gap between the rhetoric of quality governance and the reality of month-to-month activities at the board level. The imperative for effective board-level engagement in this area cannot be met until these barriers are addressed.
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BMJ quality & safety · Jun 2014
Caring for critically ill children in the community: a needs assessment.
The goal of this study was to identify barriers and facilitators to the optimal management of critically ill children who present initially to community hospitals and how best to support the needs of front-line healthcare providers in these settings prior to transfer to the regional academic paediatric health sciences centre. ⋯ This study identifies the need to fully understand the management realities of front-line caregivers of critically ill children in community hospital settings. We demonstrate the need to focus on the management of younger paediatric patients, technical skills development, practice of acute situations with less than optimal staffing resources, and access to facilitated real-world experiences with appropriate supervision and mentoring. Passive interventions such as web-based guidelines should not be used in isolation but as a support to ongoing exposure and engagement by content experts.
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BMJ quality & safety · Jun 2014
Safely and effectively reducing inpatient length of stay: a controlled study of the General Internal Medicine Care Transformation Initiative.
Whether improving the efficiency of hospital care will worsen post-discharge outcomes is unclear. We designed this study to evaluate the General Internal Medicine (GIM) Care Transformation Initiative implemented at one of the seven teaching hospitals in the Canadian province of Alberta. ⋯ The Care Transformation Initiative was associated with substantial reductions in LOS without increasing post-discharge events commonly quoted as proxies for quality.
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BMJ quality & safety · Jun 2014
Creating a safe, reliable hospital at night handover: a case study in implementation science.
We developed protocols to handover patients from day to hospital at night (H@N) teams. ⋯ A carefully designed prioritisation process within the H@N handover can be effective at flagging acutely unwell patients. However, the protocol we introduced was unsustainable. In a complex healthcare system, sustainable implementation of new processes may be threatened by conflicting goals.
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BMJ quality & safety · Jun 2014
ReviewHow can the criminal law support the provision of quality in healthcare?
The egregious failings in patient safety at Mid Staffordshire NHS Foundation Trust between 2005 and 2009 identified by Sir Robert Francis QC in his public inquiry prompted him to recommend the introduction of a new criminal offence into English law in circumstances where a patient dies or is seriously harmed by a breach of fundamental standards. The authors evaluate whether, from the perspective of fairness and justice, a new criminal offence in this context is necessary and desirable. ⋯ The criminal law has an important role to play in the healthcare context. Its central function is not primarily to deter and coerce people into complying with standards of behaviour deemed desirable. Rather, its central function lies in its symbolic and expressive significance, publicly proclaiming that the highly culpable mistreatment of others is wrongful and worthy of public censure and sanction.