BMJ quality & safety
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BMJ quality & safety · May 2016
ReviewImplementation of a quality improvement initiative to reduce daily chest radiographs in the intensive care unit.
To reduce the number of routine chest radiographs (CXRs) done in a tertiary care intensive care unit (ICU). ⋯ A quality improvement that includes education, reminders of appropriate indications and computerised decision support can decrease the number of routine CXRs in an ICU.
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BMJ quality & safety · May 2016
ReviewSecular trends and evaluation of complex interventions: the rising tide phenomenon.
Evaluations of service delivery interventions with contemporaneous controls often yield null results, even when the intervention appeared promising in advance. There can be many reasons for null results. In this paper we introduce the concept of a 'rising tide' phenomenon being a possible explanation of null results. ⋯ We offer recommendations for interpretation of research findings where improvements in the intervention group are matched by improvements in the control group. Understanding the rising tide phenomenon is important for a more nuanced interpretation of null results arising in the context of system-wide improvement. Recognition that a rising tide may have predisposed to a null result in one health system cautions against generalising the result to another health system where strong secular trends are absent.