BMJ quality & safety
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BMJ quality & safety · Apr 2020
Contribution of primary care organisation and specialist care provider to variation in GP referrals for suspected cancer: ecological analysis of national data.
To examine how much of the variation between general practices in referral rates and cancer detection rates is attributable to local health services rather than the practices or their populations. ⋯ This is the first large-scale finding that a substantial proportion of the variation between general practitioner practices in referrals is attributable to their local healthcare systems. Efforts to reduce variation need to focus not just on individual practices but on local diagnostic service provision and culture at the interface of primary and secondary care.
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BMJ quality & safety · Apr 2020
Multicenter Study Observational StudyStudy of a multisite prospective adverse event surveillance system.
We have designed a prospective adverse event (AE) surveillance method. We performed this study to evaluate this method's performance in several hospitals simultaneously. ⋯ This study demonstrated that it is possible to implement prospective surveillance in different settings. Such surveillance appears to be better suited to evaluating hospital safety concerns within rather than between hospitals as we could not definitively rule out whether the observed variation in AE risk was due to population or surveillance factors.
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BMJ quality & safety · Mar 2020
Comparative StudyReducing peripherally inserted central catheters and midline catheters by training nurses in ultrasound-guided peripheral intravenous catheter placement.
Training nurses in ultrasound-guided peripheral intravenous catheter placement might reduce the use of more invasive venous access devices (peripherally inserted central catheters (PICC) and midline catheters). ⋯ These results suggest that an abbreviated training in ultrasound-guided peripheral intravenous catheter placement for nurses on an inpatient medical unit is sufficient to reduce PICC and midline catheters.
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Hospitalised patients whose inpatient teams rotate off service experience increased mortality related to end-of-rotation care transitions, yet standardised handoff practices are lacking. ⋯ In this controlled pilot study, a structured ICU end-of-rotation care transition strategy was feasible to implement with high fidelity. While mortality and LOS were not affected in a pilot study with limited power, the pragmatic strategy of this intervention holds promise for future trials.
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summary"...I encourage all patient safety stakeholders to resist an overemphasis on absolute safety, and instead draw on the strengths of both the safety I and safety II approaches. We should be clear about what types of harms can or cannot be prevented and anticipated, work to eliminate those where there is good evidence for preventability by adopting evidence-based practices, improve the ability of everyone responsible for safety to identify risks, conduct better risk analyses to anticipate and reduce unintended harms, measure and celebrate the routine adaptations that prevent harm, and reward organisational learning and improvement." – Thomas, 2020.