BMJ quality & safety
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BMJ quality & safety · Oct 2016
ReviewDual-process cognitive interventions to enhance diagnostic reasoning: a systematic review.
Diagnostic error incurs enormous human and economic costs. The dual-process model reasoning provides a framework for understanding the diagnostic process and attributes certain errors to faulty cognitive shortcuts (heuristics). The literature contains many suggestions to counteract these and to enhance analytical and non-analytical modes of reasoning. ⋯ Results to date are promising and this relatively young field is now close to a point where these kinds of cognitive interventions can be recommended to educators. Further research with refined methodology and more diverse samples is required before firm recommendations may be made for medical education and policy; however, these results suggest that such interventions hold promise, with much current enthusiasm for new research.
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BMJ quality & safety · Oct 2016
Randomized Controlled TrialSupporting adherence for people starting a new medication for a long-term condition through community pharmacies: a pragmatic randomised controlled trial of the New Medicine Service.
To examine the effectiveness of the New Medicine Service (NMS), a national community pharmacy service to support medicines-taking in people starting a new medicine for a long-term condition, compared with normal practice. ⋯ The NMS significantly increased the proportion of patients adhering to their new medicine by about 10%, compared with normal practice.
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BMJ quality & safety · Sep 2016
A mixed-methods investigation of health professionals' perceptions of a physiological track and trigger system.
Physiological track and trigger systems (PTTSs) regulate the monitoring of patients' vital signs and facilitate the detection and treatment of deteriorating patients. These systems are widely used, although compliance with protocol is often poor. ⋯ These findings reveal that non-compliance with PTTS protocol is unlikely to be attributable to negative perceptions of PTTSs. Instead, there are a number of barriers to the implementation of the system. These findings suggest that interprofessional training in PTTSs is essential while increased support for PTTS implementation among senior doctors would also yield improved adherence to protocol.
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BMJ quality & safety · Jul 2016
Are reductions in emergency department length of stay associated with improvements in quality of care? A difference-in-differences analysis.
We sought to determine whether patients seen in hospitals who had reduced overall emergency department (ED) length of stay (LOS) in the 2 years following the introduction of the Ontario Emergency Room Wait Time Strategy were more likely to experience improvements in other measures of ED quality of care for three important conditions. ⋯ These results suggest that a policy approach that targets only reductions in ED LOS is not associated with broader improvements in selected quality measures. At the same time, there is no evidence that efforts to address crowding have a detrimental effect on quality of care.