BMJ quality & safety
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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.
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BMJ quality & safety · Apr 2016
ReviewMeasuring and improving patient safety through health information technology: The Health IT Safety Framework.
Health information technology (health IT) has potential to improve patient safety but its implementation and use has led to unintended consequences and new safety concerns. A key challenge to improving safety in health IT-enabled healthcare systems is to develop valid, feasible strategies to measure safety concerns at the intersection of health IT and patient safety. In response to the fundamental conceptual and methodological gaps related to both defining and measuring health IT-related patient safety, we propose a new framework, the Health IT Safety (HITS) measurement framework, to provide a conceptual foundation for health IT-related patient safety measurement, monitoring, and improvement. ⋯ The framework proposes to integrate both retrospective and prospective measurement of HIT safety with an organization's existing clinical risk management and safety programs. It aims to facilitate organizational learning, comprehensive 360 degree assessment of HIT safety that includes vendor involvement, refinement of measurement tools and strategies, and shared responsibility to identify problems and implement solutions. A long term framework goal is to enable rigorous measurement that helps achieve the safety benefits of health IT in real-world clinical settings.
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BMJ quality & safety · Feb 2016
Review Comparative StudySustained reductions in time to antibiotic delivery in febrile immunocompromised children: results of a quality improvement collaborative.
Timely delivery of antibiotics to febrile immunocompromised (F&I) paediatric patients in the emergency department (ED) and outpatient clinic reduces morbidity and mortality. ⋯ This stepwise approach with pre-arrival planning using the Chronic Care Model, followed by standardisation of processes, created a sustainable improvement of timely antibiotic delivery in F&I patients.
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BMJ quality & safety · Dec 2015
ReviewA quality improvement project to improve early sepsis care in the emergency department.
Sepsis causes substantial morbidity and mortality in hospitalised patients. Although many studies describe the use of protocols in the management of patients with severe sepsis and septic shock, few have addressed emergency department (ED) screening and management for patients initially presenting with uncomplicated sepsis (ie, patients without organ failure or hypotension). ⋯ The new protocol demonstrates that early screening interventions can lead to expedited delivery of care to patients with sepsis in the ED and could serve as a model for other facilities. Mortality was not significantly improved by our intervention, which included patients with uncomplicated sepsis.
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BMJ quality & safety · Dec 2015
ReviewBarriers and facilitators related to the implementation of surgical safety checklists: a systematic review of the qualitative evidence.
The objective of this review is to obtain a better understanding of the user-related barriers against, and facilitators for, the implementation of surgical safety checklists. ⋯ The complex reality in which the checklist needs to be implemented requires an approach that includes more than eliminating barriers and supporting facilitating factors. Implementation leaders must facilitate team learning to foster the mutual understanding of perspectives and motivations, and the realignment of routines. This paper provides a pragmatic overview of the user-related barriers and facilitators upon which theories, hypothesising potential change strategies and interactions, can be developed and tested empirically.