BMJ quality & safety
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BMJ quality & safety · Nov 2015
ReviewReducing the incidence of oxyhaemoglobin desaturation during rapid sequence intubation in a paediatric emergency department.
Rapid sequence intubation (RSI) is the standard for definitive airway management in emergency medicine. In a video-based study of RSI in a paediatric emergency department (ED), we reported a high degree of process variation and frequent adverse effects, including oxyhaemoglobin desaturation (SpO2<90%). This report describes a multidisciplinary initiative to improve the performance and safety of RSI in a paediatric ED. ⋯ Following the simultaneous introduction of four interventions in a paediatric ED, RSI was performed more reliably, successfully and safely.
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BMJ quality & safety · Oct 2015
ReviewIntegrating empowerment evaluation and quality improvement to achieve healthcare improvement outcomes.
While the body of evidence-based healthcare interventions grows, the ability of health systems to deliver these interventions effectively and efficiently lags behind. Quality improvement approaches, such as the model for improvement, have demonstrated some success in healthcare but their impact has been lessened by implementation challenges. ⋯ An illustrative healthcare quality improvement example that compares the model for improvement and the GTO method for reducing hospital admissions through improved diabetes care is described. We conclude with suggestions for integrating GTO and the model for improvement.
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BMJ quality & safety · Aug 2015
ReviewMeasuring the effect of Choosing Wisely: an integrated framework to assess campaign impact on low-value care.
The Choosing Wisely campaign began in the USA in 2012 to encourage physicians and patients to discuss inappropriate and potentially harmful tests, treatments and procedures. Since its inception, the campaign has grown substantially and has been adopted by 12 countries around the world. Of great interest to countries implementing the campaign, is the effectiveness of Choosing Wisely to reduce overutilisation. This article presents an integrated measurement framework that may be used to assess the impact of a Choosing Wisely campaign on physician and provider awareness and attitudes on low-value care, provider practice behaviour and overuse of low-value services.
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BMJ quality & safety · Jul 2015
ReviewTeamwork, communication and safety climate: a systematic review of interventions to improve surgical culture.
To define the target domains of culture-improvement interventions, to assess the impact of these interventions on surgical culture and to determine whether culture improvements lead to better patient outcomes and improved healthcare efficiency. ⋯ The literature provides promising evidence for various strategies to improve surgical culture, although these approaches differ in terms of the interventions employed as well as the techniques used to measure culture. Nevertheless, culture improvement appears to be associated with other positive effects, including better patient outcomes and enhanced healthcare efficiency.
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BMJ quality & safety · Jul 2015
ReviewTeamwork, communication and safety climate: a systematic review of interventions to improve surgical culture.
To define the target domains of culture-improvement interventions, to assess the impact of these interventions on surgical culture and to determine whether culture improvements lead to better patient outcomes and improved healthcare efficiency. ⋯ The literature provides promising evidence for various strategies to improve surgical culture, although these approaches differ in terms of the interventions employed as well as the techniques used to measure culture. Nevertheless, culture improvement appears to be associated with other positive effects, including better patient outcomes and enhanced healthcare efficiency.