BMJ quality & safety
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BMJ quality & safety · Oct 2018
Perceptions of rounding checklists in the intensive care unit: a qualitative study.
Rounding checklists are an increasingly common quality improvement tool in the intensive care unit (ICU). However, effectiveness studies have shown conflicting results. We sought to understand ICU providers' perceptions of checklists, as well as barriers and facilitators to effective utilisation of checklists during daily rounds. ⋯ Our results provide potential insights about why ICU rounding checklists frequently fail to improve outcomes and offer a framework for effective checklist implementation through greater feedback and accountability.
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BMJ quality & safety · Dec 2013
Teaching about how doctors think: a longitudinal curriculum in cognitive bias and diagnostic error for residents.
Trends in medical education have reflected the patient safety movement's initial focus on systems. While the role of cognitive-based diagnostic errors has been increasingly recognised among safety experts, literature describing strategies to teach about this important problem is scarce. ⋯ A longitudinal curriculum in diagnostic error and cognitive bias improved internal medicine residents' knowledge and recognition of cognitive biases as measured by a novel assessment tool. Further study is needed to refine learner assessment tools and examine optimal strategies to teach clinical reasoning and cognitive bias avoidance strategies.
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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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In a companion paper, we proposed that cognitive debiasing is a skill essential in developing sound clinical reasoning to mitigate the incidence of diagnostic failure. We reviewed the origins of cognitive biases and some proposed mechanisms for how debiasing processes might work. In this paper, we first outline a general schema of how cognitive change occurs and the constraints that may apply. ⋯ We outline three groups of suggested interventions going forward: educational strategies, workplace strategies and forcing functions. We stress the importance of ambient and contextual influences on the quality of individual decision making and the need to address factors known to impair calibration of the decision maker. We also emphasise the importance of introducing these concepts and corollary development of training in critical thinking in the undergraduate level in medical education.
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BMJ quality & safety · Jan 2019
Speaking up about patient safety concerns: the influence of safety management approaches and climate on nurses' willingness to speak up.
Speaking up is important for patient safety, but healthcare professionals often hesitate to voice their concerns. Direct supervisors have an important role in influencing speaking up. However, good insight into the relationship between managers' behaviour and employees' perceptions about whether speaking up is safe and worthwhile is still lacking. ⋯ Results provide initial support that nurses who perceive higher levels of commitment-based safety management feel safer to take interpersonal risks and are more willing to speak up about patient safety concerns. Furthermore, nurses' perceptions of control-based safety management are found to be positively related to a climate for safety, although no association was found with speaking up. Both control-based and commitment-based management approaches seem to be relevant for managing patient safety, but when it comes to encouraging speaking up, a commitment-based safety management approach seems to be most valuable.