BMJ quality & safety
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BMJ quality & safety · May 2011
Effective quality improvement of thromboprophylaxis in acute medicine.
The Health Select Committee Report on the prevalence of venous thromboembolism (VTE) in 2005 suggested that poor awareness of the risks of VTE contributed significantly to mortality and morbidity in hospitalised patients. It recommended that all hospitalised patients should undergo a VTE risk assessment. In 2006, an audit in medical patients at Guy's and St Thomas' NHS Foundation Trust (GSTFT) revealed a lack of documentation of VTE risk assessment and poor use of thromboprophylaxis in 'at risk' patients. In 2007, the GSTFT 'Venous Thromboembolism in Adult Medical Inpatients' guideline was approved. The aim was to achieve a thromboprophylaxis culture within Acute Medicine and, in doing so, achieve a high adherence rate. ⋯ In conclusion, the most effective means of achieving VTE guideline adherence is to establish a thromboprophylaxis culture. This can be accomplished through a multiple intervention and continuous feedback approach. However, it is essential to ensure that a comprehensive VTE risk assessment is carried out to ensure that those not requiring treatment do not receive it unnecessarily.
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While the complaints process is intended to improve healthcare, some doctors appear to practise defensive medicine after receiving a complaint. This response occurs in countries that use a tort-based medicolegal system as well as in countries with less professional liability. Defensive medicine is based on avoiding malpractice liability rather than considering a risk-benefit analysis for both investigations and treatment. ⋯ Shame is implicated in the observable changes in practising behaviour after receipt of a complaint. Identifying and responding to shame is required if doctors are to respond to a complaint with an overall improvement in clinical practice. This will eventually improve the outcomes of the complaints process.
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BMJ quality & safety · Apr 2011
Building an integrated methodology of learning that can optimally support improvements in healthcare.
The methods for healthcare reform are strikingly underdeveloped, with much reliance on political power. A methodology that combined methods from sources such as clinical trials, experience-based wisdom, and improvement science could be among the aims of the upcoming work in the USA on comparative effectiveness and on the agenda of the Center for Medicare and Medicaid Innovation in the Centers for Medicare and Medicaid Services. Those working in quality improvement have an unusual opportunity to generate substantial input into these processes through professional organisations such as the Academy for Healthcare Improvement and dominant leadership organisations such as the Institute for Healthcare Improvement.
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BMJ quality & safety · Apr 2011
An assessment of the quality and impact of NPSA medication safety outputs issued to the NHS in England and Wales.
To assess the quality and impact of medication safety outputs issued by the National Patient Safety Agency (NPSA) to the NHS in England and Wales. ⋯ Medication alerts issued by the NPSA have stimulated significant work to improve medication safety and are believed to have had an important impact on patient safety.
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BMJ quality & safety · Apr 2011
Structure, process or outcome: which contributes most to patients' overall assessment of healthcare quality?
The paper explores which type of quality aspects (structure, process, outcome) most strongly determines patients' overall assessment of healthcare, and whether there is a variation between different types of patient groups in this respect. ⋯ Improving process and structure aspects of healthcare is most likely to increase patients' overall evaluation of the quality of care as expressed in a global rating. A more sophisticated method of patient reported outcome measurement, with pre- and post-treatment questionnaires and the inclusion of quality-of-life criteria, might lead to higher associations between outcome and the overall evaluation of the received care.