BMJ quality & safety
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BMJ quality & safety · Apr 2014
ReviewSurgical checklists: a systematic review of impacts and implementation.
Surgical complications represent a significant cause of morbidity and mortality with the rate of major complications after inpatient surgery estimated at 3-17% in industrialised countries. The purpose of this review was to summarise experience with surgical checklist use and efficacy for improving patient safety. ⋯ Surgical checklists represent a relatively simple and promising strategy for addressing surgical patient safety worldwide. Further studies are needed to evaluate to what degree checklists improve clinical outcomes and whether improvements may be more pronounced in particular settings.
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BMJ quality & safety · Sep 2019
Randomized Controlled TrialElectronic health record-based clinical decision support alert for severe sepsis: a randomised evaluation.
Sepsis remains the top cause of morbidity and mortality of hospitalised patients despite concerted efforts. Clinical decision support for sepsis has shown mixed results reflecting heterogeneous populations, methodologies and interventions. ⋯ An EHR-based severe sepsis alert did not result in a statistically significant improvement in several sepsis treatment performance measures.
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BMJ quality & safety · May 2016
ReviewImplementation of a quality improvement initiative to reduce daily chest radiographs in the intensive care unit.
To reduce the number of routine chest radiographs (CXRs) done in a tertiary care intensive care unit (ICU). ⋯ A quality improvement that includes education, reminders of appropriate indications and computerised decision support can decrease the number of routine CXRs in an ICU.
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BMJ quality & safety · May 2016
Observational StudyEnvironmental factors and their association with emergency department hand hygiene compliance: an observational study.
Hand hygiene is effective in preventing healthcare-associated infections. Environmental conditions in the emergency department (ED), including crowding and the use of non-traditional patient care areas (ie, hallways), may pose barriers to hand hygiene compliance. We examined the relationship between these environmental conditions and proper hand hygiene. ⋯ Unique environmental conditions pose barriers to hand hygiene compliance in the ED setting and should be considered by ED hand hygiene improvement efforts. Further study is needed to evaluate the impact of these environmental conditions on actual rates of infection transmission.
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BMJ quality & safety · May 2017
Our current approach to root cause analysis: is it contributing to our failure to improve patient safety?
Despite over a decade of efforts to reduce the adverse event rate in healthcare, the rate has remained relatively unchanged. Root cause analysis (RCA) is a process used by hospitals in an attempt to reduce adverse event rates; however, the outputs of this process have not been well studied in healthcare. This study aimed to examine the types of solutions proposed in RCAs over an 8-year period at a major academic medical institution. ⋯ This study found that the most commonly proposed solutions were weaker actions, which were less likely to decrease event recurrence. These findings support recent attempts to improve the RCA process and to develop guidance for the creation of effective and sustainable solutions to be used by RCA teams.