BMJ quality & safety
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"...I encourage all patient safety stakeholders to resist an overemphasis on absolute safety, and instead draw on the strengths of both the safety I and safety II approaches. We should be clear about what types of harms can or cannot be prevented and anticipated, work to eliminate those where there is good evidence for preventability by adopting evidence-based practices, improve the ability of everyone responsible for safety to identify risks, conduct better risk analyses to anticipate and reduce unintended harms, measure and celebrate the routine adaptations that prevent harm, and reward organisational learning and improvement." – Thomas, 2020.
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BMJ quality & safety · Aug 2020
Review Meta AnalysisDoes team reflexivity impact teamwork and communication in interprofessional hospital-based healthcare teams? A systematic review and narrative synthesis.
Teamwork and communication are recognised as key contributors to safe and high-quality patient care. Interventions targeting process and relational aspects of care may therefore provide patient safety solutions that reflect the complex nature of healthcare. Team reflexivity is one such approach with the potential to support improvements in communication and teamwork, where reflexivity is defined as the ability to pay critical attention to individual and team practices with reference to social and contextual information. ⋯ The reviewed literature suggests that VRE is well placed to provide more locally appropriate solutions to contributory patient safety factors, ranging from individual and social learning to improvements in practices and systems.
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BMJ quality & safety · Sep 2021
Randomized Controlled TrialMedical crisis checklists in the emergency department: a simulation-based multi-institutional randomised controlled trial.
Studies carried out in simulated environments suggest that checklists improve the management of surgical and intensive care crises. Whether checklists improve the management of medical crises simulated in actual emergency departments (EDs) is unknown. ⋯ In this multi-institution study, checklists markedly improved local resuscitation teams' management of medical crises simulated in situ, and most personnel reported that they would use the checklists if they had a similar case in reality.
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BMJ quality & safety · Apr 2021
Multicenter Study Observational StudyMortality and pulmonary complications in patients undergoing upper extremity surgery at the peak of the SARS-CoV-2 pandemic in the UK: a national cohort study.
This study reports the 30-day mortality, SARS-CoV-2 complication rate and SARS-CoV-2-related hospital processes at the peak of the first wave of the pandemic in the UK. ⋯ The SARS-CoV-2-related complication rate for upper limb surgery even at the peak of the UK pandemic was low at 0.18% and the mortality was zero for patients admitted on the day of surgery. Urgent surgery should not be delayed pending the results of SARS-CoV-2 testing. Routine SARS-CoV-2 testing for day case upper limb surgery not requiring general anaesthesia may be excessive and have unintended negative impacts.
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BMJ quality & safety · Oct 2021
Randomized Controlled TrialEffectiveness of a multifaceted intervention to improve emergency department care of low back pain: a stepped-wedge, cluster-randomised trial.
Overuse of lumbar imaging is common in the emergency department (ED). Few trials have examined interventions to address this. We evaluated the effectiveness of a multifaceted intervention to implement guideline recommendations for low back pain in the emergency department. ⋯ It is uncertain if a multifaceted intervention to implement guideline recommendations for low back pain care decreased lumbar imaging in the ED; however, it did reduce opioid prescriptions without adversely affecting patient outcomes. Trial registration number ACTRN12617001160325.