International journal for quality in health care : journal of the International Society for Quality in Health Care
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Int J Qual Health Care · Dec 2014
Systematic biases in group decision-making: implications for patient safety.
Key decisions in modern health care systems are often made by groups of people rather than lone individuals. However, group decision-making can be imperfect and result in organizational and clinical errors which may harm patients-a fact highlighted graphically in recent (and historical) health scandals and inquiries such as the recent report by Sir Robert Francis into the serious failures in patient care and safety at Mid Staffordshire Hospitals NHS Trust in the English NHS. In this article, we draw on theories from organization studies and decision science to explore the ways in which patient safety may be undermined or threatened in health care contexts as a result of four systematic biases arising from group decision-making: 'groupthink', 'social loafing', 'group polarization' and 'escalation of commitment'. For each group bias, we describe its antecedents, illustrate how it can impair group decisions with regard to patient safety, outline a range of possible remedial organizational strategies that can be used to attenuate the potential for adverse consequences and look forward at the emerging research agenda in this important but hitherto neglected area of patient safety research.
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Int J Qual Health Care · Dec 2014
Multicenter StudyInfluence of adverse drug events on morbidity and mortality in intensive care units: the JADE study.
To identify the influence of adverse drug events (ADEs) on morbidity and mortality in intensive care units (ICUs). ⋯ ADEs were common in ICUs and significantly associated with longer length of ICU stay but did not influence on mortality.
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Int J Qual Health Care · Aug 2014
Failure mode and effects analysis applied to the maintenance and repair of anesthetic equipment in an austere medical environment.
Medical technology designed for Western settings frequently does not function adequately or as intended when placed in an austere clinical environment because of issues such as the instability of the electrical grid, environmental conditions, access to replacement parts, level of provider training and general absence of biomedical engineering support. The purpose of this study was to demonstrate the feasibility of applying failure mode and effects analysis as part of an implementation strategy for medical devices in austere medical settings. ⋯ This study demonstrates the feasibility of using the failure mode and effects analysis approach to improve implementation of technology in austere medical environments.
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Int J Qual Health Care · Aug 2014
The eCollaborative: using a quality improvement collaborative to implement the National eHealth Record System in Australian primary care practices.
The new national patient-controlled electronic health record is an important quality improvement, and there was a pressing need to pilot its use in Australian primary care practices. Implementation of electronic health records in other countries has met with mixed success. ⋯ The collaborative methodology was adapted for implementing innovation and proved useful for engaging with multiple small practices, facilitating low-risk testing of processes, sharing ideas among participants, development of clinical champions and development of resources to support wider use. Email discussion between participants and system designers facilitated improvements. Data quality was a key challenge for this innovation, and quality measures chosen require development. Patient participants were partners in improvement.
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Int J Qual Health Care · Aug 2014
Randomized Controlled TrialFeasibility and evaluation of a pilot community health worker intervention to reduce hospital readmissions.
To pilot-test the feasibility and preliminary effect of a community health worker (CHW) intervention to reduce hospital readmissions. ⋯ Under performance-based payment systems, identifying cost-effective solutions for reducing hospital readmissions will be crucial to the economic survival of all hospitals, especially safety-net systems. This pilot study suggests that with appropriate supportive infrastructure, hospital-based CHWs may represent a feasible strategy for improving transitional care among vulnerable populations. An ongoing, randomized, controlled trial of a CHW intervention, developed according to the lessons of this pilot, will provide further insight into the utility of this approach to reducing readmissions.