Quality & Safety in Health Care最新文献

{"title":"Quality and Safety in the Literature: May 2022","authors":"Albert G. Emery, N. Houchens, Ashwin Gupta","doi":"10.1136/bmjqs-2022-014848","DOIUrl":"https://doi.org/10.1136/bmjqs-2022-014848","url":null,"abstract":"© Author(s) (or their employer(s)) 2022. No commercial reuse. See rights and permissions. Published by BMJ. COMPARATIVE EFFECTIVENESS OF AN AUTOMATED TEXT MESSAGING SERVICE FOR MONITORING COVID-19 AT HOME Ann Intern Med, 16 November 2021 As cases of SARSCoV2 infection (COVID19) have risen dramatically over the course of the pandemic, global interest in utilisation of telemedicine services has increased. 2 In an effort to avoid exposure to infected persons in healthcare settings, the total number of virtual health encounters has risen sharply in both primary care and subspecialty clinics. 4 Even prior to the onset of the pandemic, telemedicine services were used in a myriad of specialties, ranging from cardiothoracic surgery to psychiatry to palliative care as a means of monitoring symptoms and collecting patient data to detect and address early patient deterioration and prevent excess morbidity and mortality. Early in the pandemic, clinicians and researchers quickly noted the opportunities for telemedicine to prevent such morbidity and mortality specifically related to COVID19. 9 An application called COVID Watch, developed by researchers at the University of Pennsylvania Health System (Penn Medicine), is a home monitoring programme for outpatients diagnosed with COVID19. COVID Watch sends twicedaily automated text messages to patients, inquiring about worsening symptoms and increased shortness of breath. In the event of worsening shortness of breath, the patient is contacted by a clinician via telephone within 1 hour for further evaluation and consideration of emergency department (ED) escalation. To understand the effectiveness of the COVID Watch programme, Delgado and colleagues performed a retrospective cohort study, analysing a population of patients within Penn Medicine. Included patients were adults aged 18 years or older who tested positive for COVID19 in the outpatient setting between 23 March and 30 November 2020. Excluded were people enrolled in home health or hospice services, those residing at longterm care facilities, those with active ‘do not resuscitate’ orders and those tested for COVID19 in areas where COVID Healthcare quality and safety span multiple topics across the spectrum of academic and clinical disciplines. Keeping abreast of the rapidly growing body of work can be challenging. In this series, we provide succinct summaries of selected relevant studies published in the last several months. Some articles will focus on a particular theme, whereas others will highlight unique publications from highimpact medical journals.","PeriodicalId":49653,"journal":{"name":"Quality & Safety in Health Care","volume":"31 1","pages":"409 - 414"},"PeriodicalIF":0.0,"publicationDate":"2022-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45509146","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of the surgical safety checklist on provider and patient outcomes: a systematic review","authors":"B. Armstrong, I. A. Dutescu, Lori Nemoy, Ekta Bhavsar, Diana N. Carter, Kimberley-Dale Ng, S. Boet, P. Trbovich, V. Palter","doi":"10.1136/bmjqs-2021-014361","DOIUrl":"https://doi.org/10.1136/bmjqs-2021-014361","url":null,"abstract":"Background Despite being implemented for over a decade, literature describing how the surgical safety checklist (SSC) is completed by operating room (OR) teams and how this relates to its effectiveness is scarce. This systematic review aimed to: (1) quantify how many studies reported SSC completion versus described how the SSC was completed; (2) evaluate the impact of the SSC on provider outcomes (Communication, case Understanding, Safety Culture, CUSC), patient outcomes (complications, mortality rates) and moderators of these relationships. Methods A systematic literature search was conducted using Medline, CINAHL, Embase, PsycINFO, PubMed, Scopus and Web of Science on 10 January 2020. We included providers who treat human patients and completed any type of SSC in any OR or simulation centre. Statistical directional findings were extracted for provider and patient outcomes and key factors (eg, attentiveness) were used to determine moderating effects. Results 300 studies were included in the analysis comprising over 7 302 674 operations and 2 480 748 providers and patients. Thirty-eight per cent of studies provided at least some description of how the SSC was completed. Of the studies that described SSC completion, a clearer positive relationship was observed concerning the SSC’s influence on provider outcomes (CUSC) compared with patient outcomes (complications and mortality), as well as related moderators. Conclusion There is a scarcity of research that examines how the SSC is completed and how this influences safety outcomes. Examining how a checklist is completed is critical for understanding why the checklist is successful in some instances and not others.","PeriodicalId":49653,"journal":{"name":"Quality & Safety in Health Care","volume":"31 1","pages":"463 - 478"},"PeriodicalIF":0.0,"publicationDate":"2022-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49142092","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Channelling the force of audit and feedback: averting the dark side","authors":"Eilidh M. Duncan, N. Ivers, J. Grimshaw","doi":"10.1136/bmjqs-2021-014520","DOIUrl":"https://doi.org/10.1136/bmjqs-2021-014520","url":null,"abstract":"","PeriodicalId":49653,"journal":{"name":"Quality & Safety in Health Care","volume":"31 1","pages":"695 - 697"},"PeriodicalIF":0.0,"publicationDate":"2022-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41999240","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Experience of hospital-initiated medication changes in older people with multimorbidity: a multicentre mixed-methods study embedded in the OPtimising thERapy to prevent Avoidable hospital admissions in Multimorbid older people (OPERAM) trial","authors":"S. Thevelin, Catherine Pétein, Beatrice Metry, L. Adam, Anniek van Herksen, K. Murphy, W. Knol, D. O’Mahony, N. Rodondi, A. Spinewine, O. Dalleur","doi":"10.1136/bmjqs-2021-014372","DOIUrl":"https://doi.org/10.1136/bmjqs-2021-014372","url":null,"abstract":"Background A patient-centred approach to medicines optimisation is considered essential. The OPtimising thERapy to prevent Avoidable hospital admissions in Multimorbid older people (OPERAM) trial evaluated the effectiveness of medication review with shared decision-making (SDM) in older people with multimorbidity. Beyond evaluating the clinical effectiveness, exploring the patient experience facilitates a better understanding of contextual factors and mechanisms affecting medication review effectiveness. Objective To explore experiences of hospital-initiated medication changes in older people with multimorbidity. Methods We conducted a multicentre mixed-methods study, embedded in the OPERAM trial, combining semi-structured interviews and the Beliefs about Medicines Questionnaire (BMQ) with a purposive sample of 48 patients (70–94 years) from four European countries. Interviews were analysed using the Framework approach. Trial implementation data on SDM were collected and the 9-item SDM questionnaire was conducted with 17 clinicians. Results Patients generally displayed positive attitudes towards medication review, yet emphasised the importance of long-term, trusting relationships such as with their general practitioners for medication review. Many patients reported a lack of information and communication about medication changes and predominantly experienced paternalistic decision-making. Patients’ beliefs that ‘doctors know best’, ‘blind trust’, having limited opportunities for questions, use of jargon terms by clinicians, ‘feeling too ill’, dismissive clinicians, etc highlight the powerlessness some patients felt during hospitalisation, all representing barriers to SDM. Conversely, involvement of companions, health literacy, empathetic and trusting patient-doctor relationships, facilitated SDM. Paradoxical to patients’ experiential accounts, clinicians reported high levels of SDM. The BMQ showed that most patients had high necessity and low concern beliefs about medicines. Beliefs about medicines, experiencing benefits or harms from medication changes, illness perception, trust and balancing advice between different healthcare professionals all affected acceptance of medication changes. Conclusion To meet patients’ needs, future medicines optimisation interventions should enhance information exchange, better prepare patients and clinicians for partnership in care and foster collaborative medication reviews across care settings.","PeriodicalId":49653,"journal":{"name":"Quality & Safety in Health Care","volume":"31 1","pages":"888 - 898"},"PeriodicalIF":0.0,"publicationDate":"2022-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42400970","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The problem with making Safety-II work in healthcare","authors":"M. Verhagen, M. D. de Vos, M. Sujan, J. Hamming","doi":"10.1136/bmjqs-2021-014396","DOIUrl":"https://doi.org/10.1136/bmjqs-2021-014396","url":null,"abstract":"© Author(s) (or their employer(s)) 2022. No commercial reuse. See rights and permissions. Published by BMJ. INTRODUCTION Patient safety is typically assessed by the frequency of adverse events or incidents, which means we seek to determine safety by its absence rather than its presence. The SafetyII perspective aspires to overcome this paradox by bringing into focus situations where safety is actually present, that is, in everyday work that usually goes well. Central to SafetyII is the notion that, in complex systems such as healthcare, safety is a consequence of collective efforts to adapt to dynamic conditions and uncertainty, rather than the natural state of a system where nothing untoward happens. This type of thinking has been met with significant interest and enthusiasm in healthcare, because it feeds increased appreciation for the fact that healthcare workers continuously ensure that most patients receive safe and highquality care in challenging circumstances. However, despite its appeal and potential, significant challenges remain for the fruitful interpretation and application of the SafetyII perspective in healthcare, which could give rise to misinterpretations, misuse and a missed opportunity for the potential enrichment of quality and safety practices in healthcare.","PeriodicalId":49653,"journal":{"name":"Quality & Safety in Health Care","volume":"31 1","pages":"402 - 408"},"PeriodicalIF":0.0,"publicationDate":"2022-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46196892","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Speaking up in resource-constrained settings: how to secure safe surgical care in the moment and in the future?","authors":"Graham P. Martin, N. Armstrong","doi":"10.1136/bmjqs-2021-014624","DOIUrl":"https://doi.org/10.1136/bmjqs-2021-014624","url":null,"abstract":"","PeriodicalId":49653,"journal":{"name":"Quality & Safety in Health Care","volume":"31 1","pages":"631 - 633"},"PeriodicalIF":0.0,"publicationDate":"2022-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43839312","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quality and Safety in the Literature: March 2022","authors":"I. Khurana, Ashwin Gupta, N. Houchens","doi":"10.1136/bmjqs-2021-014678","DOIUrl":"https://doi.org/10.1136/bmjqs-2021-014678","url":null,"abstract":"","PeriodicalId":49653,"journal":{"name":"Quality & Safety in Health Care","volume":"31 1","pages":"238 - 242"},"PeriodicalIF":0.0,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48542757","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reduced rate of postpartum readmissions among homeless compared with non-homeless women in New York: a population-based study using serial, cross-sectional data","authors":"Rie Sakai-Bizmark, H. Kumamaru, Dennys Estevez, Sophia Neman, Lauren E. M. Bedel, Laurie A Mena, Emily H Marr, M. Ross","doi":"10.1136/bmjqs-2020-012898","DOIUrl":"https://doi.org/10.1136/bmjqs-2020-012898","url":null,"abstract":"Objective To assess differences in rates of postpartum hospitalisations among homeless women compared with non-homeless women. Design Cross-sectional secondary analysis of readmissions and emergency department (ED) utilisation among postpartum women using hierarchical regression models adjusted for age, race/ethnicity, insurance type during delivery, delivery length of stay, maternal comorbidity index score, other pregnancy complications, neonatal complications, caesarean delivery, year fixed effect and a birth hospital random effect. Setting New York statewide inpatient and emergency department databases (2009–2014). Participants 82 820 and 1 026 965 postpartum homeless and non-homeless women, respectively. Main outcome measures Postpartum readmissions (primary outcome) and postpartum ED visits (secondary outcome) within 6 weeks after discharge date from delivery hospitalisation. Results Homeless women had lower rates of both postpartum readmissions (risk-adjusted rates: 1.4% vs 1.6%; adjusted OR (aOR) 0.87, 95% CI 0.75 to 1.00, p=0.048) and ED visits than non-homeless women (risk-adjusted rates: 8.1% vs 9.5%; aOR 0.83, 95% CI 0.77 to 0.90, p<0.001). A sensitivity analysis stratifying the non-homeless population by income quartile revealed significantly lower hospitalisation rates of homeless women compared with housed women in the lowest income quartile. These results were surprising due to the trend of postpartum hospitalisation rates increasing as income levels decreased. Conclusions Two factors likely led to lower rates of hospital readmissions among homeless women. First, barriers including lack of transportation, payment or childcare could have impeded access to postpartum inpatient and emergency care. Second, given New York State’s extensive safety net, discharge planning such as respite and sober living housing may have provided access to outpatient care and quality of life, preventing adverse health events. Additional research using outpatient data and patient perspectives is needed to recognise how the factors affect postpartum health among homeless women. These findings could aid in lowering readmissions of the housed postpartum population.","PeriodicalId":49653,"journal":{"name":"Quality & Safety in Health Care","volume":"31 1","pages":"267 - 277"},"PeriodicalIF":0.0,"publicationDate":"2021-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41415561","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"National cross-sectional cohort study of the relationship between quality of mental healthcare and death by suicide","authors":"B. Shiner, D. Gottlieb, Maxwell Levis, Talya Peltzman, N. Riblet, Sarah L. Cornelius, Carey J Russ, B. Watts","doi":"10.1136/bmjqs-2020-012944","DOIUrl":"https://doi.org/10.1136/bmjqs-2020-012944","url":null,"abstract":"Background Patient safety-based interventions aimed at lethal means restriction are effective at reducing death by suicide in inpatient mental health settings but are more challenging in the outpatient arena. As an alternative approach, we examined the association between quality of mental healthcare and suicide in a national healthcare system. Methods We calculated regional suicide rates for Department of Veterans Affairs (VA) Healthcare users from 2013 to 2017. To control for underlying variation in suicide risk in each of our 115 mental health referral regions (MHRRs), we calculated standardised rate ratios (SRRs) for VA users compared with the general population. We calculated quality metrics for outpatient mental healthcare in each MHRR using individual metrics as well as an Overall Quality Index. We assessed the correlation between quality metrics and suicide rates. Results Among the 115 VA MHRRs, the age-adjusted, sex-adjusted and race-adjusted annual suicide rates varied from 6.8 to 92.9 per 100 000 VA users, and the SRRs varied between 0.7 and 5.7. Mean regional-level adherence to each of our quality metrics ranged from a low of 7.7% for subspecialty care access to a high of 58.9% for care transitions. While there was substantial regional variation in quality, there was no correlation between an overall index of mental healthcare quality and SRR. Conclusion There was no correlation between overall quality of outpatient mental healthcare and rates of suicide in a national healthcare system. Although it is possible that quality was not high enough anywhere to prevent suicide at the population level or that we were unable to adequately measure quality, this examination of core mental health services in a well-resourced system raises doubts that a quality-based approach alone can lower population-level suicide rates.","PeriodicalId":49653,"journal":{"name":"Quality & Safety in Health Care","volume":"31 1","pages":"434 - 440"},"PeriodicalIF":0.0,"publicationDate":"2021-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47908432","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of COVID-19 restrictions on diabetes health checks and prescribing for people with type 2 diabetes: a UK-wide cohort study involving 618 161 people in primary care","authors":"M. Carr, A. Wright, L. Leelarathna, H. Thabit, N. Milne, N. Kanumilli, D. Ashcroft, M. Rutter","doi":"10.1101/2021.04.21.21255869","DOIUrl":"https://doi.org/10.1101/2021.04.21.21255869","url":null,"abstract":"Objective To compare rates of performing National Institute for Health and Care Excellence-recommended health checks and prescribing in people with type 2 diabetes (T2D), before and after the first COVID-19 peak in March 2020, and to assess whether trends varied by age, sex, ethnicity and deprivation. Methods We studied 618 161 people with T2D followed between March and December 2020 from 1744 UK general practices registered with the Clinical Practice Research Datalink. We focused on six health checks: haemoglobin A1c, serum creatinine, cholesterol, urinary albumin excretion, blood pressure and body mass index assessment. Regression models compared observed rates in April 2020 and between March and December 2020 with trend-adjusted expected rates derived from 10-year historical data. Results In April 2020, in English practices, rates of performing health checks were reduced by 76%–88% when compared with 10-year historical trends, with older people from deprived areas experiencing the greatest reductions. Between May and December 2020, the reduced rates recovered gradually but overall remained 28%–47% lower, with similar findings in other UK nations. Extrapolated to the UK population, there were ~7.4 million fewer care processes undertaken March–December 2020. In England, rates for new medication fell during April with reductions varying from 10% (95% CI: 4% to 16%) for antiplatelet agents to 60% (95% CI: 58% to 62%) for antidiabetic medications. Overall, between March and December 2020, the rate of prescribing new diabetes medications fell by 19% (95% CI: 15% to 22%) and new antihypertensive medication prescribing fell by 22% (95% CI: 18% to 26%), but prescribing of new lipid-lowering or antiplatelet therapy was unchanged. Similar trends were observed across the UK, except for a reduction in new lipid-lowering therapy prescribing in the other UK nations (reduction: 16% (95% CI: 10% to 21%)). Extrapolated to the UK population, between March and December 2020, there were ~31 800 fewer people with T2D prescribed a new type of diabetes medication and ~14 600 fewer prescribed a new type of antihypertensive medication. Conclusions Over the coming months, healthcare services will need to manage this backlog of testing and prescribing. We recommend effective communications to ensure patient engagement with diabetes services, monitoring and opportunities for prescribing, and when appropriate use of home monitoring, remote consultations and other innovations in care.","PeriodicalId":49653,"journal":{"name":"Quality & Safety in Health Care","volume":"31 1","pages":"503 - 514"},"PeriodicalIF":0.0,"publicationDate":"2021-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46257889","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}