BMJ Quality & Safety最新文献

{"title":"The incidence of avoidable healthcare-associated harm in prisons in England: a retrospective case note review.","authors":"Isobel Joy McFadzean, Saied Ibrahim, Verity Wainwright, Maria Panagioti, Melanie Jordan, Sandra Flynn, Richard N Keers, Tim Millar, Darren M Ashcroft, Adrian Edwards, Anthony J Avery, Jenny Shaw, Andrew Carson-Stevens","doi":"10.1136/bmjqs-2025-019935","DOIUrl":"https://doi.org/10.1136/bmjqs-2025-019935","url":null,"abstract":"<p><strong>Objective: </strong>To estimate the incidence of avoidable healthcare-associated harm for prisoners in England.</p><p><strong>Design: </strong>A retrospective cross-sectional case note review of prisoner healthcare records.</p><p><strong>Setting: </strong>18 prisons in England were purposively sampled for maximum variation of characteristics based on prison category (open, local, training, high security and female), type (publicly and privately run) and population size.</p><p><strong>Population: </strong>After screening 15 027 prisoner records, two cohorts were selected: a sample of 6294 'enhanced risk' prisoners and a random sample of 853 prisoners not included in the enhanced risk sample (n=7147).</p><p><strong>Main outcome measures: </strong>The primary outcome was the incidence of patient harm per 100 000 patient-years, judged at least probably avoidable. The secondary outcome was the incidence of patient harm judged at least possibly avoidable. Cases of avoidable harm were characterised in terms of patient impact, known as patient outcome(s), and the severity of harm experienced.</p><p><strong>Results: </strong>Within 18 prisons, 247 cases of avoidable harm were experienced by 244 prisoners and were identified from 7147 patient records. The incidence of avoidable harm was 2241.4 (95% CI 1970.5 to 2539.0) per 100 000 patient-years, and this rate could be as high as 3412.0 (95% CI 3075.8 to 3774.9) based on the records screened during this study. Most patient outcomes involved prisoners experiencing discomfort and pain (99/247, 40.1%) and delays receiving appropriate healthcare management or assessment (91/247, 36.8%). The identified cases of avoidable healthcare-associated harm for prisoners resulted mainly in moderate harm severity (157/247 cases, 63.6%), followed by severe harm (27, 10.9%) and death (27, 10.9%).</p><p><strong>Conclusions: </strong>Compared with community settings, people in prison experience a 41-67 times greater risk of avoidable significant healthcare-associated harm. This stark disparity underscores the urgent need for government and policy action. Delivering safe, equitable healthcare in secure environments remains a major challenge that demands focused attention.</p>","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":""},"PeriodicalIF":6.5,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147833373","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"We need a new paradigm to think about generative AI.","authors":"Adam Rodman, Laura Zwaan","doi":"10.1136/bmjqs-2025-019828","DOIUrl":"https://doi.org/10.1136/bmjqs-2025-019828","url":null,"abstract":"","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":""},"PeriodicalIF":6.5,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147833348","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How can we prevent clinical deskilling when using AI?","authors":"Ian Scott, Anton van der Vegt, Peter Douglas","doi":"10.1136/bmjqs-2026-020130","DOIUrl":"https://doi.org/10.1136/bmjqs-2026-020130","url":null,"abstract":"","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":""},"PeriodicalIF":6.5,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147833416","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Four key things to know about the reliability of measurements.","authors":"Timothy P Hofer","doi":"10.1136/bmjqs-2025-018924","DOIUrl":"https://doi.org/10.1136/bmjqs-2025-018924","url":null,"abstract":"<p><p>Reliability is the most reported measurement characteristic used as evidence of the quality of a measurement. However, researchers often miss opportunities to design studies in a way that allows reliability to be calculated and report a calculation that is not germane to the purpose of the measurement.Reliability is a number that quantifies the ability of a measurement to distinguish between the members of a population with respect to a measured quantity. It is a simple function of the signal and noise in a measurement. In this paper, I review four key attributes. First, reliability has a single technical definition, but there are many statistics that purport to quantify reliability that do not fit this definition or obscure their relationship to it. This undermines the fundamental simplicity of the concept and its useful implications. Second, researchers sometimes do not appreciate that the relevant calculation of reliability changes with the purpose and conditions of measurement and then report the wrong number. Third, reliability is a summary measure with several components that may be as or more relevant to report than reliability. Fourth, reliability is specific to a population, for example, a patient satisfaction score that is highly reliable in one population could have abysmal reliability in a different population when using the same survey instrument.Reliability is an important part of evaluating and improving the measurements that form the foundations of scientific research in healthcare quality and safety. Understanding these four key attributes of reliability will improve the description and use of healthcare quality and safety measurements.</p>","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":""},"PeriodicalIF":6.5,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147833434","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Widening global gap in safe surgery: revisiting the surgical safety checklist at the 20th anniversary of the WHO Surgical Safety Checklist.","authors":"Karolina Kogut, Nobhojit Roy, Mary E Brindle","doi":"10.1136/bmjqs-2026-020251","DOIUrl":"https://doi.org/10.1136/bmjqs-2026-020251","url":null,"abstract":"","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":""},"PeriodicalIF":6.5,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147760722","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What do people do in the aftermath of healthcare-related harm? A qualitative study on experiences and factors influencing decision-making.","authors":"Lavanya Thana, Helen Crocker, Shivali Modha, Linda Mulcahy, Catherine Pope, Charles Vincent, Helen Hogan, Michele Peters","doi":"10.1136/bmjqs-2024-018214","DOIUrl":"10.1136/bmjqs-2024-018214","url":null,"abstract":"<p><strong>Objectives: </strong>To capture experiences of people self-reporting harm and contrast responses and actions between those who do or do not take formal action.</p><p><strong>Design: </strong>Semi-structured qualitative interview study.</p><p><strong>Setting: </strong>People self-reporting harm experienced in the National Health Service (NHS) or their family/friends identified from a general Great British population survey.</p><p><strong>Participants: </strong>49 participants.</p><p><strong>Results: </strong>There were commonalities in experiences after harm whether formal action (including making a formal complaint or litigation) was taken or not. Many participants reported raising concerns informally with NHS staff, trying to access explanations or support, but were usually unsuccessful. Decision-making on action was complex. There were multiple reasons for not pursuing formal action, including fears of damaging relationships with clinicians, being occupied coping with the consequences of the harm or not wanting to take action against the NHS. NHS advocacy services were not regarded as helpful. Knowledge of how to proceed and feeling entitled to do so, along with proactive social networks, could facilitate action, but often only after people were spurred on by anger and frustration about not receiving an explanation, apology or support for recovery from the NHS. Those from marginalised groups were more likely to feel disempowered to act or be discouraged by family or social contacts, which could lead to self-distancing and reduced trust in services.</p><p><strong>Conclusions: </strong>People actively seek resolution and recovery after harm but often face multiple barriers in having their needs for explanations, apologies and support addressed. Open and compassionate engagement, especially with those from more marginalised communities, plus tailored support to address needs, could promote recovery, decrease compounded harm and reduce use of grievance services where other provision may be more helpful.</p>","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":"334-345"},"PeriodicalIF":6.5,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13151440/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144180133","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"When students run the clinic, who's watching? A call for a framework to evaluate student-run clinics.","authors":"Nicholas Peoples, Alireza Ahmadvand","doi":"10.1136/bmjqs-2025-019604","DOIUrl":"10.1136/bmjqs-2025-019604","url":null,"abstract":"","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":"358-362"},"PeriodicalIF":6.5,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145910430","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Physician participation in pre-emptive patient safety huddles.","authors":"Allison Bond, Andrew D Auerbach","doi":"10.1136/bmjqs-2025-019350","DOIUrl":"10.1136/bmjqs-2025-019350","url":null,"abstract":"","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":"297-299"},"PeriodicalIF":6.5,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145676317","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Understanding factors influencing sustainability and sustainment of evidence-based bronchiolitis management of infants in Australian and New Zealand hospital settings: a qualitative process evaluation.","authors":"Victoria Ramsden, Franz E Babl, Libby Haskell, Catherine Wilson, Elizabeth McInnes, Sandy Middleton, Lisa Kuhn, Alexandra Wallace, Elyssia Bourke, Faye Jordan, Julian Wong, Kai Steinmann, Lauren Shumack, Lisa Kane, Natalie Phillips, Paige Marsh, Shefali Jani, Trevor Kuang, Yvonne Janiszewski, Ed Oakley, Anna Lithgow, Peter Wilson, Rachel Schembri, Stuart Dalziel, Emma Tavender","doi":"10.1136/bmjqs-2025-019007","DOIUrl":"10.1136/bmjqs-2025-019007","url":null,"abstract":"<p><strong>Background: </strong>The 2017 Paediatric Research in Emergency Departments International Collaborative (PREDICT) Bronchiolitis Knowledge Translation (KT) Study, a cluster randomised trial in 26 Australasian hospitals, found targeted interventions provided over one bronchiolitis season effectively de-implemented five low-value practices (salbutamol, glucocorticoids, chest radiography, antibiotics and epinephrine) by 14.1% (adjusted risk difference, 95% CI 6.5% to 21.7%; p<0.001). A 2-year follow-up study found de-implementation was sustained. This process evaluation aimed to identify factors that influenced sustainability of de-implementation of these five low-value practices in PREDICT Bronchiolitis KT Study intervention hospitals and examine fidelity and/or adaptation of the targeted interventions over 4 years post intervention delivery (sustainment).</p><p><strong>Methods: </strong>Semistructured qualitative interviews were conducted, over 2021 and 2022, with a purposive sample of emergency department (ED) and paediatric inpatient clinicians. Data were analysed thematically into facilitators and barriers using the Consolidated Framework for Sustainability Constructs in Healthcare (CFSCH). The Framework for Reporting Adaptations and Modifications to Evidence-based Implementation Strategies was used to explore fidelity and adaptation.</p><p><strong>Results: </strong>50 clinicians (nurses: n=26; doctors: n=24) from 12 intervention hospitals were interviewed. Eight themes were identified and mapped to three CFSCH domains: (1) organisational setting; (2) initiative design and delivery and (3) people involved. Facilitators were a culture of evidence-based practice, ongoing multimodal education, strong clinical leadership as unofficial champions and the previous effectiveness of the PREDICT Bronchiolitis KT Study interventions. Barriers were lack of paediatric trained ED staff, assumptions by senior clinicians that junior doctors can provide evidence-based bronchiolitis management, bronchiolitis not a current improvement priority and lack of bronchiolitis education sessions. Use of the targeted interventions reduced over time and, when used, was adapted locally.</p><p><strong>Conclusion: </strong>This study provides insights into factors influencing the sustainability of de-implementation of low-value care in acute care settings. Fostering an evidence-based practice culture, supported by senior leadership and ongoing multimodal education, supports sustainability of improvements in this setting.</p><p><strong>Trial registration number: </strong>Australian and New Zealand Clinical Trials Registry No: ACTRN12621001287820.</p>","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":"316-325"},"PeriodicalIF":6.5,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145231514","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Widespread inappropriate prescribing for older people with reduced kidney function: what are the harms and how do we tackle them? A scoping review for primary care.","authors":"Owen Thomas, Liz Glidewell, Sarah Alderson, David K Raynor, Su Wood","doi":"10.1136/bmjqs-2025-018736","DOIUrl":"10.1136/bmjqs-2025-018736","url":null,"abstract":"<p><strong>Background: </strong>Increasing age is associated with reductions in kidney function and increasing polypharmacy. Most medicines are eliminated through the kidney, meaning older patients are at risk of medication accumulation and toxicity. This scoping review synthesised: (1) the prevalence at which older patients with reduced kidney function in primary care are exposed to inappropriate prescribing; (2) its associated harms; (3) the reasons for this occurring; and (4) the interventions used to improve prescribing practices.</p><p><strong>Methods: </strong>This scoping review searched 'Medline', 'Embase', 'PsycINFO', 'CINAHL' and 'Web of Science' for publications before October 2024. References were managed on EndNote V.X5 and thematic data analysis was undertaken on Microsoft Excel. Common themes were identified, summary statistics were calculated and insights were summarised through a narrative technique.</p><p><strong>Results: </strong>43 relevant studies explored the scale of inappropriate prescribing, estimating prevalences of patient exposure ranging from 0.6% to 49.1% (median 24.9%). Five studies explored the associated harm from inappropriate prescribing, but only one study assessed harm as a primary outcome. Eight studies that assessed difficulties in following prescribing guidelines in reduced kidney function suggested that a lack of awareness and trusted guidelines are fundamental problems. While 13 studies evaluated interventions for improving prescribing in reduced kidney function, only two demonstrated evidence of effectiveness and only one intervention was theoretically informed.</p><p><strong>Conclusions: </strong>Despite significant heterogeneity in study characteristics, it is clear that the prevalence of inappropriate prescribing for older people is uncomfortably high. There is a lack of evidence linking this to associated adverse outcomes, as well as identifying the causative issues driving this behaviour and the preventative interventions that could prevent harm.</p>","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":"346-357"},"PeriodicalIF":6.5,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13151456/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145243659","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}