BMJ Quality & Safety最新文献

{"title":"Impact of medical safety huddles on patient safety: a stepped-wedge cluster randomised study.","authors":"Meiqi Guo, Mark Bayley, Xiang Y Ye, Richard Dunbar-Yaffe, Chris Fortin, Katharyn Go, Alyssa Macedo, John Matelski, Amanda Mayo, Jordan Pelc, Lawrence R Robinson, Leahora Rotteau, Jesse Wolfstadt, Peter Cram, Lauren Linett, Christine Soong","doi":"10.1136/bmjqs-2025-019170","DOIUrl":"10.1136/bmjqs-2025-019170","url":null,"abstract":"<p><strong>Background: </strong>Medical safety huddles are short, structured meetings for physicians to proactively discuss and respond to profession-specific patient safety concerns, with the goal of decreasing future adverse events. Prior observational studies found associations with improved patient safety outcomes, but no randomised controlled studies have been conducted.</p><p><strong>Objective: </strong>The primary objective was to determine the impact of medical safety huddles on adverse events. Secondary objectives included the fidelity of huddle implementation and the impact on patient safety culture among physicians.</p><p><strong>Design: </strong>Stepped-wedge cluster randomised trial with four sequences, and each hospital site was a cluster.</p><p><strong>Setting: </strong>Inpatient oncology, surgery and rehabilitation programmes in four academic hospitals.</p><p><strong>Participants: </strong>Physicians in participating programmes.</p><p><strong>Intervention: </strong>Medical safety huddles were adapted for local context and implemented sequentially based on a computer-generated random sequence every 2 months after a 4-month control period. All sites remained in the intervention phase for at least 9 months.</p><p><strong>Main outcome and measures: </strong>The primary outcome was the rate of adverse events, as determined through blinded chart audits of 912 randomly selected patients. The fidelity of implementation was assessed through the huddle attendance rate, number of safety issues raised in the huddles and number of actions taken in response. Patient safety culture was assessed using the Agency for Healthcare Research and Quality Hospital Survey on Patient Safety.</p><p><strong>Results: </strong>The adjusted rate of adverse events (per 1000 patient days) in the postintervention phase was 12% lower compared with preintervention (RR: 0.88; 95% CI: 0.80 to 0.98; p=0.016). The odds of having adverse events posthuddle implementation were 17% lower in the postintervention period compared with preintervention (OR intervention vs control: 0.83; 95% CI: 0.80 to 0.87; p<0.001). The mean huddle attendance rate at each site ranged from 30% to 85%, and the mean number of issues raised per huddle and the mean number of actions taken per huddle ranged from 1.6 to 3.1. The mean (SD) overall patient safety rating increased from 2.3 (0.53) to 2.8 (0.88), p=0.010. The mean per cent (SD) positive score for the composite measures of 'Organisational learning' increased significantly from 35% (26%) to 54% (23%), p=0.00, 'Response to error' 37% (24%) to 52% (22%), p=0.025 and 'Communication about error' 36% (28%) to 64% (42%), p=0.016 after implementation.</p><p><strong>Conclusions and relevance: </strong>Medical safety huddles decreased adverse events and may improve patient safety culture through engaging physicians.</p><p><strong>Trial registration number: </strong>NCT05365516.</p>","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":"326-333"},"PeriodicalIF":6.5,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145197851","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":"Surgical safety checklist awareness and safety attitudes in the Eastern Mediterranean region: a cross-sectional study.","authors":"Assem Gebreal, Fatma Badr El Dine, Albaraa Abdulsalam, Doaa Hamdy Aly, Shaimaa Abdelaziz Abdelmoneim, Walid M Abd El Maksoud, Siwar Belhaj Salem, Alaa Nadir Mohamed Abdelrahim, Saja A Albanaa, Saja Alasaad, Rajiv Yussuf Ali, Ramez M Odat, Noha Taymour, Tabraiz Amin Malik, Abdelrahman Zaki Ali Mohammed, Notaila Mohammed Fayed, Khlood Saleh Mohammed Al-Ansi, Majda Attar, Ibrahim Mutwakil Gamal Ahmed, Ramy Mohamed Ghazy","doi":"10.1136/bmjqs-2025-019076","DOIUrl":"https://doi.org/10.1136/bmjqs-2025-019076","url":null,"abstract":"<p><strong>Background: </strong>The World Health Organization Surgical Safety Checklist (WHO-SSC) is a global tool designed to enhance teamwork and safety in operating rooms (ORs). Its use remains under-reported in the Eastern Mediterranean Region (EMR). This study aimed to assess WHO-SSC awareness, adoption, satisfaction with its implementation, barriers and its impact on healthcare professionals' safety attitudes.</p><p><strong>Methods: </strong>Using a validated questionnaire, a cross-sectional survey was conducted from 11 March to 18 June 2024, in hospitals across 12 countries in the EMR through face-to-face and online distribution. Healthcare professionals' safety attitude was assessed using the modified operating-room version of the Safety Attitudes Questionnaire. A multiple logistic regression model was used for data analysis, reporting aOR with 95% CIs.</p><p><strong>Results: </strong>The study involved 3861 respondents, comprising 1348 surgeons, 1277 OR nurses and 1236 anaesthesiologists. Overall, 52.5% of respondents reported awareness of the WHO-SSC. Among those aware, adoption was highest in private and teaching hospitals and lowest in charity hospitals, with 56.2% expressing satisfaction with its implementation. Reported 'always' adherence to the checklist was 32% in elective surgeries, compared with 19% in emergency surgeries. The main barriers included a lack of training, time constraints, limited awareness and poor team communication. Overall, 61.4% of participants demonstrated a positive safety attitude. Positive attitudes were associated with older age, being from a low-income and middle-income country, and WHO-SSC awareness.</p><p><strong>Conclusion: </strong>This study emphasises inadequate awareness and adoption of the WHO-SSC in the EMR. Strengthening training, institutional support and context-specific implementation strategies is essential to enhance surgical safety culture in the region.</p>","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":"147760685","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":"Sustainability of the de-implementation of low-value care in infants with bronchiolitis: 2-year follow-up of a cluster randomised controlled trial.","authors":"Victoria Ramsden, Franz E Babl, Libby Haskell, Catherine Wilson, Sandy Middleton, Rachel Schembri, Alex King, Alexandra Wallace, Alison Partyka, Casey Baldock, Julian Wong, Kai Steinmann, Louise Mills, Natalie Phillips, Nola Poulter, Shefali Jani, Suzanne Kenny, Ed Oakley, Anna Lithgow, Peter Wilson, Elizabeth McInnes, Stuart Dalziel, Emma Tavender","doi":"10.1136/bmjqs-2024-018135","DOIUrl":"10.1136/bmjqs-2024-018135","url":null,"abstract":"<p><strong>Background: </strong>In 2017, the PREDICT (Paediatric Research in Emergency Departments International Collaborative) network conducted a cluster randomised controlled trial (cRCT) at 26 Australian and New Zealand hospitals to improve bronchiolitis care. Findings demonstrated that targeted interventions significantly improved adherence with five evidence-based low-value bronchiolitis practices (no chest radiography, salbutamol, glucocorticoids, antibiotics and epinephrine) in the first 24 hours of hospitalisation (adjusted risk difference, 14.1%; 95% CI: 6.5% to 21.7%; p<0.001). During the intervention year (2017), intervention hospital (n=13) compliance was 85.1% (95% CI: 82.6% to 89.7%). This study aimed to determine if improvements in bronchiolitis management were sustained at intervention hospitals 2 years post-trial completion.</p><p><strong>Methods: </strong>International, multicentre follow-up study of hospitals in Australia and New Zealand that participated in a cRCT of de-implementation of low-value bronchiolitis practices, 1 year (2018) and 2 years (2019) post-trial completion, obtained retrospectively from medical audits. Sustainability was defined a priori as no more than a <7% decrease to any level of improvement in adherence for all five low-value practices (composite outcome) from the cRCT intervention year.</p><p><strong>Results: </strong>Of the 26 hospitals, 11 intervention and 10 control hospitals agreed to participate in the follow-up study. Data were collected on 3299 infants with bronchiolitis 1 year (intervention and control hospitals) and 1689 infants 2 years post-trial (intervention hospitals). Adherence with no use of the five low-value practices 2 years post-trial completion was 80.9% (adjusted predicted adherence, 80.8%, 95% CI: 77.4% to 84.2%; estimated risk difference from cRCT outcome -3.9%, 95% CI: -8.6% to 0.8%) at intervention hospitals, fulfilling the a priori definition of sustainability.</p><p><strong>Discussion: </strong>Targeted interventions, delivered over one bronchiolitis season, resulted in sustained improvements in bronchiolitis management in infants 2 years later. This follow-up study provides evidence for sustainability in de-implementing low-value care in bronchiolitis management.</p><p><strong>Trial registration details: </strong>Australian and New Zealand Clinical Trials Registry No: ACTRN12621001287820.</p>","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":"304-315"},"PeriodicalIF":6.5,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144616176","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":"Inappropriate prescribing for older people with reduced kidney function: can we do better at the primary care level?","authors":"Laetitia Hattingh, Matt Percival","doi":"10.1136/bmjqs-2025-019580","DOIUrl":"10.1136/bmjqs-2025-019580","url":null,"abstract":"","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":"300-302"},"PeriodicalIF":6.5,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145480824","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":"Learning to forget: deimplementation and the science of sustainability in healthcare.","authors":"Rachel Flynn, Christine Cassidy, Shannon D Scott","doi":"10.1136/bmjqs-2025-019666","DOIUrl":"10.1136/bmjqs-2025-019666","url":null,"abstract":"","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":"293-296"},"PeriodicalIF":6.5,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145910382","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":"Optimising professional support for doctors who experience work performance issues: a realist evaluation.","authors":"Nicola Brennan, Ellie Reynolds, Tristan Price, Geoff Wong, Jennifer Cleland, Helen Lloyd, Lyndsey Withers, Thomas Gale","doi":"10.1136/bmjqs-2025-019749","DOIUrl":"https://doi.org/10.1136/bmjqs-2025-019749","url":null,"abstract":"<p><strong>Background: </strong>The optimal performance of doctors is critical to delivering high-quality, safe healthcare. However, 6-12% of doctors may experience challenges that impact their work performance. In many countries, including the UK, there is variation in the practice and quality of professional support services between different types of organisations. The aims of our study were (1) to identify why, how, in what contexts and for whom professional support works, (2) to develop a guide for healthcare organisations to use to optimise professional support.</p><p><strong>Methods: </strong>We carried out a realist evaluation consistent with Realist And Meta-narrative Evidence Syntheses: Evolving Standards (RAMESES) II standards. 45 interviews were conducted with professional support staff and doctors who had undertaken professional support across seven sites in England. Interviews were analysed using a realist logic. To develop the guide, six workshops were held with the same groups plus a patient and public involvement group.</p><p><strong>Results: </strong>We identified six principles of effective professional support, based on 47 context-mechanism-outcome configurations. (1) Work-place culture influences support-seeking behaviour. (2) Trust and psychological safety are central to enable candid conversations and engagement. (3) Doctors can then develop self-awareness and situational awareness, reframe challenges, accept responsibility where appropriate and recognise structural factors underpinning their difficulties. (4) Doctors are more likely to feel motivated to engage through positive framing. (5) Personal and professional growth occurs when doctors are empowered to make changes to their practice. (6) Cultures that stigmatise help-seeking undermine support, while those that model vulnerability and normalise support enhance the likelihood of positive outcomes.</p><p><strong>Conclusions: </strong>Our guide provides step-by-step advice to identify key actions for those delivering professional support . Since the realist approach identifies principles and causal explanations, the findings are likely transferable to other settings/countries.</p>","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":""},"PeriodicalIF":6.5,"publicationDate":"2026-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147728179","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":"Impact of financial incentive for team-based dementia care on patient outcomes in acute-care hospitals in Japan: a difference-in-differences analysis.","authors":"Jinyan Wu, Kojiro Morita, Ayumi Igarashi, Hideo Yasunaga, Taisuke Yasaka, Yuya Kimura, Taro Kojima, Hiroki Matsui, Kiyohide Fushimi, Noriko Yamamoto-Mitani","doi":"10.1136/bmjqs-2025-019634","DOIUrl":"https://doi.org/10.1136/bmjqs-2025-019634","url":null,"abstract":"<p><strong>Background: </strong>Dementia increases the risk of adverse outcomes during hospitalisation, underscoring the need for system-level strategies. In 2016, Japan introduced Dementia Care Add-on 1 (DCA1), a financial incentive requiring hospitals to establish multidisciplinary dementia care teams. The short-term impact of DCA1 has been elucidated; however, its potential for medium-term to long-term benefits remains uncertain. In this study, we aimed to evaluate the medium-term to long-term impact of DCA1 on care processes and patient outcomes in older adults with dementia in acute-care hospitals.</p><p><strong>Methods: </strong>Patients aged ≥65 years with moderate-to-severe dementia who were admitted to acute-care hospitals between April 2014 and March 2020 were identified using a nationwide inpatient database. Hospital-level propensity score matching was conducted, followed by a difference-in-differences analysis comparing identified inpatients of DCA1-certified and non-certified hospitals. Outcome measures were length of stay (LOS), activities of daily living maintenance, potentially inappropriate medication prescriptions, in-hospital fractures and home discharge. A sensitivity analysis excluding hospitals certified only for the less stringent DCA2 scheme was conducted.</p><p><strong>Results: </strong>Overall, 309 791 patients from 235 matched hospital pairs were analysed. DCA1 certification was not associated with improvements in the measured outcomes. Notably, >60% of DCA1 hospitals billed for <20% of eligible patients, indicating limited and inconsistent implementation. In a restricted analysis excluding DCA2-certified hospitals, DCA1 certification showed a statistically significant reduction in LOS (change: -11.3%; 95% CI -19.8% to -3.0%). No significant associations were observed for the other outcomes.</p><p><strong>Conclusions: </strong>DCA1 was not associated with measurable improvements in patient outcomes at the certification level. However, under more homogeneous comparison conditions, an association was observed with shorter LOS. These findings show that structural certification alone may be insufficient to achieve consistent improvements in dementia care outcomes in acute hospital settings.</p>","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":""},"PeriodicalIF":6.5,"publicationDate":"2026-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147728229","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":"Radiology reporting in the age of artificial intelligence: implications for patient safety.","authors":"Igor Toker, Sven Jansen, Julius Knoche, Daniel Lorenz","doi":"10.1136/bmjqs-2025-018928","DOIUrl":"https://doi.org/10.1136/bmjqs-2025-018928","url":null,"abstract":"","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":""},"PeriodicalIF":6.5,"publicationDate":"2026-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147643831","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 do community advocates address racial inequities in maternity care for Black, African, Caribbean and mixed-Black families? A realist review.","authors":"Sarindi Aryasinghe, Ruchi Wadhwa, Phoebe Averill, Gabriella Sarpong, Susan Ibuanokpe, Phayza Fudlalla, Carole Waithe, Rhianna Newby-Mayers, Abimbola Ayorinde, Sabrina Das, Helen Ward","doi":"10.1136/bmjqs-2025-019646","DOIUrl":"https://doi.org/10.1136/bmjqs-2025-019646","url":null,"abstract":"<p><strong>Background: </strong>Black, African, Caribbean and mixed-Black women face higher maternal mortality and poorer maternity outcomes than white women due to structural, institutional and interpersonal racism. Experiences of coercion, neglect and biased decision-making foster mistrust and disengagement from care. In response, families adopt protective strategies, including using community advocates. Advocates, such as doulas and perinatal support professionals, can provide continuous, culturally tailored support that complements clinical care, improving maternal health outcomes and care satisfaction.</p><p><strong>Aim: </strong>To explore how, for whom and in what contexts community advocates address racial inequities in maternity care for Black, African, Caribbean and mixed-Black families.</p><p><strong>Methods: </strong>We conducted a realist review, developing initial programme theories and searching MEDLINE, Embase, CINAHL, Maternity and Infant Care, PsycINFO, Global Health, HMIC, Web of Science and grey literature. Sources were included if they examined use of community advocates in maternity care for Black, African, Caribbean and mixed-Black families. Data were analysed to generate and refine context-mechanism-outcome configurations with input from lived experience, policy, practitioner and academic experts.</p><p><strong>Results: </strong>Of 1168 records screened, 46 met inclusion criteria, from the USA, UK, and Canada. Three components emerged: how advocates co-create personalised care, how they are supported and how they are embedded in health systems to influence service improvements. Advocates address racial inequities by building trust, fostering family empowerment and autonomy. Effectiveness depends on formal recognition, fair remuneration, training, mentorship and institutional anti-racism support ensuring independence and accountability.</p><p><strong>Conclusion: </strong>Community advocates can reduce racial inequities in maternity care by co-creating culturally responsive, individualised, non-judgemental and empathetic care with families. Sustained impact depends on adequate support and systemic anti-racism reforms that embed advocates while preserving their independence.</p><p><strong>Prospero registration number: </strong>CRD42024596506.</p>","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":""},"PeriodicalIF":6.5,"publicationDate":"2026-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147643788","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":"Integrating 'What Matters' conversations into preoperative care: a qualitative evaluation of surgical team workflows and barriers.","authors":"Kirstin Manges Piazza, Lindsay R Pelcher, Phoebe Whiteside, Morgan Cribbin, Amanda D Peeples, Caroline Pascal, Laura Ellen Ashcraft, Robert E Burke, Daniel Hall","doi":"10.1136/bmjqs-2025-019321","DOIUrl":"https://doi.org/10.1136/bmjqs-2025-019321","url":null,"abstract":"<p><strong>Background: </strong>There is no low-risk surgery for frail, high-risk patients. Frailty screening helps identify these patients, enabling surgical teams to tailor treatment plans that align with patient values and mitigate risks. However, the way clinicians assess values and counsel older patients about surgical options is unclear. As part of a larger Veterans Administration (VA) quality improvement (QI) initiative to implement Surgical Pause, this pre-implementation qualitative assessment examined how outpatient surgical teams identify and use older adults' goals, values and care preferences in elective surgery decision-making.</p><p><strong>Methods: </strong>We triangulated pre-implementation interview, observational and focus group data to understand the clinical context, workflows and staff perspectives around preoperative goal clarification conversations. Using thematic analysis, we described clinicians' attitudes towards integrating structured 'What Matters' conversations into routine preoperative care, mapped existing processes and identified barriers and opportunities for quality improvement.</p><p><strong>Results: </strong>The final sample included 27 interviews, 75 observations and 7 focus groups across 18 outpatient clinics at four medical centres. Overall, clinicians supported discussing 'What Matters' with high-risk older patients considering elective surgery, but their practices varied. Participants reported inconsistent processes for integrating patient priorities into decisions. Key barriers included reliance on a 'fix it' care model, workflow integration and visibility, and time constraints. Facilitators included leveraging performance metrics, improving documentation and referral systems, and staff training.</p><p><strong>Conclusions: </strong>Although surgical clinicians recognise the importance of discussing patient goals, explicit 'What Matters' conversations with patients rarely occurred. In contrast, frequently used implicit strategies include chart reviews, clinical assessment, discussion of treatment options, informed consent and referrals. Future work should enhance strategies to improve goal clarification and promote high-quality decision-making with frail older patients.</p>","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":""},"PeriodicalIF":6.5,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147589878","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}