BMJ Quality & Safety最新文献

{"title":"Factors affecting implementation of a National Clinical Programme for self-harm in hospital emergency departments: a qualitative study.","authors":"Selena O'Connell, Grace Cully, Sheena McHugh, Margaret Maxwell, Anne Jeffers, Katerina Kavalidou, Sally Lovejoy, Rhona Jennings, Vincent Russell, Ella Arensman, Eve Griffin","doi":"10.1136/bmjqs-2024-017415","DOIUrl":"10.1136/bmjqs-2024-017415","url":null,"abstract":"<p><strong>Background: </strong>A substantial number of people experiencing self-harm or suicidal ideation present to hospital emergency departments (EDs). In 2014, a National Clinical Programme was introduced in EDs in Ireland to standardise care provision. Internationally, there has been limited research on the factors affecting the implementation of care for people who present with mental health crises in EDs.</p><p><strong>Methods: </strong>This qualitative study examined factors influencing the implementation of the National Clinical Programme for Self-harm and Suicide-related Ideation in 15 hospitals in Ireland from early (2015-2017) through to later implementation (2019-2022). Semi-structured interviews were conducted with staff involved in programme delivery, with the topic guide and thematic analysis informed by the Consolidated Framework for Implementation Research.</p><p><strong>Results: </strong>A total of 30 participants completed interviews: nurse specialists (n=16), consultant psychiatrists (n=6), nursing managers (n=2), emergency medicine staff (n=2) and members of the national programme team (n=4). Enablers of implementation included the introduction of national, standardised guidance for EDs; implementation strategies led by the national programme team; and training and support for nurse specialists. The following inner-setting factors were perceived as barriers to implementation in some hospitals: limited access to a designated assessment room, delayed access to clinical input and poor collaboration with ED staff. Overall, these barriers dissipated over time, owing to implementation strategies at national and local levels. The varied availability of aftercare impacted providers' ability to deliver the programme and the adaptability of programme delivery had a mixed impact across hospitals.</p><p><strong>Conclusions: </strong>The perceived value of the programme and national leadership helped to advance implementation. Strategies related to ongoing training and education, developing stakeholder interrelationships and evaluation and monitoring have helped address implementation barriers and promote continued sustainment of the programme. Continued efforts are needed to support nurse specialists delivering the programme and foster partnerships with community providers to improve the transition to aftercare.</p>","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":"657-666"},"PeriodicalIF":6.5,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12505067/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142387872","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":"Through the patients' eyes: psychometric evaluation of the 64-item version of the Experienced Patient-Centeredness Questionnaire (EPAT-64).","authors":"Eva Christalle, Stefan Zeh, Hannah Führes, Alica Schellhorn, Pola Hahlweg, Jördis Maria Zill, Martin Härter, Carsten Bokemeyer, Jürgen Gallinat, Christoffer Gebhardt, Christina Magnussen, Volkmar Müller, Katharina Schmalstieg-Bahr, André Strahl, Levente Kriston, Isabelle Scholl","doi":"10.1136/bmjqs-2024-017434","DOIUrl":"10.1136/bmjqs-2024-017434","url":null,"abstract":"<p><strong>Background: </strong>Patient-reported experience measures (PREMs) are valuable tools to evaluate patient-centredness (PC) from the patients' perspective. Despite their utility, a comprehensive PREM addressing PC has been lacking. To bridge this gap, we developed the preliminary version of the Experienced Patient-Centeredness Questionnaire (EPAT), a disease-generic tool based on the integrative model of PC comprising 16 dimensions. It demonstrated content validity. This study aimed to test its psychometric properties and to develop a final 64-item version (EPAT-64).</p><p><strong>Methods: </strong>In this cross-sectional study, we included adult patients treated for cardiovascular diseases, cancer, musculoskeletal diseases and mental disorders in inpatient or outpatient settings in Germany. For each dimension of PC, we selected four items based on item characteristics such as item difficulty and corrected item-total correlation. We tested structural validity using confirmatory factor analysis, examined reliability by McDonald's Omega and tested construct validity by examining correlations with general health status and satisfaction with care.</p><p><strong>Results: </strong>Analysis of data from 2.024 patients showed excellent acceptance and acceptable item-total correlations for all EPAT-64 items, with few items demonstrating ceiling effects. The confirmatory factor analysis indicated the best fit for a bifactor model, where each item loaded on both a general factor and a dimension-specific factor. Omega showed high reliability for the general factor, while varying for specific dimensions. Construct validity was confirmed by absence of strong correlations with general health status and a strong correlation of the general factor with satisfaction with care.</p><p><strong>Conclusions: </strong>EPAT-64 demonstrated commendable psychometric properties. This tool allows comprehensive assessment of PC, offering flexibility to users who can measure each dimension with a four-item module or choose modules based on their needs. EPAT-64 serves multiple purposes, including quality improvement and evaluation of interventions aiming to enhance PC. Its versatility empowers users in diverse healthcare settings.</p>","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":"643-656"},"PeriodicalIF":6.5,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12505071/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142457778","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":"<i>Better without catheter</i>: the nationwide spread of a deimplementation strategy in clinical practice.","authors":"Eva Willemiek Verkerk, Maike Wm Raasing, Rudolf Bertijn Kool, Bart J Laan","doi":"10.1136/bmjqs-2025-018681","DOIUrl":"10.1136/bmjqs-2025-018681","url":null,"abstract":"<p><p>Many successful implementation studies fail to be sustained and spread after the publication. We aimed to spread a successful deimplementation strategy that reduced inappropriate peripheral venous catheter and urinary catheter use and evaluated the spread, adoption and effects of this strategy in clinical practice.We adapted the original successful study into a more accessible project, creating a toolkit called <i>Better without catheter</i> We recruited 39 hospitals (more than half of all Dutch hospitals) across the Netherlands, which participated in regular online meetings. After 21 months, we sent an online survey to the project leaders of the participating hospitals to assess progress, barriers and facilitators to adopting the project.Widespread promotion and targeted emails were key factors in spreading <i>Better without catheter</i> There was considerable variation in the hospitals' progress; five had not yet started, six had completed the project and the others were at various stages in between. Major barriers included lack of time and resources, organisational facilities and the composition of local project teams. Key facilitators were organisational support and the involvement of physicians and nurse leaders. Project leaders valued the toolkit, the flexibility to tailor the project and the online meetings.Overall, the spread and adoption of this deimplementation strategy showed encouraging results, with 39 hospitals joining the network within 2 years. Although reach and engagement were high, the hospitals' progress in the project was frequently hindered by organisational and management factors. Four elements supported the uptake: widespread promotion, the translation of the original study into an accessible improvement project with practical tools, the flexibility to tailor the approach locally and participation in a peer network.</p>","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":"702-710"},"PeriodicalIF":6.5,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144265240","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":"County-level racial bias is associated with worse care for white and especially black older US adults: a cross-sectional observational study.","authors":"Matthew L Mizel, Ann Haas, John L Adams, Steven C Martino, Amelia M Haviland, Bonnie Ghosh-Dastidar, Jacob W Dembosky, Malcolm Williams, Gary Abel, Jessica Maksut, Jennifer Gildner, Marc N Elliott","doi":"10.1136/bmjqs-2024-017430","DOIUrl":"10.1136/bmjqs-2024-017430","url":null,"abstract":"<p><strong>Objective: </strong>To assess the association of county-level bias about black and white people with patient experience, influenza immunisation, and quality of clinical care for black and white older US adults (age 65+ years).</p><p><strong>Design: </strong>Linear multivariable regression measured the cross-sectional association of county-level estimates of implicit and explicit bias about black and white people with patient experiences, influenza immunisation, and clinical quality-of-care for black and white older US adults.</p><p><strong>Participants: </strong>We used data from 1.9 million white adults who completed implicit and explicit bias measures during 2003-2018, patient experience and influenza immunisation data from respondents to the 2009-2017 Medicare Consumer Assessment of Healthcare Providers and Systems (MCAHPS) Surveys, and clinical quality-of-care data from patients whose records were included in 2009-2017 Healthcare Effectiveness Data and Information Set (HEDIS) submissions (n=0.8-2.9 million per measure).</p><p><strong>Main outcome measures: </strong>Three patient experience measures and patient-reported influenza immunisation from the MCAHPS Survey; five HEDIS measures.</p><p><strong>Results: </strong>In county-level models, higher pro-white implicit bias was associated with lower immunisation rates and worse scores for some patient experience measures for black and white adults as well as larger-magnitude black-white disparities. Higher pro-white implicit bias was associated with worse scores for some HEDIS measures for black and white adults but not with black-white disparities in clinical quality of care. Most significant associations were small in magnitude (effect sizes of 0.2-0.3 or less).</p><p><strong>Conclusions: </strong>To the extent that county-level pro-white implicit bias is indicative of bias among healthcare providers, there may be a need for interventions designed to prevent such bias from adversely affecting the experiences and preventive care of black patients and the clinical quality of care for all patients.</p>","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":"667-678"},"PeriodicalIF":6.5,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142387871","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":"Implementation strategies of financial navigation and its effects on alleviating financial toxicity among cancer survivors: a systematic review.","authors":"Yujia Feng, Mingzhu Su, Xiaojie Sun, Jinxin Zhang, Nengliang Aaron Yao","doi":"10.1136/bmjqs-2024-017557","DOIUrl":"10.1136/bmjqs-2024-017557","url":null,"abstract":"<p><strong>Purpose: </strong>This systematic review aims to identify the implementation strategies of financial navigation and systematically synthesise its effects on mitigating financial toxicity among cancer survivors, based on the theoretical framework of implementation science.</p><p><strong>Methods: </strong>Medline, Web of Science Core Collection, ScienceDirect and ProQuest Health & Medical Collection databases were searched for studies published before 22 August 2023. We sought original research on financial navigation interventions among adult cancer survivors with financial toxicity in healthcare settings. The Revised Cochrane risk-of-bias tool for randomised trials, 2.0 and the Risk Of Bias In Non-randomised Studies of Interventions-I were used to assess the risk of bias in included studies. In addition, the implementation strategies of the included studies were categorised and collated based on Expert Recommendations for Implementing Change, and the Consolidated Framework for Implementation Research was adopted to explain barriers and facilities for implementation.</p><p><strong>Results: </strong>In total, 6855 records were screened, yielding 14 full-text articles, which were included (3 randomised clinical trials and 11 non-randomised studies). 'Train and educate stakeholders' (n=13 (92.9%)) and 'use evaluative and iterative strategies' (n=12 (85.7%)) were the most common implementation strategies in financial navigation. The feasibility of financial navigation is relatively high, but generally hindered by the health condition of cancer survivors, low willingness to participate and insufficient number of navigators to cover all participants. After the intervention, three of seven studies reported statistically significant mitigations in patient-reported financial toxicity. In studies reporting statistically significant outcomes, 'adapt and tailor to the context' and 'change infrastructure' were proposed as key corresponding recommendations.</p><p><strong>Conclusions: </strong>Financial navigation is a potentially beneficial intervention for lessening the financial toxicity of cancer survivors, but more high-level evidence is needed for further validation. Financial navigation combined with the theoretical framework of implementation science provides a foundation for the future realisation of the leap from knowledge to practice.</p><p><strong>Prospero registration number: </strong>CRD42023469114.</p>","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":"691-701"},"PeriodicalIF":6.5,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143522708","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":"Use of structured handoff protocols for within-hospital unit transitions: a systematic review from Making Healthcare Safer IV.","authors":"Sean McCarthy, Aneesa Motala, Emily Lawson, Paul G Shekelle","doi":"10.1136/bmjqs-2024-018385","DOIUrl":"10.1136/bmjqs-2024-018385","url":null,"abstract":"<p><strong>Background: </strong>Handoffs are a weak link in the chain of clinical care of inpatients. Within-unit handoffs are increasing in frequency due to changes in duty hours. There are strong rationales for standardising the reporting of critical information between providers, and such practices have been adopted by other industries.</p><p><strong>Objectives: </strong>As part of Making Healthcare Safer IV we reviewed the evidence from the last 10 years that the use of structured handoff protocols influences patient safety outcomes within acute care hospital units.</p><p><strong>Methods: </strong>We searched four databases for systematic reviews and original research studies of any design that assessed structured handoff protocols and reported patient safety outcomes. Screening and eligibility were done in duplicate, while data extraction was done by one reviewer and checked by a second reviewer. The synthesis of results is narrative. Certainty of evidence was based on the Grading of Recommendations Assessment, Development and Evaluation framework as modified for Making Healthcare Safer IV.</p><p><strong>Results: </strong>We searched for evidence on 12 handoff tools. Two systematic reviews of Situation, Background, Assessment, Recommendation (SBAR) (including 11 and 28 original research studies; 5 and 15 were about the use in handoffs) and two newer original research studies provided low certainty evidence that the SBAR tool improves patient safety outcomes. Ten original research studies (about nine implementations) provided moderate certainty evidence that the I-PASS tool (Illness severity, Patient summary, Action list, Situation awareness, Synthesis to receiver) reduces medical errors and adverse events. No other structured handoff tool was assessed in more than one study or one setting.</p><p><strong>Conclusion: </strong>The SBAR and I-PASS structured tools for within-unit handoffs probably improve patient safety, with I-PASS having a stronger certainty of evidence. Other published tools lack sufficient evidence to draw conclusions.</p><p><strong>Prospero registration number: </strong>CRD42024576324.</p>","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":"680-690"},"PeriodicalIF":6.5,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12232517/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143967291","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":"Can handoffs bridge the interprofessional divide to build a team?","authors":"Aubrey Samost-Williams, Eric J Thomas","doi":"10.1136/bmjqs-2025-018816","DOIUrl":"10.1136/bmjqs-2025-018816","url":null,"abstract":"","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":"637-639"},"PeriodicalIF":6.5,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12355651/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144759170","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":"How to scale and spread catheter avoidance nationwide.","authors":"Jerome A Leis","doi":"10.1136/bmjqs-2025-019048","DOIUrl":"10.1136/bmjqs-2025-019048","url":null,"abstract":"","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":"640-642"},"PeriodicalIF":6.5,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12505051/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144759171","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":"Translation without substitution: the need for responsible AI integration in patient instructions.","authors":"Ricky Odedra, Ruud Gerard Nijman, Phoebe Averill, Erik Mayer","doi":"10.1136/bmjqs-2025-019098","DOIUrl":"https://doi.org/10.1136/bmjqs-2025-019098","url":null,"abstract":"","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":""},"PeriodicalIF":6.5,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145069059","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":"Do patient safety incident investigations align with systems thinking? An analysis of contributing factors and recommendations.","authors":"Lorelle Bowditch, Charlotte Molloy, Brandon King, Masoumeh Abedi, Samantha Jackson, Mia Bierbaum, Yinghua Yu, Louise Raggett, Paul Salmon, Jeffrey Braithwaite, Johanna I Westbrook, Robyn Clay-Williams, Raghu Lingam, Sandy Middleton, Farah Magrabi, Virginia Mumford, Peter Hibbert","doi":"10.1136/bmjqs-2025-019063","DOIUrl":"https://doi.org/10.1136/bmjqs-2025-019063","url":null,"abstract":"<p><strong>Background: </strong>Globally, up to 17% of hospitalised people suffer a patient safety incident. Learning from adverse events through patient safety investigation is critical to prevention; however, their utility is still questioned. Two key investigation outputs include identifying contributing factors (CFs) and proposing recommendations to prevent future occurrences. Criticisms of current methods include incomplete analysis of CFs and weak incident prevention strategies. A proposed solution is systems thinking analysis, which recognises healthcare complexity. However, it is not clear whether such methods are being applied in practice.</p><p><strong>Objective: </strong>This study aimed to assess current use of systems thinking-based strategies by examining a set of Australian patient safety incident investigations.</p><p><strong>Methods: </strong>Investigations (n=300) from 56 different Australian health services were deductively analysed. Identified CFs were classified by healthcare system level using a framework combining Systems Engineering Initiative for Patient Safety (SEIPS) principles and AcciMap's hierarchical structure. Recommendation sustainability and effectiveness were classified as weak, medium or strong using US Department of Veteran Affairs' criteria.</p><p><strong>Results: </strong>51% of incidents were issues with clinical processes and procedures. The investigations identified CFs that disproportionally focused on the people involved in those processes (n=677, 47%) rather than other system levels and as a consequence, most recommendations were of medium (n=665, 51%) and weak (n=560, 43%) strength. Notably, 10% of investigations lacked any CFs or recommendations.</p><p><strong>Conclusion: </strong>The focus on individual actions highlighted that simple linear thinking persists in patient safety incident investigations. This study proposes five key areas of effective incident analysis and investigation: a sociotechnical focus; improved data collection techniques; investigative independence; the professionalisation of investigators; and the aggregation of data. Learning from incidents is key to maximising their preventative effectiveness, especially in an increasingly complex healthcare system.</p>","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":""},"PeriodicalIF":6.5,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145051789","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}