BMJ Quality & Safety最新文献

{"title":"Orthopaedic surgical implementation gap: an exploratory descriptive analysis tracking the use of common elective orthopaedic surgeries in England across two decades.","authors":"Laura Kudrna, Kelly Ann Schmidtke, Hannah Crothers, Katharine Reeves, Mary Kariuki, Chetan Khatri, Imran A Ahmed, Gevdeep Bhabra, Stephen Metcalfe, Samuel I Watson, Richard Lilford","doi":"10.1136/bmjqs-2026-020202","DOIUrl":"https://doi.org/10.1136/bmjqs-2026-020202","url":null,"abstract":"","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":""},"PeriodicalIF":6.8,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149179377","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 non-technical skills training on patient outcomes in surgery: a systematic review and meta-analysis.","authors":"Ibrahim M Muhammad, Maha F Valiyakathu, Gianluigi Zanovello, Stefan Haensel, Bhaskar Somani, Nicholas Raison","doi":"10.1136/bmjqs-2026-020646","DOIUrl":"https://doi.org/10.1136/bmjqs-2026-020646","url":null,"abstract":"<p><strong>Background: </strong>Non-technical skills (NTS) such as teamwork, communication and leadership are essential for surgical safety, but their impact on patient outcomes is uncertain. This systematic review evaluated whether NTS interventions improve operative and patient outcomes in surgical settings.</p><p><strong>Methods: </strong>Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines, seven databases were searched for randomised and non-randomised studies of NTS interventions reporting patient or operative outcomes. Eligible interventions included team training, simulation, Crew Resource Management, Team Strategies and Tools to Enhance Performance and Patient Safety and in-theatre coaching. Risk of bias was assessed with the Cochrane risk-of-bias tool for randomized trials and Risk Of Bias In Non-randomised Studies - of Interventions tools, and findings were synthesised both quantitatively and narratively.</p><p><strong>Results: </strong>13 studies met inclusion criteria. NTS interventions consistently improved teamwork, communication and checklist adherence, with a statistically significant gain in validated performance scores (mean difference (MD) 6.91 points, 95% CI 2.95 to 10.9). Clinical outcomes were less consistent: individual large, system-level programmes reported reductions in complications and mortality (relative reductions ≈15-20%), but pooled controlled analyses did not demonstrate statistically significant improvements in complications (OR 0.91, 95% CI 0.45 to 1.86), readmission (OR 0.90, 95% CI 0.61 to 1.33) or length of stay (MD -0.84 days, 95% CI -3.40 to 1.73).</p><p><strong>Conclusions: </strong>NTS training reliably improves observed teamwork and communication behaviours in the operating theatre, but the current evidence for a resulting benefit to patients is weak and dominated by non-randomised, higher risk of bias studies; the sole randomised trial found no significant benefit. Sustained, system-wide implementation with ongoing reinforcement and cultural alignment was associated with more consistent behavioural gains, but adequately powered randomised trials are needed before firm practice recommendations can be made.</p><p><strong>Prospero registration number: </strong>CRD420250648285.</p>","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":""},"PeriodicalIF":6.8,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149103548","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":"Uncovering the missing links: from peripheral intravenous catheter policy and care to measurable outcomes.","authors":"Josephine Lovegrove, Claire Rickard","doi":"10.1136/bmjqs-2025-020023","DOIUrl":"https://doi.org/10.1136/bmjqs-2025-020023","url":null,"abstract":"","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":""},"PeriodicalIF":6.8,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149103685","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":"Who chooses to engage? Understanding the characteristics of physicians who voluntarily engage with an audit and feedback intervention: a retrospective cohort study.","authors":"Cherry Chu, Noah Ivers, Braeden Terpou, Mina Tadrous, Canyucel Gungor, Geneviève Rouleau, Laura Desveaux","doi":"10.1136/bmjqs-2025-019490","DOIUrl":"10.1136/bmjqs-2025-019490","url":null,"abstract":"<p><strong>Background: </strong>Voluntary clinician engagement in audit and feedback (A&F) initiatives is often suboptimal. We compared a range of characteristics between physicians who voluntarily engaged and those who did not.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study using administrative databases and a survey. The cohort included Ontario primary care physicians practising between April 2017 and March 2020. The A&F group voluntarily enrolled in an A&F intervention; control physicians did not enrol. We compared demographic, practice and patient characteristics between groups. Four validated questionnaires measured beliefs about feedback and improvement. Logistic regression modelled adjusted odds of A&F engagement.</p><p><strong>Results: </strong>Of 10 654 active primary care physicians in Ontario, 1400 voluntarily engaged in A&F compared with 9254 controls. Physicians had higher odds of engaging with A&F if they had a larger roster size (OR (95% CI) 2.75 (2.15 to 3.51), p<0.001) and worked in home care (1.75 (1.55 to 1.97), p<0.001), and lower odds of engaging if they had higher continuity of care (0.66 (0.49 to 0.90), p=0.008), practised for more years (0.53 (0.44 to 0.62), p<0.001) and enrolled in a fee-for-service model (0.74 (0.65 to 0.85), p<0.001). Physicians engaged with A&F had fewer racialised or immigrant patients (25% vs 30% in marginalisation quintile 5, standardised mean difference=0.10), while other demographic characteristics were similar. Among the survey respondents (36 A&F physicians and 90 controls), higher principal support (2.28 (1.29 to 4.48), p=0.008), lower perceived need for change (discrepancy) (0.39 (0.20 to 0.70), p=0.003) and lower engagement in QI (0.43 (0.18 to 0.88), p=0.032) predicted A&F engagement.</p><p><strong>Conclusion: </strong>To expand A&F's reach and impact, future efforts should (1) tailor outreach to physicians with larger, more diverse practice populations, (2) seek to understand why physicians with higher perceived need for change engage less, (3) understand which physicians are most likely to benefit and (4) co-design how to make A&F more relevant and actionable for those serving marginalised communities.</p>","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":"661-672"},"PeriodicalIF":6.8,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13638282/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145740996","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":"Interprofessional learning as a mechanism for quality improvement and patient safety.","authors":"Andreas Xyrichis, Merrick Zwarenstein","doi":"10.1136/bmjqs-2026-020465","DOIUrl":"10.1136/bmjqs-2026-020465","url":null,"abstract":"","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":"658-660"},"PeriodicalIF":6.8,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148444247","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":"10.1136/bmjqs-2026-020130","url":null,"abstract":"","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":"722-726"},"PeriodicalIF":6.8,"publicationDate":"2026-09-21","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":"Audit and feedback in primary care: if you build it, will they come? Understanding which clinicians engage with an audit and feedback intervention.","authors":"Steve Van den Bulck, Bert Vaes","doi":"10.1136/bmjqs-2025-019939","DOIUrl":"10.1136/bmjqs-2025-019939","url":null,"abstract":"","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":"655-657"},"PeriodicalIF":6.8,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148381529","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":"International survey of people living with chronic conditions: development and evaluation of the PaRIS Patient Questionnaire (PaRIS-PQ) in 18 countries.","authors":"Jose M Valderas, Ian Porter, Jonathan P Evans, Monique Heijmans, Mieke Rijken, Oliver Groene, Janika Bloemeke-Cammin, Rosa Sunol, Rachel Williams, Marta Ballester, Katherine de Bienassis, Candan Kendir, Frederico Guanais, Dolf de Boer, Michael van den Berg","doi":"10.1136/bmjqs-2025-018548","DOIUrl":"10.1136/bmjqs-2025-018548","url":null,"abstract":"<p><strong>Background: </strong>The Patient Reported Indicator Surveys (PaRIS) initiative of the Organisation for Economic Co-operation and Development aimed to develop a valid and reliable instrument for self-reported assessment of health outcomes and experiences in primary and ambulatory care for people living with chronic conditions. This paper reports on the development and evaluation of the PaRIS Patient Questionnaire (PaRIS-PQ) in an 18-country field trial.</p><p><strong>Methods: </strong>Following systematic reviews of instruments measuring core domains in the PaRIS conceptual framework (outcomes, experiences, health and healthcare capabilities and health behaviours), four instruments for each domain were shortlisted, and their psychometric performance was assessed using the Evaluating the Measurement of Patient-Reported Outcomes tool. In a modified Delphi procedure, one instrument was selected for each domain, along with additional relevant items. The preliminary English questionnaire was translated and cognitively tested. Psychometric evaluation was conducted on field trial data at item (missingness, distribution, ceiling/floor effects) and scale level (reliability, structure, construct validity).</p><p><strong>Findings: </strong>217 instruments were identified measuring one or more of the domains of the conceptual framework. Following mapping and prioritisation, the first draft of the PaRIS-PQ included 118 items. In the field trial (18 countries, 10 894 patients) median completion time ranged 24-33 minutes. PaRIS-PQ performed well at item and scale level. Reliability was ≥0.70 for most relevant measures at patient level, but not at practice and country level. Validity was adequate overall. Removal of additional items (3) resulted in the final PaRIS-PQ (115 items).</p><p><strong>Interpretation: </strong>PaRIS-PQ demonstrates adequate psychometric performance for measuring experiences and outcomes of primary care for people living with chronic conditions. The instrument facilitates the collection of essential information for health policy and systems decision-making.</p>","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":"687-697"},"PeriodicalIF":6.8,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13638274/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145147749","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":"Development and pilot evaluation of the implementation of a whole-team training pack to improve the effectiveness, efficiency, safety and equity of remote general practice.","authors":"Joseph Clift, Francesca Helen Dakin, Anwar Khan, Nicholas Woodier, Trisha Greenhalgh, Rebecca Payne","doi":"10.1136/bmjqs-2026-020139","DOIUrl":"10.1136/bmjqs-2026-020139","url":null,"abstract":"<p><p>Remote consulting was rapidly implemented in UK general practice with limited preparation or training. Subsequent research and national investigations have identified patient safety risks. Although evidence-based recommendations and competencies for safer remote care now exist, there is limited guidance on how to implement them in everyday practice.This project aimed to develop, pilot and refine a scalable, whole-team training intervention and to assess its feasibility and acceptability within general practice.Drawing on findings from the Remote by Default 2 study and national patient safety investigations, we co-produced a vignette-based, whole-practice training package with NHS (National Health Service) Resolution and the Health Services Safety Investigations Body. Seven fictionalised patient safety cases were developed to reflect common risks in remote care and were designed to be worked through by practice teams using their own systems and processes. Training was delivered to six general practices across the UK in facilitated sessions lasting 1-2 hours. Anonymous staff feedback was collected immediately after training, with additional reflective feedback obtained several weeks later to support iterative refinement.Sixty-seven staff participated, including clinicians, managers, receptionists and administrative staff. Feedback suggested that the case-based format was engaging and supported whole-team reflection on how remote care systems operate in practice. Participants valued the focus on practice systems rather than individual performance and reported perceived increased awareness of safety risks associated with remote consulting. Equity-related issues featured prominently, with teams reflecting on how remote access and triage processes may disadvantage some patient groups and identifying potential system changes, such as prioritising face-to-face assessment or updating vulnerability registers.This study has demonstrated the feasibility and acceptability of whole-team, systems-focused training to support safer remote general practice.</p>","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":"714-721"},"PeriodicalIF":6.8,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148315734","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 of a patient-centred complex intervention to improve Initial Medication Adherence to cardiovascular disease and diabetes treatments in primary care (the IMA-cRCT study): a mixed-methods process evaluation.","authors":"Carmen Corral-Partearroyo, Alba Sánchez-Viñas, María Teresa Peñarrubia-María, Montserrat Gil-Girbau, Ignacio Aznar-Lou, Claudia Palma-Vasquez, Carmen Gallardo-González, María Del Carmen Olmos-Palenzuela, Maria Rubio-Valera","doi":"10.1136/bmjqs-2024-018403","DOIUrl":"10.1136/bmjqs-2024-018403","url":null,"abstract":"<p><strong>Introduction: </strong>The initial medication adherence (IMA) intervention aims to improve adherence to cardiovascular disease (CVD) and diabetes treatments in primary care (PC) through standardised shared decision-making (SDM) and healthcare professional (HCP) collaboration (general practitioners (GPs), nurses and pharmacists). This study assessed the intervention's implementation (strategies, fidelity and integration into routine practice-based on the Normalisation Process Theory), mechanisms of action and the role of context.</p><p><strong>Methods: </strong>The IMA-cRCT was an effectiveness-implementation cluster-Randomised Controlled Trial involving 24 Spanish PC centres (>300 HCP; >3000 patients) based on real-world evidence. This nested process evaluation used quantitative (monitoring data; HCP questionnaires) and qualitative methods (field diaries; 36 semistructured individual interviews and two focus groups (19 patients, 28 HCPs)). Quantitative data explored implementation and context and were analysed descriptively, while qualitative data examined implementation, mechanisms of action and context and were analysed using framework analysis. Both analyses were integrated for interpretation.</p><p><strong>Results: </strong>Intervention implementation fidelity (6.5/10) and normalisation into clinical practice (7.6/10) were adequate, particularly regarding SDM and use of decision aids. HCPs recognised the importance of SDM, although some assumed it was already part of routine practice. The anticipated mechanisms of action were moderately supported. HCPs' knowledge and attitudes towards SDM improved as they acknowledged its relevance to practice. Some patients reported participation in decision-making, while others preferred the GP to decide on their behalf. Patients found leaflets helpful for understanding information. Contextual factors influencing the intervention were mainly organisational, such as lack of time and familiarity with SDM.</p><p><strong>Conclusions: </strong>The interprofessional SDM-based IMA intervention was considered beneficial for patients and HCPs, with adequate implementation fidelity and normalisation into practice. The intervention was important for HCPs, and patients accepted it. However, greater effort is needed to extend SDM throughout healthcare, moving towards patient-centred care. These results have enhanced understanding of SDM interventions and support their refinement for future implementation.</p><p><strong>Trial registration number: </strong>ClinicalTrials.gov, NCT05026775.</p>","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":"673-686"},"PeriodicalIF":6.8,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13638341/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144246363","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}