BMJ Quality & Safety最新文献

{"title":"Low-quality evidence on practices to prevent transmission of resistant organisms calls for rigorous trials and a paradigm shift.","authors":"Barbara Trautner, Marin L Schweizer","doi":"10.1136/bmjqs-2024-017996","DOIUrl":"10.1136/bmjqs-2024-017996","url":null,"abstract":"","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":"210-212"},"PeriodicalIF":5.6,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142791135","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":"Prevention in adults of transmission of infection with multidrug-resistant organisms: an updated systematic review from Making Healthcare Safer IV.","authors":"Sean McCarthy, Aneesa Motala, Paul G Shekelle","doi":"10.1136/bmjqs-2024-017545","DOIUrl":"10.1136/bmjqs-2024-017545","url":null,"abstract":"<p><strong>Background: </strong>Healthcare-associated infections due to multidrug-resistant organisms (MDROs) remain a high priority patient safety topic, despite broad acceptance as standard-of-care safety practices to prevent central line-associated bloodstream infection, catheter-associated urinary tract infection and ventilator-associated pneumonia. Prior editions of Making Healthcare Safer have mixed certainty evidence for various other patient safety practices.</p><p><strong>Objectives: </strong>As part of Making Healthcare Safer IV, we performed an updated systematic review on the certainty of evidence for the following safety practices at reducing in-facility MDRO infections in adult patients: universal gloving, contact precautions, cohorting, environmental decontamination, patient decolonisation and the adverse effects of isolation.</p><p><strong>Methods: </strong>We searched PubMed and the Cochrane Library 2011-May 2023 for systematic reviews and original research studies, both randomised and observational. Settings were limited to high-income countries. 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 GRADE (Grading of Recommendations Assessment, Development and Evaluation) framework.</p><p><strong>Results: </strong>Three systematic reviews and three original research studies provided moderate certainty evidence that patient decolonisation reduced MDRO infections, although restricted to certain populations and organisms. One systematic review provided low certainty evidence that universal gloving was beneficial, again limited to certain populations. One systematic review and two original research studies provided low certainty evidence of benefit for environmental decontamination. One systematic review and one new original study provided low certainty evidence of benefit for cohorting in outbreak settings, and very low certainty evidence of benefit in endemic settings. Six original research studies provide mixed evidence for benefit of contact precautions. There is very low certainty evidence of a signal of increased non-infectious adverse events under patients in contact isolation.</p><p><strong>Conclusion: </strong>In general, the reviewed patient safety practices reduced MDRO infections, but certainty of evidence was low.</p><p><strong>Prospero registration number: </strong>CRD42023444973.</p>","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":"244-256"},"PeriodicalIF":5.6,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142341463","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":"Global, regional and national time trends in incidence of adverse effects of medical treatment, 1990-2019: an age-period-cohort analysis from the Global Burden of Disease 2019 study.","authors":"Liangquan Lin","doi":"10.1136/bmjqs-2023-016971","DOIUrl":"10.1136/bmjqs-2023-016971","url":null,"abstract":"<p><strong>Background: </strong>Current adverse effects of medical treatment (AEMT) incidence estimates rely on limited record reviews and underreporting surveillance systems. This study evaluated global and national longitudinal patterns in AEMT incidence from 1990 to 2019 using the Global Burden of Disease (GBD) framework.</p><p><strong>Methods: </strong>AEMT was defined as harm resulting from a procedure, treatment or other contact with the healthcare system. The overall crude incidence rate, age-standardised incidence rate and their changes over time were analysed to evaluate temporal trends. Data were stratified by sociodemographic index (SDI) quintiles, age groups and sex to address heterogeneity across and within nations. An age-period-cohort model framework was used to differentiate the contributions of age, period and cohort effects on AEMT incidence changes. The model estimated overall and age-specific annual percentage changes in incidence rates.</p><p><strong>Findings: </strong>Although the global population increased 44.6% from 1990 to 2019, AEMT incidents rose faster by 59.3%. The net drift in the global incidence rate was 0.631% per year. The proportion of all cases accounted for by older adults and the incidence rate among older adults increased globally. The high SDI region had much higher and increasing incidence rates versus declining rates in lower SDI regions. The age effects showed that in the high SDI region, the incidence rate is higher among older adults. Globally, the period effect showed a rising incidence of risk after 2002. Lower SDI regions exhibited a significant increase in incidence risk after 2012. Globally, the cohort effect showed a continually increasing incidence risk across sequential birth cohorts from 1900 to 1950.</p><p><strong>Conclusion: </strong>As the global population ageing intensifies alongside the increasing quantity of healthcare services provided, measures need to be taken to address the continuously rising burden of AEMT among the older population.</p>","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":"223-233"},"PeriodicalIF":5.6,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141305394","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":"Rapid response systems, antibiotic stewardship and medication reconciliation: a scoping review on implementation factors, activities and outcomes.","authors":"Jonas Torp Ohlsen, Eirik Søfteland, Per Espen Akselsen, Jörg Assmus, Stig Harthug, Regina Küfner Lein, Nick Sevdalis, Hilde Valen Wæhle, John Øvretveit, Miriam Hartveit","doi":"10.1136/bmjqs-2024-017185","DOIUrl":"10.1136/bmjqs-2024-017185","url":null,"abstract":"<p><strong>Introduction: </strong>Many patient safety practices are only partly established in routine clinical care, despite extensive quality improvement efforts. Implementation science can offer insights into how patient safety practices can be successfully adopted.</p><p><strong>Objective: </strong>The objective was to examine the literature on implementation of three internationally used safety practices: medication reconciliation, antibiotic stewardship programmes and rapid response systems. We sought to identify the implementation activities, factors and outcomes reported; the combinations of factors and activities supporting successful implementation; and the implications of the current evidence base for future implementation and research.</p><p><strong>Methods: </strong>We searched Medline, Embase, Web of Science, Cumulative Index to Nursing and Allied Health Literature, PsycINFO and Education Resources Information Center from January 2011 to March 2023. We included original peer-reviewed research studies or quality improvement reports. We used an iterative, inductive approach to thematically categorise data. Descriptive statistics and hierarchical cluster analyses were performed.</p><p><strong>Results: </strong>From the 159 included studies, eight categories of implementation activities were identified: <i>education; planning and preparation; method-based approach; audit and feedback; motivate and remind; resource allocation; simulation and training;</i> and <i>patient involvement</i>. Most studies reported activities from multiple categories. Implementation factors included: c<i>linical competence and collaboration; resources; readiness and engagement; external influence; organisational involvement; QI competence;</i> and <i>feasibility of innovation</i>. Factors were often suggested post hoc and seldom used to guide the selection of implementation strategies. Implementation outcomes were reported as: <i>fidelity or compliance; proxy indicator for fidelity; sustainability; acceptability;</i> and <i>spread</i>. Most studies reported implementation improvement, hindering discrimination between more or less important factors and activities.</p><p><strong>Conclusions: </strong>The multiple activities employed to implement patient safety practices reflect mainly method-based improvement science, and to a lesser degree determinant frameworks from implementation science. There seems to be an unexploited potential for continuous adaptation of implementation activities to address changing contexts. Research-informed guidance on how to make such adaptations could advance implementation in practice.</p>","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":"257-268"},"PeriodicalIF":5.6,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141282906","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":"Choosing 'Less' Wisely as a marker of decisional conflict.","authors":"Karen Okrainec, Melissa Roy","doi":"10.1136/bmjqs-2024-017933","DOIUrl":"10.1136/bmjqs-2024-017933","url":null,"abstract":"","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":"207-209"},"PeriodicalIF":5.6,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143051572","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":"The problem with the existing reporting standards for adverse event and medical error research.","authors":"Christopher R Carpenter, Richard T Griffey, Anne W S Rutjes, Maria Unbeck, Lee M Adler, David C Stockwell, David Classen","doi":"10.1136/bmjqs-2024-017491","DOIUrl":"10.1136/bmjqs-2024-017491","url":null,"abstract":"<p><p>The Enhancing the Quality and Transparency of Health Research (EQUATOR) Network indexes over 600 reporting guidelines designed to improve the reproducibility of manuscripts across medical fields and study designs. Although several such reporting guidelines touch on adverse events that may occur in the context of a study, there is a large body of research whose primary focus is on adverse events, near-misses and medical errors that do not currently have a dedicated reporting guideline to help set reporting standards and facilitate comparisons across studies. As part of the process prescribed by EQUATOR for developing such a reporting guideline, we performed a needs assessment, evaluating whether existing standards address key features of a proposed reporting guideline in development, entitled <i>Standard Elements in Studies of Adverse Events and Medical Error</i> (SESAME). We evaluated 12 EQUATOR reporting guidelines for the presence of eight key features of SESAME. Five of the 12 failed to include any of these key features. None of the remaining seven incorporated more than four of the eight SESAME key components, confirming the need for a dedicated reporting guideline for studies of adverse events and medical errors.</p>","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":"273-278"},"PeriodicalIF":5.6,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143397964","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 from an allied health perspective on quality and safety.","authors":"Nicole Müller, Refaie Amr El, Margaret McGrath, Joseph McVeigh","doi":"10.1136/bmjqs-2024-018107","DOIUrl":"https://doi.org/10.1136/bmjqs-2024-018107","url":null,"abstract":"","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143656070","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":"Just how many diagnostic errors and harms are out there, really? It depends on how you count.","authors":"David E Newman-Toker","doi":"10.1136/bmjqs-2024-017967","DOIUrl":"https://doi.org/10.1136/bmjqs-2024-017967","url":null,"abstract":"","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143639576","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":"Equity in action: a scoping review and meta-framework for embedding equity in quality improvement.","authors":"Tara A Burra, Bourne Auguste, Lisha Lo, Toluwanimi Durowaye, Haben Dawit, Susanna Fung, Christine Shea, Terri Rodak, Noor Ramji, Sanjeev Sockalingam, Brian M Wong","doi":"10.1136/bmjqs-2024-018335","DOIUrl":"https://doi.org/10.1136/bmjqs-2024-018335","url":null,"abstract":"<p><strong>Background: </strong>There are increasing efforts to include equity in all quality improvement (QI) initiatives. A comprehensive framework to embed equity in QI has been lacking, which acts as a barrier to the QI community from taking action to reduce healthcare inequities.</p><p><strong>Objectives: </strong>The objectives of this scoping review were to: (1) map and summarise available equity frameworks for QI and (2) create a 'meta-framework' for QI leaders and practitioners, with engagement of people with lived experience of health inequities.</p><p><strong>Methods: </strong>Articles were identified with searches of four databases (MEDLINE, Embase, PsycInfo and CINAHL) and review of reference lists from included articles. Articles that reported how equity can be meaningfully integrated into QI were included. A qualitative inductive thematic analysis and community member engagement and consultation were completed to clarify recommended strategies for embedding equity in QI.</p><p><strong>Results: </strong>The search strategy yielded 2776 unique articles, with 40 meeting the inclusion criteria. A meta-framework for embedding equity in QI was created that has two enablers: broadening theoretic underpinnings and organisational culture, structures and leadership. The meta-framework also has six domains: (1) engage with people with lived experience of health inequities; (2) define the equity problem and aim; (3) diversify and train the QI team; (4) examine broader root causes; (5) intervene to reduce inequities; and (6) measure impacts on equity. The community member consultation identified key facilitators and common pitfalls in involving community members in QI.</p><p><strong>Conclusion: </strong>This meta-framework is a comprehensive resource to integrate equity into all aspects of QI practice. Further study of its implementation is recommended. Revisions to QI guidelines and training curricula are also needed to drive and sustain the embedding of equity in QI.</p>","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143623466","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 hospitals' LGBTQ+ inclusion efforts on patient satisfaction from 2016 to 2023: a retrospective longitudinal observational study.","authors":"Hyunmin Yu, Matthew D McHugh, José A Bauermeister, Tari Hanneman, Heather Brom","doi":"10.1136/bmjqs-2024-018235","DOIUrl":"https://doi.org/10.1136/bmjqs-2024-018235","url":null,"abstract":"<p><strong>Background: </strong>Given the emphasis on promoting inclusive policies, we investigated the relationship between US hospitals' inclusion efforts for lesbian, gay, bisexual, transgender, queer or questioning, and other sexual and gender-diverse (LGBTQ+) populations and patient satisfaction from 2016 to 2023.</p><p><strong>Methods: </strong>This retrospective longitudinal observational study analysed 6 years of data between 2016 and 2023 from the Healthcare Equality Index (HEI), which measures hospitals' LGBTQ+ inclusion efforts, and the Hospital Consumer Assessment of Healthcare Providers and Systems, which measures patient satisfaction. Generalised estimating equations (GEE) were used to obtain population-averaged estimates of the association between hospitals' LGBTQ+ inclusion efforts-assessed by (1) their participation and (2) performance in the HEI (range: 0-100)-and patient satisfaction-measured by (1) patients' hospital rating (range: 0-100) and (2) willingness to recommend the hospital (range: 0-100). We accounted for hospital characteristics, including medical teaching status, specialised service capability, hospital size, ownership, system membership, region and metropolitan location.</p><p><strong>Results: </strong>Compared with hospitals that never participated in the HEI, those that occasionally participated reported a 0.33-point higher patient rating (p=0.019, 95% CI 0.05, 0.60) and a 0.49-point higher patient recommendation score (p=0.011, 95% CI 0.11, 0.87). Those who always participated reported a 1.30-point higher rating (p<0.001, 95% CI 0.89, 1.70) and a 1.90-point higher recommendation score (p<0.001, 95% CI 1.36, 2.44). Among hospitals that participated in the HEI, a 10-point increase in the total HEI score was associated with a 0.10-point increase in patient ratings (p=0.031, 95% CI 0.01, 0.20) and a 0.15-point increase in patient recommendations (p=0.023, 95% CI 0.02, 0.28).</p><p><strong>Conclusion: </strong>Hospitals engaging in LGBTQ+ inclusion efforts are associated with higher patient satisfaction.</p>","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143572007","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}