BMJ Quality & Safety最新文献

{"title":"Learning from healthcare complaints: challenges and opportunities.","authors":"Tom W Reader","doi":"10.1136/bmjqs-2025-019081","DOIUrl":"https://doi.org/10.1136/bmjqs-2025-019081","url":null,"abstract":"","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":""},"PeriodicalIF":6.5,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144999519","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":"Service users' experiences of maternity care in England informed by the Saving Babies' Lives Care Bundle Version 2: A reflexive thematic analysis.","authors":"Holly E Reid, Debbie M Smith, Kate Widdows, Alexander Ep Heazell","doi":"10.1136/bmjqs-2025-018582","DOIUrl":"https://doi.org/10.1136/bmjqs-2025-018582","url":null,"abstract":"<p><strong>Background: </strong>In 2019, NHS England launched the second version of the Saving Babies' Lives Care Bundle (SBLCBv2), recommendations that maternity providers are expected to fully implement, in an ongoing effort to reduce stillbirths and preterm births. Although stillbirth rates have seen an overall significant reduction since the inception of the SBLCB, experiences of maternity care in England are deteriorating. This study aimed to explore service users' experiences of SBLCBv2-informed maternity care to help understand the aspects of care they received positively and those needing improvement.</p><p><strong>Methods: </strong>This qualitative study captured service users' experiences of receiving maternity care across England between November 2022 and December 2023. Purposive sampling was employed to include service users from diverse backgrounds with a variety of experiences of each element of SBLCBv2. Participants (n=29) were 16 years or older, had given birth within the previous 12 months and could comprehend and speak English. Semi-structured interviews were conducted via video call and the data analysed using reflexive thematic analysis.</p><p><strong>Results: </strong>Four main themes with nine subthemes were developed: (1) feelings towards measuring and monitoring, (2) the importance of clear communication, (3) healthcare professionals' roles in decision-making and (4) belief in service users, trust in healthcare professionals. Each theme is discussed in relation to the five elements, and the 'Important Principles', of SBLCBv2.</p><p><strong>Conclusions: </strong>Our findings echo maternity care needs reported elsewhere in the literature, suggesting the interventions introduced in SBLCBv2 are generally acceptable but that information about SBLCBv2 must be personalised, and clearly presented, to each individual. Professionals play an important role in service users' decision-making, and participants' perceptions of how collaborative and supportive professionals were in decision-making processes varied. Believing service users and trusting professionals are of paramount importance for ensuring service users have positive maternity care experiences.</p>","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":""},"PeriodicalIF":6.5,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144942354","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":"Effectiveness of clinician-directed default nudges on reducing overuse of tests and treatments in healthcare: a systematic review of randomised controlled trials.","authors":"Gemma Altinger, Caitlin M P Jones, Giovanni E Ferreira, Jason Soon, Tammy C Hoffmann, Christopher Maher, Rui Chang, Jeffrey A Linder, Adrian Traeger","doi":"10.1136/bmjqs-2025-018793","DOIUrl":"10.1136/bmjqs-2025-018793","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the effectiveness of clinician-directed default nudges for reducing overuse of tests and treatments.</p><p><strong>Design: </strong>A systematic review was conducted to synthesise evidence from randomised controlled trials examining the effect of clinician-directed default nudges on overuse of tests or treatments, measured as a proportion of encounters or patients. Four databases and three clinical trial registries were searched up to 13 January 2025. Two reviewers screened, extracted data, assessed risk of bias and certainty of evidence using Cochrane guidance. Because there was high clinical heterogeneity, we used the Synthesis Without Meta-analysis guidelines for our overall analysis. A secondary exploratory meta-analysis was performed on a subgroup of default nudge interventions targeting opioid prescriptions.</p><p><strong>Results: </strong>We included six trials (five cluster randomised trials and one patient randomised trial, n=767 to 21 331). Trials targeted overuse of opioids, antibiotics, high-risk medicines for older patients and imaging during palliative radiotherapy. Lowering default quantities of opioids may cause reductions in opioid overuse, but on one occasion increased overuse. It is unclear if opt-out defaults reduce antibiotic overuse in patients with sepsis eligible for de-escalation or if lowering default doses reduce overuse of high-risk medications in older patients. Reducing the default frequency of imaging probably causes large reductions in unnecessary imaging in people receiving palliative radiotherapy. A subgroup meta-analysis was only possible on one type of default for opioids. A 10-tablet default may reduce overuse of large packs of opioids (risk difference=-14.3%, 95% CI -51.4% to +22.9%, 3 trials, 18 186 encounters, very low certainty evidence).</p><p><strong>Conclusions: </strong>Clinician-directed default nudges had inconsistent effects on overuse of healthcare, with limited and mostly low certainty evidence. High-quality trials are essential to determine whether default nudges reduce overuse or improve patient outcomes.</p><p><strong>Prospero registration number: </strong>42024516423.</p>","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":""},"PeriodicalIF":6.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144667026","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":"Key partner priorities for measures of safe outpatient paediatric medication use.","authors":"Jonelle Prideaux, Maria T Britto, Lisa M Vaughn, Katherine A Auger, Cassandra Dodds Fetters, James M Hoffman, Julia M Kim, Kathleen E Walsh","doi":"10.1136/bmjqs-2025-018799","DOIUrl":"https://doi.org/10.1136/bmjqs-2025-018799","url":null,"abstract":"<p><strong>Background and objectives: </strong>Paediatric medication use is at high risk for errors due to factors such as weight-based dosing and liquid medications. In the outpatient setting, where most children take their medicines, errors are common and can be dangerous. However, errors are not widely measured in this setting. Continuous measurement is the first step towards quality improvement. Our aim was to collaborate with a variety of professional and patient/family key partners to identify types of measures needed to assess paediatric outpatient medication errors, including those that occur in the home.</p><p><strong>Methods: </strong>We conducted qualitative interviews and concept mapping with parents, pharmacists, paediatricians, nurses, health system leaders and healthcare organisational leaders. Using concept mapping, a multiple-step structured process of surveys, sorting and analysis using multidimensional scaling and hierarchical cluster analysis, participants generated measures and prioritised those they considered most important and feasible to measure in future medication error instruments. At the same time, interviews identified gaps in current measurement approaches and top priorities to fill these gaps. Results were compared during analysis.</p><p><strong>Results: </strong>Concept mapping participants (n=71) contributed ideas which key partner panel (n=9) mapped into seven clusters: prescribing errors, giving medication/administration, pharmacy dispensing, dosing tools and education, monitoring for problems, error surveillance and family partnership in understanding errors. Interview participants (n=24) highlighted the need for health system measures of safe outpatient medication used for quality improvement, including feasible measures related to home administration, dispensing errors and measures of harm. The ability to segment data by high-risk populations (eg, preferred language) was a priority.</p><p><strong>Conclusions: </strong>Measures of safe administration at home were the highest priority for parents and healthcare professionals. Development of these measures is critical as no scalable measures for this element of care are available. These and other prioritised measures will likely need to include caregiver report.</p>","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":""},"PeriodicalIF":6.5,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144942288","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":"Bridging diagnostic safety and mental health: a systematic review highlighting inequities in autism spectrum disorder diagnosis.","authors":"Abirami Srivarathan, Andrea Bradford, Sara Shearkhani, Layla Heimlich, Sheryl Jefferson, Kristen E Miller, Kelly Smith, Helen Haskell, Traber D Giardina","doi":"10.1136/bmjqs-2025-018723","DOIUrl":"https://doi.org/10.1136/bmjqs-2025-018723","url":null,"abstract":"<p><strong>Introduction: </strong>There is increased recognition that diagnostic errors disproportionately affect marginalised and underserved patient populations in the USA. However, evidence on diagnostic inequities in mental disorders is sparse and not well integrated into the overall diagnostic safety literature.</p><p><strong>Objective: </strong>We systematically reviewed and narratively synthesised evidence on inequities in diagnosis of mental disorders, guided by the Diagnostic Process Framework developed by The National Academies of Sciences, Engineering, and Medicine.</p><p><strong>Methods: </strong>We conducted a systematic review and a narrative synthesis. Medline, Embase, PsycInfo and CINAHL were searched for studies published between 2015 and 2024. Studies were eligible if they reported on inequities in the diagnosis of mental disorders and applied a quantitative, qualitative or mixed-methods design. Studies had to be peer reviewed, US based and published in English. The Mixed-Methods Appraisal Tool was used for quality appraisal. Data were analysed with a descriptive intent, and inequities were mapped into the diagnostic process.</p><p><strong>Results: </strong>20 studies of varying methodological quality were included. Though not the initial focus, autism spectrum disorder (ASD) emerged as the most studied mental disorder (n=17). Of the diagnostic errors identified, most fell into the category of delayed diagnosis. 11 factors emerged as contributors to diagnostic inequities. Limited health literacy among patients and caregivers was the leading cause of diagnostic error in symptom recognition. Insurance coverage issues delayed patient engagement with the healthcare system. Provider bias during clinical history-taking and interviewing was seen as a key cause of delays and misdiagnoses. Within diagnostic testing and interpretation, culturally inequivalent assessment measures might cause misdiagnosis and delayed diagnosis for Black/African American and Hispanic/Latino patients. The use of medical jargon and lack of qualified language interpreters during communicating the diagnosis were associated with diagnostic errors impacting patients with limited health literacy and low English language proficiency.</p><p><strong>Conclusions: </strong>Diagnostic inequities in ASD and other mental disorders persist across US patient populations. Multiple factors such as parental health literacy, provider bias and limited access interact and impact the diagnostic process. Addressing these interconnected barriers is essential to ensure timely, accurate and equitable care.</p><p><strong>Prospero registration number: </strong>CRD42024581271.</p>","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":""},"PeriodicalIF":6.5,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144942378","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":"Why tackling overuse will not succeed without changing our culture.","authors":"Rudolf Bertijn Kool, Andrea M Patey","doi":"10.1136/bmjqs-2024-018440","DOIUrl":"10.1136/bmjqs-2024-018440","url":null,"abstract":"","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":"563-566"},"PeriodicalIF":6.5,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143963463","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":"False hope of a single generalisable AI sepsis prediction model: bias and proposed mitigation strategies for improving performance based on a retrospective multisite cohort study.","authors":"Rudolf Schnetler, Anton van der Vegt, Vikrant R Kalke, Paul Lane, Ian Scott","doi":"10.1136/bmjqs-2024-018328","DOIUrl":"10.1136/bmjqs-2024-018328","url":null,"abstract":"<p><strong>Objective: </strong>To identify bias in using a single machine learning (ML) sepsis prediction model across multiple hospitals and care locations; evaluate the impact of six different bias mitigation strategies and propose a generic modelling approach for developing best-performing models.</p><p><strong>Methods: </strong>We developed a baseline ML model to predict sepsis using retrospective data on patients in emergency departments (EDs) and wards across nine hospitals. We set model sensitivity at 70% and determined the number of alerts required to be evaluated (number needed to evaluate (NNE), 95% CI) for each case of true sepsis and the number of hours between the first alert and timestamped outcomes meeting sepsis-3 reference criteria (HTS3). Six bias mitigation models were compared with the baseline model for impact on NNE and HTS3.</p><p><strong>Results: </strong>Across 969 292 admissions, mean NNE for the baseline model was significantly lower for EDs (6.1 patients, 95% CI 6 to 6.2) than for wards (7.5 patients, 95% CI 7.4 to 7.5). Across all sites, median HTS3 was 20 hours (20-21) for wards vs 5 (5-5) for EDs. Bias mitigation models significantly impacted NNE but not HTS3. Compared with the baseline model, the best-performing models for NNE with reduced interhospital variance were those trained separately on data from ED patients or from ward patients across all sites. These models generated the lowest NNE results for all care locations in seven of nine hospitals.</p><p><strong>Conclusions: </strong>Implementing a single sepsis prediction model across all sites and care locations within multihospital systems may be unacceptable given large variances in NNE across multiple sites. Bias mitigation methods can identify models demonstrating improved performance across most sites in reducing alert burden but with no impact on the length of the prediction window.</p>","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":"580-589"},"PeriodicalIF":6.5,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143728434","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":"Unreasonable effectiveness of training AI models locally.","authors":"Gabriel Wardi, Christopher A Longhurst","doi":"10.1136/bmjqs-2025-018543","DOIUrl":"10.1136/bmjqs-2025-018543","url":null,"abstract":"","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":"567-569"},"PeriodicalIF":6.5,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12353756/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143962029","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":"Grand rounds in methodology: improving the design of staggered implementation cluster randomised trials.","authors":"Samuel I Watson, Richard Hooper","doi":"10.1136/bmjqs-2025-018697","DOIUrl":"10.1136/bmjqs-2025-018697","url":null,"abstract":"<p><p>The stepped-wedge cluster randomised trial is a popular design in implementation and health services research. All clusters, such as clinics or hospitals, start in the control state, and gradually switch over to treatment in a random order until all clusters have received the intervention. The design allows for the incorporation of an experiment into the gradual roll-out of an intervention across clusters. However, the traditional stepped-wedge layout may not be the best choice in many scenarios. In this article, we discuss modifications to the stepped-wedge design that maintain a staggered roll-out, but which may improve some key characteristics. We consider improving the timing of implementation periods, reducing the volume of data collection and allowing for the recruitment of clusters over the course of the trial.</p>","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":"631-636"},"PeriodicalIF":6.5,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12418559/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144697625","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":"Cluster randomised evaluation of a training intervention to increase the use of statistical process control charts for hospitals in England: making data count.","authors":"Kelly Ann Schmidtke, Laura Kudrna, Laura Quinn, Paul Bird, Karla Hemming, Zoe Venable, Richard Lilford","doi":"10.1136/bmjqs-2024-017094","DOIUrl":"10.1136/bmjqs-2024-017094","url":null,"abstract":"<p><strong>Background: </strong>The way that data are presented can influence quality and safety initiatives. Time-series charts highlight changes but do not clarify whether data lie outside expected variation. Statistical process control (SPC) charts make this distinction and have been demonstrated to be effective in supporting hospital initiatives. To improve the uptake of the SPC methodology by hospitals in England, a training intervention was created. The current study evaluates the effectiveness of that training against the background of a wider national initiative to encourage the adoption of SPC charts.</p><p><strong>Methods: </strong>A parallel cluster randomised trial was conducted with 16 English NHS hospitals. Half were randomised to the training intervention and half to the control. The primary analysis compares the difference in use of SPC charts within hospital board papers in a postrandomisation period (adjusting for baseline use). Trainees completed feedback forms with Likert scale and open-ended items.</p><p><strong>Results: </strong>Fifteen hospitals participated across the study arms. SPC chart use increased in both intervention and control hospitals between the baseline and postrandomisation period (29 and 30 percentage points, respectively). There was no statistically significant difference between the intervention and control hospitals in use of SPC charts in the postrandomisation period (average absolute difference 9% (95% CI -34% to 52%). In the feedback forms, 93.9% (n=31/33) of trainees affirmed learning and 97.0% (n=32/33) had formed an intention to change their behaviour.</p><p><strong>Conclusions: </strong>Control chart use increased in both intervention and control hospitals. This is consistent with a rising tide and/or contamination effect, such that the culture of control chart use is spreading across hospitals in England. Further research is needed to support hospitals implementing SPC training initiatives and to link SPC implementation to quality and safety outcomes. Such research could support future quality and safety initiatives nationally and internationally.</p><p><strong>Trial registration number: </strong>NCT04977414.</p>","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":"621-630"},"PeriodicalIF":6.5,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12418577/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142139171","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}