BMJ Quality & Safety最新文献

{"title":"Cocreation and codesign in maternal health: processes, outcomes and implementation challenges.","authors":"Mohamed Rishard, Kavinda Rajaratne, Kavinda Jayasingha, Hemantha Senanayake, Millawage Supun Dilara Wijesinghe","doi":"10.1136/bmjqs-2025-019030","DOIUrl":"10.1136/bmjqs-2025-019030","url":null,"abstract":"<p><strong>Objective: </strong>To describe the application of cocreation/codesign in maternal health, characterise reported processes (including barriers/facilitators) and summarise clinical and experiential outcomes without inferring causal effects.</p><p><strong>Methods: </strong>Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a comprehensive search of PubMed, MEDLINE, Embase, Cochrane Library and ScienceDirect (2014-2025) identified 1487 records. After deduplication and screening, 60 studies were included in this review. The eligibility criteria encompassed qualitative and quantitative studies employing cocreation or codesign in maternal or obstetric care, with open-access English full texts. Two blinded reviewers screened the studies using Rayyan and resolved conflicts by consensus agreement. Data extraction followed the Cochrane guidelines, and a narrative synthesis was performed because of study heterogeneity. The risk of bias was assessed using the Newcastle-Ottawa Scale, risk-of-bias 2 and the Risk Of Bias In Non-Randomised Studies - of Exposure (ROBINS-E) tools.</p><p><strong>Results: </strong>Across 60 heterogeneous studies, cocreation and codesign were used to develop and adapt psychosocial support, communication and feedback interventions and digital tools such as decision-support and telemonitoring systems. Studies most often reported process and experiential outcomes, including acceptability, satisfaction, engagement and perceived relevance, to users and communities. The designs, contexts and outcome measures varied, and comparative evidence was limited. Common challenges included power imbalances, time and resource constraints, and difficulties in spreading and sustaining interventions. The reported enablers included early and ongoing stakeholder involvement, iterative cycles and attention to access barriers, including digital inclusion.</p><p><strong>Conclusion: </strong>When cocreation and codesign are clearly described and suited to the context, they can support culturally relevant and equitable maternal care by incorporating stakeholder voices into service and intervention development. The current evidence does not support firm conclusions regarding effectiveness. Future work should transparently report codesign methods, specify the intended mechanism and context, and evaluate codesigned interventions with stronger comparative designs and longer follow-ups.</p><p><strong>Prospero registration number: </strong>CRD42024622020.</p>","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":"699-713"},"PeriodicalIF":6.8,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13638332/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146256815","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":"Documentation-related diagnostic safety concerns in primary care: a structured medical record review of 1116 patient records.","authors":"Rita Fernholm, Caroline Kappelin, Elinor Nemlander","doi":"10.1136/bmjqs-2026-020701","DOIUrl":"https://doi.org/10.1136/bmjqs-2026-020701","url":null,"abstract":"<p><strong>Background: </strong>Diagnostic safety concerns are among the most consequential yet least visible threats to patient safety in primary care. Non-specific symptoms potentially associated with cancer represent a high-risk context, where delayed diagnosis may have serious consequences despite a low probability of serious disease.</p><p><strong>Objective: </strong>To identify diagnostic safety concerns and areas for improvement in assessing patients presenting with non-specific symptoms in primary care.</p><p><strong>Method: </strong>A structured medical record review combining quantitative assessment and qualitative thematic analysis was conducted in Region Stockholm, Sweden. In a region-wide quality improvement initiative, 27 primary care centres reviewed 1116 medical records of patients aged 40-75 years with selected ICD-10 (International Classification of Diseases, 10th Revision) codes recorded in 2023. Reviews used a structured template addressing diagnostic reasoning, data collection and healthcare use. Quantitative data were analysed descriptively, and qualitative data were analysed using reflexive thematic analysis.</p><p><strong>Results: </strong>Overall, 358 records (32%) had at least one diagnostic safety concern. Absence of documentation of differential diagnostic reasoning was identified in 21% of records, insufficient data collection in 18% and failure to consider alternative diagnoses in 12%; these concerns co-occurred in 13% of records. Four themes were identified: invisible diagnostic reasoning, narrow diagnostic framing, failure to re-evaluate, and fragmented care and patient complexity as a cross-cutting contextual influence on diagnostic vulnerabilities.</p><p><strong>Conclusion: </strong>Among patients presenting with non-specific symptoms potentially associated with cancer, documentation-related diagnostic safety concerns arose from whether and how diagnostic reasoning was documented, revisited and communicated across encounters. While the findings support safety-netting and diagnostic re-evaluation, they also highlight vulnerabilities including negative test results functioning as diagnostic endpoints and care fragmentation undermining diagnostic progression. Structured record review linked to reflective learning may help address these patterns in practice.</p>","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":""},"PeriodicalIF":6.8,"publicationDate":"2026-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148987889","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":"Establishing quality prescribing indicators for Australian primary care: a Delphi study.","authors":"James Nind, Anna Mackintosh, Amanda J Cross, Gregory M Peterson, Constance Dimity Pond, Elizabeth Manias, Bandana Saini, Jan Radford, Johnson George","doi":"10.1136/bmjqs-2026-020441","DOIUrl":"https://doi.org/10.1136/bmjqs-2026-020441","url":null,"abstract":"<p><strong>Background: </strong>Medication-related problems (MRPs) place a substantial burden on the healthcare system, contributing to hospital admissions and significant healthcare costs. Quality prescribing indicators (QPIs) offer a way to evaluate and guide improvements in prescribing with the aim of improving medicine use.</p><p><strong>Objectives: </strong>This study aimed to establish an updated set of QPIs for Australian primary care.</p><p><strong>Method: </strong>Potential QPIs were identified from a scoping review and reviewed by clinical members of the research team. Potential QPIs (n=37) that were identified to be relevant, feasible and impactful by the research team were assessed by an expert panel using a two-round Delphi consensus-building approach. The panel (n=42) included experienced general practitioners, pharmacists and nurse practitioners from urban/regional settings across Victoria, New South Wales and Tasmania. Each QPI's validity and importance were scored on a 5-point Likert scale. Participants could provide comments that were anonymously presented in round 2, along with other participants' scores. A QPI was approved if >80% of participants scored it a 4 or 5 for both validity and importance.</p><p><strong>Results: </strong>A total of 23 of the 37 selected QPIs were approved, covering proton pump inhibitors, vaccinations, antihypertensives, anti-inflammatories, inhaled corticosteroids, mental health treatments and analgesics. The selected QPIs provide information on appropriate initiation, monitoring, deprescribing and the avoidance of high-risk prescribing. While mean scores and rate of acceptance were high, comments suggested perceived difficulties implementing some of the QPIs.</p><p><strong>Discussion: </strong>QPIs for primary care were developed after a rigorous review and consensus process. These should be progressed to field testing and implementation. If integrated into routine primary care practice through educational audit and feedback, the QPIs may improve the quality use of medicines.</p>","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":""},"PeriodicalIF":6.8,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148981985","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":"Standard Elements in Studies of Adverse Events and Medical Error (SESAME): explanation and elaboration.","authors":"Richard T Griffey, Lee M Adler, David C Stockwell, Peter D Hibbert, Dorthe O Klein, Rene Schwendimann, Andrew D Auerbach, Rachel Ancona, Ryan M Schneider, David Classen, Christopher R Carpenter, Anne W S Rutjes, Maria Unbeck","doi":"10.1136/bmjqs-2025-019469","DOIUrl":"https://doi.org/10.1136/bmjqs-2025-019469","url":null,"abstract":"<p><p>Studies that evaluate adverse events and medical error often suffer from incomplete and inadequate reporting, which affects the interpretability and reproducibility of their findings. To address this, we developed the 44-item Standard Elements in Studies of Adverse Event or Medical Error (SESAME) checklist using a rigorous process following the recommendations of the Enhancing the QUAlity and Transparency Of health Research Network. The aim of this manuscript is to explain the scope and aim of the checklist by providing a detailed explanation of each item in the SESAME checklist, illustrated by examples from selected studies of adverse events and medical error.</p>","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":""},"PeriodicalIF":6.8,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148944438","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-focused patient safety: reframing cultural competence, cultural humility and structural competence as determinants of patient safety.","authors":"Anna Robinson-Barella, Hiranmayi Madabhushi Hari, Kayleigh Davison, Matthew Cooper, Evgenia Stepanova, Andrew Kenneth Husband, Hamde Nazar","doi":"10.1136/bmjqs-2026-020554","DOIUrl":"https://doi.org/10.1136/bmjqs-2026-020554","url":null,"abstract":"<p><p>Cultural competence and cultural humility have previously been framed as concepts reflecting the knowledge, skills and commitment to self-reflection concerning person-centred healthcare. Emerging evidence has linked cultural misunderstanding, language barriers and implicit bias with diagnostic error, medication mismanagement and inequitable health outcomes for patients. Beyond this, the concept of structural competence has acknowledged how organisational, institutional, social and political structures can shape care and impact patient safety. There has yet to be appreciation of these terms together, integrating them towards a common goal of preventing avoidable harm arising from inequity. In this viewpoint, we argue that, together, cultural competence, cultural humility and structural competence are central to safe, equitable and person-centred care. We propose a new paradigm, equity-focused patient safety, to promote the integration of cultural competence, cultural humility and structural competence to enable healthcare professionals and organisations to proactively anticipate, recognise and mitigate inequitable risks to patient safety across healthcare practice, organisations and systems. We also debate that equity-focused patient safety should be embedded across the undergraduate education, postgraduate training and continuing professional development for healthcare professional groups to position equity as a fundamental determinant of patient safety.</p>","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":""},"PeriodicalIF":6.8,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148944443","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":"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":"614-631"},"PeriodicalIF":6.8,"publicationDate":"2026-08-19","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":"The incidence of avoidable healthcare-associated harm in prisons in England: a retrospective case note review.","authors":"Isobel Joy McFadzean, Saied Ibrahim, Verity Wainwright, Maria Panagioti, Melanie Jordan, Sandra Flynn, Richard N Keers, Tim Millar, Darren M Ashcroft, Adrian Edwards, Anthony J Avery, Jenny Shaw, Andrew Carson-Stevens","doi":"10.1136/bmjqs-2025-019935","DOIUrl":"10.1136/bmjqs-2025-019935","url":null,"abstract":"<p><strong>Objective: </strong>To estimate the incidence of avoidable healthcare-associated harm for prisoners in England.</p><p><strong>Design: </strong>A retrospective cross-sectional case note review of prisoner healthcare records.</p><p><strong>Setting: </strong>18 prisons in England were purposively sampled for maximum variation of characteristics based on prison category (open, local, training, high security and female), type (publicly and privately run) and population size.</p><p><strong>Population: </strong>After screening 15 027 prisoner records, two cohorts were selected: a sample of 6294 'enhanced risk' prisoners and a random sample of 853 prisoners not included in the enhanced risk sample (n=7147).</p><p><strong>Main outcome measures: </strong>The primary outcome was the incidence of patient harm per 100 000 patient-years, judged at least probably avoidable. The secondary outcome was the incidence of patient harm judged at least possibly avoidable. Cases of avoidable harm were characterised in terms of patient impact, known as patient outcome(s), and the severity of harm experienced.</p><p><strong>Results: </strong>Within 18 prisons, 247 cases of avoidable harm were experienced by 244 prisoners and were identified from 7147 patient records. The incidence of avoidable harm was 2241.4 (95% CI 1970.5 to 2539.0) per 100 000 patient-years, and this rate could be as high as 3412.0 (95% CI 3075.8 to 3774.9) based on the records screened during this study. Most patient outcomes involved prisoners experiencing discomfort and pain (99/247, 40.1%) and delays receiving appropriate healthcare management or assessment (91/247, 36.8%). The identified cases of avoidable healthcare-associated harm for prisoners resulted mainly in moderate harm severity (157/247 cases, 63.6%), followed by severe harm (27, 10.9%) and death (27, 10.9%).</p><p><strong>Conclusions: </strong>Compared with community settings, people in prison experience a 41-67 times greater risk of avoidable significant healthcare-associated harm. This stark disparity underscores the urgent need for government and policy action. Delivering safe, equitable healthcare in secure environments remains a major challenge that demands focused attention.</p>","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":"602-613"},"PeriodicalIF":6.8,"publicationDate":"2026-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13539849/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147833373","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":"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":"10.1136/bmjqs-2025-018928","url":null,"abstract":"","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":"649-654"},"PeriodicalIF":6.8,"publicationDate":"2026-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13539828/pdf/","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":"OA","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":"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":"591-601"},"PeriodicalIF":6.8,"publicationDate":"2026-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13316744/pdf/","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"When documentation changes but behaviour persists: de-implementation in a neonatal intensive care unit.","authors":"Mohammad Adawi, Matthew Garber, Padma Nandula, Vasantha H S Kumar, Ida Alami, Sanket D Shah","doi":"10.1136/bmjqs-2026-020531","DOIUrl":"10.1136/bmjqs-2026-020531","url":null,"abstract":"<p><p>De-implementation of low-value clinical practices requires changes in both documentation and clinician behaviour, yet documentation may not accurately reflect bedside practice. We conducted a multifaceted quality improvement de-implementation initiative in a level III neonatal intensive care unit that combined education, electronic medical record workflow modification and reinforcement of symptom-based feeding assessment to eliminate routine gastric residual (GR) checks in infants with birth weight <1500 g. Following implementation, documented GR checks declined to zero, with no increase in necrotising enterocolitis or feeding intolerance and no improvement in time to full enteral feeds.To evaluate behavioural adoption, we performed a secondary analysis of an anonymous nursing survey. Of 56 nurses, 24 responded to the item assessing ongoing practice; 7 of 24 (29%) reported continuing GR checks without documentation. While most nurses supported the protocol change, some reported anxiety and perceived increases in emesis, abdominal imaging and feeding interruptions despite stable clinical outcomes. Less-experienced nurses were more likely to report concern about potential disciplinary consequences (OR 7.33; 95% CI 1.2 to 45; p<0.05). In sensitivity analysis, nurses who did not report continued checks demonstrated higher anxiety (OR 152; 95% CI 3.0 to 7600; p<0.001) although this post hoc finding should be interpreted cautiously.These findings demonstrate discordance between documented and actual practice following de-implementation. Documentation alone may overestimate implementation fidelity, particularly when discontinuing practices perceived as protective, highlighting the need for measurement strategies that capture true bedside behaviour.</p>","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":"646-648"},"PeriodicalIF":6.8,"publicationDate":"2026-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148618305","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}