BMJ Quality & Safety最新文献

{"title":"Evaluation of the accuracy and safety of machine translation of patient-specific discharge instructions: a comparative analysis.","authors":"Marianna Kong, Alicia Fernandez, Jaskaran Bains, Ana Milisavljevic, Katherine C Brooks, Akash Shanmugam, Leslie Avilez, Junhong Li, Vladyslav Honcharov, Andersen Yang, Elaine C Khoong","doi":"10.1136/bmjqs-2024-018384","DOIUrl":"10.1136/bmjqs-2024-018384","url":null,"abstract":"<p><strong>Introduction: </strong>Machine translation of patient-specific information could mitigate language barriers if sufficiently accurate and non-harmful and may be particularly useful in healthcare encounters when professional translators are not readily available. We evaluated the translation accuracy and potential for harm of ChatGPT-4 and Google Translate in translating from English to Spanish, Chinese and Russian.</p><p><strong>Methods: </strong>We used ChatGPT-4 and Google Translate to translate 50 sets (316 sentences) of deidentified, patient-specific, clinician free-text emergency department instructions into Spanish, Chinese and Russian. These were then back-translated into English by professional translators and double-coded by physicians for accuracy and potential for clinical harm.</p><p><strong>Results: </strong>At the sentence level, we found that both tools were ≥90% accurate in translating English to Spanish (accuracy: GPT 97%, Google Translate 96%) and English to Chinese (accuracy: GPT 95%; Google Translate 90%); neither tool performed as well in translating English to Russian (accuracy: GPT 89%; Google Translate 80%). At the instruction set level, 16%, 24% and 56% of Spanish, Chinese and Russian GPT-translated instruction sets contained at least one inaccuracy. For Google Translate, 24%, 56% and 66% of Spanish, Chinese and Russian translations contained at least one inaccuracy. The potential for harm due to inaccurate translations was ≤1% for both tools in all languages at the sentence level and ≤6% at the instruction set level. GPT was significantly more accurate than Google Translate in Chinese and Russian at the sentence level; the potential for harm was similar.</p><p><strong>Conclusion: </strong>These results support the potential of machine translation tools to mitigate gaps in translation services for low-stakes written communication from English to Spanish, while also strengthening the case for caution and for professional oversight in non-low-risk communication. Further research is needed to evaluate machine translation for other languages and more technical content.</p>","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12252260/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144599388","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":"From parallel tracks to integrated practice: advancing the integration of quality improvement and implementation science.","authors":"Stephanie Bogdewic, Susan Cronin, Rohit Ramaswamy","doi":"10.1136/bmjqs-2025-018917","DOIUrl":"https://doi.org/10.1136/bmjqs-2025-018917","url":null,"abstract":"","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144590490","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 online patient access to clinical notes on quality of care: a systematic review.","authors":"Yoko Yoshimura, Geva Greenfield, Elena Lammila-Escalera, Brian Mcmillan, Benedict Hayhoe, Azeem Majeed, Ana Luisa Neves","doi":"10.1136/bmjqs-2024-018363","DOIUrl":"https://doi.org/10.1136/bmjqs-2024-018363","url":null,"abstract":"<p><strong>Background: </strong>Access to electronic health records (EHRs) has the potential to improve the quality of care. Clinical notes, free-text entries documenting clinicians' observations and decisions, are central to EHRs. Sharing these notes may reduce information asymmetry, enhance transparency and empower patients. However, their impact on care quality remains unclear.</p><p><strong>Aim: </strong>To assess the impact of sharing clinical notes online with patients on the domains of quality as defined by the Institute of Medicine (ie, patient-centredness, effectiveness, efficiency, safety, timeliness and equity).</p><p><strong>Methodology: </strong>A systematic review was conducted with no time limit, using CINAHL, Cochrane, OVID Embase, HMIC, Medline/PubMed and PsycINFO. A narrative synthesis method was employed to extract the study characteristics, and reported outcomes were organised using the six IOM quality domains. The risk of bias of included studies was assessed using the Risk of Bias in Non-randomised Studies of Interventions (ROBINS-I) tool.</p><p><strong>Results: </strong>Nineteen studies involving 203 152 participants met inclusion criteria. Outcomes included patient-centredness (n=16), patient safety (n=14), equity (n=6), efficiency (n=4), timeliness (n=0) and effectiveness (n=0). Patient-centredness studies reported high satisfaction (n=6), increased engagement (n=11) and stronger patient-provider trust (n=7). Patient safety studies noted improvements in medication adherence (n=4) and note accuracy (n=5), alongside privacy concerns (n=5). Equity studies found benefits for minority (n=3) and less-educated patients (n=2), with one reporting equitable outcomes (n=1). No significant changes in efficiency were observed (n=4).</p><p><strong>Discussion: </strong>Online sharing of clinical notes with patients positively impacted self-reported patient-centredness and patient safety, particularly benefiting underserved populations. However, privacy concerns must be effectively addressed, and robust safeguarding is essential to mitigate confidentiality issues. Further research is needed to evaluate the long-term impact on timeliness, effectiveness and efficiency of care.</p>","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144583051","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":"More alerts, less harm? Rethinking medication safety with AI.","authors":"Clare Tolley, Andrew Kenneth Husband","doi":"10.1136/bmjqs-2025-018661","DOIUrl":"https://doi.org/10.1136/bmjqs-2025-018661","url":null,"abstract":"","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144583052","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 a patient-centred complex intervention to improve Initial Medication Adherence to cardiovascular disease and diabetes treatments in primary care (the IMA-cRCT study): a pragmatic cluster randomised controlled trial using real-world data.","authors":"Carmen Corral-Partearroyo, Alba Sánchez-Viñas, Ignacio Aznar-Lou, María Teresa Peñarrubia-María, Montserrat Gil-Girbau, Carmen Gallardo-González, María Del Carmen Olmos-Palenzuela, Maria Rubio-Valera","doi":"10.1136/bmjqs-2024-018402","DOIUrl":"https://doi.org/10.1136/bmjqs-2024-018402","url":null,"abstract":"<p><strong>Introduction: </strong>Non-adherence to cardiovascular disease and diabetes treatments contributes to suboptimal clinical outcomes and higher cost. The initial medication adherence (IMA) intervention is a multidisciplinary primary care (PC) intervention based on shared decision-making (SDM). The IMA-cluster-randomised controlled trial (cRCT) study evaluated the impact of the IMA intervention on medication initiation, secondary adherence and clinical outcomes compared with usual care (UC).</p><p><strong>Methods: </strong>This was a pragmatic cRCT with a hybrid effectiveness-implementation design which randomised 24 PC centres in Spain to intervention or UC. Patients receiving a new prescription of antihypertensive, lipid-lowering, antiplatelet and/or oral/injectable antidiabetic medication at the intervention centres (March 2022-September 2022) were attended by general practitioners (GPs), nurses and community pharmacists who had been trained in SDM and given decision aids (leaflets and website). Real-world data from prescription and dispensing records-used to assess medication initiation and secondary adherence (correct dosing and continued use)-and clinical outcome data from electronic health records were collected up to 18 months after initial prescription and analysed using multilevel regression models.</p><p><strong>Results: </strong>Overall, 4910 prescriptions were issued to 3629 patients (Intervention=2148; UC=1481) by 150 GPs (Intervention=91; UC=59). No differences were detected between groups in medication initiation or secondary adherence. Among clinical outcomes, only blood pressure outcomes favoured the IMA intervention, reflecting a small but clinically meaningful improvement.</p><p><strong>Conclusions: </strong>The IMA intervention had limited overall impact, with no effect on adherence, but showed potential benefits in blood pressure. However, SDM, as an ethically grounded approach, may enhance patients and professional experiences, supporting its consideration for broader implementation. Future efforts should prioritise these benefits by investing in professional training and patient support, addressing implementation challenges and deepening understanding of SDM effects, which would warrant further evaluation.</p><p><strong>Trial registration number: </strong>NCT05026775.</p>","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144538503","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":"Large-scale observational study of AI-based patient and surgical material verification system in ophthalmology: real-world evaluation in 37 529 cases.","authors":"Hitoshi Tabuchi, Naofumi Ishitobi, Hodaka Deguchi, Yuta Nakaniida, Hayato Tanaka, Masahiro Akada, Mao Tanabe","doi":"10.1136/bmjqs-2024-018018","DOIUrl":"10.1136/bmjqs-2024-018018","url":null,"abstract":"<p><strong>Background: </strong>Surgical errors in ophthalmology can have devastating consequences. We developed an artificial intelligence (AI)-based surgical safety system to prevent errors in patient identification, surgical laterality and intraocular lens (IOL) selection. This study aimed to evaluate its effectiveness in real-world ophthalmic surgical settings.</p><p><strong>Methods: </strong>In this retrospective observational before-and-after implementation study, we analysed 37 529 ophthalmic surgeries (18 767 pre-implementation, 18 762 post implementation) performed at Tsukazaki Hospital, Japan, between 1 March 2019 and 31 March 2024. The AI system, integrated with the WHO surgical safety checklist, was implemented for patient identification, surgical laterality verification and IOL authentication.</p><p><strong>Results: </strong>Post implementation, five medical errors (0.027%) occurred, with four in non-authenticated cases (where the AI system was not fully implemented or properly used), compared with one (0.0053%) pre-implementation (p=0.125). Of the four non-authenticated errors, two were laterality errors during the initial implementation period and two were IOL implantation errors involving unlearned IOLs (7.3% of cases) due to delayed AI updates. The AI system identified 30 near misses (0.16%) post implementation, vs 9 (0.048%) pre-implementation (p=0.00067), surgical laterality errors/near misses occurred at 0.039% (7/18 762) and IOL recognition at 0.29% (28/9713). The system achieved>99% implementation after 3 months. Authentication performance metrics showed high efficiency: facial recognition (1.13 attempts, 11.8 s), surgical laterality (1.05 attempts, 3.10 s) and IOL recognition (1.15 attempts, 8.57 s). Cost-benefit analysis revealed potential benefits ranging from US$181 946.94 to US$2 769 129.12 in conservative and intermediate scenarios, respectively.</p><p><strong>Conclusions: </strong>The AI-based surgical safety system significantly increased near miss detection and showed potential economic benefits. However, errors in non-authenticated cases underscore the importance of consistent system use and integration with existing safety protocols. These findings emphasise that while AI can enhance surgical safety, its effectiveness depends on proper implementation and continuous refinement.</p>","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":"433-442"},"PeriodicalIF":5.6,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12229072/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142754517","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":"Support for hospital doctors' workplace well-being in England: the Care Under Pressure 3 realist evaluation.","authors":"Anna Melvin, Alison Pearson, Daniele Carrieri, Charlotte Bramwell, Jason Hancock, Jessica Scott, Helen Foster Collins, Stuart McPhail, Mark Pearson, Chrysanthi Papoutsi, Geoff Wong, Karen Mattick","doi":"10.1136/bmjqs-2024-017698","DOIUrl":"10.1136/bmjqs-2024-017698","url":null,"abstract":"<p><strong>Introduction: </strong>The vital role of medical workforce well-being for improving patient experience and population health while assuring safety and reducing costs is recognised internationally. Yet the persistence of poor well-being outcomes suggests that current support initiatives are suboptimal. The aim of this research study was to work with, and learn from, diverse hospital settings to understand how to optimise strategies to improve doctors' well-being and reduce negative impacts on the workforce and patient care.</p><p><strong>Methods: </strong>Realist evaluation consistent with the Realist And Meta-narrative Evidence Synthesis: Evolving Standards (RAMESES) II quality standards. Realist interviews (n=124) with doctors, well-being intervention implementers/practitioners and leaders in eight hospital settings (England) were analysed using realist logic.</p><p><strong>Results: </strong>There were four key findings, underpinned by 21 context-mechanism-outcome configurations: (1) solutions needed to align with problems, to support doctor well-being and avoid harm to doctors; (2) doctors needed to be involved in creating solutions to their well-being problems; (3) doctors often did not know what support was available to help them with well-being problems and (4) there were physical and psychological barriers to accessing well-being support.</p><p><strong>Discussion and conclusion: </strong>Doctors are mandated to 'first, do no harm' to their patients, and the same consideration should be extended to doctors themselves. Since doctors can be harmed by poorly designed or implemented well-being interventions, new approaches need careful planning and evaluation. Our research identified many ineffective or harmful interventions that could be stopped. The findings are likely transferable to other settings and countries, given the realist approach leading to principles and causal explanations.</p>","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":"443-456"},"PeriodicalIF":5.6,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12229071/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143958323","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":"Understanding the evidence for artificial intelligence in healthcare.","authors":"Gretchen Purcell Jackson, Edward H Shortliffe","doi":"10.1136/bmjqs-2025-018559","DOIUrl":"10.1136/bmjqs-2025-018559","url":null,"abstract":"","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":"421-424"},"PeriodicalIF":5.6,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12229047/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143960022","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":"Doing 'detective work' to find a cancer: how are non-specific symptom pathways for cancer investigation organised, and what are the implications for safety and quality of care? A multisite qualitative approach.","authors":"Georgia B Black, Brian D Nicholson, Julie-Ann Moreland, Naomi J Fulop, Georgios Lyratzopoulos, Ruth Baxter","doi":"10.1136/bmjqs-2024-017749","DOIUrl":"10.1136/bmjqs-2024-017749","url":null,"abstract":"<p><strong>Background: </strong>Over the past two decades, the UK has actively developed policies to enhance early cancer diagnosis, particularly for individuals with non-specific cancer symptoms. Non-specific symptom (NSS) pathways were piloted and then implemented in 2015 to address delays in referral and diagnosis. The aim of this study was to outline the functions that enable NSS teams to investigate cancer and other diagnoses for patients with NSSs.</p><p><strong>Methods: </strong>The analysis was derived from a multisite ethnographic study conducted between 2020 and 2023 across four major National Health Service (NHS) trusts. Data collection encompassed observations, patient shadowing, interviews with clinicians and patients (n=54) and gathered documents. We used principles of the functional resonance analysis method to identify the functions of the NSS pathway and analyse their relevance to patient safety.</p><p><strong>Results: </strong>Our analysis produced 29 distinct functions within NSS pathways, organised into two clusters: pretesting assessment and information gathering, and post-testing interpretation and management. Safety-critical functions encompassed assessing the reason for referral, deciding on a plan of investigation and estimating the remaining cancer risk. We also identified ways that teams build and maintain safety across all functions, for example, by cultivating generalist-specialist expertise within the team and creating continuity through patient navigation. Variation in practice across sites revealed targets for an NSS pathway blueprint that would foster local development and quality improvement.</p><p><strong>Conclusions: </strong>Our findings suggest that national and local improvement plans could differentiate specific policies to reduce unwarranted variation and support adaptive variation that facilitates the delivery of safe care within the local context. Enhancing multidisciplinary teams with additional consultants and deploying patient navigators with clinical backgrounds could improve safety within NSS pathways. Future research should investigate different models of generalist-specialist team composition.</p>","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":"457-468"},"PeriodicalIF":5.6,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12229070/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143063701","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":"Quantifying the cost savings and health impacts of improving colonoscopy quality: an economic evaluation.","authors":"Stephen McCarthy, Matthew David Rutter, Peter McMeekin, Jamie Catlow, Linda Sharp, Matthew Brookes, Roland Valori, Rashmi Bhardwaj-Gosling, Tom Lee, Richard McNally, Andrew McCarthy, Joanne Gray","doi":"10.1136/bmjqs-2023-016932","DOIUrl":"10.1136/bmjqs-2023-016932","url":null,"abstract":"<p><strong>Objective: </strong>To estimate and quantify the cost implications and health impacts of improving the performance of English endoscopy services to the optimum quality as defined by postcolonoscopy colorectal cancer (PCCRC) rates.</p><p><strong>Design: </strong>A semi-Markov state-transition model was constructed, following the logical treatment pathway of individuals who could potentially undergo a diagnostic colonoscopy. The model consisted of three identical arms, each representing a high, middle or low-performing trust's endoscopy service, defined by PCCRC rates. A cohort of 40-year-old individuals was simulated in each arm of the model. The model's time horizon was when the cohort reached 90 years of age and the total costs and quality-adjusted life-years (QALYs) were calculated for all trusts. Scenario and sensitivity analyses were also conducted.</p><p><strong>Results: </strong>A 40-year-old individual gains 0.0006 QALYs and savings of £6.75 over the model lifetime by attending a high-performing trust compared with attending a middle-performing trust and gains 0.0012 QALYs and savings of £14.64 compared with attending a low-performing trust. For the population of England aged between 40 and 86, if all low and middle-performing trusts were improved to the level of a high-performing trust, QALY gains of 14 044 and cost savings of £249 311 295 are possible. Higher quality trusts dominated lower quality trusts; any improvement in the PCCRC rate was cost-effective.</p><p><strong>Conclusion: </strong>Improving the quality of endoscopy services would lead to QALY gains among the population, in addition to cost savings to the healthcare provider. If all middle and low-performing trusts were improved to the level of a high-performing trust, our results estimate that the English National Health Service would save approximately £5 million per year.</p>","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":"469-478"},"PeriodicalIF":5.6,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12229050/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141455228","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}