BMJ Quality & Safety最新文献

{"title":"Are we careless about continuity of care?","authors":"Persijn Honkoop, Marco Krukerink","doi":"10.1136/bmjqs-2025-019416","DOIUrl":"https://doi.org/10.1136/bmjqs-2025-019416","url":null,"abstract":"","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":""},"PeriodicalIF":6.5,"publicationDate":"2025-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145586047","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":"Socioeconomic inequalities in adherence to clinical practice guidelines and breast cancer survival: a multicentre population-based study in Spain.","authors":"Dafina Petrova, Daniel Redondo-Sánchez, Miguel Rodríguez-Barranco, Rafael Marcos-Gragera, Marcela Guevara, Marià Carulla, Arantza López de Munain, Ana Vizcaíno, Sonia Del Barco, Encarnación González-Flores, Marina Pollán, María-José Sánchez","doi":"10.1136/bmjqs-2024-017809","DOIUrl":"10.1136/bmjqs-2024-017809","url":null,"abstract":"<p><strong>Introduction and aims: </strong>Women residing in lower socioeconomic status (SES) areas have lower breast cancer survival but it is not clear how differences in the quality of care received contribute to these disparities. We compared adherence to clinical practice guidelines (CPG) for the diagnosis and treatment of breast cancer and subsequent breast cancer survival between women residing in lower versus higher SES areas.</p><p><strong>Methods: </strong>We conducted a multicentre population-based study of all new cases of invasive breast cancer in women diagnosed 2010-2014 in six Spanish provinces with population-based cancer registries (n=3206). Clinical data were extracted in the framework of the European Cancer High Resolution studies and vital status follow-up covered a minimum of 5 years. SES of the patient's residence was measured with the 2011 Spanish Deprivation Index. Adherence to CPG was measured with 16 indicators based on European and Spanish guidelines. Relative survival was modelled using flexible parametric models.</p><p><strong>Results: </strong>There were no differences in the type of treatment received but women living in the lowest SES areas were less likely to undergo a sentinel lymph node biopsy, reconstruction after mastectomy, surgery within 30 days after pathological diagnosis and adjuvant treatment within 6 weeks after surgery. After accounting for demographic and clinical factors, women residing in lower SES areas had higher risk of death, HR=1.57 (95% CI 1.04, 2.36). Further accounting for adherence to CPG in the model, in particular having undergone a sentinel lymph node biopsy, eliminated the significant effect of SES.</p><p><strong>Conclusions: </strong>Despite the overall coverage of the Spanish health system, women living in more deprived areas were less likely to receive care in line with CPG and had shorter survival.</p>","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":"810-823"},"PeriodicalIF":6.5,"publicationDate":"2025-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12703246/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142908981","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 SMART aims to systems thinking: expanding the scope of quality improvement and patient safety education.","authors":"Elena Huang, Jessica Hart, James Won","doi":"10.1136/bmjqs-2025-019288","DOIUrl":"10.1136/bmjqs-2025-019288","url":null,"abstract":"","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":"781-784"},"PeriodicalIF":6.5,"publicationDate":"2025-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145367413","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":"Contextual factors that influence adoption and sustainment of self-management support in cancer survivorship care: a practical application of theory with qualitative interviews.","authors":"Nickola Pallin, John Browne, Roisin Connolly, Josephine Hegarty, Sheena McHugh","doi":"10.1136/bmjqs-2024-017561","DOIUrl":"10.1136/bmjqs-2024-017561","url":null,"abstract":"<p><strong>Background: </strong>Self-management support (SMS) is a recommended component of cancer survivorship care that improves health-related quality of life and reduces healthcare utilisation. However, widespread implementation has been difficult to achieve, with a gap in the literature on system-wide implementation efforts. This study examines contextual factors perceived to influence SMS adoption and sustainment in cancer centres in the Republic of Ireland.</p><p><strong>Method: </strong>Semistructured interviews were conducted with 47 key informants from 20 cancer organisations across community and hospital settings. Participants were asked to report the level of adoption and sustainment of SMS at their organisation. This information was used to categorise organisations as low, medium or high implementers. We conducted cross-case analysis following the principles of Framework Analysis. Using the Consolidated Framework for Implementation Research as a menu of constructs, we examined factors influencing adoption and sustainment and variation in levels of implementation.</p><p><strong>Results: </strong>National policy, external accreditation, external financing opportunities and the presence of champions in organisations are influential early in the implementation process driving adoption. Healthcare provider-led programmes and evidence of SMS improving patient outcomes and aligning with an organisation's priorities are necessary to secure buy-in, particularly among senior leadership. An organisational culture of entrepreneurship enables adoption and sustainment, with resources and a culture supporting staff well-being enabling sustainment.</p><p><strong>Conclusion: </strong>While national policy is a driver, additional factors related to programme attributes and local contextual features such as the presence of champions, organisational readiness and culture influence implementation. The results may be used for future evaluations of SMS implementation in cancer survivorship care and to inform the development of tailored implementation strategies.</p>","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":"798-809"},"PeriodicalIF":6.5,"publicationDate":"2025-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12703244/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142614508","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":"QIing your QI: a 13-year experience of a paediatric residency QI programme.","authors":"Adolfo Leonel Molina, Michele K Nichols, Colm P Travers, Stephanie Berger, Emily A Smitherman, David P Galloway, Rachel Kassel, Samuel Gentle, Andrea Kennedy, Chang L Wu, Susan Walley","doi":"10.1136/bmjqs-2025-018715","DOIUrl":"10.1136/bmjqs-2025-018715","url":null,"abstract":"<p><strong>Introduction: </strong>QI education is essential for resident physicians with established requirements from the Accreditation Council for Graduate Medical Education outlining the necessary components. Literature supports the inclusion of both didactic and experiential learning, however, most studies review knowledge and attitude based assessments of residency QI programs. In 2012, our pediatric residency program identified a gap in resident engagement in QI, which led to the formalization of a QI education program grounded in the Institute for Healthcare Improvement (IHI) Model for improvement with objective measures of QI projects.</p><p><strong>Methods: </strong>Over 13 years, our program implemented interative interventions across three phases to enchance QI training. Initial core interventions involved the structure of didactics to teach core principles of QI and with time focusing on more individualized mentorship. Our efforts were guided through a residency QI committee. Our aim was to (1) increase the percentage of resident QI projects with SMART aims, and (2) increase the use of QI graphs (run charts and SPC charts) of resident QI projects. We tracked graduating resident exit survey satisfaction with the QI program as a balancing measure.</p><p><strong>Results: </strong>From 2012 through 2025, over 300 resident completed 390 QI projects that were reviewed. The percentage of of projects with SMART aims and QI graphs increased over time. The percentage of projects applying for American Board of Pediatrics Part IV applications and presenting at conferences also increased. Resident satisfaction remained with with an average \"Poor\" rating of only 2.6%.</p><p><strong>Conclusions: </strong>Using the model for improvement to assess objective measures in a residency QI program is both feasible and effective. This 13-year intiative demonstrates how systematic, iterative improvement can improve the rigor of resident QI projects. Future goals including leveraging informatics to further support residents with their projects and track downstream patient outcomes.</p>","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":"824-832"},"PeriodicalIF":6.5,"publicationDate":"2025-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144793446","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 computerised alerts to reduce drug-drug interactions (DDIs) and DDI-related harm in hospitalised patients: a quasi-experimental controlled pre-post study.","authors":"Melissa Therese Baysari, Sarah Nicole Hilmer, Richard O Day, Bethany Annemarie Van Dort, Wu Yi Zheng, Renee Quirk, Danielle Deidun, Maria Moran, Kristian Stanceski, Nanda Aryal, Ahmed Abo Salem, Lauren Farrow, Jannah Baker, Andrew Hargreaves, James Grant, Paula Doherty, Karma Zarif Sourial Mekhail, Johanna I Westbrook, Ling Li","doi":"10.1136/bmjqs-2024-018243","DOIUrl":"10.1136/bmjqs-2024-018243","url":null,"abstract":"<p><strong>Background: </strong>Drug-drug interaction (DDI) alerts target the co-prescription of two potentially interacting medications and are a frequent feature of electronic medical records (EMRs). There have been few controlled studies evaluating the effectiveness of DDI alerts. This study aimed to determine the impact of DDI alerts on rates of DDIs and on associated patient harms.</p><p><strong>Methods: </strong>Quasi-experimental controlled pre-post study in five Australian hospitals. Three hospitals acted as control hospitals (EMR with no DDI alerts) and two as intervention (EMR with DDI alerts). Only DDI alerts at the highest severity level (defined as 'major contraindicated') were switched on at intervention hospitals. These alerts were not tailored to clinical context (ie, patient, drug). A total of 2078 patients were randomly selected from all patients (adult and paediatric) admitted to hospitals 6 months before and 6 months after EMR implementation. A retrospective chart review was performed by study pharmacists. The primary outcome was the proportion of admissions with a clinically relevant DDI. Secondary outcomes included the proportions of admissions with a potential DDI and with DDI-related harm.</p><p><strong>Results: </strong>Potential DDIs were identified in the majority of admissions (n=1574, 74.7%) and clinically relevant DDIs identified in half (n=1026, 48.7%). DDI alerts were associated with a reduction in the proportion of admissions with potential DDIs (adjusted OR (AOR)=0.38 (0.19, 0.78)) but no change in clinically relevant DDIs (AOR=1.12 (0.68, 1.84)) or in DDI-related harm (AOR=2.42 (0.47,12.31)). 199 DDIs (76 at control and 123 at intervention hospitals) for 35 patient admissions were associated with patient harm, and 2 patients experienced severe DDI-related harm pre-EMR implementation.</p><p><strong>Discussion: </strong>Implementation of DDI alerts, without tailoring alerts to clinical context, is unlikely to reduce patient harms from DDIs. Organisations should reconsider implementation of DDI alerts in EMRs where significant tailoring of alerts is not possible. Future research should focus on identifying safe, efficient and cost-effective ways of refining DDI alerts, so expected clinical benefits are achieved, and negative consequences of excessive alerting are minimised.</p>","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":"788-797"},"PeriodicalIF":6.5,"publicationDate":"2025-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12703349/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143977307","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":"More alerts, less harm? Rethinking medication safety with AI.","authors":"Clare Tolley, Andrew Kenneth Husband","doi":"10.1136/bmjqs-2025-018661","DOIUrl":"10.1136/bmjqs-2025-018661","url":null,"abstract":"","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":"785-787"},"PeriodicalIF":6.5,"publicationDate":"2025-11-19","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":"Addressing the risk of look-alike, sound-alike medication errors: bending metal or twisting arms?","authors":"Denham L Phipps","doi":"10.1136/bmjqs-2025-018648","DOIUrl":"10.1136/bmjqs-2025-018648","url":null,"abstract":"","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":"714-716"},"PeriodicalIF":6.5,"publicationDate":"2025-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143973858","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":"Better bottom lines: patient satisfaction associated with addressing sexual and gender minority health.","authors":"Carl Streed, Jessica Halem, Amy LeClair","doi":"10.1136/bmjqs-2025-018587","DOIUrl":"10.1136/bmjqs-2025-018587","url":null,"abstract":"","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":"711-713"},"PeriodicalIF":6.5,"publicationDate":"2025-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143963120","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":"Comparing safety, performance and user perceptions of a patient-specific indication-based prescribing tool with current practice: a mixed methods randomised user testing study.","authors":"Calandra Feather, Jonathan Clarke, Nicholas Appelbaum, Ara Darzi, Bryony Dean Franklin","doi":"10.1136/bmjqs-2024-017733","DOIUrl":"10.1136/bmjqs-2024-017733","url":null,"abstract":"<p><strong>Background: </strong>Medication errors are the leading cause of preventable harm in healthcare. Despite proliferation of medication-related clinical decision support systems (CDSS), current systems have limitations. We therefore developed an indication-based prescribing tool. This performs dose calculations using an underlying formulary and provides patient-specific dosing recommendations. Objectives were to compare the incidence and types of erroneous medication orders, time to prescribe (TTP) and perceived workload using the NASA Task Load Index (TLX), in simulated prescribing tasks with and without this intervention. We also sought to identify the workflow steps most vulnerable to error and to gain participant feedback.</p><p><strong>Methods: </strong>A simulated, randomised, cross-over exploratory study was conducted at a London NHS Trust. Participants completed five simulated prescribing tasks with, and five without, the intervention. Data collection methods comprised direct observation of prescribing tasks, self-reported task load and semistructured interviews. A concurrent triangulation design combined quantitative and qualitative data.</p><p><strong>Results: </strong>24 participants completed a total of 240 medication orders. The intervention was associated with fewer prescribing errors (6.6% of 120 orders) compared with standard practice (28.3% of 120 orders; odds ratio 0.18, p<0.01), a shorter TTP and lower overall NASA-TLX scores (p<0.01). Control arm workflow vulnerabilities included failures in identifying correct doses, applying maximum dose limits and calculating patient-specific dosages. Intervention arm errors primarily stemmed from misidentifying patient-specific information from the medication scenario. Thematic analysis of participant interviews identified six themes: navigating trust and familiarity, addressing challenges and suggestions for improvement, integration of local guidelines and existing CDSS, intervention endorsement, 'search by indication' and targeting specific patient and staff groups.</p><p><strong>Conclusion: </strong>The intervention represents a promising advancement in medication safety, with implications for enhancing patient safety and efficiency. Further real-world evaluation and development of the system to meet the needs of more diverse patient groups, users and healthcare settings is now required.</p><p><strong>Trial registration number: </strong>NCT05493072.</p>","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":"737-746"},"PeriodicalIF":6.5,"publicationDate":"2025-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12573381/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142692320","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}