BMJ quality & safety
-
BMJ quality & safety · Dec 2011
Team situation awareness and the anticipation of patient progress during ICU rounds.
The ability of medical teams to develop and maintain team situation awareness (team SA) is crucial for patient safety. Limited research has investigated team SA within clinical environments. This study reports the development of a method for investigating team SA during the intensive care unit (ICU) round and describes the results. ⋯ A new method for measuring team SA during the ICU round was successfully employed. A number of areas for future research were identified, including refinement of the situation awareness and teamwork measures.
-
BMJ quality & safety · Dec 2011
Impact of department volume on surgical site infections following arthroscopy, knee replacement or hip replacement.
To examine the association between surgical department volume and the risk of surgical site infections (SSI) after orthopaedic procedures. ⋯ The authors' findings offer some support for recommendations to concentrate arthroscopy and knee replacement in surgical departments with more than 50 procedures and hip replacement in departments with more than 100 procedures per year in order to reduce SSI.
-
BMJ quality & safety · Dec 2011
Funnel plots for comparing provider performance based on patient-reported outcome measures.
Patient-reported outcome measures (PROMs) often produce skewed distributions of individual scores after a healthcare intervention. For health performance indicators derived from skewed distributions, funnel plots designed with symmetric control limits may increase the risk of false alarms about poor performance. ⋯ When designing funnel plots for comparisons of provider performance based on highly skewed data, the use of simulated control limits should be considered.
-
BMJ quality & safety · Dec 2011
Identifying unintended consequences of quality indicators: a qualitative study.
For the first 5 years of the UK primary care pay for performance scheme, the Quality and Outcomes Framework (QOF), quality indicators were introduced without piloting. However, in 2009, potential new indicators were piloted in a nationally representative sample of practices. This paper describes an in-depth exploration of family physician, nurse and other primary-care practice staff views of the value of piloting with a particular focus on unintended consequences of 13 potential new QOF indicators. ⋯ It is important to identify concerns and experiences about unintended consequences of indicators at an early stage when there is time to remove or adapt problem indicators. Since the UK government currently spends over £1 billion each year on QOF, the £150,000 spent on each piloting cohort (0.0005% of the total QOF budget) appears to be good value for money.