BMJ quality & safety
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BMJ quality & safety · Sep 2013
The Housestaff Incentive Program: improving the timeliness and quality of discharge summaries by engaging residents in quality improvement.
Quality improvement has become increasingly important in the practice of medicine; however, engaging residents in meaningful projects within the demanding training environment remains challenging. ⋯ Our discharge summary improvement project provides an instructive example of how residents can lead clinically meaningful quality improvement projects.
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BMJ quality & safety · Sep 2013
Anastomotic leakage as an outcome measure for quality of colorectal cancer surgery.
When comparing mortality rates between hospitals to explore hospital performance, there is an important role for adjustment for differences in case-mix. Identifying outcome measures that are less influenced by differences in case-mix may be valuable. The main goal of this study was to explore whether hospital differences in anastomotic leakage (AL) and postoperative mortality are due to differences in case-mix or to differences in treatment factors. ⋯ Hospital variation in AL is relatively independent of differences in case-mix. In contrast to 'postoperative mortality' the observed AL rates of hospitals evaluated in our study were only slightly affected after adjustment for case-mix factors. Therefore, AL rates may be suitable as an outcome indicator for measurement of surgical quality of care.
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BMJ quality & safety · Sep 2013
Comparative StudyPatterns in the recording of vital signs and early warning scores: compliance with a clinical escalation protocol.
The recognition of patient deterioration depends largely on identifying abnormal vital signs, yet little is known about the daily pattern of vital signs measurement and charting. ⋯ There was only partial adherence to the vital signs monitoring protocol. Sicker patients appear more likely to have vital signs measured overnight, but even their observations were often not followed by timely repeat assessments. The observed pattern of monitoring may reflect the impact of competing clinical priorities.
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BMJ quality & safety · Sep 2013
ReviewSurgical technology and operating-room safety failures: a systematic review of quantitative studies.
Surgical technology has led to significant improvements in patient outcomes. However, failures in equipment and technology are implicated in surgical errors and adverse events. We aim to determine the proportion and characteristics of equipment-related error in the operating room (OR) to further improve quality of care. ⋯ Equipment-related failures form a substantial proportion of all error occurring in the OR. Those procedures that rely more heavily on technology may bear a higher proportion of equipment-related error. There is clear benefit in the use of preoperative checklist-based systems. We propose the adoption of an equipment check, which may be incorporated into the current WHO checklist.
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BMJ quality & safety · Sep 2013
Observational StudyAn observational study of nurse staffing ratios and hospital readmission among children admitted for common conditions.
Hospital patient-to-nurse staffing ratios are associated with quality outcomes in adult patient populations but little is known about how these factors affect paediatric care. We examined the relationship between staffing ratios and all-cause readmission (within 14 days, 15-30 days) among children admitted for common medical and surgical conditions. ⋯ Children with common conditions treated in hospitals in which nurses care for fewer patients each are significantly less likely to experience readmission between 15 and 30 days after discharge. Lower patient-to-nurse ratios hold promise for preventing unnecessary hospital readmissions for children through more effective predischarge monitoring of patient conditions, improved discharge preparation and enhanced quality improvement success.