BMJ quality & safety
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BMJ quality & safety · Jun 2016
Access to primary care and the route of emergency admission to hospital: retrospective analysis of national hospital administrative data.
The UK government is pursuing policies to improve primary care access, as many patients visit accident and emergency (A and E) departments after being unable to get suitable general practice appointments. Direct admission to hospital via a general practitioner (GP) averts A and E use, and may reduce total hospital costs. It could also enhance the continuity of information between GPs and hospital doctors, possibly improving healthcare outcomes. ⋯ Among hospital inpatients admitted as an emergency, patients registered to more accessible general practices were more likely to have been admitted via a GP (vs an A and E department). This furthers evidence suggesting that access to general practice is related to use of emergency hospital services in England. The relative merits of the two admission routes remain unclear.
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BMJ quality & safety · Jun 2016
Observational StudyThe impact of interruptions on the duration of nursing interventions: a direct observation study in an academic emergency department.
Interruptions to nursing workload may contribute to procedural failures and clinical errors impacting quality/safety of care, but the impact of interruptions on the duration of these activities has not been closely scrutinised. This study analyses the effect of interruptions to care provided by nurses and clinical technicians on the length of clinical procedures and interventions (excluding the length of the interruption). ⋯ Our findings are consistent with outcomes of studies in non-healthcare domains, but are contrary to a study of ED physicians, suggesting differential responses to interruptions by physicians and nurses. Future studies on interruptions in healthcare should thus be discipline specific. Though the effect of interruptions on intervention length is only about 2 min, in an ED setting, this can increase patient risks and costs. To better focus efforts to reduce interruptions future research should focus on further separation of interruption type (eg, urgent vs routine or unnecessary).
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BMJ quality & safety · Jun 2016
Randomized Controlled TrialStrengthening the afferent limb of rapid response systems: an educational intervention using web-based learning for early recognition and responding to deteriorating patients.
The timely recognition and response to patients with clinical deteriorations constitute the afferent limb failure of a rapid response system (RRS). This area is a persistent problem in acute healthcare settings worldwide. In this study, we evaluated the effect of an educational programme on improving the nurses' knowledge and performances in recognising and responding to clinical deterioration. ⋯ A web-based educational programme developed for hospital nurses to strengthen the afferent limb of the RRS significantly increased their knowledge and performances in assessing, managing and reporting clinical deterioration.
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BMJ quality & safety · May 2016
ReviewImplementation of a quality improvement initiative to reduce daily chest radiographs in the intensive care unit.
To reduce the number of routine chest radiographs (CXRs) done in a tertiary care intensive care unit (ICU). ⋯ A quality improvement that includes education, reminders of appropriate indications and computerised decision support can decrease the number of routine CXRs in an ICU.