BMJ quality & safety
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BMJ quality & safety · Jul 2014
Developing a reliable and valid patient measure of safety in hospitals (PMOS): a validation study.
Patients represent an important and as yet untapped source of information about the factors that contribute to the safety of their care. The aim of the current study is to test the reliability and validity of the Patient Measure of Safety (PMOS), a brief patient-completed questionnaire that allows hospitals to proactively identify areas of safety concern and vulnerability, and to intervene before incidents occur. ⋯ The PMOS is the first patient questionnaire used to assess factors contributing to safety in hospital settings from a patient perspective. It has demonstrated acceptable reliability and validity. Such information is useful to help hospitals/units proactively improve the safety of their care.
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BMJ quality & safety · Jul 2014
Relationship between patient reported experience (PREMs) and patient reported outcomes (PROMs) in elective surgery.
Our aim was to see if the reporting of better experiences by elective surgical patients was associated with better outcomes (effectiveness and safety). The objectives were to: describe the distribution of experience scores and any association with patients' characteristics; determine the relationship of experience with effectiveness and with safety; and explore the influence of patient characteristics, year and provider on the relationship between experience and effectiveness. ⋯ Patients distinguish between the three domains of quality when reporting their experience and outcome. If the weak positive associations between domains were shown to be causal, there would be implications for maximising performance measures for providers.
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BMJ quality & safety · Jun 2014
Interactive questioning in critical care during handovers: a transcript analysis of communication behaviours by physicians, nurses and nurse practitioners.
Although there is a growing recognition of the importance of active communication behaviours from the incoming clinician receiving a patient handover, there are currently no agreed-upon measures to objectively describe those behaviours. This study sought to identify differences in incoming clinician communication behaviours across levels of clinical training for physicians and nurses. ⋯ Differences across clinician type and levels of clinical training were found in both measures during patient handovers. The findings suggest that training could enable physicians and nurses to learn communication competencies during patient handovers which were used more frequently by more experienced practitioners, including interjecting less frequently and using interactive questioning strategies to clarify understanding, and assertively question the appropriateness of diagnoses, treatment plans and prognoses. Accompanying cultural change initiatives might be required to routinely employ these strategies in the clinical setting, particularly for nursing personnel.
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BMJ quality & safety · Jun 2014
Safely and effectively reducing inpatient length of stay: a controlled study of the General Internal Medicine Care Transformation Initiative.
Whether improving the efficiency of hospital care will worsen post-discharge outcomes is unclear. We designed this study to evaluate the General Internal Medicine (GIM) Care Transformation Initiative implemented at one of the seven teaching hospitals in the Canadian province of Alberta. ⋯ The Care Transformation Initiative was associated with substantial reductions in LOS without increasing post-discharge events commonly quoted as proxies for quality.
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BMJ quality & safety · Jun 2014
ReviewHow can the criminal law support the provision of quality in healthcare?
The egregious failings in patient safety at Mid Staffordshire NHS Foundation Trust between 2005 and 2009 identified by Sir Robert Francis QC in his public inquiry prompted him to recommend the introduction of a new criminal offence into English law in circumstances where a patient dies or is seriously harmed by a breach of fundamental standards. The authors evaluate whether, from the perspective of fairness and justice, a new criminal offence in this context is necessary and desirable. ⋯ The criminal law has an important role to play in the healthcare context. Its central function is not primarily to deter and coerce people into complying with standards of behaviour deemed desirable. Rather, its central function lies in its symbolic and expressive significance, publicly proclaiming that the highly culpable mistreatment of others is wrongful and worthy of public censure and sanction.