BMJ quality & safety
-
BMJ quality & safety · Jun 2014
Caring for critically ill children in the community: a needs assessment.
The goal of this study was to identify barriers and facilitators to the optimal management of critically ill children who present initially to community hospitals and how best to support the needs of front-line healthcare providers in these settings prior to transfer to the regional academic paediatric health sciences centre. ⋯ This study identifies the need to fully understand the management realities of front-line caregivers of critically ill children in community hospital settings. We demonstrate the need to focus on the management of younger paediatric patients, technical skills development, practice of acute situations with less than optimal staffing resources, and access to facilitated real-world experiences with appropriate supervision and mentoring. Passive interventions such as web-based guidelines should not be used in isolation but as a support to ongoing exposure and engagement by content experts.
-
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.
-
BMJ quality & safety · Jun 2014
Governance of quality of care: a qualitative study of health service boards in Victoria, Australia.
To describe the engagement of health service boards with quality-of-care issues and to identify factors that influence boards' activities in this area. ⋯ Although health service boards are eager to establish quality of care as a governance priority, several obstacles are blocking progress. The result is a gap between the rhetoric of quality governance and the reality of month-to-month activities at the board level. The imperative for effective board-level engagement in this area cannot be met until these barriers are addressed.
-
BMJ quality & safety · May 2014
ReviewTeam-training in healthcare: a narrative synthesis of the literature.
Patients are safer and receive higher quality care when providers work as a highly effective team. Investment in optimising healthcare teamwork has swelled in the last 10 years. Consequently, evidence regarding the effectiveness for these interventions has also grown rapidly. We provide an updated review concerning the current state of team-training science and practice in acute care settings. ⋯ Overall, moderate-to-high-quality evidence suggests team-training can positively impact healthcare team processes and patient outcomes. Additionally, toolkits are available to support intervention development and implementation. Evidence suggests bundled team-training interventions and implementation strategies that embed effective teamwork as a foundation for other improvement efforts may offer greatest impact on patient outcomes.
-
BMJ quality & safety · May 2014
Using 'nudge' principles for order set design: a before and after evaluation of an electronic prescribing template in critical care.
Computerised order sets have the potential to reduce clinical variation and improve patient safety but the effect is variable. We sought to evaluate the impact of changes to the design of an order set on the delivery of chlorhexidine mouthwash and hydroxyethyl starch (HES) to patients in the intensive care unit. ⋯ The presentation of choices within an electronic prescribing system influenced the delivery of evidence-based interventions in a predictable way and the effect was well sustained. This approach has the potential to enhance the effectiveness of computerised order sets.