BMJ quality & safety
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BMJ quality & safety · Jan 2014
Randomized Controlled Trial Multicenter StudyEffects of a team-based assessment and intervention on patient safety culture in general practice: an open randomised controlled trial.
The measurement of safety culture in healthcare is generally regarded as a first step towards improvement. Based on a self-assessment of safety culture, the Frankfurt Patient Safety Matrix (FraTrix) aims to enable healthcare teams to improve safety culture in their organisations. In this study we assessed the effects of FraTrix on safety culture in general practice. ⋯ Applied as a team-based instrument to assess safety culture, FraTrix did not lead to measurable improvements in error management. Comparable studies with more positive results had less robust study designs. In future research, validated combined methods to measure safety culture will be required. In addition, more attention should be paid to evaluation of process parameters. Implemented actions and incident reporting may be more appropriate target endpoints.
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BMJ quality & safety · Jan 2014
Multicenter Study Observational StudyCharacterising the complexity of medication safety using a human factors approach: an observational study in two intensive care units.
To examine medication safety in two intensive care units (ICU), and to assess the complexity of medication errors and adverse drug events (ADE) in ICUs across the stages of the medication-management process. ⋯ Understanding the complexity of the vulnerabilities of the medication-management process is important to devise solutions to improve patient safety. Electronic health record technology with computerised physician order entry may be one step necessary to improve medication safety in ICUs. Solutions that target multiple stages of the medication-management process are necessary to address sequential errors.
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BMJ quality & safety · Jan 2014
Comparative StudySign-out snapshot: cross-sectional evaluation of written sign-outs among specialties.
Sign-out is the process (written, verbal or both) by which one clinical team transmits information about patients to another team. Poor quality sign-outs are associated with adverse events and delayed treatment. How different specialties approach written sign-outs is unknown. ⋯ Specialties have varied sign-out practices, and thus structured templates alone do not guarantee inclusion of critical content. Sign-outs across specialties often lacked complex clinical information such as clinical condition, anticipatory guidance and overnight tasks.
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BMJ quality & safety · Jan 2014
A system-wide approach to explaining variation in potentially avoidable emergency admissions: national ecological study.
Some emergency admissions can be avoided if acute exacerbations of health problems are managed by the range of health services providing emergency and urgent care. ⋯ Interventions to reduce avoidable admissions should be targeted at deprived communities. Better use of emergency departments, ambulance services and primary care could further reduce avoidable emergency admissions.
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BMJ quality & safety · Dec 2013
Teaching about how doctors think: a longitudinal curriculum in cognitive bias and diagnostic error for residents.
Trends in medical education have reflected the patient safety movement's initial focus on systems. While the role of cognitive-based diagnostic errors has been increasingly recognised among safety experts, literature describing strategies to teach about this important problem is scarce. ⋯ A longitudinal curriculum in diagnostic error and cognitive bias improved internal medicine residents' knowledge and recognition of cognitive biases as measured by a novel assessment tool. Further study is needed to refine learner assessment tools and examine optimal strategies to teach clinical reasoning and cognitive bias avoidance strategies.