BMJ quality & safety
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BMJ quality & safety · Dec 2012
Context, culture and (non-verbal) communication affect handover quality.
Transfers of care, also known as handovers, remain a substantial patient safety risk. Although research on handovers has been done since the 1980s, the science is incomplete. Surprisingly few interventions have been rigorously evaluated and, of those that have, few have resulted in long-term positive change. Researchers, both in medicine and other high reliability industries, agree that face-to-face handovers are the most reliable. It is not clear, however, what the term face-to-face means in actual practice. ⋯ Attention to patterns of NVB in face-to-face handovers coupled with education and practice can improve quality and reliability.
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BMJ quality & safety · Dec 2012
Impact of a hospital-wide hand hygiene initiative on healthcare-associated infections: results of an interrupted time series.
Evidence that hand hygiene (HH) reduces healthcare-associated infections has been available for almost two centuries. Yet HH compliance among healthcare professionals continues to be low, and most efforts to improve it have failed. ⋯ Our initiative was associated with a large and significant hospital-wide improvement in HH which was sustained through the following year and a significant, sustained reduction in the incidence of healthcare-associated infection. The observed increased incidence of the tracer condition supports the assertion that HH improvement contributed to infection reduction. Persistent variation in HH performance among different groups requires further study.
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BMJ quality & safety · Dec 2012
Multicenter StudySearching for the missing pieces between the hospital and primary care: mapping the patient process during care transitions.
Safe patient transitions depend on effective communication and a functioning care coordination process. Evidence suggests that primary care physicians are not satisfied with communication at transition points between inpatient and ambulatory care, and that communication often is not provided in a timely manner, omits essential information, or contains ambiguities that put patients at risk. ⋯ Process mapping is effective in bringing together key stakeholders and makes explicit the mental models that frame their understanding of the clinical process. Exploring the barriers and facilitators to safe and reliable patient transitions highlights opportunities for further improvement work and illustrates ideas for best practices that might be transferrable to other settings.
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BMJ quality & safety · Dec 2012
Multicenter StudyAre patients discharged with care? A qualitative study of perceptions and experiences of patients, family members and care providers.
Advocates for quality and safety have called for healthcare that is patient-centred and decision-making that involves patients. ⋯ Our findings suggest that involvement of patients and families in the preparations for discharge is determined by the extent to which care providers are willing and able to accommodate patients' and families' capabilities, needs and preferences. Future interventions should be directed at healthcare providers' attitudes and their organisation's leadership, with a focus on improving communication among care providers, patients and families, and between hospital and community care providers.
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BMJ quality & safety · Dec 2012
Multicenter Study"It's like two worlds apart": an analysis of vulnerable patient handover practices at discharge from hospital.
Handover practices at hospital discharge are relatively under-researched, particularly as regards the specific risks and additional requirements for handovers involving vulnerable patients with limited language, cognitive and social resources. ⋯ Discharge handovers are often haphazard. Healthcare professionals do not consider current handover practices safe, with patients expected to transfer information without being empowered to understand and act on it. This can lead to misinformation, omission or duplication of tests or interventions and, potentially, patient harm. Vulnerable patients may be at greater risk given their limited language, cognitive and social resources. Patient safety at discharge could benefit from strategies to enhance patient education and promote empowerment.