BMJ quality & safety
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BMJ quality & safety · Aug 2012
Design and trial of a new ambulance-to-emergency department handover protocol: 'IMIST-AMBO'.
Information communicated by ambulance paramedics to Emergency Department (ED) staff during handover of patients has been found to be inconsistent and incomplete, and yet has major implications for patients' subsequent hospital treatment and trajectory of care. ⋯ IMIST-AMBO shows promise for improving the ambulance-ED handover communication interface. Involving paramedics and ED clinicians in its development enhanced the resulting protocol, strengthened ED clinicians' and ambulance paramedics' sense of ownership over the protocol and bolstered their peers' willingness to adopt it.
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Medical revalidation decisions need to be reliable if they are to reassure on the quality and safety of professional practice. This study tested an innovative method in which general practitioners (GPs) were assessed on their reflection and response to a set of externally specified feedback. ⋯ Unlike face-to-face appraisal, anonymous assessment of insightful practice offers a valid and reliable method to decide GP revalidation. Further validity studies are needed.
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BMJ quality & safety · Aug 2012
Should measures of patient experience in primary care be adjusted for case mix? Evidence from the English General Practice Patient Survey.
Uncertainties exist about when and how best to adjust performance measures for case mix. Our aims are to quantify the impact of case-mix adjustment on practice-level scores in a national survey of patient experience, to identify why and when it may be useful to adjust for case mix, and to discuss unresolved policy issues regarding the use of case-mix adjustment in performance measurement in health care. ⋯ While its effect is modest for most practices, case-mix adjustment corrects significant underestimation of scores for a small proportion of practices serving vulnerable patients and may reduce the risk that providers would 'cream-skim' by not enrolling patients from vulnerable socio-demographic groups.
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BMJ quality & safety · Aug 2012
A collaborative project to improve identification and management of patients with chronic kidney disease in a primary care setting in Greater Manchester.
Research has demonstrated a knowledge and practice gap in the identification and management of chronic kidney disease (CKD). In 2009, published data showed that general practices in Greater Manchester had a low detection rate for CKD. ⋯ Evidence-based improvement can be implemented in practice for chronic disease management. A collaborative approach has been successful in enabling teams to test and apply changes to identify patients and improve care. The model has proved to be more successful for some practices, suggesting a need to develop more context-sensitive approaches to implementation and actively manage the factors that influence the success of the collaborative.
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BMJ quality & safety · Jul 2012
ReviewCognitive interventions to reduce diagnostic error: a narrative review.
Errors in clinical reasoning occur in most cases in which the diagnosis is missed, delayed or wrong. The goal of this review was to identify interventions that might reduce the likelihood of these cognitive errors. ⋯ We identified a wide range of possible approaches to reduce cognitive errors in diagnosis. Not all the suggestions have been tested, and of those that have, the evaluations typically involved trainees in artificial settings, making it difficult to extrapolate the results to actual practice. Future progress in this area will require methodological refinements in outcome evaluation and rigorously evaluating interventions already suggested, many of which are well conceptualised and widely endorsed.