BMJ quality & safety
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BMJ quality & safety · Apr 2012
Comparative StudyAssessment of adverse events in medical care: lack of consistency between experienced teams using the global trigger tool.
Many patients are harmed as the result of healthcare. A retrospective structured record review is one way to identify adverse events (AEs). One such review approach is the global trigger tool (GTT), a consistent and well-developed method used to detect AEs. The GTT was originally intended to be used for measuring data over time within a single organisation. However, as the method spreads, it is likely that comparisons of GTT safety outcomes between hospitals will occur. ⋯ The results do not encourage the use of the GTT for making comparisons between hospitals. The use of the GTT to this end would require substantial training to achieve better agreement across reviewer teams.
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Attributes of the organisational culture of residency training programmes may impact patient safety. Training environments are complex, composed of clinical teams, residency programmes, and clinical units. We examined the relationship between residents' perceptions of their training environment and disclosure of or apology for their worst error. ⋯ Factors in the learning environments of residents are associated with responses to medical errors. Organisational safety culture can be measured, and used to evaluate environmental attributes of clinical training that are associated with disclosure of, and apology for, medical error.
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BMJ quality & safety · Apr 2012
Exploring the role of salient distracting clinical features in the emergence of diagnostic errors and the mechanisms through which reflection counteracts mistakes.
Flaws in clinical reasoning are present in most diagnostic errors and occur even when physicians have enough knowledge to solve the problem. Deliberate reflection has been shown to improve diagnoses. The sources of faulty reasoning and how reflection counteracts them remain largely unknown. ⋯ Salient features in a case tend to attract physicians' attention and may misdirect diagnostic reasoning when they turn out to be unrelated to the problem, causing errors. Reflection helps by enabling physicians to overcome the influence of distracting features. The lack of effect for students suggests that this is only possible when there is enough knowledge to recognise which features discriminate between alternative diagnoses.
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BMJ quality & safety · Apr 2012
Association of National Hospital Quality Measure adherence with long-term mortality and readmissions.
In existing studies, the association between adherence with recommended hospital care processes and subsequent outcomes has been inconsistent. This has substantial implications because process measure scores are used for accountability, quality improvement and reimbursement. Our investigation addresses methodological concerns with previous studies to better clarify the process-outcomes association for three common conditions. ⋯ Adherence with recommended AMI and PN care processes is associated with improved long-term outcomes, whereas the results for HF measures are inconsistent. The evidence base for all process measures must be critically evaluated, including the strength of association between these care processes and outcomes in real-world populations. Some currently recommended processes may not be suitable as accountability measures.
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BMJ quality & safety · Mar 2012
Perceptions of junior doctors in the NHS about their training: results of a regional questionnaire.
To explore the views of doctors in training about their current roles and their potential value to the National Health Service (NHS) in improving healthcare quality and productivity. ⋯ Doctors in training have a desire and perceived ability to contribute to improvement in the NHS but do not perceive their working environment as receptive to their skills. Junior doctors who attend leadership training report higher levels of desire and ability to express these skills. This study suggests junior doctors are an untapped NHS resource and that they and their organisations would benefit from more formalised provision of training in leadership.