BMJ quality & safety
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BMJ quality & safety · Jul 2019
Variation in the delivery of telephone advice by emergency medical services: a qualitative study in three services.
An emergency ambulance is not always the appropriate response for emergency medical service patients. Telephone advice aims to resolve low acuity calls over the phone, without sending an ambulance. In England, variation in rates of telephone advice and patient recontact between services raises concerns about inequities in care. To understand this variation, this study aimed to explore operational factors influencing the provision of telephone advice. ⋯ Some of the variation observed can be explained by operational differences between services and some of it by access to alternative response options in the wider urgent and emergency care system. The findings indicate scope for greater consistency in the delivery of telephone advice to ensure the widest range of options to meet the needs of different populations, regardless of geographical location.
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BMJ quality & safety · Jun 2019
Drivers of potentially avoidable emergency admissions in Ireland: an ecological analysis.
Many emergency admissions are deemed to be potentially avoidable in a well-performing health system. ⋯ The results suggest potentially avoidable emergency admissions and total/other emergency admissions are primarily driven by socioeconomic conditions, hospital admission policy and private health insurance coverage. The distinction between potentially avoidable and all other emergency admissions may not be as useful as previously believed when attempting to identify the causes of regional variation in emergency admission rates.
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BMJ quality & safety · Apr 2019
Observational StudyMinor flow disruptions, traffic-related factors and their effect on major flow disruptions in the operating room.
Studies in operating rooms (OR) show that minor disruptions tend to group together to result in serious adverse events such as surgical errors. Understanding the characteristics of these minor flow disruptions (FD) that impact major events is important in order to proactively design safer systems OBJECTIVE: The purpose of this study is to use a systems approach to investigate the aetiology of minor and major FDs in ORs in terms of the people involved, tasks performed and OR traffic, as well as the location of FDs and other environmental characteristics of the OR that may contribute to these disruptions. ⋯ Room design and layout issues may create barriers to task performance, potentially contributing to the escalation of FDs in the OR.
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BMJ quality & safety · Apr 2019
ReviewMeasuring the teamwork performance of teams in crisis situations: a systematic review of assessment tools and their measurement properties.
Educational interventions to improve teamwork in crisis situations have proliferated in recent years with substantial variation in teamwork measurement. This systematic review aimed to synthesise available tools and their measurement properties in order to identify the most robust tool for measuring the teamwork performance of teams in crisis situations. ⋯ A number of tools are available for assessing teamwork performance of teams in crisis situations. Although selection will ultimately depend on the user's context, TEAM may be the most promising tool given its measurement evidence. Currently, there is a lack of tools to assess teamwork performance during intraoperative crisis situations. Additional research is needed in this regard.