BMJ quality & safety
-
BMJ quality & safety · Apr 2011
Building an integrated methodology of learning that can optimally support improvements in healthcare.
The methods for healthcare reform are strikingly underdeveloped, with much reliance on political power. A methodology that combined methods from sources such as clinical trials, experience-based wisdom, and improvement science could be among the aims of the upcoming work in the USA on comparative effectiveness and on the agenda of the Center for Medicare and Medicaid Innovation in the Centers for Medicare and Medicaid Services. Those working in quality improvement have an unusual opportunity to generate substantial input into these processes through professional organisations such as the Academy for Healthcare Improvement and dominant leadership organisations such as the Institute for Healthcare Improvement.
-
BMJ quality & safety · Mar 2011
Evaluation of an instrument to measure teamwork in multidisciplinary critical care teams.
Teamwork failures contribute to adverse events causing harm to patients. Establishing and maintaining a team and managing the tasks are active processes. Medical education largely ignores teamwork skills. However, lack of robust instruments to measure teamwork limits evaluation of interventions to improve it. The authors aimed to develop and validate an instrument to measure teamwork behaviours. ⋯ The instrument performed well as an overall measure of team behaviour and reflected three dimensions of teamwork. Triangulation of information on the instrument, the factors and individual items will allow a methodical and informed approach to further development of the instrument. The ultimate goal is an instrument that can robustly evaluate interventions to improve team function in healthcare.
-
BMJ quality & safety · Mar 2011
Peri-operative medical emergency team activation in liver transplantation.
The medical emergency team (MET) system functions to promptly identify acutely ill patients at-risk for deterioration. Liver transplant (LT) patients are at-risk for serious post-operative complications. ⋯ LT patients with post-operative complications prompting MET activation had higher morbidity and mortality compared with controls; however, the MET may have been under-utilised and/or delayed. Further prospective multi-centre investigation is warranted.
-
BMJ quality & safety · Feb 2011
Measuring patients' experiences and views of the emergency and urgent care system: psychometric testing of the urgent care system questionnaire.
Patients seeking emergency and urgent care tend to experience a system, making choices about which service to use and making use of a number of services within a healthcare episode. The aim was to psychometrically test the Urgent Care System Questionnaire (UCSQ) for the routine measurement of the patient perspective of the emergency and urgent care system. ⋯ Preliminary testing suggests that the UCSQ has reasonable acceptability, validity and reliability. Further testing is required, particularly its responsiveness to changes in emergency and urgent care systems.
-
To review studies on hospital doctors' handovers to identify the methods and main findings. ⋯ The handover literature does not fully identify where communication failures typically occur or influencing conditions, thus hampering the design of effective handover training and tools. A systematic analysis of all the stages of doctors' handovers is required.