Qual Saf Health Care
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Qual Saf Health Care · Feb 2007
Randomized Controlled Trial Multicenter StudyMultifaceted implementation of stroke prevention guidelines in primary care: cluster-randomised evaluation of clinical and cost effectiveness.
To evaluate clinical and cost effectiveness of implementing evidence-based guidelines for the prevention of stroke. ⋯ Implementation of evidence-based guidelines improved the quality of primary care for atrial fibrillation and TIA. The intervention was feasible and very cost effective. Key components of the model include contextual analysis, strong professional support, clear recommendations based on robust evidence, simplicity of adoption, good communication and use of established networks and opinion leaders.
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Qual Saf Health Care · Feb 2007
Multicenter StudyInfluencing referral practice using feedback of adherence to NICE guidelines: a quality improvement report for dyspepsia.
Rising demand and increasing waiting times for upper gastrointestinal endoscopy (gastroscopy). ⋯ Referral assessment can be successfully introduced and shows promise as a way of improving the quality of referrals and reducing demand. Hospital clinicians are more resistant than GPs to referral assessment but nevertheless responded to the feedback by reducing their endoscopy gastroscopy requests. Most such referrals are generated in hospitals rather than in primary care: this finding has important implications for demand management.
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Qual Saf Health Care · Feb 2007
Comparative StudyInsufficient communication about medication use at the interface between hospital and primary care.
Lack of updated and uniform medication lists poses a problem for the continuity in patient care. The aim of this study was to estimate whether hospitals succeed in making accurate medication lists congruent with patients' actual medication use. Subsequently, the authors evaluated where errors were introduced and the possible implications of incongruent medication lists. ⋯ Approximately one fifth of used POM is unknown to the hospital and only half of used POM registered in discharge letters. Insufficient medication lists hamper clarifying whether or not patients use medication according to prescription. In order to prevent medication errors a systematic follow-up after discharge focusing on making an updated medication list might be needed.
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Qual Saf Health Care · Feb 2007
Assessing system failures in operating rooms and intensive care units.
The current awareness of the potential safety risks in healthcare environments has led to the development of largely reactive methods of systems analysis. Proactive methods are able to objectively detect structural shortcomings before mishaps and have been widely used in other high-risk industries. ⋯ The results seem to justify the conclusion that the LOTICS scale can be used in both the operating room and ICU to gain insight into the system failures, in a relatively quick and reliable manner. Furthermore the LOTICS scale can be used to compare organisations to each other, monitor changes in patient safety, as well as monitor the effectiveness of the changes made to improve the level of patient safety.
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Many studies demonstrate a high rate of treatment-related adverse outcomes or adverse events. No studies have prospectively evaluated adverse events in patients discharged home from the emergency department (ED). ⋯ Most adverse events occurring following an ED visit are preventable and often relate to diagnostic or management errors.