Abstract:
OBJECTIVE:We sought to identify the characteristics of patients who experience medical emergency team calls in the radiology department (MET-RD) and the relationship between these characteristics and patient outcomes. DESIGN/PARTICIPANTS:Retrospective review of 111 inpatient MET-RD calls (May 2008-April 2010). SETTING:Academic medical centre with a well established MET system. MEASUREMENTS:The characteristics of patients before, during and after transport to radiology were extracted from medical records and administrative databases. These characteristics were compared between patients with good and poor outcomes. MAIN RESULTS:The majority of patients who experience MET-RD calls had a Charlson Comorbidity Index ≥4 and were from non-intensive care units (60%). Almost half (43%) of MET-RD calls occurred during patients' first day in hospital. Patients commonly arrived with nasal cannula oxygen (38%), recent tachypnoea (28%) and tachycardia (34%). A minority (16%) fulfilled MET call criteria in the 12 h before the MET-RD. MET-RD etiologies were cardiac (41%), respiratory (29%) or neurological (25%), and occurred most frequently during CT (44%) and MRI (22%) testing. Post MET-RD, the majority of patients (70%) required a higher level of care. Death before discharge (25%) was associated with need for cardiovascular support prior to RD transport (p=0.02), need for RD monitoring (p=0.02) and need for heightened RD surveillance (p=0.04). CONCLUSIONS:The majority of patients who experienced MET-RD calls came from non-intensive care units, with comorbidities and vital sign alterations prior to arrival at the RD. Risk appeared to be increased for those requiring CT and MRI. These findings suggest that prior identification of a subset of patients at risk of instability in the RD may be possible.
journal_name
BMJ Qual Safjournal_title
BMJ quality & safetyauthors
Ott LK,Pinsky MR,Hoffman LA,Clarke SP,Clark S,Ren D,Hravnak Mdoi
10.1136/bmjqs-2011-000423subject
Has Abstractpub_date
2012-06-01 00:00:00pages
509-18issue
6eissn
2044-5415issn
2044-5423pii
bmjqs-2011-000423journal_volume
21pub_type
杂志文章abstract:BACKGROUND:Realising the full potential of the WHO Surgical Safety Checklist (SSC) to reduce perioperative harm requires the constructive engagement of all operating room (OR) team members during its administration. To facilitate research on SSC implementation, a valid and reliable instrument is needed for measuring OR...
journal_title:BMJ quality & safety
pub_type: 杂志文章
doi:10.1136/bmjqs-2015-004448
更新日期:2016-10-01 00:00:00
abstract:OBJECTIVE:To explore whether differences between collaboratives with respect to type of topic, type of targets, measures (systems) are also reflected in the degree of effectiveness. STUDY SETTING:182 teams from long-term healthcare organisation developed improvement initiatives in seven quality-improvement collaborati...
journal_title:BMJ quality & safety
pub_type: 杂志文章
doi:10.1136/bmjqs.2010.047159
更新日期:2011-04-01 00:00:00
abstract:OBJECTIVE:To understand what patients and family members know about problems and failures in healthcare. DESIGN:Qualitative, semistructured open-ended interviews were conducted with 39 patients and 80 family members about their experiences of incidents in tertiary healthcare. Nineteen interviews involved more than one...
journal_title:BMJ quality & safety
pub_type: 杂志文章
doi:10.1136/bmjqs-2011-000100
更新日期:2012-03-01 00:00:00
abstract:BACKGROUND:Improved hospital care is needed to reduce newborn mortality in low/middle-income countries (LMIC). Nurses are essential to the delivery of safe and effective care, but nurse shortages and high patient workloads may result in missed care. We aimed to examine nursing care delivered to sick newborns and identi...
journal_title:BMJ quality & safety
pub_type: 杂志文章
doi:10.1136/bmjqs-2019-009363
更新日期:2020-01-01 00:00:00
abstract:OBJECTIVES:To determine frequencies of healthcare workers (HCWs) speak up-related behaviours and the association of speak up-related safety climate with speaking up and withholding voice. DESIGN:Cross-sectional survey of doctors and nurses. Data were analysed using multilevel logistic regression models SETTING: 4 hosp...
journal_title:BMJ quality & safety
pub_type: 杂志文章
doi:10.1136/bmjqs-2017-007388
更新日期:2018-10-01 00:00:00
abstract:OBJECTIVE:To describe the development of evidence-based electronic prescribing (e-prescribing) triggers and treatment algorithms for potentially inappropriate medications (PIMs) for older adults. DESIGN:Literature review, expert panel and focus group. SETTING:Primary care with access to e-prescribing systems. PARTIC...
journal_title:BMJ quality & safety
pub_type: 杂志文章
doi:10.1136/bmjqs.2010.049635
更新日期:2011-10-01 00:00:00
abstract::Statistical hypothesis testing involving the comparison of three or more means and/or proportions is a frequent undertaking in medical statistics. For comparison of means, analysis of variance is a common choice and for comparison of proportions, χ(2) tests are common. However, both these approaches have important lim...
journal_title:BMJ quality & safety
pub_type: 杂志文章
doi:10.1136/bmjqs-2011-000477
更新日期:2012-06-01 00:00:00
abstract::This commentary explores the nature of creating safety in the here-and-now. Creating safety encompasses two dimensions: revisiting specific behaviours by focusing on substandard performance (reflection), and a more broad-ranging attention to everyday behaviours that are taken as given (reflexivity). The piece pays par...
journal_title:BMJ quality & safety
pub_type: 杂志文章
doi:10.1136/bmjqs.2010.046714
更新日期:2011-04-01 00:00:00
abstract:OBJECTIVE:Hospital care comprises nearly a third of US healthcare expenditures. Fifteen to 20 per cent of this spending is considered to be potentially preventable. Risk prediction models have suboptimal accuracy and typically exclude patient experience data. No studies have explored patient perceptions of the likeliho...
journal_title:BMJ quality & safety
pub_type: 杂志文章
doi:10.1136/bmjqs-2017-007184
更新日期:2018-09-01 00:00:00
abstract:BACKGROUND:Healthcare systems worldwide are concerned with strengthening board-level governance of quality. We applied Lozeau, Langley and Denis' typology (transformation, customisation, loose coupling and corruption) to describe and explain the organisational response to an improvement intervention in six hospital boa...
journal_title:BMJ quality & safety
pub_type: 杂志文章
doi:10.1136/bmjqs-2018-008291
更新日期:2019-03-01 00:00:00
abstract:OBJECTIVE:Paediatric cardiac surgery has a low error tolerance and demands high levels of cognitive and technical performance. Growing evidence suggests that further improvements in patient outcomes depend on system factors, in particular, effective team skills. The hypotheses that small intraoperative non-routine even...
journal_title:BMJ quality & safety
pub_type: 杂志文章
doi:10.1136/bmjqs.2010.048983
更新日期:2011-07-01 00:00:00
abstract:BACKGROUND:Diagnostic errors (missed, delayed or wrong diagnosis) have recently gained attention and are associated with significant preventable morbidity and mortality. The authors reviewed the recent literature and identified interventions that address system-related factors that contribute directly to diagnostic err...
journal_title:BMJ quality & safety
pub_type: 杂志文章,评审
doi:10.1136/bmjqs-2011-000150
更新日期:2012-02-01 00:00:00
abstract:BACKGROUND:The discharge letter is the primary means of communication at patient discharge, yet discharge letters are often not completed on time. A multifaceted intervention was performed to improve communication in patient hand-off from the intensive care unit (ICU) to the wards by improving the timeliness of dischar...
journal_title:BMJ quality & safety
pub_type: 杂志文章
doi:10.1136/bmjqs-2011-000074
更新日期:2011-11-01 00:00:00
abstract:OBJECTIVES:Systemic issues can adversely affect the diagnostic process. Many system-related barriers can be masked by 'resilient' actions of frontline providers (ie, actions supporting the safe delivery of care in the presence of pressures that the system cannot readily adapt to). We explored system barriers and resili...
journal_title:BMJ quality & safety
pub_type: 杂志文章
doi:10.1136/bmjqs-2012-001661
更新日期:2013-12-01 00:00:00
abstract:BACKGROUND:Plan-do-study-act (PDSA) cycles provide a structure for iterative testing of changes to improve quality of systems. The method is widely accepted in healthcare improvement; however there is little overarching evaluation of how the method is applied. This paper proposes a theoretical framework for assessing t...
journal_title:BMJ quality & safety
pub_type: 杂志文章,评审
doi:10.1136/bmjqs-2013-001862
更新日期:2014-04-01 00:00:00
abstract:BACKGROUND:Transfers of care have become increasingly frequent and complex with shorter inpatient stays and changes in work hour regulations. Potential hazards exist with transfers. There are few reports of institution-wide efforts to improve handoffs. METHODS:An institution-wide physician handoff task force was devel...
journal_title:BMJ quality & safety
pub_type: 杂志文章
doi:10.1136/bmjqs-2011-000658
更新日期:2012-10-01 00:00:00
abstract:BACKGROUND:Community pharmacists are well positioned to support patients' minor ailments. The objective was to evaluate the clinical and humanistic impact of a minor ailment service (MAS) in community pharmacy compared with usual pharmacist care (UC). METHODS:A cluster randomised controlled trial was conducted. Interv...
journal_title:BMJ quality & safety
pub_type: 杂志文章
doi:10.1136/bmjqs-2019-010608
更新日期:2020-11-01 00:00:00
abstract:BACKGROUND:A safe delivery is part of a good start in life, and a continuous focus on preventing harm during delivery is crucial, even in settings with a good safety record. In January 2013, the labour unit at Copenhagen University Hospital, Hvidovre, undertook a quality improvement (QI) project to prevent asphyxia and...
journal_title:BMJ quality & safety
pub_type: 杂志文章
doi:10.1136/bmjqs-2017-006599
更新日期:2018-08-01 00:00:00
abstract:OBJECTIVE:Patient safety studies have identified older adults as a high-risk group for adverse events (AEs). As frequent users of the emergency department (ED), they are vulnerable to the negative consequences of ED crowding. The study objective was to determine whether a prolonged ED stay is associated with an increas...
journal_title:BMJ quality & safety
pub_type: 杂志文章
doi:10.1136/bmjqs.2009.034926
更新日期:2011-07-01 00:00:00
abstract:BACKGROUND:Learning is in delicate balance with safety, as faculty supervisors try to foster trainee development while safeguarding patients. This balance is particularly challenging if trainees are allowed to experience the educational benefits of failure, acknowledged as a critical resource for developing competence ...
journal_title:BMJ quality & safety
pub_type: 杂志文章
doi:10.1136/bmjqs-2019-009808
更新日期:2020-09-01 00:00:00
abstract:INTRODUCTION:Emergent evidence suggests that patients can identify and report safety issues while in hospital. However, little is known about the best method for collecting information from patients about safety concerns. This study presents an exploratory pilot of three mechanisms for collecting data on safety concern...
journal_title:BMJ quality & safety
pub_type: 杂志文章
doi:10.1136/bmjqs-2015-004260
更新日期:2017-01-01 00:00:00
abstract:BACKGROUND:Recent research suggests that hospital rates of postoperative venous thromboembolism (VTE) are subject to surveillance bias: the more hospitals 'look for' VTE, the more VTE they find. However, little is known about what drives variation in hospital VTE imaging rates. We conducted an observational study to ex...
journal_title:BMJ quality & safety
pub_type: 杂志文章
doi:10.1136/bmjqs-2014-003150
更新日期:2014-11-01 00:00:00
abstract::BACKGROUND Previous research has shown a correlation between physician job satisfaction and patient satisfaction with quality of care, but the connection between job satisfaction of other primary care team members and patient satisfaction is yet unclear. OBJECTIVE To evaluate whether there is an association between pa...
journal_title:BMJ quality & safety
pub_type: 杂志文章
doi:10.1136/bmjqs.2009.038166
更新日期:2011-06-01 00:00:00
abstract:BACKGROUND:Burnout is widespread among healthcare providers and is associated with adverse safety behaviours, operational and clinical outcomes. Little is known with regard to the explanatory links between burnout and these adverse outcomes. OBJECTIVES:(1) Test the psychometric properties of a brief four-item burnout ...
journal_title:BMJ quality & safety
pub_type: 杂志文章
doi:10.1136/bmjqs-2014-002831
更新日期:2014-10-01 00:00:00
abstract:BACKGROUND:Patient safety experts have postulated that increasing patient participation in communications during patient handovers will improve the quality of patient transitions, and that this may reduce hospital readmissions. Choosing strategies that enhance patient safety through improved handovers requires better u...
journal_title:BMJ quality & safety
pub_type: 杂志文章,多中心研究
doi:10.1136/bmjqs-2012-001171
更新日期:2012-12-01 00:00:00
abstract:BACKGROUND:Human auditing has been the gold standard for evaluating hand hygiene (HH) compliance but is subject to the Hawthorne effect (HE), the change in subjects' behaviour due to their awareness of being observed. For the first time, we used electronic HH monitoring to characterise the duration of the HE on HH even...
journal_title:BMJ quality & safety
pub_type: 杂志文章
doi:10.1136/bmjqs-2019-010310
更新日期:2020-11-01 00:00:00
abstract:INTRODUCTION:Intravenous medication errors persist despite the use of smart pumps. This suggests the need for a standardised methodology for measuring errors and highlights the importance of identifying issues around smart pump medication administration in order to improve patient safety. OBJECTIVES:We conducted a mul...
journal_title:BMJ quality & safety
pub_type: 杂志文章,多中心研究
doi:10.1136/bmjqs-2015-004465
更新日期:2017-02-01 00:00:00
abstract:BACKGROUND:Outcome benefits of using the WHO Surgical Safety Checklist rely on compliance with checklist administration. OBJECTIVE:To evaluate engagement of operating room (OR) subteams (anaesthesia, surgery and nursing), and compliance with administering checklist domains (Sign In, Time Out and Sign Out) and checklis...
journal_title:BMJ quality & safety
pub_type: 杂志文章
doi:10.1136/bmjqs-2015-004545
更新日期:2016-12-01 00:00:00
abstract::Risk-adjustment schemes are used to monitor hospital performance, on the assumption that excess mortality not explained by case mix is largely attributable to suboptimal care. We have developed a model to estimate the proportion of the variation in standardised mortality ratios (SMRs) that can be accounted for by vari...
journal_title:BMJ quality & safety
pub_type: 杂志文章
doi:10.1136/bmjqs-2012-001202
更新日期:2012-12-01 00:00:00
abstract:BACKGROUND:Insulin is a high-risk medicine which may cause significant patient harm or death when given incorrectly. A 10-fold error in administered insulin dose commonly occurs when the abbreviation 'u' is used for 'units' and subsequently misinterpreted as a 'zero.' METHOD:A multidisciplinary working party was conve...
journal_title:BMJ quality & safety
pub_type: 杂志文章,多中心研究
doi:10.1136/bmjqs.2010.049668
更新日期:2011-07-01 00:00:00