Abstract:
OBJECTIVE:Implement and demonstrate feasibility of in situ simulations to identify latent safety threats (LSTs) at a higher rate than lab-based training, and reinforce teamwork training in a paediatric emergency department (ED). METHODS:Multidisciplinary healthcare providers responded to critical simulated patients in an urban ED during all shifts. Unannounced in situ simulations were limited to 10 min of simulation and 10 min of debriefing, and were video recorded. A standardised debriefing template was used to assess LSTs. The primary outcome measure was the number and type of LSTs identified during the simulations. Secondary measures included: participants' assessment of impact on patient care and value to participants. Blinded video review using a modified Anaesthetists Non-Technical Skills scale was used to assess team behaviours. RESULTS:218 healthcare providers responded to 90 in situ simulations conducted over 1 year. A total of 73 LSTs were identified; a rate of one every 1.2 simulations performed. In situ simulations were cancelled at a rate of 28% initially, but the cancellation rate decreased as training matured. Examples of threats identified include malfunctioning equipment and knowledge gaps concerning role responsibilities. 78% of participants rated the simulations as extremely valuable or valuable, while only 5% rated the simulation as having little or no value. Of those responding to a postsimulation survey, 77% reported little or no clinical impact. Video recordings did not indicate changes in non-technical skills during this time. CONCLUSIONS:In situ simulation is a practical method for the detection of LSTs and to reinforce team training behaviours. Embedding in situ simulation as a routine expectation positively affected operations and the safety climate in a high risk clinical setting.
journal_name
BMJ Qual Safjournal_title
BMJ quality & safetyauthors
Patterson MD,Geis GL,Falcone RA,LeMaster T,Wears RLdoi
10.1136/bmjqs-2012-000942subject
Has Abstractpub_date
2013-06-01 00:00:00pages
468-77issue
6eissn
2044-5415issn
2044-5423pii
bmjqs-2012-000942journal_volume
22pub_type
杂志文章abstract:BACKGROUND:There have been repeated calls to better involve patients and the public and to place them at the centre of healthcare. Serious clinical and service failings in the UK and internationally increase the urgency and importance of addressing this problem. Despite this supportive policy context, progress to achie...
journal_title:BMJ quality & safety
pub_type: 杂志文章
doi:10.1136/bmjqs-2015-004839
更新日期:2016-08-01 00:00:00
abstract:OBJECTIVE:To assess the psychometric properties of the French-language version of the Hospital Survey on Patient Safety Culture (HSOPSC). METHODS:Data were obtained from a staff survey at a Swiss multisite hospital. We computed descriptive statistics and internal consistency coefficients, then conducted a confirmatory...
journal_title:BMJ quality & safety
pub_type: 杂志文章
doi:10.1136/bmjqs-2013-002024
更新日期:2014-05-01 00:00:00
abstract:BACKGROUND:Advocates for quality and safety have called for healthcare that is patient-centred and decision-making that involves patients. OBJECTIVE:The aim of the paper is to explore the barriers and facilitators to patient-centred care in the hospital discharge process. METHODS:A qualitative study using purposive s...
journal_title:BMJ quality & safety
pub_type: 杂志文章,多中心研究
doi:10.1136/bmjqs-2012-001165
更新日期:2012-12-01 00:00:00
abstract:BACKGROUND:Our goal was to compare hospital scores from the most widely used commercial website in the USA to hospital scores from more systematic measures of patient experience and outcomes, and to assess what drives variation in the commercial website scores. METHODS:For a national sample of US hospitals, we compare...
journal_title:BMJ quality & safety
pub_type: 杂志文章
doi:10.1136/bmjqs-2012-001360
更新日期:2013-03-01 00:00:00
abstract:OBJECTIVE:To determine the quality and diagnostic accuracy of in-hospital adult clinical emergency calls. DESIGN:Prospective observational study. SETTING:Three National Health Service acute hospitals in England. PARTICIPANTS:Adult patients sustaining an in-hospital cardiac arrest (CA) or medical emergency (ME) which...
journal_title:BMJ quality & safety
pub_type: 杂志文章
doi:10.1136/bmjqs-2011-000319
更新日期:2012-03-01 00:00:00
abstract:BACKGROUND:National Hospital Quality Measures (NHQM) should accurately reflect quality of care, as they increasingly impact reimbursement and reputation. However, similar to risk adjustment of outcomes measures, NHQM process measures pose unique methodological concerns, including lack of representativeness of the final...
journal_title:BMJ quality & safety
pub_type: 杂志文章
doi:10.1136/bmjqs-2015-004888
更新日期:2017-03-01 00:00:00
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:The goal of this study was to identify barriers and facilitators to the optimal management of critically ill children who present initially to community hospitals and how best to support the needs of front-line healthcare providers in these settings prior to transfer to the regional academic paediatric health...
journal_title:BMJ quality & safety
pub_type: 杂志文章
doi:10.1136/bmjqs-2013-002070
更新日期:2014-06-01 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: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:INTRODUCTION:Adverse events (AEs) affect 3-12% of hospitalised patients. These are estimates from a labour-intensive chart review process,which is not feasible outside research. Clinical deterioration on the wards triggers a rapid response teams (RRTs) consult and can be used to identify an AE prospectively. OBJECTIVE...
journal_title:BMJ quality & safety
pub_type: 杂志文章
doi:10.1136/bmjqs-2014-003833
更新日期:2015-12-01 00:00:00
abstract::Medical errors continue to occur despite multiple strategies devised for their prevention. Although many safety initiatives lead to improvement, they are often short lived and unsustainable. Our goal was to build a culture of patient safety within a structure that optimised teamwork and ongoing engagement of the healt...
journal_title:BMJ quality & safety
pub_type: 杂志文章
doi:10.1136/bmjqs-2012-001011
更新日期:2013-05-01 00:00:00
abstract:BACKGROUND:Monitoring blood pressure at 72 hours and 7-10 days post partum in women with hypertensive disorders is recommended to decrease morbidity. However, there are no recommendations as to how to achieve this. OBJECTIVE:To compare the effectiveness of text-based blood pressure monitoring to in-person visits for w...
journal_title:BMJ quality & safety
pub_type: 杂志文章,随机对照试验
doi:10.1136/bmjqs-2018-007837
更新日期:2018-11-01 00:00:00
abstract:OBJECTIVES:To demonstrate complementary results of regression and statistical process control (SPC) chart analyses for hospital-acquired pressure ulcers (HAPUs), and identify possible links between changes and opportunities for improvement between hospital microsystems and macrosystems. METHODS:Ordinary least squares ...
journal_title:BMJ quality & safety
pub_type: 杂志文章
doi:10.1136/bmjqs-2011-000340
更新日期:2012-06-01 00:00:00
abstract:BACKGROUND:Under the 'Choosing Wisely' (CW) framework, professional organisations internationally have advocated limiting imaging for asymptomatic patients following curative cancer therapy, based on limited value and high cost. F18-fluorodeoxyglucose (FDG) positron emission tomography-CT (PET/CT) was widely adopted lo...
journal_title:BMJ quality & safety
pub_type: 杂志文章
doi:10.1136/bmjqs-2019-010756
更新日期:2020-05-28 00:00:00
abstract:OBJECTIVE:To assess quality of care for children presenting with acute abdominal pain using validated indicators. DESIGN:Audit of care quality for acute abdominal pain according to 21 care quality indicators developed and validated in four stages. SETTING AND PARTICIPANTS:Medical records of children aged 1-15 years r...
journal_title:BMJ quality & safety
pub_type: 杂志文章
doi:10.1136/bmjqs-2019-010088
更新日期:2020-06-01 00:00:00
abstract:OBJECTIVES:To sustainably reduce the rate of mislabelled laboratory specimens through implementation of a series of interventions as led and coordinated by a multidisciplinary performance improvement team. METHODS:The quality improvement project was performed at Cedars-Sinai Medical Center in Los Angeles, an academic ...
journal_title:BMJ quality & safety
pub_type: 杂志文章
doi:10.1136/bmjqs-2014-003005
更新日期:2014-08-01 00:00:00
abstract:OBJECTIVE:To examine the effectiveness and cost-effectiveness of the community pharmacy New Medicine Service (NMS) at 26 weeks. METHODS:Pragmatic patient-level parallel randomised controlled trial in 46 English community pharmacies. 504 participants aged ≥14, identified in the pharmacy when presenting a prescription f...
journal_title:BMJ quality & safety
pub_type: 杂志文章
doi:10.1136/bmjqs-2018-009177
更新日期:2020-04-01 00:00:00
abstract:OBJECTIVE:This article is an exploration of views and experiences of Patient Safety Walkrounds, a widely recommended strategy for identifying patient safety problems and improving safety culture. DESIGN AND SETTING:Qualitative analysis of semistructured, in-depth interviews with 11 senior leaders and 33 front-line sta...
journal_title:BMJ quality & safety
pub_type: 杂志文章
doi:10.1136/bmjqs-2012-001706
更新日期:2014-10-01 00:00:00
abstract:OBJECTIVE:Valid, reliable critical appraisal tools advance quality improvement (QI) intervention impacts by helping stakeholders identify higher quality studies. QI approaches are diverse and differ from clinical interventions. Widely used critical appraisal instruments do not take unique QI features into account and e...
journal_title:BMJ quality & safety
pub_type: 杂志文章
doi:10.1136/bmjqs-2014-003151
更新日期:2015-12-01 00:00:00
abstract:BACKGROUND:Errors in clinical reasoning occur in most cases in which the diagnosis is missed, delayed or wrong. The goal of this review was to identify interventions that might reduce the likelihood of these cognitive errors. DESIGN:We searched PubMed and other medical and non-medical databases and identified addition...
journal_title:BMJ quality & safety
pub_type: 杂志文章,评审
doi:10.1136/bmjqs-2011-000149
更新日期:2012-07-01 00:00:00
abstract:BACKGROUND:Experts in patient safety stress the importance of a shared culture of safety. Lack of consensus may be detrimental to patient safety. This study examines differences in patient safety culture perceptions among providers, management and staff in a large national survey of safety culture in ambulatory practic...
journal_title:BMJ quality & safety
pub_type: 杂志文章
doi:10.1136/bmjqs-2014-003914
更新日期:2016-08-01 00:00:00
abstract:PURPOSE:To evaluate the impact of implementation of a dedicated intensivist-led medical emergency team (IL-MET) on mortality in patients admitted to the intensive care unit (ICU). METHODS:All adult ward admissions to the ICU between July 2002 and December 2009 were reviewed (n=1920) after excluding readmissions and ad...
journal_title:BMJ quality & safety
pub_type: 杂志文章
doi:10.1136/bmjqs-2011-000393
更新日期:2012-02-01 00:00:00
abstract:INTRODUCTION:Hip fractures are associated with high rates of morbidity and mortality and their incidence is set to increase. The National Hip Fracture Database and the Best Practice Tariff were introduced with the aim of improving patient care. This complete audit cycle charts the substantial clinical improvements that...
journal_title:BMJ quality & safety
pub_type: 杂志文章
doi:10.1136/bmjqs-2014-003700
更新日期:2015-08-01 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:OBJECTIVE:To examine the association of mortality by day of the week for emergency and elective patients. DESIGN:Retrospective observational study using the international dataset from the Global Comparators (GC) project consisting of hospital administrative data. SETTING:28 hospitals from England, Australia, USA and ...
journal_title:BMJ quality & safety
pub_type: 杂志文章
doi:10.1136/bmjqs-2014-003467
更新日期:2015-08-01 00:00:00
abstract::Current methods used to evaluate the effects of healthcare improvement efforts have limitations. Designs with strong causal inference-such as individual patient or cluster randomisation-can be inappropriate and infeasible to use in single-centre settings. Simpler designs-such as prepost studies-are unable to infer cau...
journal_title:BMJ quality & safety
pub_type: 杂志文章
doi:10.1136/bmjqs-2019-009734
更新日期:2020-02-01 00:00:00
abstract:PURPOSE:To compare the effectiveness of two types of online learning methodologies for improving the patient-safety behaviours mandated in the Joint Commission National Patient Safety Goals (NPSG). METHODS:This randomised controlled trial was conducted in 2010 at Massachusetts General Hospital and Brigham and Women's ...
journal_title:BMJ quality & safety
pub_type: 杂志文章,随机对照试验
doi:10.1136/bmjqs-2011-000702
更新日期:2012-10-01 00:00:00
abstract:BACKGROUND:Catheter-associated urinary tract infections (CAUTI) are costly, common and often preventable by reducing unnecessary urinary catheter (UC) use. METHODS:To summarise interventions to reduce UC use and CAUTIs, we updated a prior systematic review (through October 2012), and a meta-analysis regarding interven...
journal_title:BMJ quality & safety
pub_type: 杂志文章,meta分析,评审
doi:10.1136/bmjqs-2012-001774
更新日期:2014-04-01 00:00:00
abstract:BACKGROUND:Relatively little is known about how scorecards presenting performance indicators influence medication safety. We evaluated the effects of implementing a ward-level medication safety scorecard piloted in two English NHS hospitals and factors influencing these. METHODS:We used a mixed methods, controlled bef...
journal_title:BMJ quality & safety
pub_type: 杂志文章,多中心研究
doi:10.1136/bmjqs-2012-001730
更新日期:2014-02-01 00:00:00