Abstract:
OBJECTIVE:To assess the effectiveness of a multifaceted intervention based on industrial process improvement to identify and sustainably correct deficiencies in thromboprophylaxis delivery. SUMMARY BACKGROUND DATA:Deep vein thrombosis and pulmonary embolism are major causes of morbidity and mortality in surgical patients, but effective prophylactic treatments are available. Ensuring reliable delivery of the intended thromboprophylaxis is, however, a long-standing problem. METHODS:Delivery of thromboprophylactic treatment on an emergency general surgery admissions ward was targeted during a multidisciplinary intervention to improve process reliability using industrial quality improvement approaches. Delivery was audited against guidelines before and after 3- month intervention. Clinical outcome was evaluated by reviewing all radiological investigations for suspected Deep Vein Thrombosis (DVT) or Pulmonary Embolism (PE) from patients admitted to the unit in the 1 year immediately before and that immediately after intervention. RESULTS:Delivery of thromboprophylaxis according to guidelines was improved from 35% before to 87% 3 months after intervention (χ(2)=87.412, p<0.0001) and sustained at 86% 10 months after intervention. Radiologically identified thromboembolic events occurring up to 60 days after admission in patients admitted for over 48 h fell from 23/3075 (0.75%) before to 9/3080 (0.29%) after intervention (HR 0.39, CI 0.29 to 0.53, χ(2)=6.18, p=0.01292). The risk of thromboembolism in the two groups diverged during follow-up to 60 days, before converging again. CONCLUSIONS:A quality improvement process resulted in major sustainable improvements in the delivery of thromboprophylaxis associated with a 61% reduction in radiologically detected clinical episodes of thromboembolism 2 months after admission. Further study of this approach to improving care quality is warranted.
journal_name
BMJ Qual Safjournal_title
BMJ quality & safetyauthors
Kreckler S,Morgan RD,Catchpole K,New S,Handa A,Collins G,McCulloch Pdoi
10.1136/bmjqs-2013-001855subject
Has Abstractpub_date
2013-11-01 00:00:00pages
916-22issue
11eissn
2044-5415issn
2044-5423pii
bmjqs-2013-001855journal_volume
22pub_type
杂志文章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: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
abstract::'The Problem with…' series covers controversial topics related to efforts to improve healthcare quality, including widely recommended, but deceptively difficult strategies for improvement and pervasive problems that seem to resist solution. ...
journal_title:BMJ quality & safety
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更新日期:2018-09-01 00:00:00
abstract:BACKGROUND:A growing body of peer-reviewed studies demonstrate the importance of safety culture in healthcare safety improvement, but little attention has focused on developing a common set of definitions, dimensions and measures. OBJECTIVES:Specific objectives of this literature review include: summarising definition...
journal_title:BMJ quality & safety
pub_type: 杂志文章,评审
doi:10.1136/bmjqs.2010.040964
更新日期:2011-04-01 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::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:BACKGROUND:Diagnostic error is commonly defined as a missed, delayed or wrong diagnosis and has been described as among the most important patient safety hazards. Diagnostic errors also account for the largest category of medical malpractice high severity claims and total payouts. Despite a large literature on the inci...
journal_title:BMJ quality & safety
pub_type: 杂志文章,评审
doi:10.1136/bmjqs-2019-010822
更新日期:2020-12-01 00:00:00
abstract:OBJECTIVE:To assess the quality of guidelines, consensus statements and systematic reviews on flu and pneumococcal immunisations in HIV-infected children. METHOD:The authors screened PubMed and Embase databases until the year 2009 for guidelines, consensus statements and systematic reviews on flu and pneumococcal immu...
journal_title:BMJ quality & safety
pub_type: 杂志文章,评审
doi:10.1136/bmjqs.2010.047316
更新日期:2011-05-01 00:00:00
abstract:OBJECTIVE:To empirically assess the quality of hospital care in China and trends over a 5-year period during which the government significantly increased its investment in healthcare. DESIGN:Retrospective, observational study comparing hospital quality between two periods: October 2012-March 2013 and October 2017-Marc...
journal_title:BMJ quality & safety
pub_type: 杂志文章
doi:10.1136/bmjqs-2018-008938
更新日期:2019-12-01 00:00:00
abstract:OBJECTIVE:To determine the association between daily levels of registered nurse (RN) and nursing assistant staffing and hospital mortality. DESIGN:This is a retrospective longitudinal observational study using routinely collected data. We used multilevel/hierarchical mixed-effects regression models to explore the asso...
journal_title:BMJ quality & safety
pub_type: 杂志文章
doi:10.1136/bmjqs-2018-008043
更新日期:2019-08-01 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:OBJECTIVES:In order to improve its quality-assurance programme based on ISO 9001, the Central Sterile Supply Department of a public university hospital has performed a prospective risk analysis using the Preliminary Risk Analysis method (PRA). The objectives were the achievement of a global risk mapping related to the ...
journal_title:BMJ quality & safety
pub_type: 杂志文章
doi:10.1136/bmjqs.2010.048074
更新日期:2011-08-01 00:00:00
abstract:RESEARCH QUESTIONS:The paper explores which type of quality aspects (structure, process, outcome) most strongly determines patients' overall assessment of healthcare, and whether there is a variation between different types of patient groups in this respect. METHODS:Secondary analyses were undertaken on survey data fr...
journal_title:BMJ quality & safety
pub_type: 杂志文章
doi:10.1136/bmjqs.2010.042358
更新日期:2011-04-01 00:00:00
abstract:BACKGROUND:In Scotland, the uptake of clinic-based breast (72%) and cervical (77%) screening is higher than home-based colorectal screening (~60%). To inform new approaches to increase uptake of colorectal screening, we compared the perceptions of colorectal screening among women with different screening histories. ME...
journal_title:BMJ quality & safety
pub_type: 杂志文章
doi:10.1136/bmjqs-2019-009998
更新日期:2020-06-01 00:00:00
abstract:BACKGROUND:Meaningful partnering with patients is advocated to enhance care delivery. Little is known about how this is operationalised at the point of care during hospital ward rounds, where decision-making concerning patient care frequently occurs. OBJECTIVE:Describe participation of patients, with differing prefere...
journal_title:BMJ quality & safety
pub_type: 杂志文章
doi:10.1136/bmjqs-2017-007292
更新日期:2019-01-01 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: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:OBJECTIVE:Administrative data systems are used to identify hospital-based patient safety events; few studies evaluate their accuracy. We assessed the accuracy of a new set of patient safety indicators (PSIs; designed to identify in hospital complications). STUDY DESIGN:Prospectively defined analysis of registry data (...
journal_title:BMJ quality & safety
pub_type: 杂志文章
doi:10.1136/bmjqs-2018-008852
更新日期:2020-03-01 00:00:00
abstract::Cystic fibrosis (CF) is a chronic disease requiring patients to have frequent specialty healthcare visits to delay progression of lung disease, prevent and treat failure to thrive and initiate early interventions to prevent acute illness and complications. The CF Foundation recommends that patients have visits with th...
journal_title:BMJ quality & safety
pub_type: 杂志文章,评审
doi:10.1136/bmjqs-2013-002345
更新日期:2014-04-01 00:00:00
abstract:BACKGROUND:Non-drug technologies offer many benefits, but have been associated with adverse events, prompting calls for improved postmarket surveillance. There is little empirical research to guide the development of such a system. The purpose of this study was to identify optimal postmarket surveillance strategies for...
journal_title:BMJ quality & safety
pub_type: 杂志文章,多中心研究
doi:10.1136/bmjqs-2012-001298
更新日期:2013-03-01 00:00:00
abstract:BACKGROUND:Root cause analyses of surgical complications are of high importance to ensure surgical quality, but specific details on technical causes often remain unclear. Identifying subclinical intraoperative incidents attributable to technical errors is essential for developing rescue mechanisms to prevent adverse ou...
journal_title:BMJ quality & safety
pub_type: 杂志文章
doi:10.1136/bmjqs-2014-003816
更新日期:2015-08-01 00:00:00
abstract:INTRODUCTION:Individual effort and practice systems contribute to quality performance, but the nature of their contributions remains unclear. METHODS:This study assessed the roles of individual attributes and behaviours versus practice attributes in quality performance by assessing general internists' perceptions of f...
journal_title:BMJ quality & safety
pub_type: 杂志文章
doi:10.1136/bmjqs.2010.048991
更新日期:2011-08-01 00:00:00
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journal_title:BMJ quality & safety
pub_type: 杂志文章,随机对照试验
doi:10.1136/bmjqs-2016-006123
更新日期:2017-09-01 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:BACKGROUND:The egregious failings in patient safety at Mid Staffordshire NHS Foundation Trust between 2005 and 2009 identified by Sir Robert Francis QC in his public inquiry prompted him to recommend the introduction of a new criminal offence into English law in circumstances where a patient dies or is seriously harmed...
journal_title:BMJ quality & safety
pub_type: 杂志文章,评审
doi:10.1136/bmjqs-2013-002688
更新日期:2014-06-01 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:BACKGROUND:Free-text directions generated by prescribers in electronic prescriptions can be difficult for patients to understand due to their variability, complexity and ambiguity. Pharmacy staff are responsible for transcribing these directions so that patients can take their medication as prescribed. However, little ...
journal_title:BMJ quality & safety
pub_type: 杂志文章
doi:10.1136/bmjqs-2019-010405
更新日期:2020-05-25 00:00:00
abstract:OBJECTIVE:Computerised order sets have the potential to reduce clinical variation and improve patient safety but the effect is variable. We sought to evaluate the impact of changes to the design of an order set on the delivery of chlorhexidine mouthwash and hydroxyethyl starch (HES) to patients in the intensive care un...
journal_title:BMJ quality & safety
pub_type: 杂志文章
doi:10.1136/bmjqs-2013-002395
更新日期:2014-05-01 00:00:00
abstract::There have been repeated calls from all quarters of healthcare for more clinicians to be leaders. The risks of not accepting this responsibility have been demonstrated by harrowing reports into failed care in England. Ambiguity persists over what clinical leadership encompasses, how it can be developed and how to insp...
journal_title:BMJ quality & safety
pub_type: 杂志文章
doi:10.1136/bmjqs-2013-002534
更新日期:2014-08-01 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