Abstract:
BACKGROUND:Patient participation in care is a fundamental element of safe and high-quality healthcare with the potential to enhance health outcomes and improve patient satisfaction. OBJECTIVES:To test the efficacy of a clinician-facilitated, bedside multimedia (MyStay) intervention designed to support patient participation in their recovery after total knee replacement surgery. The primary outcome was patients' reported worst pain intensity on postoperative day 3. Secondary outcomes were patient activation, length of hospital stay, knee function and satisfaction with care. METHODS:Unmasked, cluster randomised, four-period cross-over trial with a simultaneous process evaluation within in a large private, not-for-profit, metropolitan teaching hospital. Statistical analyses used linear mixed models with random effects for wards, cohorts within wards and patients within cohorts and fixed effects for treatment and period. RESULTS:241 patients were recruited between March 2014 and June 2015. Patients were admitted to intervention (104) or control (137) clusters. Intervention group patients reported significantly lower mean pain intensity scores on postoperative day 3 (6.1 vs 7.1, 95% CI -1.94 to -0.08, p=0.04). The percentages of patients who reported severe pain (score ≥7) were 43.7% and 64.2% in the intervention and control groups, respectively (χ2 9.89, p=0.002; generalised linear mixed model Wald test, p=0.05). Intervention group patients on average stayed in hospital one less day (5.3 vs 6.3, 95% CI 0.05 to 1.94, p=0.04), reported higher activation (45.1% vs 27.1% at level 4 activation) (p=0.04) and higher overall satisfaction with care (9.3 vs 8.6, 95% CI 1.09 to 0.219, p=0.01), and were more likely to refer family or friends to the health service (9.3 vs 8.7, 95% CI 1.07 to 0.13, p=0.02). CONCLUSION:The clinician-facilitated, MyStay bedside multimedia intervention enhanced patients' activation and participation in their care after surgery; pain intensity and length of stay in hospital were reduced and patients were more satisfied with their care. TRIAL REGISTRATION:ACTRN12614000340639 (http://www.anzctr.org.au/default.aspx).
journal_name
BMJ Qual Safjournal_title
BMJ quality & safetyauthors
McDonall J,de Steiger R,Reynolds J,Redley B,Livingston PM,Hutchinson AF,Botti Mdoi
10.1136/bmjqs-2018-008975subject
Has Abstractpub_date
2019-10-01 00:00:00pages
782-792issue
10eissn
2044-5415issn
2044-5423pii
bmjqs-2018-008975journal_volume
28pub_type
杂志文章,随机对照试验abstract::In a high-reliability organisation (HRO), safety and quality (SQ) is an organisational priority, and all workforce members are engaged, continuously learning and improving their work. To build organisational capacity for SQ work, we have developed a role-tailored capacity-building framework that we are currently emplo...
journal_title:BMJ quality & safety
pub_type: 杂志文章
doi:10.1136/bmjqs-2016-006240
更新日期:2017-08-01 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::This paper adopts methods from the organisational team training literature to outline how health professions education can improve patient safety. We argue that health educators can improve training quality by intentionally encouraging errors during simulation-based team training. Preventable medical errors are inevit...
journal_title:BMJ quality & safety
pub_type: 杂志文章
doi:10.1136/bmjqs-2012-000945
更新日期:2013-06-01 00:00:00
abstract:OBJECTIVE:To examine the association of consultants' experience with mortality by day of the week when elective surgery was performed. DESIGN:Retrospective observational study using English hospital administrative data. SETTING:All acute and specialist English National Health Service (NHS) hospitals carrying out elec...
journal_title:BMJ quality & safety
pub_type: 杂志文章
doi:10.1136/bmjqs-2015-004105
更新日期:2016-05-01 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: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: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
abstract:BACKGROUND:Careful design of preprinted order sets is needed to prevent medical overuse. Recent work suggests that removing a single checkbox from an order set changes physicians' clinical decision-making. LOCAL PROBLEM:During a 2-month period, our coronary care unit (CCU) ordered almost eight times as many serum thyr...
journal_title:BMJ quality & safety
pub_type: 杂志文章
doi:10.1136/bmjqs-2018-008995
更新日期:2019-10-01 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:INTRODUCTION:Trauma resuscitation is a complex and time-sensitive endeavour with significant risk for error. These errors can manifest from sequential system, team and knowledge-based failures, defined as latent safety threats (LSTs). In situ simulation (ISS) provides a novel prospective approach to recreate clinical s...
journal_title:BMJ quality & safety
pub_type: 杂志文章
doi:10.1136/bmjqs-2020-011363
更新日期:2020-10-23 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: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: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
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: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::People who are sick are often the most vulnerable in society. They frequently rely on caring and competent healthcare professionals and should and do have expectations of a safe and caring environment. In a recent unexpected adventure through the healthcare system, the organisation, professionalism, caring and compass...
journal_title:BMJ quality & safety
pub_type: 杂志文章
doi:10.1136/bmjqs-2011-000235
更新日期:2011-11-01 00:00:00
abstract::The opening keynote session of the 16th Annual National Patient Safety Foundation Patient Safety Congress, held 14-16 May 2014, featured a debate addressing the merits and challenges of accountability with respect to key issues in patient safety. The specific resolution debated was: Certain safety practices should be ...
journal_title:BMJ quality & safety
pub_type: 杂志文章
doi:10.1136/bmjqs-2014-003429
更新日期:2015-02-01 00:00:00
abstract:BACKGROUND:Interest in human factors has increased across healthcare communities and institutions as the value of human centred design in healthcare becomes increasingly clear. However, as human factors is becoming more prominent, there is growing evidence of confusion about human factors science, both anecdotally and ...
journal_title:BMJ quality & safety
pub_type: 杂志文章
doi:10.1136/bmjqs-2012-001450
更新日期:2013-10-01 00:00:00
abstract:BACKGROUND:There is widespread recognition that leadership skills are essential for effective performance in the workplace, but the evidence detailing effective leadership behaviours for surgeons during operations is unclear. DATA SOURCES:Boolean searches of four on-line databases and detailed hand search of relevant ...
journal_title:BMJ quality & safety
pub_type: 杂志文章,评审
doi:10.1136/bmjqs.2010.040295
更新日期:2011-07-01 00:00:00
abstract:BACKGROUND:Patient and public involvement (PPI) is often an essential requirement for research funding. Distinctions can be drawn between clinical research, which generally focuses on patients, and implementation research, which generally focuses on health professional behaviour. There is uncertainty about the role of ...
journal_title:BMJ quality & safety
pub_type: 杂志文章
doi:10.1136/bmjqs-2017-006954
更新日期:2018-10-01 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::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:Existing evidence indicates that reducing nurse staffing and/or skill mix adversely affects care quality. Nursing shortages may lead managers to dilute nursing team skill mix, substituting assistant personnel for registered nurses (RNs). However, no previous studies have described the relationship between nu...
journal_title:BMJ quality & safety
pub_type: 杂志文章
doi:10.1136/bmjqs-2018-008948
更新日期:2019-09-01 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: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::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: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: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:Few studies have investigated whether clinicians can use checklists to verify their diagnostic decisions. Checklists may improve accuracy by prompting clinicians to reconsider or recollect information but might impair decision making by adding to clinicians' cognitive load. This study assessed whether checkl...
journal_title:BMJ quality & safety
pub_type: 杂志文章
doi:10.1136/bmjqs-2012-001537
更新日期:2013-04-01 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