Abstract:
BACKGROUND:Good outcomes for in-hospital cardiac arrest (IHCA) depend on a skilled resuscitation team, prompt initiation of high-quality cardiopulmonary resuscitation and defibrillation, and organisational structures to support IHCA response. We examined the role of nurses in resuscitation, contrasting higher versus lower performing hospitals in IHCA survival. METHODS:We conducted a descriptive qualitative study at nine hospitals in the American Heart Association's Get With The Guidelines-Resuscitation registry, purposefully sampling hospitals that varied in geography, academic status, and risk-standardised IHCA survival. We conducted 158 semistructured interviews with nurses, physicians, respiratory therapists, pharmacists, quality improvement staff, and administrators. Qualitative thematic text analysis followed by type-building text analysis identified distinct nursing roles in IHCA care and support for roles. RESULTS:Nurses played three major roles in IHCA response: bedside first responder, resuscitation team member, and clinical or administrative leader. We found distinctions between higher and lower performing hospitals in support for nurses. Higher performing hospitals emphasised training and competency of nurses at all levels; provided organisational flexibility and responsiveness with nursing roles; and empowered nurses to operate at a higher scope of clinical practice (eg, bedside defibrillation). Higher performing hospitals promoted nurses as leaders-administrators supporting nurses in resuscitation care at the institution, resuscitation team leaders during resuscitation and clinical champions for resuscitation care. Lower performing hospitals had more restrictive nurse roles with less emphasis on systematically identifying improvement needs. CONCLUSION:Hospitals that excelled in IHCA survival emphasised mentoring and empowering front-line nurses and ensured clinical competency and adequate nursing training for IHCA care. Though not proof of causation, nurses appear to be critical to effective IHCA response, and how to support their role to optimise outcomes warrants further investigation.
journal_name
BMJ Qual Safjournal_title
BMJ quality & safetyauthors
Guetterman TC,Kellenberg JE,Krein SL,Harrod M,Lehrich JL,Iwashyna TJ,Kronick SL,Girotra S,Chan PS,Nallamothu BKdoi
10.1136/bmjqs-2019-009487subject
Has Abstractpub_date
2019-11-01 00:00:00pages
916-924issue
11eissn
2044-5415issn
2044-5423pii
bmjqs-2019-009487journal_volume
28pub_type
杂志文章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: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
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doi:10.1136/bmjqs-2015-004260
更新日期:2017-01-01 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: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:OBJECTIVE:To examine how disciplinary tribunals assess different forms of misconduct in deciding whether to remove doctors from practice for professional misconduct. DESIGN AND SETTING:Multivariable regression analysis of 485 cases in which tribunals found doctors guilty of professional misconduct. The cases came from...
journal_title:BMJ quality & safety
pub_type: 杂志文章
doi:10.1136/bmjqs-2012-000941
更新日期:2012-12-01 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:OBJECTIVES:To synthesise qualitative studies that investigated the experiences of healthcare professionals with using information from patient-reported outcome measures (PROMs) to improve the quality of care. DESIGN:A qualitative systematic review was conducted by searching PubMed, PsycINFO and CINAHL with no time res...
journal_title:BMJ quality & safety
pub_type: 杂志文章,评审
doi:10.1136/bmjqs-2013-002524
更新日期:2014-06-01 00:00:00
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
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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: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
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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:In 2005, The Joint Commission included medication reconciliation as a National Patient Safety Goal to reduce medication errors related to omissions, duplications and interactions. Hospitals continue to struggle to implement successful programmes that meet these objectives. METHODS:The authors used improveme...
journal_title:BMJ quality & safety
pub_type: 杂志文章
doi:10.1136/bmjqs.2010.047845
更新日期:2011-04-01 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: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: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
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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
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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:Interest in patient safety (PS) is growing exponentially, fuelled by epidemiological research unveiling the extent of unsafe care. However, there is little information about the frequency of harm in developing and transitional countries. To address this issue, the authors performed a study known as the Ibero...
journal_title:BMJ quality & safety
pub_type: 杂志文章
doi:10.1136/bmjqs.2011.051284
更新日期:2011-12-01 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
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journal_title:BMJ quality & safety
pub_type: 杂志文章
doi:10.1136/bmjqs-2017-006529
更新日期:2017-11-01 00:00:00
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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
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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
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journal_title:BMJ quality & safety
pub_type: 杂志文章
doi:10.1136/bmjqs.2010.046482
更新日期:2011-04-01 00:00:00
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journal_title:BMJ quality & safety
pub_type: 杂志文章
doi:10.1136/bmjqs-2017-007463
更新日期:2018-09-01 00:00:00
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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
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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::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
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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
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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-2011-000702
更新日期:2012-10-01 00:00:00
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journal_title:BMJ quality & safety
pub_type: 杂志文章
doi:10.1136/bmjqs-2011-000197
更新日期:2011-12-01 00:00:00