Abstract:
PROBLEM:To reduce hospital inpatient mortality and thus increase public confidence in the quality of patient care in an urban acute hospital trust after adverse media coverage. DESIGN:Eight care bundles of treatments known to be effective in reducing in-hospital mortality were used in the intervention year; adjusted mortality (from hospital episode statistics) was compared to the preceding year for the 13 diagnoses targeted by the intervention care bundles, 43 non-targeted diagnoses, and overall mortality for the 56 hospital standardised mortality ratio (HSMR) diagnoses covering 80% of hospital deaths. SETTING:Acute hospital trust in north west London. STRATEGIES FOR CHANGE:Use of clinical guidelines in care bundles in eight targeted clinical areas. INTERVENTIONS:Use of care bundles in treatment areas for the diagnoses leading to most deaths in the trust in 2006-7. KEY MEASURES FOR IMPROVEMENT:Change in adjusted mortality in targeted and non-targeted diagnostic groups; hospital standardised mortality ratio (HSMR) during the intervention year compared with the preceding year. Effect of the change The standardised mortality ratio (SMR) of the targeted diagnoses and the HSMR both showed significant reductions, and the non-targeted diagnoses showed a slight reduction. Cumulative sum charts showed significant reductions of SMRs in 11 of the 13 diagnoses targeted in the year of the quality improvements, compared with the preceding year The HSMR of the trust fell from 89.6 in 2006-7 to 71.1 in 2007-8 to become the lowest among acute trusts in England. 255 fewer deaths occurred in the trust (174 of these in the targeted diagnoses) in 2007-8 for the HSMR diagnoses than if the 2006-7 HSMR had been applicable. From 2006-7 to 2007-8 there was a 5.7% increase in admissions, 7.9% increase in expected deaths, and 14.5% decrease in actual deaths. LESSONS LEARNT:Implementing care bundles can lead to reductions in death rates in the clinical diagnostic areas targeted and in the overall hospital mortality rate.
journal_name
BMJjournal_title
BMJ (Clinical research ed.)authors
Robb E,Jarman B,Suntharalingam G,Higgens C,Tennant R,Elcock Kdoi
10.1136/bmj.c1234subject
Has Abstractpub_date
2010-03-31 00:00:00pages
c1234eissn
0959-8138issn
1756-1833journal_volume
340pub_type
杂志文章,多中心研究abstract:OBJECTIVE:To investigate the association between elective caesarean sections and neonatal respiratory morbidity and the importance of timing of elective caesarean sections. DESIGN:Cohort study with prospectively collected data from the Aarhus birth cohort, Denmark. SETTING:Obstetric department and neonatal department...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.39405.539282.BE
更新日期:2008-01-12 00:00:00
abstract:OBJECTIVE:To determine the relation between mothers' self reported drinking habits before, during, and after pregnancy and infants' mental and motor development at 18 months of age. DESIGN:Follow up study of all singleton live births born to primigravidas living in Dundee and booked into antenatal clinics from 1 May 1...
journal_title:BMJ (Clinical research ed.)
pub_type: 临床试验,杂志文章
doi:10.1136/bmj.303.6793.22
更新日期:1991-07-06 00:00:00
abstract:OBJECTIVE:To determine whether patients with unexpected prehospital cardiac arrest could be identified in whom ambulance resuscitation attempts would be futile. DESIGN:Review of ambulance and hospital records; detailed review of automated external defibrillator rhythm strips of patients in whom no shock was advised. ...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.311.6996.49
更新日期:1995-07-01 00:00:00
abstract:OBJECTIVE:To examine variations in teenage pregnancy rates in Trent region and to determine possible associations with local general practice characteristics such as the age and sex of the doctors. DESIGN:Cross sectional survey. SETTING:All 826 general practices in Trent region in existence between 1994 and 1997. SU...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.320.7238.842
更新日期:2000-03-25 00:00:00
abstract:OBJECTIVE:To design and evaluate a computer advisory system for the treatment of gestational trophoblastic tumour. DESIGN:A comparison of clinicians' treatment decisions with those of the computer system. Two datasets were used: one to calibrate the system and one to independently evaluate it. SETTING:Department of m...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.305.6857.804
更新日期:1992-10-03 00:00:00
abstract::The meaning of the GP contract has changed since the last major upheaval in the mid-1960s. The government has always dealt with general practitioners as independent contractors, but the way in which it treated them in 1990 was entirely different from the way in which they were treated in 1966. In 1966, the profession'...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.314.7084.895
更新日期:1997-03-22 00:00:00
abstract::In Oregon, Planned Parenthood and a group of physicians who perform abortions have filed a civil suit against several anti-abortion groups individuals. The suit seeks $200 million in damages and an injunction to bar the defendants from posting information on the Internet that threatens the lives and well-being of the...
journal_title:BMJ (Clinical research ed.)
pub_type: 新闻
doi:10.1136/bmj.318.7178.214a
更新日期:1999-01-23 00:00:00
abstract::The development of a molecular genetics diagnostic service over a three year period was studied in a National Health Service region with a population of three million. Starting from a time when few diagnostic applications were possible, the number of disorders and the overall demand had grown rapidly. Conditions for w...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.297.6652.843
更新日期:1988-10-01 00:00:00
abstract:OBJECTIVES:To investigate current practice of screening children from abroad for infections after coming to the United Kingdom, and to make recommendations for future practice. DESIGN:A review of literature and a questionnaire sent to all health authorities and boards in the United Kingdom. SETTING:All health authori...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.301.6755.800
更新日期:1990-10-06 00:00:00
abstract:OBJECTIVE:To observe the effects of stimulation of the sacral anterior roots on anorectal and low colonic pressures and to programme implanted stimulators to produce defecation. DESIGN:Prospective study of 12 consecutive patients. SETTING:Spinal injuries unit and university gastrointestinal physiology department. PA...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.300.6738.1494
更新日期:1990-06-09 00:00:00
abstract:OBJECTIVE:To assess the cost effectiveness of different screening strategies for abdominal aortic aneurysm in men, from the perspective of a national health service. SETTING:Screening units at regional hospitals. PARTICIPANTS:Hypothetical cohort of 65 year old men from the general population. MAIN OUTCOME MEASURES:C...
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pub_type: 杂志文章
doi:10.1136/bmj.e4276
更新日期:2012-07-05 00:00:00
abstract:OBJECTIVE:To assess whether sleep apnoea syndrome is an independent risk factor for hypertension. DESIGN:Population study. SETTING:Sleep clinic in Toronto. PARTICIPANTS:2,677 adults, aged 20-85 years, referred to the sleep clinic with suspected sleep apnoea syndrome. OUTCOME MEASURES:Medical history, demographic da...
journal_title:BMJ (Clinical research ed.)
pub_type: 评论,杂志文章
doi:10.1136/bmj.320.7233.479
更新日期:2000-02-19 00:00:00
abstract::National allocation of resources to regional health authorities and by them to districts is now determined by a weighted capitation formula. The national formula was derived from regression analysis, with hospital utilisation as an index of need for health care--a method which has fundamental limitations. This paper a...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.306.6881.835
更新日期:1993-03-27 00:00:00
abstract:OBJECTIVE:To determine whether elderly people can learn to use the inhaler used to deliver zanamivir (Relenza Diskhaler) as effectively as the Turbohaler and to identify which aspects of inhaler technique are most problematic. DESIGN:Randomised, controlled, intervention study. SETTING:Wards for acute elderly care in ...
journal_title:BMJ (Clinical research ed.)
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1136/bmj.322.7286.577
更新日期:2001-03-10 00:00:00
abstract:OBJECTIVE:To quantify the association between exposure to higher temperatures and the risk of myocardial infarction at an hourly temporal resolution. DESIGN:Case-crossover study. SETTING:England and Wales Myocardial Ischaemia National Audit Project (MINAP) database. PARTICIPANTS:24,861 hospital admissions for myocar...
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pub_type: 杂志文章
doi:10.1136/bmj.e8050
更新日期:2012-12-13 00:00:00
abstract:OBJECTIVE:To determine whether diurnal variation occurs in the onset of stroke. DESIGN:Community based study over four years. SETTING:Oxfordshire, United Kingdom. SUBJECTS:105,000 people, of whom 675 had a first ever stroke. 545 had a cerebral infarction, 66 had primary intracerebral haemorrhage, 33 had subarachnoid...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.304.6820.155
更新日期:1992-01-18 00:00:00
abstract:OBJECTIVE:To assess the effect of weight loss induced by a very low energy diet on moderate and severe obstructive sleep apnoea in obese men. Design Single centre, two arm, parallel, randomised, controlled, open label trial. Blocked randomisation procedure used for treatment allocation. Setting Outpatient obesity clini...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,随机对照试验
doi:10.1136/bmj.b4609
更新日期:2009-12-03 00:00:00
abstract:OBJECTIVE:To evaluate the impact of the US Air Force suicide prevention programme on risk of suicide and other outcomes that share underlying risk factors. DESIGN:Cohort study with quasi-experimental design and analysis of cohorts before (1990-6) and after (1997-2002) the intervention. PARTICIPANTS:5,260,292 US Air F...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.327.7428.1376
更新日期:2003-12-13 00:00:00
abstract:OBJECTIVE:To explore the factors that influence help seeking for mental distress by offenders. DESIGN:Qualitative study based on in-depth interviews with prisoners before and after release. SETTING:One category B local prison in southern England. PARTICIPANTS:35 male offenders aged 18-52, a quarter of whom had been ...
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pub_type: 杂志文章
doi:10.1136/bmj.39059.594444.AE
更新日期:2007-02-10 00:00:00
abstract:OBJECTIVE:To compare the efficacy and safety of rectal artemether with intravenous quinine in the treatment of cerebral malaria in children. DESIGN:Randomised, single blind, clinical trial. SETTING:Acute care unit at Mulago Hospital, Uganda's national referral and teaching hospital in Kampala. PARTICIPANTS:103 child...
journal_title:BMJ (Clinical research ed.)
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1136/bmj.330.7487.334
更新日期:2005-02-12 00:00:00
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pub_type: 杂志文章,评审
doi:10.1136/bmj.309.6958.862
更新日期:1994-10-01 00:00:00
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journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.306.6882.883
更新日期:1993-04-03 00:00:00
abstract:PROBLEM:Deep infection after joint arthroplasty can be catastrophic, leading to further surgery, loss of the prosthesis, disability, and risk of mortality. Twenty nine new cases of methicillin resistant Staphylococcus aureus occurred in the first year after elective orthopaedic surgery was centralised to a district gen...
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pub_type: 杂志文章
doi:10.1136/bmj.329.7458.149
更新日期:2004-07-17 00:00:00
abstract:UNLABELLED:OBJECTIVE-To assess the risk of cardiorespiratory symptoms and mortality in non-smokers who were passively exposed to environmental smoke. DESIGN:Prospective study of cohort from general population first screened between 1972 and 1976 and followed up for an average of 11.5 years, with linkage of data from p...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.299.6696.423
更新日期:1989-08-12 00:00:00
abstract:OBJECTIVE:To examine the relation between energy intake in childhood and adult mortality from cancer. STUDY DESIGN:Cohort study. SETTING:16 rural and urban centres in England and Scotland. SUBJECTS:3834 people who took part in Lord Boyd Orr's Carnegie survey of family diet and health in prewar Britain between 1937 a...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.316.7130.499
更新日期:1998-02-14 00:00:00
abstract:OBJECTIVES:To compare outcome and costs of general practitioners, senior house officers, and registrars treating patients who attended accident and emergency department with problems assessed at triage as being of primary care type. DESIGN:Prospective intervention study which was later costed. SETTING:Inner city acci...
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pub_type: 杂志文章
doi:10.1136/bmj.312.7042.1340
更新日期:1996-05-25 00:00:00
abstract:OBJECTIVE:Detailed analysis of primary cutaneous melanoma first diagnosed in Scotland in patients aged 65 and over. DESIGN:Comparison of changing incidence, sex distribution, site, histogenetic type, tumour thickness, and prognosis of all primary cutaneous melanomas in patients aged 65 and over diagnosed in Scotland i...
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pub_type: 杂志文章
doi:10.1136/bmj.304.6829.746
更新日期:1992-03-21 00:00:00
abstract::The aim of community care is to enable people with various types of disability to live in their own homes, rather than in institutions. This involves the provision of support and services at home by various agencies. After a critical report in 1986 identified problems with coordination and flexibility of community car...
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pub_type: 杂志文章,评审
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更新日期:1996-10-05 00:00:00
abstract:OBJECTIVE:To compare characteristics of patients and outcomes after elective surgery in independent sector treatment centres (ISTCs) and NHS providers. DESIGN:Follow-up study with outcomes reported by patients three to six months after surgery. SETTING:25 ISTCs and 72 NHS providers in England. Population Consecutive ...
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pub_type: 杂志文章
doi:10.1136/bmj.d6404
更新日期:2011-10-19 00:00:00
abstract:OBJECTIVE:To study the effects on children of humanitarian aid agencies restricting help to refugee families (internally displaced people). DESIGN:Follow up study of 3 months. SETTING:Prabis peninsular outside Bissau, the capital of Guinea-Bissau, which has functioned as a refugee area for internally displaced people...
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doi:10.1136/bmj.319.7214.878
更新日期:1999-10-02 00:00:00