scholarly journals Empowering junior doctors: a qualitative study of a QI programme in South West England

2018 ◽  
Vol 94 (1116) ◽  
pp. 571-577 ◽  
Author(s):  
Natasha J Doran ◽  
Rob Bethune ◽  
Joanne Watson ◽  
Katherine Finucane ◽  
Andrew Carson-Stevens
Keyword(s):  
Patient Safety ◽  
Improve Patient Safety ◽  
Qualitative Interviews ◽  
Working Environment ◽  
Junior Doctors ◽  
Effect Change ◽  
Medical Careers ◽  
South West ◽  
Before And After ◽  
New Generation

AimTo explore how the South-West Foundation Doctor Quality Improvement programme affected foundation year 1 (F1) doctors’ attitudes and ability to implement change in healthcare.MethodsTwenty-two qualitative interviews were carried out with two cohorts of doctors. The first F1 group before and after their participation in the QI programme; the second group comprised those who had completed the programme between 1 and 5 years earlier. Qualitative data were analysed using thematic analysis techniques.Results Prior to taking part in the QI programme, junior doctors’ attitudes towards QI were mixed. Although there was agreement on the importance of QI in terms of patient safety, not all shared enthusiasm for engaging in QI, while some were sceptical that they could bring about any change. Following participation in the programme, attitudes towards QI and the ability to effect change were significantly transformed. Whether their projects were considered a success or not, all juniors reported that they valued the skills learnt and the overall experience they gained through carrying out QI projects. Participants reported feeling more empowered in their role as junior doctors, with several describing how they felt ‘listened to’ and able to ‘have a voice’, that they were beginning to see things ‘at systems level’ and learning to ‘engage more critically’ in their working environment.Conclusions Junior doctors are ideally placed to engage in QI. Training in QI at the start of their medical careers may enable a new generation of doctors to acquire the skills necessary to improve patient safety and quality of care.

Does UK medical education provide doctors with sufficient skills and knowledge to manage patients with eating disorders safely?

2018 ◽  
Vol 94 (1113) ◽  
pp. 374-380 ◽  
Author(s):  
Agnes Ayton ◽  
Ali Ibrahim
Keyword(s):  
Eating Disorders ◽  
Patient Safety ◽  
Eating Disorder ◽  
Postgraduate Training ◽  
Medical Training ◽  
Improve Patient Safety ◽  
Medical Schools ◽  
Junior Doctors ◽  
The Uk ◽  
Improve Patient

BackgroundEating disorders affect 1%–4% of the population and they are associated with an increased rate of mortality and multimorbidity. Following the avoidable deaths of three people the parliamentary ombudsman called for a review of training for all junior doctors to improve patient safety.ObjectiveTo review the teaching and assessment relating to eating disorders at all levels of medical training in the UK.MethodWe surveyed all the UK medical schools about their curricula, teaching and examinations related to eating disorders in 2017. Furthermore, we reviewed curricula and requirements for annual progression (Annual Review of Competence Progression (ARCP)) for all relevant postgraduate training programmes, including foundation training, general practice and 33 specialties.Main outcome measuresInclusion of eating disorders in curricula, time dedicated to teaching, assessment methods and ARCP requirements.ResultsThe medical school response rate was 93%. The total number of hours spent on eating disorder teaching in medical schools is <2 hours. Postgraduate training adds little more, with the exception of child and adolescent psychiatry. The majority of doctors are never assessed on their knowledge of eating disorders during their entire training, and only a few medical students and trainees have the opportunity to choose a specialist placement to develop their clinical skills.ConclusionsEating disorder teaching is minimal during the 10–16 years of undergraduate and postgraduate medical training in the UK. Given the risk of mortality and multimorbidity associated with these disorders, this needs to be urgently reviewed to improve patient safety.

Faculty Clinical Quality Goals Drive Improvement in University HealthSystem Consortium Outcome Measures

2012 ◽  
Vol 78 (7) ◽  
pp. 749-754 ◽  
Author(s):  
Kevin E. Behrns ◽  
Darwin Ang ◽  
Huazi Liu ◽  
Steven J. Hughes ◽  
Holly Creel ◽  
...  
Keyword(s):  
Patient Safety ◽  
Improve Patient Safety ◽  
Clinical Score ◽  
Outcome Data ◽  
Faculty Members ◽  
Clinical Quality ◽  
Patient Safety Indicators ◽  
Before And After ◽  
The University ◽  
Hospital Acquired

Mortality, length of stay (LOS), patient safety indicators (PSIs), and hospital-acquired conditions (HACs) are routinely reported by the University HealthSystem Consortium (UHC) to measure quality at academic health centers. We hypothesized that a clinical quality measurable goal assigned to individual faculty members would decrease UHC measures of mortality, LOS, PSIs, and HACs. For academic year (AY) 2010–2011, faculty members received a clinical quality goal related to mortality, LOS, PSIs, and HACs. The quality metric constituted 25 per cent of each faculty member's annual evaluation clinical score, which is tied to compensation. The outcomes were compared before and after goal assignment. Outcome data on 6212 patients from AY 2009–2010 were compared with 6094 patients from AY 2010–2011. The mortality index (0.89 vs 0.93; P = 0.73) was not markedly different. However, the LOS index decreased from 1.01 to 0.97 ( P = 0.011), and department-wide PSIs decreased significantly from 285 to 162 ( P = 0.011). Likewise, HACs decreased from 54 to 18 ( P = 0.0013). Seven (17.9%) of 39 faculty had quality grades that were average or below. Quality goals assigned to individual faculty members are associated with decreased average LOS index, PSIs, and HACs. Focused, relevant quality assignments that are tied to compensation improve patient safety and outcomes.

scholarly journals The impact of computerized provider order entry on emergency department flow

CJEM ◽  
2016 ◽  
Vol 18 (4) ◽  
pp. 264-269 ◽  
Author(s):  
Andrew Gray ◽  
Christopher M.B. Fernandes ◽  
Kristine Van Aarsen ◽  
Melanie Columbus
Keyword(s):  
Emergency Department ◽  
Patient Safety ◽  
Improve Patient Safety ◽  
Patient Flow ◽  
Wait Time ◽  
Order Entry ◽  
Computerized Provider Order Entry ◽  
Left Without Being Seen ◽  
Before And After ◽  
The Impact

AbstractObjectivesComputerized provider order entry (CPOE) has been established as a method to improve patient safety by avoiding medication errors; however, its effect on emergency department (ED) flow remains undefined. We examined the impact of CPOE implementation on three measures of ED throughput: wait time (WT), length of stay (LOS), and the proportion of patients that left without being seen (LWBS).MethodsWe conducted a retrospective cohort study of all ED patients of 18 years and older presenting to London Health Sciences Centre during July and August 2013 and 2014, before and after implementation of a CPOE system. The three primary variables were compared between time periods. Subgroup analyses were also conducted within each Canadian Triage and Acuity Scale (CTAS) level (1–5) individually, as well as for admitted patients only.ResultsA significant increase in WT of 5 minutes (p=0.036) and LOS of 10 minutes (p=0.001), and an increase in LWBS from 7.2% to 8.1% (p=0.002) was seen after CPOE implementation. Admitted patients’ LOS increased by 63 minutes (p<0.001), the WT of CTAS 3 and 5 patients increased by 6 minutes (p=0.001) and 39 minutes (p=0.005), and LWBS proportion increased significantly for CTAS 3–5 patients, from 24.3% to 42.0% (p<0.001) for CTAS 5 patients specifically.ConclusionsCPOE implementation detrimentally impacted all patient flow throughput measures that we examined. The most striking clinically relevant result was the increase in LOS of 63 minutes for admitted patients. This raises the question as to whether the potential detrimental effects to patient safety of CPOE implementation outweigh its benefits.

Engaging, empowering and educating junior doctors in quality improvement (QI) to improve patient safety: a trust-wide junior doctor forum

2016 ◽  
Vol 3 (Suppl 2) ◽  
pp. s39-s39
Author(s):  
Sanjay Kumar ◽  
Anna Winfield ◽  
Robert Jackson ◽  
Gillian Pearce ◽  
Sarah Fiori ◽  
...  
Keyword(s):  
Patient Safety ◽  
Quality Improvement ◽  
Junior Doctor ◽  
Improve Patient Safety ◽  
Junior Doctors ◽  
Improve Patient

How junior doctors perceive personalised yoga and group exercise in the management of occupational and traumatic stressors

2021 ◽  
pp. postgradmedj-2020-139191
Author(s):  
Jennifer Taylor ◽  
Elizabeth Stratton ◽  
Loyola McLean ◽  
Bethan Richards ◽  
Nicholas Glozier
Keyword(s):  
Therapeutic Alliance ◽  
Qualitative Interviews ◽  
Junior Doctors ◽  
Poor Sleep ◽  
Delivery Mode ◽  
Social Connection ◽  
Group Exercise ◽  
Before And After ◽  
Trauma Informed ◽  
Traumatic Stressors

ObjectivesJunior doctors are exposed to occupational and traumatic stressors, some of which are inherent to medicine. This can result in burnout, mental ill-health and suicide. Within a crossover pilot study comparing personalised, trauma-informed yoga to group-format exercise, qualitative interviews were conducted to understand the experience of junior doctors and whether such interventions were perceived to help manage these stressors.MethodsTwenty-one doctors, 76% female, were order-randomised to consecutive 8-week yoga and exercise programmes. Fifty-two interviews were recorded before and after each programme.ResultsMany participants reported being time poor, sleep-affected, frequently stressed and occasionally in physical pain/distress. Major stressor themes were workplace incivility, death/human suffering and shift work with minimal support. Both interventions were acceptable for different reasons. Personalised yoga offered a therapeutic alliance, time to check-in and reduced anxiety/rumination. Group exercise provided energy and social connection. One participant found yoga beneficial following an acute workplace trauma: ‘It was really eye opening how much I felt my body just needed to detox … I wouldn’t have gone to a group fitness the next day … I just wanted to relax and breathe …We still had a big debrief which was great … (but) I almost felt like … I dealt with it physically and emotionally before going into it (P20).’ConclusionJunior doctors found both interventions useful for stress management adjunctive to other organisational programmes though for different and complementary reasons, possibly related to delivery mode. Personalised, trauma-informed yoga provided a confidential therapeutic alliance whereas group exercise offered social connection.

scholarly journals The effect of patient safety culture on nurses’ near-miss reporting intention: the moderating role of perceived severity of near misses

2021 ◽  
Vol 26 (1-2) ◽  
pp. 6-16
Author(s):  
Yi Yang ◽  
Huaping Liu
Keyword(s):  
Patient Safety ◽  
Safety Culture ◽  
Improve Patient Safety ◽  
Patient Safety Culture ◽  
Working Environment ◽  
Near Miss ◽  
Cross Sectional Survey ◽  
Near Misses ◽  
Perceived Severity ◽  
The Relationship

Background Reporting near misses is a practical approach to improve the confounding challenge of patient safety. Evidence suggests that patient safety culture and the characteristics of errors might have important impacts on reporting. No studies, however, have examined the relationships among patient safety culture, perceived severity of near misses and near-miss reporting. Aims To explore the relationship between patient safety culture and nurses’ near-miss reporting intention, and examine the potential moderating effect the perceived severity of near misses might have on this relationship. Methods Using a cross-sectional survey, data were collected with three validated survey instruments completed by 920 Registered Nurses in eight tertiary hospitals in China. Multiple regression analysis tested relationships among the variables. Results Nurses reported a moderate–high level of near-miss reporting intention. Patient safety culture was positively associated with nurses’ near-miss reporting intention. Perceived severity of near misses did not significantly moderate the relationship between patient safety culture and reporting intention. Conclusions Nurses generally showed a positive willingness to report near misses. A specific near-miss management and education system within a learning, supportive working environment are key components to improve reporting intention among nurses which could significantly improve patient safety.

scholarly journals Improved basic life support skills and patient transportation at ambulance drivers in Medan Tuntung and Medan Sunggal area to improve patient safety

2019 ◽  
Vol 4 (2) ◽  
pp. 802-807
Author(s):  
Yetty Machrina ◽  
Kamal Basri Siregar ◽  
Nuraiza Meutia ◽  
Gema Nazri Yanni ◽  
Yunita Sari Pane
Keyword(s):  
Patient Safety ◽  
Basic Life Support ◽  
Life Support ◽  
Improve Patient Safety ◽  
Skills Training ◽  
T Test ◽  
Before And After ◽  
Support Skills ◽  
Improve Patient ◽  
Paired T Test

The technique of providing basic and quick life support (BHD) and transportation to patients with cardiac and pulmonary arrest can save a patient's life. An ambulance driver as one of the ambulance personnel should be equipped with the two forms of skills above. The aim of community service is to increase the capacity of ambulance drivers in terms of providing basic life support skills and patient transportation to improve patient safety. This training was held in September 2019, at the H. Adam Malik General Hospital Training Center Installation Medan, with 24 participants. The training is carried out with 2 methods, namely exposure to BHD theory and BHD skills training. The knowledge and skills of participants before and after the training were assessed. Pre and post assessment results were analyzed using paired t-test with a significance level of p <0.05 Ambulance drivers in the Medan Tuntung and Medan Sunggal area are mostly over 30 years old, with most working as ambulance drivers for more than 5 years. The most recent level of education is high school graduation or equivalent. The results of statistical analysis using paired t-test, obtained a significant difference in the knowledge of ambulance drivers about basic life support theory before and after training (p = 0.000). Likewise, ambulance driver skills in providing basic life support for adult patients, infants and children were significantly different before and after training (p = 0.000). Training in basic life support skills and patient transportation can increase the capacity of ambulance drivers in providing basic life support..

scholarly journals Insomnia management; don't sleep on it

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S20-S21
Author(s):  
Maria Donnelly ◽  
Nieves Mercadillo ◽  
Stuart Davidson
Keyword(s):  
Patient Safety ◽  
Improve Patient Safety ◽  
Prescription Medication ◽  
Medication Administration ◽  
Post Intervention ◽  
Before And After ◽  
Nice Guidance ◽  
Initial Intervention ◽  
Management Flow ◽  
Improve Patient

AimsIn this project our aim was to improve patient safety and care by reducing hypnotic prescription medication administration. We also wanted to reduce over-prescribing/unnecessary prescribing which has a negative pharmaceutical impact on the environment and is a huge expenditure issue for the NHS. NICE guidance for Insomnia management states “After consideration of the use of non-pharmacological measures, hypnotic drug therapy is considered appropriate for the management of severe insomnia interfering with normal daily life; it is recommended that hypnotics should be prescribed for short periods of time only, in strict accordance with their licensed indications” Side effects are common with hypnotic usage including, most importantly, the development of tolerance and rebound insomnia.MethodThe interventions we implemented included the development of an educational presentation about insomnia, the development of an “Insomnia Management Flow chart” to be used at admission point, training sessions for ward staff, shared teaching programmes with patients at their sleep management sessions, face to face and email correspondence to inform medical trainees about this project and gathering feedback from patients and staff before and after this project.ResultThe results of this project demonstrated a total reduction in hypnotic tablet administration was very significant with a 44.5% reduction post intervention.ConclusionThis demonstrates the positive change in our clinical practice that has resulted from our interventions. This will improve patient safety and reduce cost of hypnotic medications for the NHS. Following on from this initial intervention, we feel that we can continue to make further changes and expand the changes we made on this ward, to other similar wards in our hospital, trust and to other inpatient psychiatric wards further afield.

Shift schedule realignment and patient safety culture

2020 ◽  
Vol 33 (2) ◽  
pp. 145-157
Author(s):  
Made Indra Wijaya ◽  
Abd Rahim Mohamad ◽  
Muhammad Hafizurrachman
Keyword(s):  
Patient Safety ◽  
Safety Culture ◽  
Positive Impact ◽  
Improve Patient Safety ◽  
Patient Safety Culture ◽  
Quality Improvement Initiative ◽  
Content Type ◽  
Shift Schedule ◽  
Before And After ◽  
Error Coefficient

Purpose The purpose of this paper is to assess the association between shift schedule realignment and patient safety culture. Design/methodology/approach Using difference in differences model, BIMC Hospitals and Siloam Hospital Bali were compared before and after shift schedule realignment to test the association between shift schedule realignment and patient safety culture. Findings Shift schedule realignment was associated with a significant improvement in staffing (coefficient 1.272; 95% CI 0.842 – 1.702; p<0.001), teamwork within units (coefficient 1.689; 95% CI 1.206 – 2.171; p<0.001), teamwork across units (coefficient 1.862; 95% CI 1.415 – 2.308; p<0.001), handoffs and transitions (coefficient 0.999; 95% CI 0.616 – 1.382; p<0.001), frequency of error reported (coefficient 1.037; 95% CI 0.581 – 1.493; p<0.001), feedback and communication about error (coefficient 1.412; 95% CI 0.982 – 1.841; p<0.001) and communication openness (coefficient 1.393; 95% CI 0.968 – 1.818; p<0.001). Practical implications With positive impact on patient safety culture, shift schedule realignment should be considered as quality improvement initiative. It stretches the compressed workload suffered by staff while maintaining 40 h per week in accordance with applicable laws and regulations. Originality/value Shift schedule realignment, designed to improve patient safety culture, has never been implemented in any Indonesian private hospital. Other hospital managers might also appreciate knowing about the shift schedule realignment to improve the patient safety culture.

Attitude and Beliefs About Surgical Safety Checklist in a North Indian Tertiary Care Hospital a Decade Later of WHO Checklist

2020 ◽  
Author(s):  
Lovenish Bains ◽  
Anurag Mishra ◽  
Daljit Kaur ◽  
Pawan Lal ◽  
Lalit Gupta ◽  
...  
Keyword(s):  
Patient Safety ◽  
Improve Patient Safety ◽  
Tertiary Care ◽  
Health Care Facilities ◽  
Leadership Role ◽  
Junior Doctors ◽  
Care Hospital ◽  
Surgical Safety Checklist ◽  
Surgical Safety ◽  
Who Checklist

Abstract Avoidable surgical complications account for a large proportion of preventable medical injuries and deaths globally. Surgical Safety Checklist is evidence-based, internationally accepted valid instrument, which has been found to reduce postoperative morbidity and mortality; the benefits of which are most striking in low- and middle-income countries (LMICs) Despite implementation in many hospitals throughout the country, there is still lack of awareness and concern in many LMICS health care facilities towards SSCL and its use, even after a decade of WHO checklist. We conducted a survey to assess the knowledge, attitudes and beliefs about the WHO-surgical checklist in which 65.4% (138) surgeons, 25.1% (53) anaesthetists and 9.5% (20) nurses participated. Majority believed that use of SSCL improves the safety of procedures, improves communication amongst theatre staff and will result in a reduction in errors in theatre yet there was no commitment for use of SSCL. Although all theatre personnel support implementation and use of SSCL however hierarchical issues, lack of administrative support, lack of training, logistics and timing, high patient volume and overburdened residents, lack of co-ordinator or leadership role and shortage of man power can be impediment to effective use. Nurses and junior doctors play a crucial role. Commitment rather than compliance and teamwork will be the key, ably supported by education and training which should be mandatory for all OT stake holders. Therefore, any measure that can potentially improve patient safety should be embraced and benefits of SSCL be told to motivate them and enhance participation for patient safety. Committed leadership, knowledge sharing and periodic trainings, interdisciplinary communication, feedback and regular audits can define and determine effective implementation process.

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