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Journal of Health Care Management (Full-text available)

Quality and Safety in Health Care  (Full-text available via NHS OPenAthens)

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.

Methods

We purposively sampled women with different screening histories to invite to semistructured interviews: (1) participated in all; (2) participated in breast and cervical but not colorectal (‘colorectal-specific non-participants’); (3) participated in none. To identify the sample we linked the data for all women eligible for all three screening programmes in Glasgow, Scotland (aged 51–64 years; n=68 324). Interviews covered perceptions of cancer, screening and screening decisions. Framework method was used for analysis.

Results

Of the 2924 women invited, 86 expressed an interest, and 59 were interviewed. The three groups’ perceptions differed, with the colorectal-specific non-participants expressing that: (1) treatment for colorectal cancer is more severe than for breast or cervical cancer; (2) colorectal symptoms are easier to self-detect than breast or cervical symptoms; (3) they worried about completing the test incorrectly; and (4) the colorectal test could be more easily delayed or forgotten than breast or cervical screening.

Conclusion

Our comparative approach suggested targets for future interventions to increase colorectal screening uptake including: (1) reducing fear of colorectal cancer treatments; (2) increasing awareness that screening is for the asymptomatic; (3) increasing confidence to self-complete the test; and (4) providing a suggested deadline and/or additional reminders.

Posted: May 20, 2020, 5:31 pm
Introduction

Surgical site infections (SSI) are common healthcare-associated infections resulting in substantial morbidity, mortality and hospital costs.1–4 However, no standard algorithm for SSI surveillance or outbreak detection exists, and traditional surveillance techniques may fail to provide timely identification of important SSI rate increases.5 6 We previously showed that standard Shewhart and exponentially weighted moving average statistical process control (SPC) charts have potential to provide early detection of SSI outbreaks.7 We then performed a large-scale empirical optimisation study and determined that simultaneous use of two moving average (MA) SPC charts in this application was most effective in identifying clinically important increases in SSI rates, or SSI clusters, that occurred in our network of community hospitals.8 The objective of the current analysis was to evaluate the performance of this optimised combination of control charts...

Posted: May 20, 2020, 5:31 pm

Emergency department (ED) crowding has long been recognised as posing significant patient safety threats. Research has demonstrated ties between ED crowding and delays in time-sensitive, disease-specific interventions such as thrombolysis in patients with acute myocardial infarction1 and stroke,2 resuscitation in trauma patients,3 antibiotics for patients with community-acquired pneumonia,4 and more recently the timely treatment of patients with sepsis.5 Elderly patients in particular may be vulnerable to crowding.6 More broadly, it has become clear that periods of high ED crowding are associated with increased inpatient mortality, length of stay and costs,7 as well as decreased patient experience.8 9

Through health systems engineering, lean, and Six Sigma, ED leaders have sought to increase the efficiency of EDs, decrease crowding and improve the quality of care. Understanding the factors that contribute to ED crowding,...

Posted: May 20, 2020, 5:31 pm
Background

Little is known about how team processes impact providers’ abilities to prepare patients for a safe hospital discharge. Teamwork Shared Mental Models (teamwork-SMMs) are the teams’ organised understanding of individual member’s roles, interactions and behaviours needed to perform a task like hospital discharge. Teamwork-SMMs are linked to team effectiveness in other fields, but have not been readily investigated in healthcare. This study examines teamwork-SMMs to understand how interprofessional teams coordinate care when discharging patients.

Methods

This mixed methods study examined teamwork-SMMs of inpatient interprofessional discharge teams at a single hospital. For each discharge event, we collected data from the patient and their discharge team (nurse, physician and coordinator) using interviews and questionnaires. We quantitatively determined the discharge teams’ teamwork-SMM components of quality and convergence using the Shared Mental Model Scale, and then explored their relationships to patient-reported preparation for posthospital care. We used qualitative thematic analysis of narrative cases to examine the contextual differences of discharge teams with higher versus lower teamwork-SMMs.

Results

The sample included a total of 106 structured patient interviews, 192 provider day-of-discharge questionnaires and 430 observation hours to examine 64 discharge events. We found that inpatient teams with better teamwork-SMMs (ie, higher perceptions of teamwork quality or greater convergence) were more effective at preparing patients for post-hospital care. Additionally, teams with high and low teamwork-SMMs had different experiences with team cohesion, communication openness and alignment on the patient situation.

Conclusions

Examining the quality and agreement of teamwork-SMMs among teams provides a better understanding of how teams coordinate care and may facilitate the development of specific team-based interventions to improve patient care at hospital discharge.

Posted: May 20, 2020, 5:31 pm

Surgical site infection (SSI) rates are closely scrutinised by hospital committees seeking to identify opportunities to prevent these important complications. In most hospitals, SSI rates are displayed as a monthly or quarterly incidence using a bar or line graph with comparison with the hospital’s historical rate or some external benchmark.

The response to these data is usually dichotomous. Hospital committee members may make congratulatory statements if the incidence is decreasing, or alternatively express concern that action is needed if there is an upward trend. Some hospitals even formalise these reactions with red-amber-green designations, ignoring chance variation.1 2 It is striking that in clinical research we would never automatically accept any difference as being significant without demanding a more rigorous statistical analysis. Yet, when it comes to quality improvement, the direction of the change alone is often enough to generate assertive conclusions about the state of...

Posted: May 20, 2020, 5:31 pm

Journal of Behavioural Decision Making ( Free Full text)

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