eLetters

109 e-Letters

  • Weekend Effect (again) and Erudite Company
    Andrew Stein

    In this paper, Professor Sutton's team attribute higher hospital death rates at the weekend to the patients being sicker. Sutton is joining very erudite company (Prof Hawking, Prof Winston and the BMA). This group is rapidly becoming the 'climate change deniers' of healthcare. Not including this study, there have been 50 very large studies (>100,000 patients) published so far in this area (supplied on request). 44 show...

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  • SPC Versus GAM for hospital adverse events arising in a complex system
    Anthony P Morton

    Statistical process control works well when there is independence and linearity. Complex systems produce data that are often not independent, often nonlinear and display self-organisation and emergent behaviour. To say that statistical process control works when behaviour is emergent may make little sense. Increasingly adverse events like colonisation with antibiotic-resistant organisms arise in a complex system. Although...

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  • Improving safety culture to reduce adverse events
    Girish Swaminathan

    Reynolds et al1 reported the impact of providing prescriber feedback in reducing prescribing errors. The authors have concluded that reducing prescribing errors needs a multifaceted approach and feedback alone is not sufficient. Medication errors are often preventable and inappropriate prescribing is identified as an important contributing factor to medication errors.2 It is interesting to note that despite regular feedb...

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  • The Problem with Root cause analysis
    Siti Hosier

    I read with interest the article by Peerally et al (1) on 'The problem with root cause analysis'. I reflected on the recent cases that happened at Royal North Shore Hospital and Sydney Hospital (2,3,4) which led me to consider which investigative tool is best applied to different incidences and identified risks. The use of appropriate tools and involvement of key stakeholders are crucial elements to a successful investig...

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  • A role for patients and the public in improving healthcare
    Sharon Walsh

    I read with interest the article on what role the patient and public should play in healthcare improvement (1) as this is a question that my organisation has long grappled with and is now required to achieve accreditation against the mandatory National Safety and Quality Health Service Standards (2).

    For many years we had a strong Community Advisory Committee and consumers on all key quality and safety committe...

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  • The overuse of thromboprophylaxis in medical patients
    Manuel Monti

    In the important editorial of the Grant, is underlined the overuse of thromboprophylaxis in patients hospitalized in the medical field. We agree in emphasizing the difficulty of proper patient assessment that must be carefully evaluated, considering comorbidity and various risk factors,and using the main scores currently in use to assess the start of tromboprofilattica therapy. For this reason we carried out a study where...

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  • Black box medicine: a structured approach to organisational reflection on major maternal morbidity as a tool for effective organisational learning
    Alexander Davey
    Editor - Professor Knight(1) highlights a serious problem with systems of organisational learning in maternity care that is endemic across a variety of acute care settings in the NHS. I write to share my experience with a trainee based structured case note review method so other organisations and patients may benefit from what I refer to as a black box medicine (BBM) approach to major maternal morbidity. Trainee based mixed expl...
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  • Worthless Statistics in search of Meaningful Conclusion
    Louise B Andrew

    It appears that these authors believe that variability in the disciplinary rates between states is something that indicates a lack of quality and/or a lack of uniformity of safety measures.

    Nothing could be further from the truth.

    There are many more reasons affecting a state's disciplinary rates than those controlled for in the study. For just one glaringly obvious example, in certain states and i...

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  • Why do we love to hate ourselves?
    Robert L Wears

    Dhaliwal's comment [1] on Zwaan et al [2] nicely refutes what has been called "the hypothesis of special cause" [3] - the notion that when things turn out wrong, the cognitive processes leading to that outcome must have been fundamentally different (ie, error-prone) from when they turn out right. Dhaliwal's argument recapitulates thinking that is over 100 years old; one of the early contributors to psychology, Ernst Mach, wr...

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  • Statistical Process Control and Interrupted Time Series
    Alan J Poots

    I read Fretheim and Tomic's article [1] with interest as I trained in frequentist stastistics and now work primarily with Stastistical Process Control (SPC) in quality improvement (QI) initiatives.

    I concur that there are missed opportunities for using Interrupted Time Series (ITS) in QI; however, I note cautions in doing so:

    Regression models applied in ITS often have the assumption of homoscedastici...

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