eLetters

102 e-Letters

  • Public website for interrupted time series and segmented regression
    Robert G Badgett

    We agree with the authors that interrupted time series should be used more often (1). We also agree that the statistics are difficult. We find segmented regression to be the preferable form of interrupted time series (ITS) as traditional ITS with the Davies tests only looks for a change in slope at the breakpoint. This works well if there is not a simultaneous change or shift in the level of the outcome at the breakpoint; howev...

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  • Response to 'Tall Man lettering and potential prescription errors: a time series analysis of 42 children's hospitals in the USA over 9 years' by Feudtner et al
    Zahra Kiani

    We were very interested to read the recent article by Feudtner et a,1 which has stated that Tall Man lettering has not changed the rate of look- alike sound-alike (LASA) related prescription or dispensing medication errors significantly in 42 children`s hospitals form 2004 to 2012. Feudtner et al`s study is a very valuable work because they performed an extensive statistical analysis on routine medication pairs of their h...

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  • Fundamental change in our approach to EHR design is needed
    Bruce L. Wilder
    The article by Koppel, The health information technology safety framework: building great structures on vast voids, 11/19/15, seen at http://m.qualitysafety.bmj.com/content/early/2015/11/19/bmjqs-2015-004746.full.pdf, describes an EHR environment that violates just about every principle of safe system design. It is no wonder that there continue to be significant safety issues with EHRs. "Most experts would agree that cornersto...
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  • An answer to the dilemma whether emergency department length of stay improves quality of care?
    Jill D Van Acker

    Dear Editor,

    I commend Vermeulen et al for addressing a fundamental question: Is ED length of stay (ED LOS), a globally used key performance indicator, actually associated with improvement in quality of care[1]?

    Vermeulen et al set out to compare whether patients presenting with one of three acute conditions (high acuity asthma, upper arm/forearm/shoulder fracture and acute myocardial infarct) at hosp...

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  • The Quadruple Aim: Care of the Patient Requires Care of the Providers
    Christine Sinsky

    The paper by Sikka, Morath and Leape is spot on (1). The authors call for adding a fourth aim to the Triple Aim: improving the experience of those providing care--physicians, nurses and others. This builds on our previous work "From Triple to Quadruple Aim: Care of the Patient Requires Care of the Providers" in which we make a similar recommendation (2).

    We also agree with the importance of creating conditions w...

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  • Making sense of the story - the true value of incident reporting
    Tara J Lamont

    I was interested to read the thoughtful article by Imogen Mitchell and colleagues, echoing longstanding criticisms by Kaveh Shojania, Charles Vincent and others on the low value of high volume incident reporting. There is little learning from categorical data, repeated many times, around falls or minor medication errors. However, there was a time at the National Patient Safety Agency, where we experimented with a multi...

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  • Incident Reporting - Let's Decentralise
    Merilyn A. Rees

    The Editor, BMJ Quality and Safety,

    Mitchell, Schuster, Smith et al (1) present the results of semi-structured interviews with 11 international patient safety experts, 15 years after publication of the US Institute of Medicine's landmark report 'To Err Is Human'.(2) One of the Institute's recommendations was the introduction of healthcare incident reporting.

    Qualitative analysis of the interviews by Mitchel...

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  • Length of stay as a marker of quality?
    Tess Alexandra Baker

    Dear Editor,

    Vermeulen et al [1] provides further insight into the effect of emergency department (ED) crowding and length of stay (LOS) on several quality indicators. This piece of work not only adds to the body of literature which suggests ED crowding delays timeliness of interventions, but importantly highlights that government initiatives targeting LOS alone are not enough to enhance other aspects of true, q...

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  • Curricula redesign requires assessments of value
    Neel Sharma

    This study focused on the lack of standardization for human factors content in postgraduate training curricula. The authors emphasized the importance of non-technical skills (NTS) such as leadership, decision making, team working and resource management during training, highlighting that a significant proportion of errors are based on failures of NTS as opposed to just knowledge and technical errors. The curricula of medi...

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  • Let's address everyday emotional harms.
    James M Walker

    One example of our almost universal, daily inflicting of emotional harm on patients is our mis-labeling of the patient's presenting problem as the 'Chief Complaint'.

    Years ago, an ICU patient said plaintively, "I'm not a complainer." after a bedside presentation is which that is just what he was called.

    Let's call it the 'Presenting Problem'--in our talk and in our notes. It might contribute to a clima...

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