eLetters

106 e-Letters

  • 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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  • Moving Beyond Tokenism: a public health response on Researcher in Residence models
    Duika L. Burges Watson

    Marshall et al's (2014) paper was highlighted as an exemplar of stakeholder participation by a speaker at a recent public health research conference, held in Newcastle. Participants gave useful feedback about many of the core issues raised, which we reflect here.

    Marshal et al's (2014) 'Researcher in Residence' models are suggested as a means of co-engaging academics and practitioners in the promotion of evide...

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  • Ryan's Rule - consumer / family escalation.
    Tieh Hee Hai Guan Koh

    Dear Editor,

    We read with interest your Editorial re the role of families in preventing avoidable harm in children (1).

    Many public hospitals in Queensland Health in Australia have now implemented Ryan's Rule. When Ryan's parents were worried he was getting worse they didn't feel their concerns were acted upon in time. It was subsequently established that Ryan died from likely preventable causes. Ry...

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  • Response to letter regarding 'working smarter, not harder'
    Christopher W. Hayes

    We thank Dr. Iedema for highlighting that a gap exists in providers having the skillset to 'work smarter.' We agree that novel approaches to healthcare improvement are required that move beyond gadget-based solutions and that require a new set of skills of providers and provider organizations. The suggestion of video taping one's performance to review how the system (and its participants) currently operates and reflect...

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  • Working smarter, not harder
    Rick A.M. Iedema

    The Hayes, Batalden and Goldmann piece is an important contribution to the debate about what exactly is practice improvement. Most practice improvement thinking is anchored in the 'innovation' paradigm, and this paradigm is predominantly 'gadget thinking'. Others' solutions are to be adopted here because they produce great outcomes elsewhere. Except now we have to figure out how we can get the gadget to work. Few commen...

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  • "Driven to distraction" and driving for excellence in ward round practice
    Philip H. Pucher
    Dear Sir, It is with great interest that we read the recent publication by Thomas and colleagues investigating ward-based patient care.1 They describe a study in which 28 medical students were randomised to either control (no intervention) or intervention (performance feedback and error management training) groups, performing simulated ward rounds complicated by environmental distractors. Significant reductions in errors were se...
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  • Real-time information on preventable death provided by email from front-line intensivists results in high response rates with useful information
    L.Marjon Dijkema

    Dear Editor,

    Recently, Provenzano and colleagues found that an electronic tool collecting real-time clinical information directly from front-line providers was both feasible and useful to evaluate inpatient deaths [1]. These findings concur with our evaluation of the preventability of death using a simple electronic evaluation tool in our 46-bed adult Intensive Care Unit.

    From September 2010 to Sept...

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