eLetters

110 e-Letters

  • 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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  • Moving from Safety I to Safety II, but what about the media?
    Nick Woodier

    To the Editor

    I have recently returned from the Association of Simulated Practice in Healthcare 2014 conference in Nottingham and whilst there was privileged to hear and meet Professor Erik Hollnagel. He presented eloquently on his work relating to “From Safety I to Safety II” [1] which provided an excellent opening for the conference’s theme of “Changing Behaviours.” His work sparked much debate and reflection, part...

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  • Measuring the true impact of an electronic physiological surveillance system (EPSS)
    Dominick Shaw
    Dear Sir, We read with interest the article by Schmidt et al. We applaud the authors for undertaking this large and complex study and for highlighting the great potential of newer technologies to improve patient care. We hoped the authors could clarify some key issues. Firstly only one year's mortality data are used as a baseline comparator. Mortality fluctuates by year as this paper highlights, and can be affected by a large...
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  • WHO Safer Surgery Checklist not Immune to Human Errors
    Christian Schopflin

    We wish to congratulate Russ SJ et al. (1) for their excellent survey investigating patients' views of the WHO safer surgery checklist.

    The authors point out that the UK wide implementation of the checklist has encountered some difficulties. Specifically, barriers including checklist fatigue and difficulties in assembling the theatre team are mentioned. Whilst we certainly agree with this, we wish to amend the a...

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  • 'Between the flags': implementing a rapid response system at scale - A reply
    Sanjay Sharma

    The authors (1) have raised a very important issue relating to recognition and management of a deteriorating patient. Over the years, cases have been reported where outcome may have been better if deterioration was recognized in time. Once recognized, an urgent response by a qualified team could instigate immediate investigations and management as warranted, possibly averting a poor outcome.

    Code blue calls or...

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  • SURGERY AND CHECKLISTS: WHAT A PILOT WOULD LIKE TO KNOW
    Fabrizio Dal Moro

    Dear Editor, we would like to congratulate Russ et al. on their paper on the patients' views of surgical checklists (SC). In their elegant work, the above authors underlined that assessing the fidelity of the SC remains a challenge, but demonstrated a high level of patient support for use of checklists. They found that patients were surprised that SC was only a recent introduction to surgical care. Moreover, the authors...

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  • Evidence-based E-Health Policy - Vitally Important but not a New Call
    Michael J. Rigby

    The editorial from Sheikh, Atun, and Bates is welcome in flagging up a key issue in the context of England and the US. However, it is not a new issue, and it is disappointing that they do not acknowledge prior and concurrent work.

    The need for, and challenges impeding, evaluation of health information systems have been flagged up much earlier, e.g. Rigby 1999; 2001. Both the European Federation for Medical In...

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