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Quality & safety in the literature
Quality and safety in the literature: September 2021
  1. Alexis Lopez1,2,
  2. Ashwin Gupta1,2,
  3. Nathan Houchens1,2
  1. 1 Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
  2. 2 Medicine Service, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
  1. Correspondence to Dr Alexis Lopez, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI 48103, USA; lopezan{at}med.umich.edu

https://doi.org/10.1136/bmjqs-2021-013891

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    Healthcare quality and safety span multiple topics across the spectrum of academic and clinical disciplines. Keeping abreast of the rapidly growing body of work can be challenging. In this series, we provide succinct summaries of selected relevant studies published in the last several months. Some articles will focus on a particular theme, whereas others will highlight unique publications from high-impact medical journals.

    Key points

    • The use of time-limited treatment trials for critically ill intensive care unit (ICU) patients with advanced medical illnesses was associated with improvement in quality of family meetings, and reductions in non-beneficial ICU treatments and ICU length of stay, without a change in hospital mortality. JAMA Intern Med. 12 April 2021.

    • Admission avoidance ‘hospital at home’ services, combined with comprehensive geriatric assessment, led to similar outcomes in the proportion of patients living at home 6 months after an acute event requiring hospital-level care when compared with patients who were hospitalised. It was also associated with a decrease in admission to long-term residential care. Ann Intern Med. 20 April 2021.

    • The implementation of the Medicare Sepsis Performance Measure (SEP-1) in acute care led to improvements in most process measures without improving clinical outcomes. Ann Intern Med. 20 April 2021.

    Evaluation of time-limited trials among critically ill patients with advanced medical illnesses and reduction of non-beneficial ICU treatments

    JAMA Intern Med. 12 April 2021.

    Critically ill intensive care unit (ICU) patients with advanced medical illnesses and poor prognoses often receive non-beneficial care. Determining the appropriate scope of care can be challenging due to initial medical uncertainty regarding prognosis and response to therapy, lack of understanding of patient (or patient surrogate) values, and patient or family expectations that may not reflect the severity of disease. ICU care planning and communication among medical teams and patients/families can be inconsistent and of varying quality.1 As a result, patients with advanced medical illnesses and poor prognoses often receive …

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    Footnotes

    • Twitter @ashwin_b_gupta, @nate_houchens

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; internally peer reviewed.