53 e-Letters

published between 2014 and 2017

  • 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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  • 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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