We appreciate Dr. Singer's point about a more thorough discussion of
the large literature on safety climate and tools for assessing it.
Although we did include two of the articles she refers to; not all were
included. While acknowledging and discussing other instruments for
measuring Patient Safety Climate (PSC), would have made our article more
complete, the findings and conclusions of the study would not have
changed....
We appreciate Dr. Singer's point about a more thorough discussion of
the large literature on safety climate and tools for assessing it.
Although we did include two of the articles she refers to; not all were
included. While acknowledging and discussing other instruments for
measuring Patient Safety Climate (PSC), would have made our article more
complete, the findings and conclusions of the study would not have
changed. For instance, we would have still chosen the Safety Attitude
Questionnaire (SAQ) to measure PSC in nursing and residential homes, as
we aimed to benchmark our findings with other health care settings
(inpatient, ICU, ambulatory care) in the Netherlands and abroad. The
results for benchmarking constitute a substantial part of our findings and
discussion. The SAQ is a frequently used survey in multiple healthcare
settings and is often used as a foundation for other PSC surveys. Thus, we
chose the SAQ so that our assessment of PSC in nursing and residential
homes in The Netherlands would not stand in isolation, but could be
considered in the context of international results. In conclusion, we
should have discussed more recent literature on other possible PSC surveys
and explained better why we chose the SAQ. But, we believe this oversight
does not affect the substance of our findings--nor apparently does Dr
Singer.
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...
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 stressed that
the majority of patients agreed that they would like the SC to be used if
they were having an operation.
In our experience, we confirm that the value of SC does not lie in the so-
called Hawthorne effect, but in changing (improving!) the mental model. As
also documented in the field of aviation, most accidents tend to involve
non-technical skills (NTS) such as communications, leadership, conflict,
and flawed decision-making. The relationship between NTS and human error
has been extensively demonstrated.
In Aviation it is mandatory for pilots to read a checklist for every single
phase of flight.
Of course they know the checklists by heart, but what if....you are
stressed, the last leg of the day, distracted, with family problems?
Of course it may be that you don't need any checklist, but will you risk it?
Will you risk to take off from Toronto under snow knowing that pilots
didn't read any checklist because they know procedures by heart and
because statistics say it doesn't matter, and results are the same..?
We would like conclude that one of the effective barriers to error is
the surgery safety checklist and, believe it or not, we are sure that
pilots if going under surgery they would like to know that surgeon uses
appropriate checklists that day!
____________________________________________________________
Fabrizio Dal Moro is an Assistant Professor at the University of Padova,
expert on NTS.
Gianluigi Zanovello and Fabio Cassan are airline pilots in Italy:
Zanovello is a former "Frecce Tricolori" (italian acrobatic team) leader;
Cassan was fighter squadron commander (51' Stormo Aeronautica Militare
Italiana).
They teach at Practice simulation center in the medicine University
of Verona - Italy. There, surgeons can practice exactly like the pilots
and run-through not only the anatomy before the real procedure. There is
something else: get familiar with NTS and understand that communication,
decision making, teamwork, situation awareness are important as the
professional, and technical.
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.
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 cardiac arrest teams (2) were first introduced in
1970, with the motive of initiating an urgent response to a deteriorating
patient. By definition, activation of this system occurred after an arrest
had occurred, so patient had no recordable pulse, blood pressure,
respiration and did not respond to noxious stimuli.
However, more gains were to be made by initiating this response
before the patient had reached a terminal stage. Based on research showing
that cardiac arrest usually follows a series of events, attempts were made
to identify these events so as to preempt an arrest before it actually
occurred. Medical emergency teams (MET) were a culmination of these
efforts.
MET responses, introduced circa 2000 include a critical care
registrar and nurse, among others. Any clinician caring for a
deteriorating patient is encouraged to activate the response though a
rapid response system and can expect help within minutes. Whilst the
concept of MET response is similar to that of cardiac arrest teams, a
fundamental difference is in the timing of initiating the response.
However, the MET response is also activated after a level of
deterioration has occurred. The quest continued to find alarm signs or
signals that indicate deterioration is likely to occur. Once again, the
presumption is that an earlier response, before deterioration has
occurred, should result in a better outcome.
Analysis of hospital admissions suggests an adverse outcome is likely
in about 10% of admitted patients (3). Improving the outcome further,
particularly for these 10%, has triggered a nationally coordinated
approach that is being overseen by the Australian Commission on Safety and
Quality in Health Care (ACSQHC).
A new paradigm as suggested by Jones et al (4) would be required to
drive this further improvement. The focus is now on early detection and
prediction of clinical deterioration, so urgent help can be sought even
before the situation actually worsens. Eight essential elements have been
identified and compiled into a package that is the effort of ACSQHC.
Despite differences, it was encouraging that this consensus statement was
ratified by all state health ministers in Australia (5). The package,
widely distributed throughout Australian hospitals, is hoped to improve
outcomes by encouraging early detection of deterioration, and calling for
help early.
These strategies, in addition to the "swimming between the flags"
observation chart and rapid response systems include many other
initiatives with focus on education as one of the essential elements.
Different educational programs and packages such as COMPASS and DETECT (5)
have been developed in Australia specifically to improve practice
regarding the recognition and response to clinical deterioration amongst
all staff.
References:
1. Hughes C, Pain C, Braithwaite J, Hillman K. 'Between the flags':
implementing a rapid response system at scale. BMJ Qual Saf 2014;23:714-
717
2. McGrath RB. In-hospital cardiopulmonary resuscitation -- after a
quarter of a century. Ann Emerg Med 1987; 16: 1365-1368.
3. Runciman W and Moller J. Iatrogenic Injury in Australia, A Report
prepared by the Australian Patient Safety Foundation for the National
Health Priorities and Quality Branch of the Department of Health and Aged
Care of the Commonwealth of Australia (2001) available from:
http://www.apsf.net.au/dbfiles/Iatrogenic_Injury.pdf (accessed September
2014)
4. Jones AD, Dunbar NJ and Bellomo R. Clinical deterioration in
hospital inpatients: the need for another paradigm shift. Med J Aust 2012;
196 (2): 97-100
5. Australian Commission on Safety and Quality in Health Care.
National consensus statement: essential elements for recognising and
responding to clinical deterioration. Sydney: ACSQHC, 2010. Available
from: http://www.safetyandquality.gov.au/wp-content/uploads/2012/02/Nat-
Consensus-Statement-PDF-Complete-Guide.pdf (accessed Sept 2014)
The authors point out the effectiveness and need for retinopathy screening and foot care in diabetes. However, as in much of the "screening" literature, the opportunity for intervention during the screening visit is not ephasised.
We know that by achieving an HbA1c of 6% and blood pressure of 130/80 or below, not smoking, and having a hyperlipidaemia treated, most retinopathy could be avoided or delayed (U...
The authors point out the effectiveness and need for retinopathy screening and foot care in diabetes. However, as in much of the "screening" literature, the opportunity for intervention during the screening visit is not ephasised.
We know that by achieving an HbA1c of 6% and blood pressure of 130/80 or below, not smoking, and having a hyperlipidaemia treated, most retinopathy could be avoided or delayed (UKPDS and DCCT studies).[1][2][3] But few patients are aware of this information, fewer still know their own levels, and fewer still know how to achieve such levels. By providing such information, regarding the importance of the levels and finding them out and the need for medical care to reach the required targets, patients would not only be screened but an intervention would have been carried out that would enable many patients to avoid retinopathy and other complications.
Surely it is time to consider that retinopathy screening visits provide the opportunity for vastly improved quality of care, not simply a check up. Indeed, the authors note the success of foot intervention programs in preventing amputations, whilst it is only a very small further step to prevent many diabetic complications by informing patients of the need for good control of their diabetes, and the need to check control with HbA1c and blood pressure checks.
References
(1) Diabetes Control and Complications Trial (DCCT) Research Group. The Effect of Intensive Treatment of Diabetes on the Development and Progression of Long Term Complication in Insulin-Dependant Diabetes Mellitus. N Engl J Med 1993;329:977-86.
(2) Adler, AI, et al, on behalf of the UK Prospective Diabetes Study Group. Association of systolic blood pressure with macrovascular and microvascular complications of type 2 diabetes (UKPDS 36). BMJ 2000;321:412-19.
(3) Stratton, IM, et al, on behalf of the UK Prospective Diabetes Study Group. Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35). BMJ 2000;321:405-12.
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...
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 authors' catalogue of concerns by sharing our experience at Queen
Alexandra Hospital (QAH).
At QAH we operate a modified WHO safer surgery checklist to suit
local practice. The checklist is applied to every patient passing through
the theatre complex. During a routine audit we identified how an
apparently minor communication error fundamentally undermined the
checklist's safety function and placed our patients at risk.
Our venous thromboembolism (VTE) prophylaxis checkpoint reads 'VTE
prophylaxis considered?'. In practice however, this question is frequently
altered to 'Flowtron's on?' (Flowtron refers to the intermittent pneumatic
calf compression devices (IPCCD) used at QAH). The multiple meanings of
the word 'on' (either interpreted as 'on the patient' or 'switched on')
introduced ambiguity and a communication error. This incorrect use of the
checklist resulted in multiple patients having IPCCDs applied to their
calfs, yet the devices were never switched on and our patients were placed
at risk.
Our experience illustrates two important communication errors that
may undermine the checklist's safety function. Firstly, accurate and
unambiguous wording of each component of the checklist is essential. Words
with homonymous meanings should be avoided where possible. Secondly, each
checklist question must be verbalised accurately during the patient check
to avoid introducing errors.
The original WHO safer surgery checklist (2009) (2) limits such
potential error, as most questions are yes/no answerable. Any local
checklist modifications should aim to maintain this format. Introducing
words with homonymous meanings may lead to communication errors; undermine
the checklist's safety function and place patients at risk.
Reference:
1. BMJ Qual Saf. 2014 Jul 18. The WHO surgical safety checklist:
survey of patients' views. Russ SJ, Rout S, Caris J, Moorthy K, Mayer E,
Darzi A, Sevdalis N, Vincent C.
I agree that every opportunity should be taken to discuss with
patients with diabetes how they can reduce the risk of complications, and
that screening can present one such opportunity. However, because the
effectiveness of this approach has not been tested in an RCT, it was not
included in the review on which this Effective Health Care Bulletin was
based.
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...
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 number of factors including how it is expressed (1). It is possible that the year chosen may have been an outlier that triggered the Trusts to actively invest in measures including EPSS. We would therefore be grateful if the authors could provide additional data on mortality in the years prior to the intervention. Were other strategies employed alongside EPSS? For example we understand University Hospital Coventry also called in Dr Foster Intelligence in 2007 to restructure practice (2).
As the paper uses only a historical comparator it is possible that a proportion of the improvement reflects the general national improvement in hospital mortality seen over the last decade (3). Do the authors have any data comparing their improvements with other Trusts of a similar size, case-mix, and similarly average HSMR (4)?
Interventions in healthcare are rarely without some adverse effects and as such we would be interested in any data collected on the potential negative aspects. These would include consequences of the increased workload for junior doctors and financial effect cost. Establishing that these were relatively minor would be very reassuring for other Trusts considering similar strategies.
While we agree that randomised controlled trials are complex, we suggest there is a strong rationale for them to disaggregate the benefit of EPSS from many confounding factors, and to inform clear health economic analysis.
Yours sincerely,
Dominick Shaw, John Blakey and Jamie Rylance
1 http://www.nejm.org/doi/full/10.1056/NEJMsa1006396#t=articleMethods
2 http://drfosterintelligence.co.uk/wp-content/uploads/2013/02/University-Hospitals-Coventry-Warwickshire-NHS-Trust-case-study.pdf
3 http://www.biomedcentral.com/1472-6963/13/216
4 http://drfosterintelligence.co.uk/wp-content/uploads/2011/11/Hospital_Guide_2011.pdf
Grogan et al[1] report that their Patient Satisfaction Questionnaire
(PSQ) is a valid and internally reliable tool for assessing patient
satisfaction with primary care services despite the acknowledgement in
their discussion that further research is required to confirm other
aspects of reliability and validity. We feel that their conclusion is
premature.
Grogan et al[1] report that their Patient Satisfaction Questionnaire
(PSQ) is a valid and internally reliable tool for assessing patient
satisfaction with primary care services despite the acknowledgement in
their discussion that further research is required to confirm other
aspects of reliability and validity. We feel that their conclusion is
premature.
Having recently been involved in the validation of a postal
questionnaire to assess quality of life in dyspeptic patients we are aware
of the importance of a full evaluation. Our principal concerns with the
published study[1] relate to the lack of information relating to
representativeness and acceptability. The need to demonstrate
acceptability is heightened when questionnaires are to be self-completed.
Response rate data were not provided because of the study design. Response
rates give not only an indication of the acceptability of the questions
used, but also provide information about the acceptability of the concept,
e.g. will patients answer questions about their doctor? Full data sets
were available for 1151/1390 returned questionnaires; 17% of patients
chose not to complete all questions, which may indicate lack of
acceptability of certain items. Acceptability is important for several
reasons:
1) ethically we should not be utilising tools which may
distress/offend
2) financially we should not use a tool which will not be
returned or where intense effort is required to generate responses
3) in the interests of quality we should not use a tool where differential
acceptability may cause bias.
Before recommending the PSQ as a tool we
would like to see some evidence that acceptability has been demonstrated
in different patient groups.
Other evidence that would be useful before concluding that the
questionnaire should be adopted includes data on reproducibility
(consistency of response) and responsiveness over time. Before using the
questionnaire for repeated audit or to evaluate change in practice, it is
important to confirm that the questionnaire is able to reflect changes in
satisfaction over time.
Whilst the data provided indicates the PSQ to be valid and reliable,
these data must be interpreted with some caution given the lack of
information about sample selection and representativeness. Other issues
pertinent to questionnaire evaluation have not been fully explored and,
given that this is designed to be a self-completion questionnaire for use
in an area in which traditionally patients have not been consulted,
acceptability of the questionnaire and individual questions should be
assessed before concluding that the tool be adopted.
Reference
(1) Grogan S, Conner M, Norman P, Willits, Porter I. Validation of a
questionnaire measuring patient satisfaction with general practitioner
services. Quality in Health Care 2000;9:210-15
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...
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, particularly by myself when presenting our simulation work related to the Duty of Candour. We opened with a discussion considering how the NHS was perceived by the general population of the UK. The conversation moved to the role of the media in driving the campaign for patient safety and openness.
The media has embraced the reports of a small number of high profile failings in the NHS, with the now daily reporting of another “failure” or “cover-up”. It is therefore understandable why a large proportion of the population do not trust the NHS and feel there is a closed and dishonest culture [2]. The media focuses on the Safety I premise of failures [1]. This is driving the destruction of the NHS’s reputation and the wellbeing of staff and patients by focusing on the minority of outcomes which are negative. In November 2013, our local Trust was reported to be the second worst general hospital in England for avoidable deaths [3]. A review of the data and response from the Trust identified that the news report was misleading and the data inaccurate, causing unnecessary anxiety amongst patients and staff [4]. Such media reports place extra strain on the healthcare system with reputational damage and effects on morale which effect the ability of that organisation to sustain required operations.
However, now 12 years later, the focus still remains on the serious errors, incidents and failures of the NHS. These events are still the minority of events, but the focus remains on what went wrong. As it is time for healthcare to focus on Safety II, should it not be the same for the media? By focussing on what goes right and the NHS's incredible ability to succeed under varying conditions, the media can celebrate the NHS and help to drive the next stage of safety improvement. It is time for
the media to also move from Safety I to Safety II thinking.
The discussion regarding media involvement in the NHS prompted me to consider this further and I read with great interest the 2002 paper published in BMJ Quality and Safety considering the role of the media in pushing patient safety forward as the priority [5]. There is no doubt that media involvement has benefitted the patient safety agenda, by acting as a “watchdog” to hold the medical profession accountable for improved safety and quality of care. This in turn has created a passionate group of healthcare professionals striving for excellence in care.
12 years later, however, the focus still remains on the serious errors, incidents and failures of the NHS. These events are still the minority of events, but the focus remains on what went wrong. As it is time for healthcare to focus on Safety II, should it not be the same for the media? By focussing on what goes right and the NHS’s incredible ability to succeed under varying conditions [1], the media can celebrate the NHS and help to drive the next stage of safety improvement. It is time for the media to also move from Safety I to Safety II thinking.
The difficulty will be in convincing the media of its role in the next stage of safety. It remains important for the NHS to be transparent, but a balance must be sought between the ongoing need for accurate reporting of serious problems and celebration of the NHS’s staff and its successes. In a recent well known report on health and healthcare service delivery [6], the UK ranked number one against ten other wealthy countries for overall healthcare (based on quality, access, efficiency and equity).
Professor Hollnagel defined resilience as the ability of the healthcare system to adjust its functioning to sustain operations under both expected and unexpected conditions [1]. The media must understand the complexity of the NHS and be aware of the potential for their reporting to inadvertently remove those parts of the healthcare system that have contributed to its resilience.
1) Hollnagel E. Safety I and Safety II: The Past and Future of Safety
Management. Ashgate: Surrey, United Kingdom
2) YouGov UK. One in two don’t trust the NHS. [Online] 2013. Available from: https://yougov.co.uk/news/2013/06/13/1-2-do-not-trust-nhs/ [Accessed 14th November 2014].
3) Adams S. How 3,500 hospital patients lost their lives due to surgical errors or staff who were too busy to treat them... in just TWELVE months. The Mail on Sunday. [Online] November 09 2013. Available from: www.dailymail.co.uk [Accessed 14th November 2014].
4) Nottingham University Hospitals NHS Trust. Response to Mail On Sunday coverage (avoidable deaths). [Online: media response] 2013. Available from: http://www.nuh.nhs.uk/media/1459425/response_to_mail_on_sunday_coverage.pdf [Accessed 14th November 2014].
5) Millenson ML. Pushing the profession: how the news media turned patient safety into a priority. Qual Saf Health Care 2002; 11: 57–63.
6) Davis K, Stremikis K, Schoen C, Squires D. Mirror, Mirror on the Wall, 2014 Update: How the U.S. Health Care System Compares Internationally. The Commonwealth Fund. 2014.
Roberts et al[1] provide a commentary on the Patient Satisfaction
Questionnaire (PSQ) that we have developed and validated.[2][3] Whilst
they accept that the PSQ is a valid and internally reliable tool for
assessing patient satisfaction with primary care services, they suggest
that further work is required before the measure is adopted. In
particular they point to the need to assess the acceptabi...
Roberts et al[1] provide a commentary on the Patient Satisfaction
Questionnaire (PSQ) that we have developed and validated.[2][3] Whilst
they accept that the PSQ is a valid and internally reliable tool for
assessing patient satisfaction with primary care services, they suggest
that further work is required before the measure is adopted. In
particular they point to the need to assess the acceptability of the items
to different patient groups.
In the development of a measure such as the PSQ, continuing
assessment of reliability, validity and acceptability is clearly
worthwhile. Nevertheless we would argue that there already exists
sufficient data on the reliability and validity of the scale[2][3] to
warrant its adoption as means of assessing patient satisfaction with
primary care services.
In relation to the specific points raised by Roberts et al[1]:
First, in relation to the issue that certain items may be
unacceptable and produce low response rates. Analysis of items included in
both the original study where the questionnaire was developed[2] and the
validation study[3] has failed to show any differences in response rates
on individual items. Also, all items originated in interviews and open-ended questionnaires with patients, and we have no reason to believe that
they would be unacceptable to other patients.
Second, in relation to whether particular items may distress or
offend respondents. As all items were originally derived from interviews
with patients, the wording reflects the way in which patients talk about
these services. In reproducing the questionnaire we allow practitioners
the opportunity to judge the potential offensiveness of the items. We have
not received any negative feedback about items from practitioners or
respondents to the questionnaires used in our validation study in terms of
their distressing nature or offensiveness. There is no evidence to
support the suggestion that any of the items in the PSQ will distress or
offend respondents.
Third, in relation to the suggestion that the PSQ as a whole may not
be completed by particular groups: This is not an issue we have
specifically addressed in our research. To do so would require the
assessment of response rates in different groups where we might expect
differences. A further analysis might then compare the numbers of fully
versus partially completed PSQs. In relation to this latter point, from
the data reported in Grogan et al,[3] we were able to make a comparison
of questionnaires that were fully completed versus those that were only
partially completed. This indicated no significant impact of various
demographic groups (eg, age, gender) on completion rates.
In summary, whilst we accept that further work to assess the
reliability, validity, and acceptability of the PSQ is warranted, we
believe that the measure has been sufficiently tested to make it suitable
for adoption by those wishing to assess patient's satisfaction with
primary care services.
Sarah Grogan, PhD (Address for correspondence)
Senior Lecturer
Department of Psychology and Speech Pathology
Manchester Metropolitan University
Elizabeth Gaskell Building
Manchester M13 OJA, UK
Mark Conner, PhD
Senior Lecturer
School of Psychology
University of Leeds
Leeds LS2 9JT, UK
References
(1) Roberts L, Roalfe A, Wilson S. Patient Satisfaction Questionnaire
- Further validation required [Rapid Response]. Qual Health Care 22
December 2000. http://www.qualityhealthcare.com/cgi/eletters/9/4/210#EL1
(2) Grogan S, Conner M, Willits D, Norman P. Development of a
questionnaire to measure patients' satisfaction with general
practitioners' services. British Journal of General Practice 1995;45:525-
29.
(3) Grogan S, Conner M, Norman P, Willits, Porter I. Validation of a
questionnaire measuring patient satisfaction with general practitioner
services. Qual Health Care 2000;9:210-15.
We appreciate Dr. Singer's point about a more thorough discussion of the large literature on safety climate and tools for assessing it. Although we did include two of the articles she refers to; not all were included. While acknowledging and discussing other instruments for measuring Patient Safety Climate (PSC), would have made our article more complete, the findings and conclusions of the study would not have changed....
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...
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...
The authors point out the effectiveness and need for retinopathy screening and foot care in diabetes. However, as in much of the "screening" literature, the opportunity for intervention during the screening visit is not ephasised.
We know that by achieving an HbA1c of 6% and blood pressure of 130/80 or below, not smoking, and having a hyperlipidaemia treated, most retinopathy could be avoided or delayed (U...
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...
Dear Editor:
I agree that every opportunity should be taken to discuss with patients with diabetes how they can reduce the risk of complications, and that screening can present one such opportunity. However, because the effectiveness of this approach has not been tested in an RCT, it was not included in the review on which this Effective Health Care Bulletin was based.
Grogan et al[1] report that their Patient Satisfaction Questionnaire (PSQ) is a valid and internally reliable tool for assessing patient satisfaction with primary care services despite the acknowledgement in their discussion that further research is required to confirm other aspects of reliability and validity. We feel that their conclusion is premature.
Having recently been involved in the valida...
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...
Dear Editor,
Roberts et al[1] provide a commentary on the Patient Satisfaction Questionnaire (PSQ) that we have developed and validated.[2][3] Whilst they accept that the PSQ is a valid and internally reliable tool for assessing patient satisfaction with primary care services, they suggest that further work is required before the measure is adopted. In particular they point to the need to assess the acceptabi...
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