136 e-Letters

  • The problem with incident reporting
    Paresh Jobanputra

    Dear Sir or Madam

    I read with interest the editorial by Carl Macrae on incident reporting. I wonder if, in making a detailed comparison with the aviation and other industries, Macrae loses sight of one important reason why health services staff report incidents. My experience suggests that often the purpose of reports is not to learn from incidents but for staff to pre -emptively give their version of events in...

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  • Re:More information on safety culture in long-term care
    Martina Buljac-Samardzic

    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....

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  • More information on safety culture in long-term care
    Sara Singer

    To the Editor: I was a little surprised to see Buljac-Samardzic et al. in their recent article on safety culture in long-term care state that few tools are available to evaluate the effectiveness of initiatives to improve safety culture in nursing and residential homes. While there may be fewer tools available for nursing and residential homes than inpatient settings, there are several safety climate instruments that are...

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  • Statistical analysis of differences in turnover times among operating theatres
    Franklin Dexter

    Overdyk et al. used remote video auditing with real-time feedback in a surgical suite [1]. As part of their randomized trial clustered by theatre, they report less turnover times among "fast rooms," those generally including 3 or greater cases per day.

    Successive turnover times between scheduled cases within theatres on the same date tend to be correlated (e.g., caused by same surgeon, nurses, and anaesthetist)....

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  • Public website for interrupted time series and segmented regression
    Robert G Badgett

    We agree with the authors that interrupted time series should be used more often (1). We also agree that the statistics are difficult. We find segmented regression to be the preferable form of interrupted time series (ITS) as traditional ITS with the Davies tests only looks for a change in slope at the breakpoint. This works well if there is not a simultaneous change or shift in the level of the outcome at the breakpoint; howev...

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  • Response to 'Tall Man lettering and potential prescription errors: a time series analysis of 42 children's hospitals in the USA over 9 years' by Feudtner et al
    Zahra Kiani

    We were very interested to read the recent article by Feudtner et a,1 which has stated that Tall Man lettering has not changed the rate of look- alike sound-alike (LASA) related prescription or dispensing medication errors significantly in 42 children`s hospitals form 2004 to 2012. Feudtner et al`s study is a very valuable work because they performed an extensive statistical analysis on routine medication pairs of their h...

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  • 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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