Coproducing a library of videos to support families caring for children with gastrostomies: A mixed-methods evaluation with family carers and clinicians.

Introduction: Many families now perform specialist medical procedures at home. Families need appropriate training and support to do this. The aim of this study was to evaluate a library of videos, coproduced with parents and healthcare professionals, to support and educate families caring for a child with a gastrostomy.

Training and support for caring for a child's gastrostomy: a survey with family carers.

Objective: The aim of this study was to explore family carers' experiences of training and ongoing support for caring for their child's gastrostomy, and to get their views on how this could be improved.

Methods: A mixed-methods online survey with 146 family carers (eg, parents, grandparents) who care for a child with a gastrostomy. Family carers rated their own experience of training and support and made recommendations for how training and support could be improved for future families.

How to do no harm: empowering local leaders to make care safer in low-resource settings.

In a companion paper, we showed how local hospital leaders could assess systems and identify key safety concerns and targets for system improvement. In the present paper, we consider how these leaders might implement practical, low-cost interventions to improve safety. Our focus is on making immediate safety improvements both to directly improve patient care and as a foundation for advancing care in the longer-term.

First do no harm: practitioners' ability to 'diagnose' system weaknesses and improve safety is a critical initial step in improving care quality.

Healthcare systems across the world and especially those in low-resource settings (LRS) are under pressure and one of the first priorities must be to prevent any harm done while trying to deliver care. Health care workers, especially department leaders, need the diagnostic abilities to identify local safety concerns and design actions that benefit their patients. We draw on concepts from the safety sciences that are less well-known than mainstream quality improvement techniques in LRS.

A Protocol is not Enough: Enhanced Recovery Program-Based Care and Clinician Adherence Associated with Shorter Stay After Colorectal Surgery.

Background: Randomised trials have shown an Enhanced Recovery Program (ERP) can shorten stay after colorectal surgery. Previous research has focused on patient compliance neglecting the role of care providers. National data on implementation and adherence to standardised care are lacking.

Analysis of paediatric long-term ventilation incidents in the community.

Aim: To describe the nature and causes of reported patient safety incidents relating to care in the community for children dependent on long-term ventilation with the further aim of improving safety.

Methods: We undertook an analysis of patient safety incident data relating to long-term ventilation in the community using incident reports from England and Wales' National Reporting and Learning System occurring between January 2013 and December 2017. Manual screening by two authors identified 220 incidents which met the inclusion criteria.

Reliability in the process of care during emergency general surgical admission: A prospective cohort study.

Introduction: Emergency general surgery (EGS) is responsible for 80-90% of surgical in-hospital deaths and the early management of these unwell patients is critical to improving outcomes. Unfortunately care for EGS patients is often fragmented and important care processes are frequently omitted.

Methods: This study aimed to define a group of important processes during EGS admission and assess their reliability.

Understanding how colorectal units achieve short length of stay: an interview survey among representative hospitals in England.

Background: Wide variation in the outcomes of colorectal surgery persists, despite a well-established evidence-base to inform clinical practice. This variation may be attributed to differences in quality of care, but we do not know what this means in practical terms of care delivery. This telephone interview study aimed to identify distinguishing characteristics in the organisation of care among colorectal units with the best length of stay results in England.

Outlier identification in colorectal surgery should separate elective and nonelective service components.

Background: The identification of health care institutions with outlying outcomes is of great importance for reporting health care results and for quality improvement. Historically, elective surgical outcomes have received greater attention than nonelective results, although some studies have examined both. Differences in outlier identification between these patient groups have not been adequately explored.

Improving decision making in multidisciplinary tumor boards: prospective longitudinal evaluation of a multicomponent intervention for 1,421 patients.

Background: Due to its complexity, cancer care is increasingly being delivered by multidisciplinary tumor boards (MTBs). Few studies have investigated how best to organize and run MTBs to optimize clinical decision making. We developed and evaluated a multicomponent intervention designed to improve the MTB's ability to reach treatment decisions.

Surgical adverse events: a systematic review.

Background: The aim of this systematic review is to quantify potentially preventable patient harm from the frequency, severity, and preventability of the consequences and causes of surgical adverse events to help target patient safety improvement efforts.

Data Sources: Two authors independently reviewed articles retrieved from systematic searches of the Cochrane library, MEDLINE, Embase, PsycINFO, and Cumulative Index to Nursing & Allied Health Literature databases for inclusion and exclusion criteria, methodology, and end points. All retrospective record review studies of adverse events were included.

Meeting the ambition of measuring the quality of hospitals' stroke care using routinely collected administrative data: a feasibility study.

Objective: To examine the potential for using routinely collected administrative data to compare the quality and safety of stroke care at a hospital level, including evaluating any bias due to variations in coding practice.

Design: A retrospective cohort study of English hospitals' performance against six process and outcome indicators covering the acute care pathway. We used logistic regression to adjust the outcome measures for case mix.

An observational study of the frequency, severity, and etiology of failures in postoperative care after major elective general surgery.

Objective: To investigate the nature of process failures in postoperative care, to assess their frequency and preventability, and to explore their relationship to adverse events.

Background: Adverse events are common and are frequently caused by failures in the process of care. These processes are often evaluated independently using clinical audit.

Patient involvement in patient safety: the health-care professional's perspective.

Background: Despite increasing recognition that patients could play an important role in promoting the safety of their care, little is known on this issue regarding health-care professionals' (HCPs') attitudes toward patient involvement.

Objectives: To investigate physicians' and nurses' attitudes toward patient involvement in safety-related behaviors, both through their eyes as a health-care professional and as a potential patient.

Design: Cross-sectional exploratory study using 2 surveys.

Dying for the weekend: a retrospective cohort study on the association between day of hospital presentation and the quality and safety of stroke care.

Objective: To examine the association between day of admission and measures of the quality and safety of the care received by patients with stroke.

Design: Retrospective cohort study of patients admitted to hospitals with stroke (codes I60-I64 from the International Statistical Classification of Diseases and Related Health Problems, Tenth Version) from April 1, 2009, through March 31, 2010.

Setting: English National Health Service public hospitals.

Hospital patients' reports of medical errors and undesirable events in their health care.

Objective: To investigate hospital patients' reports of undesirable events in their health care.

Design: Cross-sectional mixed methods design.

Participants: A total of 80 medical and surgical patients (mean age 58, 56 male).

An observational study of teamwork skills in shift handover.

Background: Clinical handover (handoff, sign out) is frequently implicated as a cause of adverse events in hospitalised patients. Complex social interactions such as handover are subject to the teamwork skills of the participants and there is increasing evidence that the quality of teamwork in handover affects outcome. Teamwork skills have been assessed in one-to-one handovers but the applicability of these measurement tools to healthcare team shift handovers remains unproven.

The medical student as a patient: attitudes towards involvement in the quality and safety of health care.

Background: In recent years, factors that affect patients' willingness and ability to participate in safety-relevant behaviours have been investigated. However, how trained healthcare professionals or medical students would feel participating in safety-relevant behaviours as a patient in hospital remains largely unexplored.

Objectives: To investigate medical students' willingness to participate in behaviours related to the quality and safety of their health care.

Quantitative analysis of intraoperative communication in open and laparoscopic surgery.

Background: Communication is important for patient safety in the operating room (OR). Several studies have assessed OR communications qualitatively or have focused on communication in crisis situations. This study used prospective, quantitative observation based on well-established communication theory to assess similarities and differences in communication patterns between open and laparoscopic surgery.

A systematic proactive risk assessment of hazards in surgical wards: a quantitative study.

Objective: To identify and prioritize hazards in surgical wards and recommend interventions.

Background: Retrospective and prospective studies report the frequency and severity of surgical adverse events, but not in sufficient detail to allow interventions to be recommended in surgical wards.

Methods: Seventy hours of observations were used to record all activities occurring in surgical wards, and from these activities health care processes were derived.