Enhancing the quality of medicine handover at hospital discharge: a priority setting workshop.

Background: When a patient is discharged from hospital it is essential that their general practitioner (GPs) and community pharmacist are informed of changes to their medicines. This necessitates effective communication and information-sharing between hospitals and primary care clinicians.

Objective: To identify priority medicine handover issues and solutions to inform the co-design and development of a multifaceted intervention.

Improving health system responses when patients are harmed: a protocol for a multistage mixed-methods study.

Introduction: At least 10% of hospital admissions in high-income countries, including Australia, are associated with patient safety incidents, which contribute to patient harm ('adverse events'). When a patient is seriously harmed, an investigation or review is undertaken to reduce the risk of further incidents occurring. Despite 20 years of investigations into adverse events in healthcare, few evaluations provide evidence of their quality and effectiveness in reducing preventable harm.

Implementing decision aids for cardiovascular disease prevention: stakeholder interviews and case studies in Australian primary care.

Background: Australian cardiovascular disease (CVD) prevention guidelines recommend absolute CVD risk assessment, but less than half of eligible patients have the required risk factors recorded due to fragmented implementation over the last decade. Co-designed decision aids for general practitioners (GPs) and consumers have been developed that improve knowledge barriers to guideline-recommended CVD risk assessment and management. This study used a stakeholder consultation process to identify and pilot test the feasibility of implementation strategies for these decision aids in Australian primary care.

North Atlantic meltwater during Heinrich Stadial 1 drives wetter climate with more atmospheric rivers in western North America.

Atmospheric rivers (ARs) bring concentrated rainfall and flooding to the western United States (US) and are hypothesized to have supported sustained hydroclimatic changes in the past. However, their ephemeral nature makes it challenging to document ARs in climate models and estimate their contribution to hydroclimate changes recorded by time-averaged paleoclimate archives. We present new climate model simulations of Heinrich Stadial 1 (HS1; 16,000 years before the present), an interval characterized by widespread wetness in the western US, that demonstrate increased AR frequency and winter precipitation sourced from the southeastern North Pacific.

Implementing patient decision aids into general practice clinical decision support systems: Feasibility study in cardiovascular disease prevention.

Objective: Patient decision aids (DA) facilitate shared decision making, but implementation remains a challenge. This study tested the feasibility of integrating a cardiovascular disease (CVD) prevention DA into general practice software.

Methods: We developed a desktop computer application (app) to auto-populate a CVD prevention DA from general practice medical records.

Unusual Course of a Pulmonary Artery Catheter Due to Absence of Right Superior Vena Cava.

The persistent left superior vena cava may complicate the placement of vascular access. It rarely occurs with an absence of the right superior vena cava. We present a chest X-ray of a patient with this rare anomaly that was demonstrated incidentally with an unusual course of a pulmonary artery catheter course.

A 3-hour fast-track extubation protocol for early extubation after cardiac surgery.

Objectives: Early extubation after cardiac surgery improves outcomes and reduces cost. We investigated the effect of a multidisciplinary 3-hour fast-track protocol on extubation, intensive care unit length of stay time, and reintubation rate after a wide range of cardiac surgical procedures.

Methods: We performed an observational study of 472 adult patients undergoing cardiac surgery at a large academic institution.

Severe Acute Blood Loss Anemia in Jehovah's Witnesses Undergoing Cardiac Surgery: Single Academic Center Experience.

Objective: To determine the effect of severe acute blood loss anemia (ABLA) on postoperative outcomes in Jehovah's Witness (JW) patients undergoing cardiac surgery.

Design: This was a retrospective cohort study of adult JW patients undergoing cardiac surgery requiring cardiopulmonary bypass (CPB) between January 1998 and December 2018 at Barnes-Jewish Hospital in St. Louis, Missouri.

Linked fire activity and climate whiplash in California during the early Holocene.

Recent wildfire activity in semi-arid regions like western North America exceeds the range of historical records. High-resolution paleoclimate archives such as stalagmites could illuminate the link between hydroclimate, vegetation change, and fire activity in pre-anthropogenic climate states beyond the timescale of existing tree-ring records. Here we present an analysis of levoglucosan, a combustion-sensitive anhydrosugar, and lignin oxidation products (LOPs) in a stalagmite, reconstructing fire activity and vegetation composition in the California Coast Range across the 8.

Supporting quality and safety in general practice: Response rates to computer decision support.

Background And Objectives: Primary health networks (PHNs) are tasked with supporting quality improvement in general practice. Traditional methods to do this are labour intensive and lack impact measurement. We aimed to measure general practitioner (GP) response rates to computer decision support at the point of care.

Medication reconciliation at hospital discharge: A qualitative exploration of acute care nurses' perceptions of their roles and responsibilities.

Background: Safe medication management is a cornerstone of nursing practice. Nurses prepare patients for discharge which includes the ongoing safe administration of medications. Medication reconciliation at hospital discharge is an interprofessional activity that helps to identify and rectify medication discrepancies or errors to ensure the accuracy and completeness of discharge medications and information.

The role of Primary Health Networks in cardiovascular disease prevention: A qualitative interview study.

Background: Since the inception of PHNs in Australia, their role in implementing chronic disease prevention activities in general practice has been unclear. This study aimed to qualitatively explore the views of PHN staff on the role of PHNs in promoting prevention, with a focus on cardiovascular disease (CVD) prevention.

Methods: Content analysis of PHN Needs Assessments was conducted to inform interview questions.

Incidence, origins and avoidable harm of missed opportunities in diagnosis: longitudinal patient record review in 21 English general practices.

Background: Diagnostic error is a global patient safety priority.

Objectives: To estimate the incidence, origins and avoidable harm of diagnostic errors in English general practice. Diagnostic errors were defined as missed opportunities to make a correct or timely diagnosis based on the evidence available (missed diagnostic opportunities, MDOs).

Characterising the nature of clinical incidents reported across a tertiary health service: a retrospective audit.

Objective Reducing the number of adverse patient safety incidents (PSIs) requires careful monitoring and active management processes. However, there is limited information about the association between hospital settings and the type of PSI. The aims of this study were to describe the severity, nature and characteristics of PSIs from an analysis of their incidence and to assess the relationships between the type of PSI and its setting.

The accuracy, completeness and timeliness of discharge medication information and implementing medication reconciliation: A cross-sectional survey of general practitioners.

Background And Objectives: General practitioners (GPs) require accurate medication information to care for recently discharged hospital patients. Pre-discharge medication reconciliation improves the accuracy of patient medication lists that GPs receive. This study aimed to explore GPs' perceptions of the accuracy, completeness and timeliness of hospital discharge medication information, and how they undertake medication reconciliation.

User redesign, testing and evaluation of the Monitoring Risk and Improving System Safety (MoRISS) checklist for the general practice work environment.

Background: Inadequate checking of safety-critical issues can compromise care quality in general practice (GP) work settings. Adopting a systemic, methodical approach may lead to improved standardisation of processes and reliability of task performance, strengthening the safety systems concerned. This study aimed to revise, modify and test the content and relevance of a previously validated safety checklist to the current GP context.

The quality of preventive care for pre-school aged children in Australian general practice.

Background: Variable and poor care quality are important causes of preventable patient harm. Many patients receive less than recommended care, but the extent of the problem remains largely unknown. The CareTrack Kids (CTK) research programme sought to address this evidence gap by developing a set of indicators to measure the quality of care for common paediatric conditions.

Quality of care for acute abdominal pain in children.

Objective: To assess quality of care for children presenting with acute abdominal pain using validated indicators.

Design: Audit of care quality for acute abdominal pain according to 21 care quality indicators developed and validated in four stages.

Setting And Participants: Medical records of children aged 1-15 years receiving care in 2012-2013 were sampled from 57 general practitioners, 34 emergency departments (ED) and 28 hospitals across three Australian states; 6689 medical records were screened for visits for acute abdominal pain and audited by trained paediatric nurses.

Facilitators and barriers to safer care in Scottish general practice: a qualitative study of the implementation of the trigger review method using normalisation process theory.

Objectives: Patient safety is a key concern of modern health systems, with numerous approaches to support safety. One, the trigger review method (TRM), is promoted nationally in Scotland as an approach to improve the safety of care in general medical practice. However, it remains unclear which factors are facilitating or hindering its implementation.

The Quality of Care for Australian Children with Autism Spectrum Disorders.

Knowledge about the quality of care delivered to children with autism spectrum disorders (ASD) in relation to that recommended by clinical practice guidelines (CPGs) is limited. ASD care quality indicators were developed from CPGs and validated by experts, then used to assess the quality of care delivered by general practitioners (GPs) and pediatricians in Australia. Data were retrospectively collected from the medical records of 228 children (≤ 15 years) with ASD for 2012-2013.

Never events in general practice: a focus group study exploring the views of English and Scottish general practitioners of 'never events'.

Objectives: To examine general practitioner (GP) understanding of the never event (NE) concept in general practice, and to identify potential enablers and barriers to implementation in UK general practice.

Design: Qualitative study using focus groups. The data were analysed thematically and were informed by the normalisation process theory.

Assessing the Quality of the Management of Tonsillitis among Australian Children: A Population-Based Sample Survey.

Objective: The aims of this study were twofold: (1) to design and validate a set of clinical indicators of appropriate care for tonsillitis and (2) to measure the level of tonsillitis care that is in line with guideline recommendations in a sample of Australian children.

Study Design: A set of tonsillitis care indicators was developed from available national and international guidelines and validated in 4 stages. This research used the same design as the CareTrack Kids study, which was described in detail elsewhere.

'The big buzz': a qualitative study of how safe care is perceived, understood and improved in general practice.

Background: Exploring frontline staff perceptions of patient safety is important, because they largely determine how improvement interventions are understood and implemented. However, research evidence in this area is very limited. This study therefore: explores participants' understanding of patient safety as a concept; describes the factors thought to contribute to patient safety incidents (PSIs); and identifies existing improvement actions and potential opportunities for future interventions to help mitigate risks.

Never Events in UK General Practice: A Survey of the Views of General Practitioners on Their Frequency and Acceptability as a Safety Improvement Approach.

Background: Never events (NEs) are serious preventable patient safety incidents and are a component of formal quality and safety improvement (Q&SI) policies in the United Kingdom and elsewhere. A preliminary list of NEs for UK general practice has been developed, but the frequency of these events, or their acceptability to general practitioner (GPs) as a Q&SI approach, is currently unknown. The study aims to estimate (1) the frequency of 10 NEs occurring within GPs' own practices and (2) the extent to which the NE approach is perceived as acceptable for use.