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Found 1,185 results
  1. Content Article
    Appropriate care escalation requires the detection and communication of in-hospital patient deterioration. Although deterioration in the ward environment is common, there continue to be patient deaths where problems escalating care have occurred. Learning from the everyday work of health care professionals (work-as-done) and identifying performance variability may provide a greater understanding of the escalation challenges and how they overcome these. The aims of this study from Ede et al. were to i) develop a representative model detailing escalation of care ii) identify performance variability that may negatively or positively affect this process and iii) examine linkages between steps in the escalation process.
  2. Content Article
    This constructive commentary reflects on two recent related publications, the Healthcare Safety Investigation Branch (HSIB) report, Variations in the delivery of palliative care services to adults, and an article from Sarcoma UK, Family insights from Dermot’s experience of sarcoma care. Drawing from these publications, Richard, brother-in-law of Dermot, gives a family perspective, calling for a more open discussion around how we can improve palliative care and sarcoma services, and why we must listen and act upon family and patient experience and insight.
  3. Content Article
    This study published in the BMJ evaluated the effect of chair placement on length of time physicians sit during a bedside consultation and patients’ satisfaction. The study concluded that chair placement is a simple, no cost, low tech intervention that increases a physician’s likelihood of sitting during a bedside consultation and resulted in higher patients’ scores for both satisfaction and communication.
  4. Content Article
    As part of the Lancet's Child and Adolescent Health Spotlight, the journal called for young people around the world aged 18–25 years to lend their perspectives and lived experiences on the two key spotlight asks: That children must be immediately prioritised in health and social policies; children and young people deserve attention in their own right, and not only because they are an indispensable foundation for a sustainable future. That governments and health providers should prioritise health equity for children and young people, within and between countries. The Lancet received 104 submissions in Chinese, English, Portuguese and Spanish, many of which have been published as essays in Lancet publications. This article in The Lancet Child & Adolescent Health summarises the key themes that were raised in the submissions received, including: the need for honest conversations with trusted adults about less talked-about areas including sex and death. the mental health impacts of attacks on transgender young people. the issues associated with living with a chronic illness as a young person. the importance of non-tokenistic youth engagement in research.
  5. Content Article
    Healthcare decision making should be a collaboration between patients and their providers. This eBook produced by Pfizer is for patients, caregivers and care team members. It aims to help empower individuals on their healthcare journey so they can be engaged patients who understand the health information they receive in order to act upon it.
  6. Content Article
    The rise of the #TheatreCapChallenge in 2017, which saw participants donning surgical caps labelled with their names and roles, promises to be a seemingly simple intervention aimed at improving operating theatre communication and patient safety. This narrative review strives to expand upon the perceived and studied benefits of this intervention and address potential concerns that have arisen with the use of these name and role-labelled surgical caps.
  7. Content Article
    This leaflet aims to help people with type 1 diabetes decide between the different technologies available to manage diabetes. It contains summaries of devices available and infographics outlining eligibility criteria for continuous glucose monitors (CGM), insulin pumps and hybrid-closed loop systems. Diabetes care is one of the five clinical areas of focus for integrated care boards and partnerships to achieve system change and improve care as part of Core20Plus5 for children and young people with the aim to increase access to real-time continuous glucose monitors and insulin pumps across the most deprived quintiles and from ethnic minority backgrounds.
  8. Event
    until
    NHS England’s Worry and Concern Group is looking into how hospitals can make sure the worries and concerns of patients, their family and friends are taken into account by doctors, nurses and other health professionals. This webinar will explore: The work done during the worry and concern pilots The experience of patients and clinicians who took part in the pilot studies How to ensure patient involvement in the design of a nationwide worry and concern programme. Panellists: John Bamford, Patient Safety Partner Kayleigh Griffiths MBE, member of National Worry and Concern Steering Group Jane Murkin, Deputy Director Safety & Improvement – Nursing, NHS England Prof Damian Roland , Honorary Professor of Paediatric Emergency Medicine, University of Leicester John Welch, Consultant Nurse, Critical Care & Critical Care Outreach, University College London Hospitals NHS Foundation Trust. Chief Executive of the Patients Association, Rachel Power, will chair the webinar. This webinar is being held on Zoom and is free to join. Register for the webinar
  9. Content Article
    People with diabetes often encounter stigma in the form of negative social judgments, stereotypes and prejudice, which can adversely affect emotional, mental and physical health, self-care, access to healthcare and social and professional opportunities. On average, four in five adults with diabetes experience diabetes stigma and one in five experience discrimination due to diabetes in healthcare, education, and employment. Diabetes stigma and discrimination are harmful, unacceptable, unethical, and counterproductive. Collective leadership is needed to proactively challenge, and bring an end to, diabetes stigma and discrimination. To help achieve this, an international multidisciplinary expert panel conducted rapid reviews and participated in a three-round Delphi survey process. The group achieved consensus on 25 statements of evidence and 24 statements of recommendations. The consensus is that diabetes stigma is driven primarily by blame, perceptions of burden or sickness, invisibility and fear or disgust.
  10. Content Article
    Learning vicariously from the experiences of others at work, such as those working on different teams or projects, has long been recognised as a driver of collective performance in organisations. Yet as work becomes more ambiguous and less observable in knowledge-intensive organisations, previously identified vicarious learning strategies, including direct observation and formal knowledge transfer, become less feasible. Drawing on ethnographic observations and interviews with flight nurse crews in an air medical transport program, Chris Myers inductively build a model of how storytelling can serve as a valuable tool for vicarious learning. He explores a multistage process of triggering, telling, and transforming stories as a means by which flight nurses convert the raw experience of other crews’ patient transports into prospective knowledge and expanded repertoires of responses for potential future challenges. Further, he highlights how this storytelling process is situated within the transport programme’s broader structures and practices, which serve to enable flight nurses’ storytelling and to scale the lessons of their stories throughout the entire programme. He discusses the implications of these insights for the study of storytelling as a learning tool in organizations, as well as for revamping the field’s understanding of vicarious learning in knowledge-intensive work settings.
  11. Content Article
    This study evaluated the impact of narrative/story-based approaches to safety messages; e.g. injury stories on actual safety behaviour versus mechanistic instructions without use of anecdotes and ‘traditional abstract safety messages’. Story-based messages resulted in a 19% improvement in safety behaviour compared with non-narrative comms.
  12. Content Article
    Jessie Cunnett, new CEO at the Point of Care Foundation, shares her journey of commitment to humanise healthcare through her personal and professional stories. She reflects on the importance of creating space for everyone to feel seen and heard in health and care settings.
  13. Content Article
    In the past, long before Covid, doctors used to openly discuss complex cases and unexpected deaths on an anonymous basis either in the doctors' mess or in medical grand rounds hosted by their hospital’s clinical education department. What's happened to these forums for learning? Are these clinical conversations alive and well, and helping doctors and nurses alike to learn from safety incidents? Or have medical grand rounds disappeared from practice?
  14. Content Article
    This study published in BMJ Quality & Safety identified factors acting as barriers or enablers to the process of healthcare consent for people with intellectual disability and to understand how to make this process equitable and accessible. The study found that multiple reasons contribute to poor consent practices for people with intellectual disability in current health systems. Recommendations include addressing health professionals’ attitudes and lack of education in informed consent with clinician training, the co-production of accessible information resources and further inclusive research into informed consent for people with intellectual disability. Related reading on the hub: Accessible patient information: a key element of informed consent
  15. Content Article
    Ileostomy is a common treatment option for various gastrointestinal conditions. This study in Surgery aimed to examine how receiving care at different facilities might increase the risk of post-discharge complications and readmission following ileostomy. The authors used a national cohort to explore the associations of care fragmentation among ileostomy patients experiencing adverse outcomes and increased hospitalisation.
  16. Content Article
    Interprofessional communication is of extraordinary importance for patient safety. To improve interprofessional communication, joint training of the different healthcare professions is required in order to achieve the goal of effective teamwork and interprofessional care. The aim of this pilot study from Heier et al. published in BMC Medical Education was to develop and evaluate a joint training concept for nursing trainees and medical students in Germany to improve medication error communication.
  17. Content Article
    In this article for the Journal of Eating Disorders, Alykhan Asaria considers the criteria used in a paper by Guadiani et al. (J Eat Disord 10:23, 2022) to define ‘terminal anorexia nervosa’ and outlines concerns about this new term from a lived experience perspective. The author highlights issues about the ambiguities around how the criteria can be applied safely and the impact of labelling anorexia nervosa sufferers with terms. Further articles on the hub from Alykhan Asaria: ‘Terminal anorexia’: a lived experience perspective
  18. Content Article
    Patient safety and healthcare information are inextricably linked. But how can you be certain the content you’ve produced, or information you have received as a patient, is indeed ‘safe’? The sheer volume of information available is staggering – be it a leaflet about skin cancer, a poster about vaccines in your GP waiting room, a YouTube video about healthy living or a consent form for a surgical procedure. The list goes on and on and, without professional review, there really is no knowing how safe that information is. If you work in the healthcare sector, and especially if you work in the creation of healthcare information, you will probably be familiar with the Patient Information Forum and their ‘PIF TICK’. The PIF TICK provides reassurance that what is being given to patients is: safe reliable accurate accessible.   At EIDO Healthcare, we were awarded our first PIF TICK in October 2020 and have had it successfully renewed every year since. In this blog, I will talk about my experience of receiving and maintaining a PIF TICK for our library of information leaflets for patients needing surgery.
  19. Content Article
    This is part of our series of Patient Safety Spotlight interviews, where we talk to people working for patient safety about their role and what motivates them. Sonia talks to us about how her role at NHS Confederation helps her understand the issues facing NHS staff and why she decided to start drawing graphics to communicate important information to patients and staff.
  20. Content Article
    Judy Walker looks at the ways in which team learning can contribute to safety in healthcare using tools such as After Action Review (AAR). She explores research highlighted in Amy Edmondson's new book The Right Kind of Wrong that demonstrates the impact on certain safety indicators of flight crews building a team culture through working together consistently. Judy suggests that gaining insights about co-workers through proximity accelerates the process of learning for teams.
  21. Content Article
    As part of the 21st Century Cures Act (April 2021), electronic health information (EHI) must be immediately released to patients in the USA. This study in the American Journal of Surgery sought to evaluate clinician and patient perceptions regarding this immediate release of results and reports. Interviews with patients and clinicians found differences in perceived patient distress and comprehension, emphasising the impersonal nature of electronic release and necessity for therapeutic clinician-patient communication.
  22. Content Article
    In this blog, Scott Ellner, a general surgeon from the US, describes the case of a surgeon colleague who unintentionally harmed a patient, Sarah, during surgery. Sarah ended up in the surgical intensive care unit from septic shock due to a missed bowel injury. Her recovery from what should have been a straightforward procedure was long and complicated. Scott recalls how the surgeon was shocked by the way Sarah's husband responded to him when he explained what had happened—instead of an anger and blame, Sarah's husband expressed compassion for the doctor and reiterated his trust in him. Scott highlights the importance of creating a Just Culture in healthcare systems and outlines challenges to this in the current climate, referring to the case of nurse RaDonda Vaught. He also outlines the impact patient safety incidents and medical errors can have on healthcare professionals, calling on the healthcare community to embrace shared humanity. All of us come with imperfections, vulnerabilities and the capacity for healing and growth.
  23. Content Article
    The prevalence of noncommunicable diseases (NCDs) or chronic diseases is increasing in Europe. NCDs now account for 90% of deaths in the WHO European Region, yet most health systems were developed to treat and care for people with acute conditions. Health care services are still lagging behind in terms of responding to the particular needs of those living with chronic conditions, including diabetes, cardiovascular disease (hypertension and heart failure) and respiratory diseases (asthma and chronic obstructive pulmonary disease).  Policy-makers and health-care managers are working to better organize health services to reflect and cater to the needs of these patients, for example by strengthening integrated primary health-care services. Important work is also needed to increase people’s knowledge, skills and confidence to manage their own conditions on a day-to-day basis, outside of health-care settings. Patients spend on average 2 hours per year with their health professional and the rest of the time they need to take care of their health themselves. Supporting patients to self-manage their condition is crucial to improving outcomes and reducing anxiety and complications.  WHO Regional Office for Europe has published a new “how-to” guide for policy-makers, health professionals, and education and training bodies on therapeutic patient education (TPE). The guide covers commissioning, designing and delivering TPE services and training programmes for health professionals. It also looks at the evidence and theory underpinning patient education, outlines key components for delivering a high-quality service and identifies implementation opportunities and barriers. 
  24. Content Article
    Efforts to increase physician engagement in quality and safety are most often approached from an organisational or administrative perspective. Given hospital-based physicians’ strong professional identification, physician-led strategies may offer a novel strategic approach to enhancing physician engagement. It remains unclear what role medical leadership can play in leading programmes to enhance physician engagement. In this study, Rotteau et al. explore physicians’ experience of participating in a Medical Safety Huddle initiative and how participation influences engagement with organisational quality and safety efforts. They found that The Medical Safety Huddle initiative supports physician engagement in quality and safety through intrinsic motivation. However, the huddles’ implementation must align with the organisation’s multipronged patient safety agenda to support multidisciplinary collaborative quality and safety efforts and leaders must ensure mechanisms to consistently address reported safety concerns for sustained physician engagement.
  25. Content Article
    The ethnicity data gap pertains to three major challenges to address ethnic health inequality: Under-representation of ethnic minorities in research Poor data quality on ethnicity Ethnicity data not being meaningfully analysed. These challenges are especially relevant for research involving under-served migrant populations in the UK. This study in BMC Public Health aimed to review how ethnicity is captured, reported, analysed and theorised within policy-relevant research on ethnic health inequities. The authors concluded that the multi-dimensional nature of ethnicity is not currently reflected in UK health research studies, where ethnicity is often aggregated and analysed without justification. Researchers should communicate clearly how ethnicity is operationalised for their study, with appropriate justification for clustering and analysis that is meaningfully theorised.
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