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Showing results for tags 'Systematic review'.
Found 124 results
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Content ArticleThis systematic review explored the perceptions and experiences of students raising concerns during pre-registration health and/or social care training in England. Speaking up and raising concerns as a pre-registration student is a complex, multi-faceted and non-linear social phenomenon. Experiences and perceptions are impacted by the novice student position alongside individual, interpersonal and organisational factors. Open cultures within teams and organisations, leadership, support and feedback may enable students overcome barriers to raising concerns. Raising concerns may reduce avoidable harm. Pre-registration students offer a ‘fresh pair of eyes’; however, they face barriers related to their student position. Synthesis of speaking-up experiences and perceptions of students in English settings can inform the design of learning environments which equip pre-registration students with the knowledge and skills required to cultivate safety behaviours. These skills contribute positively to safety culture and support learning and improvement in complex systems such as health and social care.
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Content ArticlePoor quality ward rounds contribute to a large proportion of patient complications, delayed discharge, and increased hospital cost. This systematic review investigated all interventions aiming to improve patient and process-based outcomes in ward rounds. The review included 84 studies, from 18 countries, in 23 specialties, involving 43 570 patients. It found that checklist interventions significantly reduced ICU length of stay, improved overall documentation, and did not increase ward round duration. Structure interventions did not increase the time spent per patient or impact 30-day readmission rates or patient length of stay.
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Content ArticleAllied health professionals (AHPs) in inpatient mental health, learning disability and autism services work in cultures dominated by other professions who often poorly understand their roles. Furthermore, identified learning from safety incidents often lacks focus on AHPs and research is needed to understand how AHPs contribute to safe care in these services. A rapid literature review was conducted on material published from February 2014 to February 2024, reporting safety incidents within adult inpatient mental health, learning disability and autism services in England, with identifiable learning for AHPs. The review found that misunderstanding of AHP roles, from senior leadership to frontline staff, led to AHPs being disempowered and excluded from conversations/decisions, and patients not getting sufficient access to AHPs, contributing to safety incidents. A central thread ‘organisational culture’ ran through five subthemes: (1) (lack of) effective multidisciplinary team (MDT) working, evidenced by poor communication, siloed working, marginalisation of AHPs and a lack of psychological safety; (2) (lack of) AHP involvement in patient care including care and discharge planning, and risk assessment/management. Some MDTs had no AHPs, some recommendations by AHPs were not actioned and referrals to AHPs were not always made when indicated; (3) training needs were identified for AHPs and other professions; (4) staffing issues included understaffing of AHPs and (5) senior management and leadership were found to not value/understand AHP roles, and instil a blame culture. A need for cohesive, well-led and nurturing MDTs was emphasised.
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Content ArticleVarious psychological concepts have been proposed over time as potential solutions to improving patient safety and quality of care. Psychological safety has been identified as a crucial mechanism of learning and development, and one that can facilitate optimal patient safety in healthcare. This study investigated the quantitative evidence on the relationship between psychological safety and objective patient safety outcomes. The authors searched 8 databases and conducted manual scoping to identify peer reviewed quantitative studies published up to February 2024. Nine papers were selected for inclusion which reported on heterogeneous patient safety outcomes. Five studies showed a significant relationship between psychological safety and patient safety outcomes (e.g., ventilator associated events, reported medical errors). The majority of studies reported on the experiences of nurses working in healthcare from the USA. Patient safety is consistently characterised as the absence of harm rather than a culture that creates a safe environment. The findings of the review imply a contradiction in patient safety practices: enhancing team dynamics through patient safety culture may improve immediate problem-solving within the team, but it does not automatically translate into improved objective patient safety measures. The simplest and initial point to accept is that we simply don’t have enough research yet to establish a link between patient safety and objective measures of patient safety. Absence of evidence is not evidence of absence. However, that caveat should not prevent us from discussing the potential factors influencing the relationship. For example, a line manager may espouse the importance of safety procedures while they fail to enact, enforce, and support the same safety procedures through their actions via monitoring and allocation of time and resources. As a result, employees may experience a double bind between these seemingly conflicting behaviours: “…when employees adhere to a norm that says, 'hide errors,' they know they are violating another norm that says, 'reveal errors'. ”The employees are thus in a double bind. Ultimately, we are left with a paradox regarding patient safety in healthcare teams. Reporting patient safety problems in a team can be both an indication of high and low levels of patient safety. It’s difficult to know which without understanding the culture and history of the specific healthcare organisation, as patient safety primarily impacts emotions and attitudes rather than patient safety metrics.
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Content ArticlePatient safety is an important issue in health systems worldwide. This is a systematic review of previous studies on patient safety culture in Southeast Asian countries.
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EventuntilThe Maternity and Newborn Safety Investigations (MNSI) programme is part of a national strategy to improve maternity safety across the NHS in England. MNSI has completed over 3500 independent safety investigations, using system focused methodology, into maternity events, including direct and indirect maternal deaths in pregnancy and up to 6 weeks postpartum. In this webinar we will explore MNSI's findings following a systematic literature review analysing the research regarding cord management during neonatal transition and resuscitation. Register for the webinar
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Content ArticleIn 2016, the Care Quality Commission looked into how acute, community and mental health trusts investigate and learn from deaths. This resulted in new national guidance. Here they report on their assessments of how NHS trusts are putting it into practice.
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Content ArticleThis systematic review aimed explore the association between triclosan-containing sutures and the risk of surgical site infections. The results show that use of triclosan-containing sutures was associated with significantly fewer surgical site infections compared with sutures without triclosan.
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Content ArticleWritten instructive information for the patient is key in pharmaceutical care. However, the preexisting literature agrees on the discordance between the readability of written medication messages intended for patients. The aim of this study was to systematically review the available evidence on the effect of pharmaceutical pictograms as elements that facilitate understanding of the text in primary or secondary medication packaging.
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Content ArticleIncontrovertible evidence surrounds the need to support healthcare professionals after patient safety incidents (PSIs). However, what characterises effective organisational support is less clearly understood and defined. This review aims to determine what support healthcare professionals want for coping with PSIs, what support interventions/approaches are currently available and which have evidence for effectiveness. The study found that, beyond peer support, organisational support for PSIs appears to be misaligned with staff desires. Gaps exist in providing preparatory/preventive interventions and practical support and guidance. Reliable effectiveness data are lacking. Very few studies incorporated comparison groups or randomisation; most used self-report measures. Despite inconclusive evidence, formal peer support programmes dominate. This review illustrates a critical need to fund robust PSI-related intervention effectiveness studies to provide organisations with the evidence they need to make informed decisions when building PSI support programmes.
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Content ArticleAdverse drug events, including adverse drug reactions and medication errors, pose a significant threat to health, leading to illness and in severe cases death. This systematic review aimed to assess the effectiveness of different interventions aimed at healthcare professionals to improve the reporting of adverse drug events. The authors concluded that, compared to usual practice, the number of adverse drug reaction (ADR) reports submitted may substantially increase following an education session, paired with reminder card and ADR report form, and may slightly increase with the use of a standardised discharge form method that makes it easier for healthcare professionals to report ADRs.
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Content ArticlePeople with mental health conditions can face significant inequalities in their physical health, including a shorter life expectancy. This inequality impacts on the individual, their families, friends, communities and society in significant ways. They are also more likely to experience conditions like heart disease, stroke, and diabetes than those without mental health conditions. The reasons for this include social and financial challenges, the effects of psychiatric medications on physical health, and poorer care for physical health as a whole. Many studies show that people with mental health conditions are also more likely to experience problems during the diagnostic process, including misdiagnosis or late diagnosis of physical health problems. This study reviewed the evidence, which covers a range of mental and physical health conditions. It found consistent evidence that people with mental health conditions – from serious mental illnesses to more moderate or mild conditions – were at greater risk of exposure to diagnostic problems than people without mental health conditions, including delayed diagnosis, misdiagnosis, and non-diagnosis. Some of the studies included pointed towards issues within the healthcare system itself as underlying these inequalities.
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Content ArticleThis paper aims to summarise all available published research in English about FRAM. A PRISMA approach has been followed to review more than 1700 documents on the FRAM. The analysis presents descriptive and interpretative results on the usage of the FRAM. The FRAM’s strengths and limitations and potential future research are presented. The FRAM is not a one-size-fits-all modelling solution.
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Content ArticleElectronic health record (EHR) nudges are a common way to subtly change clinician behaviour (e.g., prompt for immunisations). This review summarizes the association between EHR nudges and health outcomes in primary care. Results show nudges improve specific aspects of healthcare quality, but most studies reported only process measures—whether the nudge was accepted— not the impact on patient safety.
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Content ArticleA review was carried out to determine how safety leadership was defined in the peer reviewed empirical literature and thematic analysis was used to identify patterned meanings across the data. Thirty-seven primary definitions, or definitions that were not borrowed from other studies, were identified. Of these 37, seven conceptual definitions were found to be evidence-based, six of which were endorsed by their operational counterpart definitions and one which was derived using exploratory research. These seven definitions showed strong alignment with the three themes that emerged from the thematic analysis that capture the why, how, and who of safety leadership. Transformational leadership theory formed the foundation for many of the definitions in the academic literature, despite recent evidence suggesting that adopting multiple forms of leadership styles would be more effective for improving workplace safety.
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Content ArticleThis study aimed to systematically evaluate interventions and effects that promote involvement in medication safety among older people with chronic diseases and to provide new ideas and references for developing standardised and effective intervention strategies to improve patient involvement in medication safety.
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Content ArticleAt several points during a hospital stay, a patient may receive a medication review with a pharmacist to reduce the risk of medication errors. This review characterises themes and components of pharmacist-led medication reviews associated with positive patient outcomes. Patient involvement in goal setting was identified as a successful component that would benefit from additional research.
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Content ArticlePrivate equity takeovers of health services worldwide are associated with worse quality of care and higher costs, according to this study from Borsa et al. In the past decade, private equity firms have increasingly invested in, acquired and consolidated healthcare facilities. Globally, healthcare buyouts have exceeded £157bn since 2021 alone. Despite much speculation, evidence about the impact of this rapidly growing global trend has been lacking. Now a systematic review of private equity healthcare service takeovers across eight countries including the US, UK, Sweden and the Netherlands provides it. Private equity (PE) ownership of healthcare services including hospitals and nursing homes is linked to a harmful effect on cost and quality of care, suggests the review published in the BMJ. The authors of the review, which was led by the University of Chicago, said: “The most unequivocal evidence points to PE being associated with an increase in healthcare costs. Evidence across studies also suggests mixed impacts of PE ownership on healthcare quality, with greater evidence that PE ownership might degrade quality in some capacity rather than improve it.”
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Content ArticleThere are reports of increasing incidence of paediatric diabetes since the onset of the COVID-19 pandemic. This study by D'Souza et al. compares the incidence rates of paediatric diabetes during and before the COVID-19 pandemic. The study found that incidence rates of type 1 diabetes and diabetic ketoacidosis at diabetes onset in children and adolescents were higher after the start of the COVID-19 pandemic than before the pandemic. Increased resources and support may be needed for the growing number of children and adolescents with diabetes. Future studies are needed to assess whether this trend persists and may help elucidate possible underlying mechanisms to explain temporal changes.
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Content ArticlePatient safety incidents, including medical errors and adverse events, frequently occur in intensive care units, leading to a significant psychological burden on healthcare professionals. This burden results in second victim syndrome, which impacts the psychological and psychosomatic wellbeing of these staff members. This systematic review and meta-analysis aimed to examine the occurrence of second victim syndrome among intensive care unit healthcare workers, including the types, prevalence, risk factors and recovery time associated with the condition.
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Content ArticleLeadership walkarounds (LWs) have been promoted in practice as means to drive operational, cultural and safety outcomes. This systematic review in BMJ Open Quality aimed to evaluate the impact of LWs on these outcomes in the US healthcare industry. The authors found only positive association of LWs with operational and perception of cultural outcomes.
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Content ArticleThis is the protocol for a Campbell systematic review. The main aim of this systematic review was to identify whether hospital leadership styles predict patient safety as measured through several indicators over time. The second aim was to assess the extent to which the prediction of hospital leadership styles on patient safety indicators varies as a function of the leader's hierarchy level in the organisation.
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Content ArticleThe adoption of virtual consultations, catalysed by the COVID-19 pandemic, has transformed the delivery of primary care services. Owing to their rapid global proliferation, there is a need to comprehensively evaluate the impact of virtual consultations on all aspects of care quality. This study aims to evaluate the impact of virtual consultations on the quality of primary care. It found that virtual consultations may be as effective as face-to-face care and have a potentially positive impact on the efficiency and timeliness of care; however, there is a considerable lack of evidence on the impacts on patient safety, equity, and patient-centeredness, highlighting areas where future research efforts should be devoted. Capitalising on real-world data, as well as clinical trials, is crucial to ensure that the use of virtual consultations is tailored according to patient needs and is inclusive of the intended end users. Data collection methods that are bespoke to the primary care context and account for patient characteristics are necessary to generate a stronger evidence base to inform future virtual care policies.
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Content ArticlePublic and patient expectations of treatment influence health behaviours and decision-making. This study aimed to understand how the media has portrayed the therapeutic use of ketamine in psychiatry. It found that ketamine treatment was portrayed in an extremely positive light, with significant contributions of positive testimony from key opinion leaders (e.g. clinicians). Positive research results and ketamine's rapid antidepressant effec were frequently emphasised, with little reference to longer-term safety and efficacy. The study concluded that information pertinent to patient help-seeking and treatment expectations is being communicated through the media and supported by key opinion leaders, although some quotes go well beyond the evidence base. Clinicians should be aware of this and may need to address their patients’ beliefs directly.
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Content ArticleThe implementation and continuous improvement of patient safety learning systems (PSLS) is a principal strategy for mitigating preventable harm to patients. Although substantial efforts have sought to improve these systems, there is a need to more comprehensively understand critical success factors. This study aims to summarise the barriers and facilitators perceived by hospital staff and physicians to influence the reporting, analysis, learning and feedback within PSLS in hospitals.
