BMJ Open Quality

IntroductionPotentially preventable deaths occur worldwide within healthcare organisations. Organisational learning from incidents is essential to improve quality of care. In England, inconsistencies in how NHS secondary care trusts reviewed, investigated and shared learning from deaths, resulted in the introduction of national guidance on Learning from Deaths (LfDs) in 2017. This guidance provides a framework for identifying, reporting, investigating and learning from deaths. Amendments to NH...

Living with dementia requires decision making about numerous topics including daily activities and advance care planning (ACP). Both individuals living with dementia and care partners require informed support for decision making. We conducted an umbrella review to assess knowledge translation (KT) interventions supporting decision making for individuals living with dementia and their informal care partners. Four databases were searched using 50 different search-terms, identifying 22 reviews pres...

BackgroundStrategies for the implementation of evidence-based interventions have proliferated, but it remains unclear how these strategies are operationalized for different types of interventions and contexts. Here, we examine seven implementation strategies--initially developed for implementing the World Health Organization (WHO) Surgical Safety Checklist (SSC)--for implementing cognitive aids for operating room (OR) crises. MethodsWe conducted semi-structured interviews with implementers of t...

PurposePeople with dementia occupy c.25% of acute hospital beds. Being in hospital can lead to distress in people with dementia, exacerbated by the difficult acute hospital environment and lack of staff preparedness to meet their often-complex needs. Acute hospital staff identify supporting distressed patients with dementia as a practice challenge. Communication skills training can improve interaction quality and staff confidence, however little communication research to date has been conducted ...

IntroductionThe PriDem programme developed a flexible, primary care-led intervention to improve post-diagnostic dementia support, involving Clinical Dementia Leads (CDLs) working with general practices to strengthen care systems. Programme theory was articulated in a logic model, to guide a feasibility implementation study, which demonstrated intervention feasibility, acceptability, and potential for systems-level change. The process of refining programme theory following feasibility testing can...

With dementia diagnoses in the UK projected to exceed one million in 2025, there is an urgent need for scalable and effective care solutions to ease pressure on health and social care systems. Artificial Intelligence (AI)-enabled smart home systems are emerging as promising digital health innovations, offering cognitive support, real-time monitoring, and decision-making assistance. However, concerns around trust, user agency, and misconceptions about AI continue to limit acceptance and may hinde...

IntroductionHealthcare organisations worldwide are expected to investigate or review incidents that unintentionally harm or could cause harm. Investigation findings are presented in a written report, which is arguably a proxy measure for the quality of investigations. The report is an important document to be read and acted upon. The aims of this study were: 1) to design a tool to support the writing and review of healthcare safety investigation reports, and 2) to validate the content of the too...

ObjectiveTo investigate the association between initial discharge planning and transfers of in-patient care with discharge delay. To identify operational changes which could expedite discharge within the Discharge to Assess (D2A) model. DesignRetrospective cohort study. SettingUniversity Hospital Southampton NHS Foundation Trust (UHSFT). ParticipantsAll adults ([≥]18 years) who registered a hospital spell in UHSFT between 1 January 2021 and 31 December 2022 (n = 258,051 spells). Individual...

BackgroundSystem-level barriers inhibit empathy in healthcare, and this can harm patients and practitioners. The barriers include burnout-inducing administrative workloads, burdensome protocols, lack of wellbeing spaces, un-empathic leadership, and not emphasising empathy as an institutional value. A workshop aimed at enhancing empathic systems was successfully delivered in Canada but has not been tested in the UK National Health Service (NHS) setting. AimTo test the feasibility of an empathic ...

BackgroundDespite widespread recognition that patient safety learning can transcend national boundaries, no international patient safety learning system (PSLS) currently exists. There is no expert consensus on the purpose, key requirements, or feasibility of such a system. ObjectiveTo gain consensus from an international panel of healthcare experts regarding the key requirements and feasibility of a potential international PSLS, with or without an incident reporting function. MethodsA two-roun...

BackgroundVoluntary incident reporting has improved safety in many high-risk industries, but several barriers have limited its effectiveness in hospitals. Designed to overcome these barriers, the novel Safety Action Feedback and Engagement (SAFE) Loop: (1) obtains input from nurses about patient safety problems; (2) invites nursing units to select a Target Event to focus on; (3) teaches nurses to write more informative incident reports; (4) prompts nurses to report Target Events for a designated...

People with dementia and their families receive a flood of wide-ranging information at diagnosis. However, it remains unclear which types of information are helpful to caregivers during the care period that follows. In collaboration with dementia medical centers and certified dementia support doctors, we distributed questionnaires to family caregivers of individuals diagnosed with dementia. A total of 159 self-administered questionnaires were retrieved. Caregiver burden was measured using the sh...

A key societal priority is to support people with dementia and their care partners to live well, particularly through improved access to high-quality information, continuity of care, and consistent post-diagnostic support. The Sage House Model represents a novel, community-based approach to integrated dementia care, co-locating diagnostic assessment, tailored support services, psychosocial interventions, and opportunities for social engagement within a single accessible centre. By reducing fragm...

BackgroundAdvance care planning (ACP) is a process that enables individuals to define and communicate their goals and preferences for future medical care, which is especially important in chronic progressive illnesses, such as Parkinsons disease (PD) and other neurodegenerative disorders. Despite its recognized benefits in improving patient autonomy and end-of-life care outcomes, ACP remains underutilized in India. This study aimed to assess the attitudes and practices of Indian neurologists and...

BackgroundThe diffusion of innovation in health care is sluggish. Evidence-based care models and interventions take years to reach patients. We believe the health care community could deliver innovation to the bedside faster if it followed other sectors by employing an organizational framework for efficiently accomplishing work. Home hospital is an example of sluggish diffusion. This model provides hospital-level care in a patients home instead of in a traditional hospital with equal or better o...

PurposeAlthough numerous research studies have demonstrated the positive impact of clinical pharmacy services, these benefits do not translate into sustained practice changes without support from hospital pharmacy leaders. Factors influencing leadership decisions to expand pharmacy services remained unclear. This study aimed to identify barriers to implementing pharmacy practice model changes and gain insights on potential methods of overcoming these barriers from the hospital pharmacy leader pe...

ObjectiveTo evaluate open science policies of leading general medical journals and the extent to which open science practices are implemented and detectable using automated tools. DesignCross-sectional audit of journal policies and retrospective observational study of journal articles, with diagnostic accuracy validation of automated screening tools against manual data extraction. Setting: Annals of Internal Medicine, BMC Medicine, The BMJ, CMAJ, JAMA, JAMA Network Open, The Lancet, Nature Med...

BackgroundBehavioral telemetry--the analysis of clinical actions NOT taken--may identify care process failures associated with adverse outcomes. While missed nursing care predicts outcomes in survey-based studies, objective EHR-derived measures are lacking. We hypothesized that missing routine cognitive assessment in ICU patients with low acute physiologic derangement would predict mortality independent of illness severity. MethodsRetrospective cohort study using MIMIC-IV (2008-2022, Beth Israe...

ObjectiveTo quantify the adoption pattern of an LLM-based clinical decision support system across private primary health facilities in Kenya (operated by Penda Health), and explore factors influencing clinician uptake and overall experience. MethodsA mixed-methods study combining quantitative analysis of CDSS metadata from all consultations that took place between 1st February and 1st October 2024, augmented by qualitative data from 42 staff members (26 clinical officers, 10 facility managers, ...

BackgroundThe adoption of remote methods of care has been accelerated by the COVID-19 pandemic, but concerns exist relating to the potential impact on health disparities. This evaluation explores the implementation of COVID-19 remote home monitoring services across England, focussing on patients experiences and engagement with the service. MethodsThe study was a rapid, multi-site, mixed methods evaluation. Data were collected between January and June 2021. We conducted qualitative interviews wi...