BMJ Open Quality

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...

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...

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...

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...

BackgroundLiving with multiple long-term conditions (MLTC) is becoming increasingly common with far-reaching consequences for individuals and healthcare systems. People with MLTC often face complex care pathways through health systems - especially hospitals, which are largely configured for specialist treatment of single conditions - yet evidence on people with MLTCs lived experience in the hospital setting is limited. This study aimed to understand the hospital care experiences of people living...

BackgroundA Hospital Medicine Advanced Practice Provider (HMAPP)-led care model developed in response to the high acuity and increased patient volumes associated with the Covid-19 pandemic. Although anecdotally perceived as a successful model, questions remained if there was adequate pre-planning and formal implementation strategy for stakeholder buy-in. ObjectiveTo elicit HM physicians and APPs perceptions of the HMAPP-led care model implementation and consider necessary steps for optimal futu...

BackgroundMultiple long-term conditions (MLTC) are increasingly common and place significant strain on healthcare systems designed around single-organ conditions, often resulting in fragmented and reactive care for people living with MLTC. There is limited understanding of how health care professionals (HCPs) make decisions for and with individuals with MLTC at the point of hospital presentation. This study examined how HCPs in emergency and acute settings make decisions around pathways and plac...

ImportanceHospital capacity constraints and rising healthcare costs necessitate innovative models for delivering acute care. While various hospital-substitution models exist, challenges in scalability and long-term viability persist. ObjectiveTo evaluate the feasibility and safety of a novel, high-acuity Next Day Clinic (NDC) as an alternative to hospitalization for select acutely ill emergency department (ED) patients. Design, Setting, and ParticipantsRetrospective matched cohort study of pat...

BackgroundAccurate and consistent laboratory measurements are essential for reliable diagnosis and clinical decision making. However, variability among automated analyzers can compromise diagnostic reliability and in population studies, instrument-specific differences in estimates hinder meaningful cross-study comparisons. ObjectiveTo evaluate inter-platform variability and interchangeability of laboratory parameters relevant to disease diagnosis across Beckman, Siemens and Roche automated anal...

ObjectiveTo meet the World Health Organization (WHO) requirement of strengthening integrated Emergency, Critical and Operative (ECO) care, it is necessary to develop ECO-related guidance and tools for Quality Improvement (QI) in Emergency Units (EUs). This study aimed to identify the barriers and facilitators for QI in EUs in Low- or Middle-Income- countries (LMICs) and explore potential measures for assessing quality of care, to inform guidance and tool development across all quality domains. ...

PurposeAmbient Documentation Tools (ADT) are an emerging technology designed to help clinicians complete documentation better with less time and effort. This study aimed to understand the impact of ADT on the pharmacist care experience. MethodsData from Epic Signal, surveys, and interviews were collected between February 2024 and October 2025 from 41 medication therapy disease management (MTDM) pharmacists across 33 primary care and subspecialty clinics at a large integrated health system who w...

Objective(s)The objective of this study was to explore the training needs and experiences of the aged care workforce providing services to Aboriginal and Torres Strait Islander peoples in South Australia. MethodAn online cross-sectional survey was distributed to aged care workers involved in the direct care or care coordination of Aboriginal and Torres Strait Islander peoples across South Australia between March and April 2024. Data collected included respondent demographics, aged care training...

Safety is a foundational concern in adolescent behavioral health crisis units (BHCUs), where therapeutic care must be delivered in complex, rapidly evolving environments. However, limited research has explored how key personnel involved in shaping the environment of care in such units, such as clinicians and healthcare designers, understand and prioritize safety. To address this gap, one-hour, online semi-structured interviews were conducted with a panel of experts (N = 13) at a national level i...

BackgroundThe physician assistant (PA) workforce has expanded rapidly in the United States, increasing the importance of effective physician-PA collaboration. Although PAs improve patient outcomes and access to care, the determinants of effective collaboration has not been well studied. North Carolina provides a relevant context due to its growing PA workforce and supervisory regulatory structure, in which physicians retain administrative responsibility for PA supervision across practice setting...

IntroductionAdverse event (AE) reporting transparency is essential for evidence-based surgical practice, yet substantial reporting gaps persist despite Consolidated Standards for Reporting Trials (CONSORT) Harms guidance. The Medical Dictionary for Regulatory Activities (MedDRA) provides standardized terminology for AE classification, but its association with AE reporting quality remains unexplored. ObjectivesThe purpose of this study was to establish the frequency of Medical Dictionary for Reg...

IntroductionMedication errors (MEs) are common events in the hospital that compromises the patient safety. Despite high prevalence of MEs being reported, there is a limited information at the outpatient settings. MethodThis study assessed the prevalence and characteristics of MEs by analyzing the data of pharmacist-led interventions recorded between 1st November 2024 to 30th September 2025 at the outpatient department of pharmacy, Jigme Dorji Wangchuck National Referral Hospital (JDWNRH). Resu...

IntroductionHealthcare organizations have begun incorporating screening procedures for social determinants of health (SDOH) into care, recognizing the impact these factors can have on health outcomes. We aimed to present methods for evaluating redundancy in the risk information gained across SDOH questions and for evaluating whether demographic biases are present in whether patients were asked SDOH questions and whether they declined to answer them. MethodsSDOH question data were analyzed for 1...

BackgroundGlioblastoma (GB) is the most common and most aggressive malignant primary brain tumor, with 5-year survival rates around 5%. While treatment-related factors significantly impact outcomes, the influence of sociodemographic variables remains unclear, with prior studies showing inconsistent findings. These inconsistencies may stem from underrepresentation of rural patients within national databases and from comparison across centers with variable treatment practices. ObjectiveTo evaluat...

Academic institutions privilege norms of continuous productivity and uninterrupted availability, creating conformity pressures that systematically disadvantage those who deviate from an implicit template of the ideal academic. This study explores how doctoral students and faculty in the health sciences perceive the reproduction of social homogeneity. Semi-structured interviews were conducted with nine participants at a German university hospital. Data were analysed using reflexive thematic anal...

ObjectiveTo develop and conduct preliminary testing of the reliability and validity of the Healthcare Worker (HCW) Culture of Support Scale (COS), intended to assess health worker perceptions of institutional support resources and organizational culture related to their well-being. MethodsA cross-sectional survey was conducted with 533 HCWs from ambulatory clinic and rural hospital settings. The survey included validated measures and newly developed items. Exploratory and confirmatory factor an...