scholarly journals Identifying positive deviants in healthcare quality and safety: a mixed methods study

2018 ◽  
Vol 111 (8) ◽  
pp. 276-291 ◽  
Author(s):  
Jane K O’Hara ◽  
Katja Grasic ◽  
Nils Gutacker ◽  
Andrew Street ◽  
Robbie Foy ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Statistical Modelling ◽  
Service Level ◽  
Knee Surgery ◽  
Mixed Methods Study ◽  
Quality And Safety ◽  
Hospital Data ◽  
Local Improvement ◽  
Patient Reported ◽  
Hip And Knee Surgery

Objective Solutions to quality and safety problems exist within healthcare organisations, but to maximise the learning from these positive deviants, we first need to identify them. This study explores using routinely collected, publicly available data in England to identify positively deviant services in one region of the country. Design A mixed methods study undertaken July 2014 to February 2015, employing expert discussion, consensus and statistical modelling to identify indicators of quality and safety, establish a set of criteria to inform decisions about which indicators were robust and useful measures, and whether these could be used to identify positive deviants. Setting Yorkshire and Humber, England. Participants None - analysis based on routinely collected, administrative English hospital data. Main outcome measures We identified 49 indicators of quality and safety from acute care settings across eight data sources. Twenty-six indicators did not allow comparison of quality at the sub-hospital level. Of the 23 remaining indicators, 12 met all criteria and were possible candidates for identifying positive deviants. Results Four indicators (readmission and patient reported outcomes for hip and knee surgery) offered indicators of the same service. These were selected by an expert group as the basis for statistical modelling, which supported identification of one service in Yorkshire and Humber showing a 50% positive deviation from the national average. Conclusion Relatively few indicators of quality and safety relate to a service level, making meaningful comparisons and local improvement based on the measures difficult. It was possible, however, to identify a set of indicators that provided robust measurement of the quality and safety of services providing hip and knee surgery.

Abstract 16074: Risk of Blood Transfusion(s) With New Oral Anticoagulants for Short-Term Thromboprophylaxis in Hip and Knee Surgery: Insights From a Meta-Analysis of Fifteen Randomized Trials Including 36,176 Patients

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Parasuram Krishnamoorthy ◽  
Saurav Chatterjee ◽  
Jalaj Garg ◽  
Partha Sardar ◽  
Franz Messerli ◽  
...  
Keyword(s):  
Blood Transfusion ◽  
Randomized Controlled Trials ◽  
Conventional Therapy ◽  
Oral Anticoagulants ◽  
Knee Surgery ◽  
New Oral Anticoagulants ◽  
Controlled Trials ◽  
Short Term ◽  
Randomized Controlled ◽  
Hip And Knee Surgery

Introduction: Blood transfusions have been associated with poor outcomes in cardiac patients. The objective of our study was to systematically examine the overall risk of blood transfusion with new oral anticoagulants (NOACs) and individually in thromboprophylaxis for hip and knee surgery. Hypothesis: Treatment with NOACs is safe for short-term thromboprophylaxis in patients undergoing hip and knee surgery compared with conventional therapy. Methods: PubMed, Cochrane CENTRAL, EMBASE, EBSCO, Web of Science and CINAHL databases were searched from January 01, 2001 through September 30, 2013. Systemic review of randomized controlled trials (RCTs) comparing the use of NOACs (apixaban, dabigatran and rivaroxaban) with conventional therapy was performed. Clinical and outcome data were extracted from individual studies by 2 independent authors. Primary endpoint of interest was transfusion events in the NOAC and comparator arms. Random effects model was used to pool event rates and results were expressed as risk ratios (RR) with 95% confidence intervals (CIs). Results: Fifteen randomized controlled trials (RCTs) including a total of 36,176 patients were included for analysis. Transfusion events were not higher with use of NOACs in comparison to all comparators in patients undergoing hip and knee surgery- RR 1.02 (95% CI 0.98-1.06), p=0.40. Statistical heterogeneity was negligible (I2=22%). Conclusions: Blood transfusion events with NOAC use were not significantly higher than that with conventional drugs in thromboprophylaxis for hip and knee surgery patients, as noted in evidence from contemporary RCTs.

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