‘The Problem with…’ series covers controversial topics related to efforts to improve healthcare quality, including widely recommended but deceptively difficult strategies for improvement and pervasive ...

Correspondence to Ms Eileen Relihan, Medication Safety Office, Chief Executive Offices, St James's Hospital, James's Street, Dublin 8, Ireland; erelihan{at}stjames.ie Design and participants Pre- and ...

Violations are deliberate deviations from standard procedure. The usual reaction is to attempt to eliminate them and reprimand those concerned. However, the situation is not that simple. Firstly, ...

Introduction Monitoring hospital mortality rates is widely recommended. However, the number of preventable deaths remains uncertain with estimates in England ranging from 840 to 40 000 per year, these ...

Problem: Sliding scale insulin (SSI) is frequently used for inpatient management of hyperglycemia and is associated with a large number of medication errors and adverse events including hypoglycemia ...

Errors must be accepted as evidence of systems flaws, not character flaws.”—Lucian Leape1 In losing Lucian Leape to heart ...

Objectives Redesign in healthcare has increased the focus on the needs of the patient. The redesign process typically involves a review of current practice using the patient pathway before considering ...

1 Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Armstrong Institute for Patient Safety & Quality, Baltimore, Maryland, USA 2 Department of ...

Correspondence to Dr Thomas H Payne, UW Medicine Information Technology Services, Box 359968, 325 Ninth Ave, Seattle, WA 98104-2499, USA; tpayne{at}u.washington.edu I have several reactions to this ...

1 NHMRC Centre of Research Excellence in Patient Safety, Monash University, Melbourne, Australia 2 The Alfred Hospital, National Trauma Research Institute, Monash University, Melbourne, Australia ...

Background Large-scale real-world data to evaluate the impact of chest pain centre (CPC) accreditation on acute coronary syndrome (ACS) emergency care in heavy-burden developing countries like China ...