Intro to the Top 10 articles of 2018

As part of our blog rollout, we’re featuring the Editorial Board’s choice of the top 10 articles from 2018. To arrive at the ‘top articles’ each year, the Editors-in-Chief, this year assisted by our new social media editor, Joel Boggan, compile a list of about 30 candidate articles based on study quality, relevance and interest for the field, and perceived relevance for impact. Members of the Editorial Advisory Board then rank these articles. The results illustrate the striking breadth of interesting topics in BMJ Quality & Safety.

Pleasingly, several of our most popular articles were focused on patient and/or family engagement, with no fewer than four of our top 10 articles on this theme. Articles on how patients themselves can be a source of intelligence about current states of safety, their role in providing feedback on how well organisations are performing, why patients may hesitate to speak up about care concerns, and the relationship between patient experience in primary care and use of emergency departments are all valuable contributions in their own right, and are continued demonstrations of our commitment to building the evidence-base on patient and public involvement and commitment in healthcare and research.

A second major theme of the top-scoring articles was safety. One paper tackled progress in patient safety in the US, identifying challenges and opportunities. A second paper was focused much more at the sharp end, and exposed, using direct observation, just how often physicians working in an Emergency Department are interrupted, as well examining the impact of multitasking and sleep deprivation on error rates. Addressing the challenge experienced by many hospitals of having to “bedspace” patients to any available bed rather than the treating specialty, the third paper offers some worrying evidence of an association with increased mortality.

Finally, we were glad to have several important contributions on the theme of quality improvement in 2018. The first tackles the long-standing question of whether improvements in organizational culture are associated with improvements in patient outcomes. In an article of interest to everyone who uses or manages an electronic health record, the second article looks at overrides of medication error notifications embedded in clinical decision support by ICU clinicians, finding that most were appropriate, but inappropriate over-rides are more likely to result in potential or actual adverse drug events. The third evaluates remote monitoring of post-partum hypertension with a text-message based system in lieu of traditional office return visits, and reports what appears to be improvements in obtaining blood pressure measurements while reducing patient convenience.

As in past years, this list of ‘articles of the year’ exhibits tremendous diversity in terms of content and methodology. This diversity reflects the broad range of heterogeneity of topics and methods relevant to understanding and improving healthcare quality and patient safety. It is also a source of pride to us at BMJ Quality & Safety. Thus, we offer our thanks to the authors of these papers listed as the Top 10 Articles of 2018. But, we also thank the authors of numerous other high quality papers published the journal, many of which could just as easily have appeared on this list. And we thank the reviewers who provide so much valued expertise that help inform our judgements about what to publish. We aim to continue to make BMJ Quality & Safety one of the best places to publish high quality research.

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