ArticleBMJ open2017
Translating staff experience into organisational improvement: the HEADS-UP stepped wedge, cluster controlled, non-randomised trial.
Article in BMJ open, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
11 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Interventions to improve team effectiveness within health care: a systematic review of the past decade.Human resources for health · 2020Pooled it
- The Effect of Toolbox Trainings on Nursing Sensitive Quality Indicators: A Randomized Controlled Trial.Journal of nursing scholarship : an official publication of Sigma Theta Tau International Honor Society of Nursing · 2025Trial
- Trial
- Nurse practitioner led implementation of huddles for staff in long term care homes during the COVID-19 pandemic.BMC geriatrics · 2023Trial
- Article
- A national multi centre pre-hospital ECPR stepped wedge study; design and rationale of the ON-SCENE study.Scandinavian journal of trauma, resuscitation and emergency medicine · 2024Article
- Increasing staff time for patient facing care on an inpatient geriatric unit through modification of multidisciplinary board rounds: a quality improvement project.BMJ open quality · 2023Article
- Increasing the use of perioperative risk scoring in emergency laparotomy: nationwide quality improvement programme.BJS open · 2022Article
- The Effectiveness of Multidisciplinary Team Huddles in Healthcare Hospital-Based Setting.Journal of multidisciplinary healthcare · 2022Article
- Huddles and their effectiveness at the frontlines of clinical care: a scoping review.Journal of general internal medicine · 2021Article
- Novel team-based approach to quality improvement effectively engages staff and reduces adverse events in healthcare settings.BMJ open quality · 2020Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
5 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesFrontline insights into care delivery correlate with patients' clinical outcomes. These outcomes might be improved through near-real time identification and mitigation of staff concerns. We evaluated the effects of a prospective frontline surveillance system on patient and team outcomes.
designProspective, stepped wedge, non-randomised, cluster controlled trial; prespecified per protocol analysis for high-fidelity intervention delivery.
participantsSeven interdisciplinary medical ward teams from two hospitals in the UK.
interventionProspective clinical team surveillance (PCTS): structured daily interdisciplinary briefings to capture staff concerns, with organisational facilitation and feedback. MAIN MEASURES: The primary outcome was excess length of stay (eLOS): an admission more than 24 hours above the local average for comparable patients. Secondary outcomes included safety and teamwork climates, and incident reporting. Mixed-effects models adjusted for time effects, age, comorbidity, palliation status and ward admissions. Safety and teamwork climates were measured with the Safety Attitudes Questionnaire. High-fidelity PCTS delivery comprised high engagement and high briefing frequency.
resultsImplementation fidelity was variable, both in briefing frequency (median 80% working days/month, IQR 65%-90%) and engagement (median 70 issues/ward/month, IQR 34-113). 1714/6518 (26.3%) intervention admissions had eLOS versus 1279/4927 (26.0%) control admissions, an absolute risk increase of 0.3%. PCTS increased eLOS in the adjusted intention-to-treat model (OR 1.32, 95% CI 1.10 to 1.58, p=0.003). Conversely, high-fidelity PCTS reduced eLOS (OR 0.79, 95% CI 0.67 to 0.94, p=0.006). High-fidelity PCTS also increased total, high-yield and non-nurse incident reports (incidence rate ratios 1.28-1.79, all p<0.002). Sustained PCTS significantly improved safety and teamwork climates over time.
conclusionsThis study highlighted the potential benefits and pitfalls of ward-level interdisciplinary interventions. While these interventions can improve care delivery in complex, fluid environments, the manner of their implementation is paramount. Suboptimal implementation may have an unexpectedly negative impact on performance. TRIAL REGISTRATION NUMBER: ISRCTN 34806867 (http://www.isrctn.com/ISRCTN34806867).
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.