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Implementing strategies to improve uptake of patient-reported outcome measures (PROMs) in gender-affirming care: a mixed-methods implementation study BMJ Open Qual. Pub Date : 2024-04-01 Rakhshan Kamran, Liam Jackman, Charlie Goodwin, Anna Laws, Melissa Stepney, Conrad Harrison, Abhilash Jain, Jeremy Rodrigues
Importance The Practical Guide to Implementing PROMs in Gender-Affirming Care (PG-PROM-GAC) is an evidence-based resource, which was developed in response to international calls for improved patient-reported outcome measure (PROM) implementation in gender-affirming care. The PG-PROM-GAC has the potential to improve PROM implementation; however, its real-world effectiveness has not yet been investigated
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Can hospitalists improve COVID-19 vaccination rates? BMJ Open Qual. Pub Date : 2024-04-01 Nina Yu, Nisha Punatar, Ulfat Shaikh, Garima Agrawal
Three years after the start of the SARS-CoV-2 virus (COVID-19) pandemic, its effects continue to affect society and COVID-19 vaccination campaigns continue to be a topic of controversy and inconsistent practice. After experiencing spikes in COVID-19 cases, our University of California Davis Health Division of Hospital Medicine sought to understand the reasons underlying the low COVID-19 vaccination
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Efforts to improve the billing accuracy of robotic-assisted thoracic surgery through education, updated procedure cards, and electronic medical record system changes BMJ Open Qual. Pub Date : 2024-04-01 Kevin A Wu, Kenneth Boccaccio, Danielle Buckles, Matthew G Hartwig, Jacob A Klapper
Precise medical billing is essential for decreasing hospital liability, upholding environmental stewardship and ensuring fair costs for patients. We instituted a multifaceted approach to improve the billing accuracy of our robotic-assisted thoracic surgery programme by including an educational component, updating procedure cards and removing the auto-populating function of our electronic medical record
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Facing the digital frontier: exploring user acceptance of electronic health records in an urban, rural and remote setting in the Philippines BMJ Open Qual. Pub Date : 2024-04-01 Regine Ynez H De Mesa, Cara Lois T Galingana, Carol Stephanie C Tan-Lim, Mark Anthony U Javelosa, Janelle Micaela S Panganiban, Noleen Marie C Fabian, Ysabela Calderon, Mia P Rey, Nannette Bernal-Sundiang, Josephine T Sanchez, Leonila F Dans, Ray U Casile, Antonio L Dans
Objectives A thorough understanding of user needs and behavioural intent-to-use underpins the development of a responsive health information system. This study aimed to examine health workers’ intent-to-use an electronic health record (EHR) system in an urban, rural and remote setting in the Philippines. Methods Following the Unified Theory of Acceptance and Use of Technology framework, user acceptance
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Quality improvement: treatment escalation plans in oncology BMJ Open Qual. Pub Date : 2024-04-01 Hiten Arun Chauhan, Rehaan Adat, Harieta Garofide, Monica Bhandari, Sivalekha Viramuthu
Treatment escalation plans (TEPs) are increasingly appreciated tools in modern hospital medicine. It records and advises on the appropriate escalation of care for our patients, often when those of us who know them best are not available. It is of value in all specialties, though notably in oncology where an oncologist would be best placed at advising on the care of their patients. A baseline study
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Using active learning strategies during a quality improvement collaborative: exploring educational games to enhance learning among healthcare professionals BMJ Open Qual. Pub Date : 2024-04-01 Marianilza Lopes da Silva, Flavia Fernanda Franco, Jessica Alves Vieira, Juliana Fernandes da Silva, Guilherme Cesar Silva Dias Santos, Beatriz Marques da Cunha, Fernando Enrique Arriel Pereira, Natalia Nardoni, Francielle Bendersky Gomes, Brunno Cesar Batista Cocentino, Roberta Gonçalves Marques, Natalia Souza de Melo, Ademir Jose Petenate, Andreza Pivato Susin Hamada, Cristiane Maria Reis Cristalda
Background The Breakthrough Series model uses learning sessions (LS) to promote education, professional development and quality improvement (QI) in healthcare. Staff divergences regarding prior knowledge, previous experience, preferences and motivations make selecting which pedagogic strategies to use in LS a challenge. Aim We aimed to assess new active-learning strategies: two educational games, a
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Achieving high inter-rater reliability in establishing data labels: a retrospective chart review study BMJ Open Qual. Pub Date : 2024-04-01 Guosong Wu, Cathy Eastwood, Natalie Sapiro, Cheligeer Cheligeer, Danielle A Southern, Hude Quan, Yuan Xu
Background In medical research, the effectiveness of machine learning algorithms depends heavily on the accuracy of labeled data. This study aimed to assess inter-rater reliability (IRR) in a retrospective electronic medical chart review to create high quality labeled data on comorbidities and adverse events (AEs). Methods Six registered nurses with diverse clinical backgrounds reviewed patient charts
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Grading recommendations for enhanced patient safety in sentinel event analysis: the recommendation improvement matrix BMJ Open Qual. Pub Date : 2024-04-01 Kelly Bos, Maarten J van der Laan, Jop Groeneweg, Gert Jan Kamps, Dink A Legemate, Ian Leistikow, Dave A Dongelmans
Objectives The goal of sentinel event (SE) analysis is to prevent recurrence. However, the rate of SEs has remained constant over the past years. Research suggests this is in part due to the quality of recommendations. Currently, standards for the selection of recommendations are lacking. Developing a method to grade recommendations could help in both designing and selecting interventions most likely
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Calculating the cost of medication errors: A systematic review of approaches and cost variables BMJ Open Qual. Pub Date : 2024-04-01 Sakunika Ranasinghe, Abarna Nadeshkumar, Savini Senadheera, Nithushi Samaranayake
Introduction Medication errors are an unnecessary cost to a healthcare system and patients of a country. This review aimed to systematically identify published cost variables used to calculate the cost of medication errors and to explore any updates on findings already known on calculating the cost of medication errors during the past 10 years. Methods A systematic review was conducted according to
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Health information technology tools to accelerate gastrointestinal evaluation in patients with iron deficiency anaemia: a cluster randomised controlled trial BMJ Open Qual. Pub Date : 2024-04-01 Aparna Priyanath Gupta, Dharmesh Patel, Ji Young Lee, Michelle Volpentesta, Michael Schachter, Stephen D Persell
Objective System-level safety measures do not exist to ensure that patients with iron deficiency anaemia (IDA) undergo proper diagnostic evaluations. We sought to determine if a set of EHR (electronic health record) tools and an expedited referral workflow increase short-term completion of bidirectional endoscopy in higher risk patients with IDA. Materials and methods We conducted a pragmatic, cluster-randomised
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Improving appropriate use of intravenous albumin: results of a single-centre audit and multifaceted intervention BMJ Open Qual. Pub Date : 2024-04-01 Corey M Forster, Shannon Halls, Sabrina Allarakhia, Dimpy Modi, Wiley Chung, Kendra Derry, Genevieve Digby, Jennifer Flemming, John McGugan, Heather Mackulin, Steven Montague, Stephanie Sibley, Samuel A Silver, Angela Sirosky-Yanyk, Andrew Stevens, Kerstin de Wit, Liying Zhang, Jeannie Callum
Background Intravenous albumin has limited indications supported by randomised controlled trials, yet it is often prescribed for indications not supported by evidence. Aim To reduce unnecessary transfusion of albumin. Interventions Under the leadership of a multidisciplinary quality improvement team, evidence-based recommendations were disseminated in tandem with a new electronic order set, an educational
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Achieving optimal cord management: a multidisciplinary quality improvement initiative BMJ Open Qual. Pub Date : 2024-04-01 Jessica Burgess-Shannon, Rebecca Clarke, Victoria Rowell, Narendra Aladangady
Optimal cord management (OCM), defined as waiting at least 60 seconds (s) before clamping the umbilical cord after birth, is an evidence-based intervention that improves outcomes for both term and preterm babies. All major resuscitation councils recommend OCM for well newborns. National Neonatal Audit Programme (NNAP) benchmarking data identified our tertiary neonatal unit as a negative outlier with
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Reducing wait times and medical costs for patients: the physiotherapy-led Spine Triage and Rehabilitation (STAR) Clinic BMJ Open Qual. Pub Date : 2024-04-01 Walter-Soon-Yaw Wong, Cara Min Sun, Hun Yi Koh, Linus Ren Hao Tan, Yilun Huang
The Sengkang General Hospital Orthopaedic Spine Outpatient Service is facing a growing challenge of increasing number of referrals and waiting times, placing a significant burden on the system. Primary care referrals have an average wait time of 61.1 days, with 34.5%f patients waiting longer than 60 days from referral to appointment, to see a spine physician. Back pain is a very common presentation
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Quality improvement collaborative approach to COVID-19 pandemic preparedness in long-term care homes: a mixed-methods implementation study BMJ Open Qual. Pub Date : 2024-04-01 Janice Sorensen, Laura Kadowaki, Lucy Kervin, Clayon Hamilton, Annette Berndt, Simran Dhadda, Abeera Irfan, Emma Leong, Akber Mithani
Background The devastating impact of the COVID-19 pandemic on long-term care (LTC) homes underscores the importance of effective pandemic preparedness and response. This mixed-methods, implementation science study investigated how a virtual-based quality improvement (QI) collaborative approach can improve uptake of pandemic-related promising practices and shared learning across six LTC homes in British
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Call me Ishmael: addressing the white whale of team communication in the operating room with labelled surgical caps at an academic medical centre BMJ Open Qual. Pub Date : 2024-04-01 Nicole Hamilton Goldhaber, Shivani Mehta, Christopher A Longhurst, Elizabeth Malachowski, Melissa Jones, Bryan M Clary, Robin L Schaefer, Michael McHale, Lisa P Rhodes, Kristin L Mekeel, J Jeffery Reeves
Introduction Effective communication in the operating room (OR) is crucial. Addressing a colleague by their name is respectful, humanising, entrusting and associated with improved clinical outcomes. We aimed to enhance team communication in the perioperative environment by offering personalised surgical caps labelled with name and provider role to all OR team members at a large academic medical centre
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Using Mixed Reality Simulation to Improve Junior Medical Trainees’ Preparedness to Manage High-Acuity Trauma BMJ Open Qual. Pub Date : 2024-04-01 Kirsty Clarke, Aws Al-mukhtar, Lina Alim, Amr Nimer, Emma Hatfield, Sanjeeve Sabharwal, Sadie Syed
High-acuity trauma necessitates experienced and rapid intervention to prevent patient harm. However, upskilling junior trainees through hands-on management of real trauma cases is rarely feasible without compromising patient safety. This quality education report sought to investigate whether a simulation course operated via mixed reality (MR) headset devices (Microsoft HoloLens) could enhance the clinical
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Surgeons’ views of peer comparison and guideline-based feedback on postsurgery opioid prescriptions: a qualitative investigation BMJ Open Qual. Pub Date : 2024-04-01 Meghan Martinez, Allison Kirkegaard, Kathryn Bouskill, Xiaowei Sherry Yan, Zachary Wagner, Katherine E Watkins
Background Excess opioid prescribing after surgery can lead to prolonged opioid use and diversion. We interviewed surgeons who were part of a three-group cluster-randomised controlled trial aimed at reducing prescribed opioid quantities after surgery via two versions of a monthly emailed behavioural ‘nudge’ (messages encouraging but not mandating compliance with social norms and clinical guidelines
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Patient and healthcare professional perspectives on the Practical Guide to Implementing PROMs in Gender-Affirming Care (PG-PROM-GAC): analysis of open-ended responses from patients and healthcare professionals BMJ Open Qual. Pub Date : 2024-04-01 Rakhshan Kamran, Liam Jackman, Anna Laws, Melissa Stepney, Conrad Harrison, Abhilash Jain, Jeremy Rodrigues
Importance Several international calls have been made for evidence-based patient-reported outcome measure (PROM) implementation for gender-affirming care. The Practical Guide to Implementing PROMs in Gender-Affirming Care (PG-PROM-GAC) is a resource which can help guide PROM implementation efforts, developed using a three-phase participatory research approach with transgender and gender-diverse (TGD)
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Using Blood Wisely: lessons learnt in establishing a national implementation programme to reduce inappropriate red blood cell transfusion BMJ Open Qual. Pub Date : 2024-04-01 Yulia Lin, Wendy Levinson, Doreen Day, Ryan Lett, Tanya Petraszko, Tai Huynh, Andrea M Patey
Background Up to 50% of blood is transfused inappropriately despite best evidence. In 2020, Choosing Wisely Canada launched a major national programme, ‘Using Blood Wisely’, the aim was to engage hospitals to audit their red blood cell transfusion use against national benchmarks and participate in a programme to decrease inappropriate use. Study design Using Blood Wisely is a quality improvement programme
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Journey of medication reconciliation compliance in a lower middle-income country: a retrospective chart review BMJ Open Qual. Pub Date : 2024-04-01 Samar Fatima, Ainan Arshad, Amara Zafar, Sana Farrukh, Anum Rahim, Saharish Nazar, Hasnain Zafar
Objective There were three main objectives of the study: to determine the overall compliance of medication reconciliation over 4 years in a tertiary care hospital, to compare the medication reconciliation compliance between paper entry (initial assessment forms) and computerised physician order entry (CPOE), and to identify the discrepancies between the medication history taken by the physician at
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Enhancing capability for continuous organisational improvement and learning in healthcare organisations: a systematic review of the literature 2013–2022 BMJ Open Qual. Pub Date : 2024-04-01 Ninni Löfqvist
Background Healthcare organisations strive to meet their current and future challenges and need to increase their capacity for continuous organisational improvement and learning (COIL). A key aspect of this capacity is the development of COIL capability among employees. Objective This systematic review aims to explore common attributes of interventions that contribute to the development of COIL capability
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A realist synthesis of multicentre comparative audit implementation: exploring what works and in which healthcare contexts BMJ Open Qual. Pub Date : 2024-03-01 Sinéad M McGlacken-Byrne, Nuala P Murphy, Sarah Barry
Background Multicentre comparative clinical audits have the potential to improve patient care, allow benchmarking and inform resource allocation. However, implementing effective and sustainable large-scale audit can be difficult within busy and resource-constrained contemporary healthcare settings. There are little data on what facilitates the successful implementation of multicentre audits. As healthcare
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Promoting equitable and patient-centred care: an analysis of patient satisfaction in urban, rural and remote primary care sites in the Philippines BMJ Open Qual. Pub Date : 2024-03-01 Janelle Micaela S Panganiban, Arianna Maever Loreche, Regine Ynez H De Mesa, Romelei Camiling-Alfonso, Noleen Marie C Fabian, Leonila F Dans, Cara Lois T Galingana, Johanna Faye E Lopez, Ray U Casile, Maria Rhodora N Aquino, Mia P Rey, Josephine T Sanchez, Mark Anthony U Javelosa, Carol Stephanie C Tan-Lim, Jose Rafael A Marfori, Ramon Pedro Paterno, Antonio L Dans
Objectives This study measured changes in patient satisfaction levels before and after the introduction of primary care system strengthening interventions in urban, rural, and remote sites in the Philippines. Methods A previously validated 16-item questionnaire was distributed to 200 patients per site before implementation of interventions and to a different set of 200 patients 1 year after implementation
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Enhancing pain care with the American Pain Society Patient Outcome Questionnaire for use in the emergency department (APS-POQ-RED): validating a patient-reported outcome measure BMJ Open Qual. Pub Date : 2024-03-01 James A Hughes, Sarah Hazelwood, Anna-Lisa Lyrstedt, Lee Jones, Nathan J Brown, Rajeev Jarugula, Clint Douglas, Kevin Chu
Background In general, the quality of pain care in emergency departments (ED) is poor, despite up to 80% of all ED patients presenting with pain. This may be due to the lack of well-validated patient-reported outcome measures (PROMs) of pain care in the ED setting. The American Pain Society-Patient Outcome Questionnaire-Revised Edition (APS-POQ-R), with slight modification for ED patients, is a potentially
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Measuring evidence-based clinical guideline compliance in the paediatric intensive care unit BMJ Open Qual. Pub Date : 2024-03-01 Rebecca E Hay, Dori-Ann Martin, Gary J Rutas, Shelina M Jamal, Simon J Parsons
Background Evidence-based clinical care guidelines improve medical treatment by reducing error, improving outcomes and possibly lowering healthcare costs. While some data exist on individual guideline compliance, no data exist on overall compliance to multiple nuanced guidelines in a paediatric intensive care setting. Methods Guideline compliance was observed and measured with a prospective cohort
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Using feedback on patient health outcomes to improve orthopaedic physical therapist practice: a quality improvement study BMJ Open Qual. Pub Date : 2024-03-01 Philip J van der Wees, Emily J Balog, James J Irrgang, Hallie Zeleznik, Paige L McDonald, Kenneth J Harwood
Objective Measuring health outcomes plays an important role in patient-centred healthcare. When aggregated across patients, outcomes can provide data for quality improvement (QI). However, most physical therapists are not familiar with QI methods based on patient outcomes. This mixed-methods study aimed to develop and evaluate a QI programme in outpatient physical therapy care based on routinely collected
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Improving inpatient hyperglycaemia in non-critically ill adults in resident wards through audit and feedback BMJ Open Qual. Pub Date : 2024-03-01 Chelsea Chang, Alcibiades Fleires, Alfarooq Alshaikhli, Hector Arredondo, Diana Gavilanes, Francisco J Cabral-Amador, Jonathon Cantu, Daniela Bazan, Kathryn Oliveira Oliveira, Rene Verduzco, Lina Pedraza
Inpatient hyperglycaemia is associated with an increase in morbidity and mortality, number of rehospitalisations and length of hospitalisation. Although the advantages of proper glycaemic control in hospitalised patients with diabetes are well established, a variety of barriers limit accomplishment of blood glucose targets. Our primary aim was to decrease the number of glucose values above 180 mg/dL
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AMU patient list generation: from junior scribe to junior doctor BMJ Open Qual. Pub Date : 2024-03-01 Zahra Ravat, Amil Sinha, Alistair Jellinek, Nigel Page
This quality improvement project (QIP) aimed to assess the impact of automating patient list generation on the acute medical unit (AMU) at Sandwell and West Birmingham Hospitals NHS Trust. The AMU patient list categorises patients requiring ‘clerking’, ‘post-take’ (PTWR) and ‘post-post-take’ (PPTWR) for the morning ward round. During weekdays, this list need only include the patients in AMU. For weekends
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Experience-based Modifications of the Bed Band ReAlised through Co-dEsign (EMBRACE) BMJ Open Qual. Pub Date : 2024-03-01 Michelle Beattie, Kevin Muirhead, Roma Gibb, Fiona Ross, Leah Macaden
Background Upper body limitations are a common disability in neurological conditions including stroke and multiple sclerosis. Care of patients with upper body limitations while in bed involves positioning techniques to maximise comfort and independence. The Bed Band is a nurse-led innovation to support people with limited mobility to maintain a comfortable position in bed, thereby promoting comfort
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A rapid improvement event: progesterone prescribing in prevention of miscarriage BMJ Open Qual. Pub Date : 2024-03-01 Lucy Anne Bolger, Nicola O'Riordan, Cathy Allen
A rapid improvement event (RIE) is a standard operational excellence technique that uses team-based problem solving to improve processes. In this study, a RIE was undertaken to improve progesterone prescribing rates for those with a history of miscarriage experiencing vaginal bleeding in early pregnancy. This was on the basis of a recent change in guidelines regarding prescribing in these instances
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Consensus-based quality standards for emergency departments in Palestine BMJ Open Qual. Pub Date : 2024-03-01 Abed Alra'oof Bani Odeh, Lee A Wallis, Motasem Hamdan, Willem Stassen
Objectives The present study aimed to establish appropriate quality standards for emergency departments (EDQS) in Palestine. Methods The study comprised four phases. First, a comprehensive literature review was conducted to develop a framework for assessing healthcare services in EDs. Second, the initial set of EDQS was developed based on the review findings. Third, local experts provided feedback
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Lack of associations between hospital rating and outcomes in patients with an acute coronary syndrome BMJ Open Qual. Pub Date : 2024-03-01 Sara Aspberg, Thomas Kahan, Fredrik Johansson
Background Public reporting of performance data has become a common tool in evaluation of healthcare providers. The rating may be misleading if the association between the measured variables and the outcome is weak. Methods and results Nationwide, register-based, cohort study. All Swedish patients hospitalised with an acute coronary syndrome during the time periods 2006–2010 and 2015–2017 were included
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Bridging the gap: a resident-led transitional care clinic to improve post hospital care in a safety-net academic community hospital BMJ Open Qual. Pub Date : 2024-03-01 Patrick Li, Tiffany Kang, Sandy Carrillo-Argueta, Vickie Kassapidis, Rebecca Grohman, Michael J Martinez, Daniel J Sartori, Rachael Hayes, Ramiro Jervis, Marwa Moussa
The transitional period between hospital discharge and primary care follow-up is a vulnerable time for patients that can result in adverse health outcomes and preventable hospital readmissions. This is especially true for patients of safety-net hospitals (SNHs) who often struggle to secure primary care access when leaving the hospital due to social, economic and cultural barriers. In this study, we
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Improving availability and accuracy of the junior doctors’ on-call handover through digitalisation BMJ Open Qual. Pub Date : 2024-03-01 Alexia Haysom, William Harry Loveday, Kajanesh Ratneswaran, Georgios Nerantzis, Nahid Hakim, Darena Dineva, Adam Richards
Clinical handovers from out-of-hours activity are essential for relaying information about events such as new admissions, outstanding or complete investigations, physical health reviews, ward jobs and risk. This information enables the day team to effectively prioritise and follow-up any necessary tasks. Junior doctors at a hospital site in the London Borough of Newham were aware that the existing
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Enhancing patient safety: a system-based analysis of morbidity and mortality conferences in managing postoperative bleeding following gastric and pancreatic cancer surgery BMJ Open Qual. Pub Date : 2024-03-01 Oumayma Lahnaoui, Amina Houmada, Amine Benkabbou, Abdelillah Ghannam, Brahim Al Ahmadi, Zakaria Belkhadir, Raouf Mohsine, Amine Souadka, Mohammed Anass Majbar
Morbidity and mortality conferences (MMCs) have evolved beyond their traditional educational role to become instrumental in enhancing patient safety. System-based MMCs offer a unique perspective on patient safety by dissecting systemic factors contributing to adverse events. This paper reviews the impact of MMC in managing postoperative bleeding after gastric and pancreatic cancer surgery, within the
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Improving medical record completeness at Wallaga University Referral Hospital: a multidimensional quality improvement project BMJ Open Qual. Pub Date : 2024-03-01 Gedefa Bayisa, Lammii Gonfaa, Ketema Badasa, Nemomsa Dugasa, Mulugeta Abebe, Habtamu Deressa, Misganu Teshoma Regassa, Amsalu Takele, Temesgen Tilahun
Background Appropriately documented medical records enhance coordination, patient outcomes and clinical research. Objective The aim of this project was to improve Wallaga University Referral Hospital’s (WURH) medical record completeness rate from 53% to 80% from 1 January 2023 to 31 August 2023. Methods A hospital-based interventional study was conducted at WURH. The Plan-Do-Study-Act cycle was used
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Customised knowledge-sharing platform to foster resident quality improvement activities, tracking and scholarship BMJ Open Qual. Pub Date : 2024-02-01 Katherine A Rowe, Alexander Carbo, Joel T Katz, Lisa Rotenstein
Introduction Meeting accreditation requirements to train resident physicians in quality improvement (QI) may require more than education. Barriers to resident QI engagement underscore the need to demonstrate the impact and value of resident QI work. It is not known whether a platform to track and publicise resident QI projects and scholarship is feasible or acceptable to implement within a residency
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Use of statistical process control in quality improvement projects in abdominal surgery: a PRISMA systematic review BMJ Open Qual. Pub Date : 2024-02-01 Yara Lima de Mendonca, Rubiana Sarto, Hannes Titeca, Rob Bethune, Andrew Salmon
Background The use of quality improvement methodology has increased in recent years due to a perceived benefit in effectively reducing morbidity, mortality and length of stay. Statistical process control (SPC) is an important tool to evaluate these actions, but its use has been limited in abdominal surgery. Previous systematic reviews have examined the use of SPC in healthcare, but relatively few surgery-related
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Feasibility, acceptability and impact of a clinical decision support tool among primary care providers in an urban, rural and remote site in the Philippines BMJ Open Qual. Pub Date : 2024-02-01 Ysabela Calderon, Gillian Sandigan, Carol Stephanie C Tan-Lim, Regine Ynez H De Mesa, Noleen Marie C Fabian, Mia P Rey, Josephine T Sanchez, Leonila F Dans, Cara Lois T Galingana, Nannette Bernal-Sundiang, Ray U Casile, Maria Rhodora N Aquino, Karl Engelene Poblete, Johanna Faye E Lopez, Herbert Zabala, Antonio L Dans
Introduction Strengthening primary care helps address health inequities that continue to persist in the Philippines. The Philippine Primary Care Studies pilot-tested interventions to improve the primary care system. One intervention was the provision of a free subscription to an electronic decision support application called UpToDate (UTD) for primary care providers (PCPs), including doctors, nurses
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Contribution of proactive management of healthcare risks to the reduction of adverse events in a maternity hospital BMJ Open Qual. Pub Date : 2024-02-01 Romulo Negrini, Liliane Costa Appel, Ana Paula Avritscher Beck, Ana Carolina Guimarães Eisencraft, Linus Pauling Fascina, Fernanda Paulino Fernandes
Background The risks of the childbirth assistance process are still very high, both for mothers and babies. According to the WHO, birth-related asphyxia accounts for 23% of all 3.3 million annual neonatal deaths and an even larger number of survivors with disabilities. On the other hand, maternal mortality is still a global challenge, affecting 17 mothers per 100 000 births in the USA. This is associated
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Streamlining patient flow and enhancing operational efficiency through case management implementation BMJ Open Qual. Pub Date : 2024-02-01 Sultanah Al Harbi, Baker Aljohani, Lamiaa Elmasry, Frenk Lee Baldovino, Kamille Bianca Raviz, Lama Altowairqi, Seetah Alshlowi
Background Improving patient flow in hospitals represents a worldwide healthcare challenge. The objective of this project was to depict the effectiveness of case management in improving patient flow in a tertiary hospital setting. Methods Quality improvement methods, including quantitative pre-Lean and post-Lean design, the Plan-Do-Check-Act concept, the Single Minute Exchange of Dies and the ‘demand
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Safety on the ground: using critical incident technique to explore the factors influencing medical registrars’ provision of safe care BMJ Open Qual. Pub Date : 2024-02-01 Katherine Ralston, Samantha Eve Smith, Joanne Kerins, Saskia Clark-Stewart, Victoria Tallentire
Background Avoidable patient harm in hospitals is common, and doctors in training can provide underused but crucial insights into the influencers of patient safety as those working ‘on the ground’ within the system. This study aimed to explore the factors that influence safe care from the perspective of medical registrars, to identify targets for safety-related improvements. Methods This study used
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Development of delivery indicators and delivery enablers for cardiovascular disease in the UK: a modified Delphi study BMJ Open Qual. Pub Date : 2024-02-01 Chris Gale, Chris Arden, Ameet Bakhai, Lucy Grothier, Huon H Gray, Helen Williams
Introduction Standards to define and measure quality in healthcare for cardiovascular disease risk reduction and secondary prevention are available, but there is a paucity of indicators that could serve as facilitators of structural change at a system level. This research study aimed to develop a range of delivery indicators to help cardiac clinical networks assess delivery of and progress towards
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Applying the lessons of design thinking: a unique programme of care for acutely unwell, community-dwelling COVID-19 patients BMJ Open Qual. Pub Date : 2024-02-01 Megan K Devlin, Natasha J McIntyre, Matthew D Ramer, Young Han Kwon, J Michael Nicholson, Marko Mrkobrada, Jami Kronick, James E Calvin, Erin Spicer
Background The COVID-19 pandemic limited access to primary care and in-person assessments requiring healthcare providers to re-envision care delivery for acutely unwell outpatients. Design thinking methodology has the potential to support the robust evolution of a new clinical model. Aim To demonstrate how design thinking methodology can rapidly and rigorously create and evolve a safe, timely, equitable
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Single-shot liposomal bupivacaine in place of rectus sheath catheters to provide non-opiate analgesia after laparotomy: a quality improvement project to reduce the need for ongoing nursing input BMJ Open Qual. Pub Date : 2024-02-01 Edward Matthews, Pranu Ragatha, Neil Smart, Rob Bethune
Opioid-sparing pain management is an integral component of enhanced recovery after colonic and rectal surgery. In our hospital, rectus sheath catheters (RSCs) are routinely placed during emergency laparotomy for colorectal procedures to allow a postoperative compartmental block of the surgical site with repeated doses of bupivacaine. However, RSCs require a significant amount of clinical nursing time
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Improving the emergency services using quality improvement project and Donabedian model in a quaternary teaching hospital in South India BMJ Open Qual. Pub Date : 2024-02-01 Apoorva Goenka, Suneel Mundkur, Sachin Sujir Nayak, Avinash Shetty, Jibu Thomas, Jayaraj Mymbilly Balakrishnan, Varalakshmi Chandra Sekaran, Brayal Dsouza
Introduction The primary goal of quality improvement is to enhance patient outcomes, particularly in the emergency department (ED). Timely and effective care is crucial in these situations. By comprehending the challenges, evaluating current performance and implementing quality improvement projects, areas in need of enhancement can be pinpointed and addressed, resulting in better outcomes. Methodology
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Increasing rates of screening and treatment of iron deficiency in ambulatory patients with heart failure with reduced ejection fraction: a quality improvement cohort study BMJ Open Qual. Pub Date : 2024-02-01 Mena Gewarges, Roslyn Mainland, Katherine Wilkinson, Jaime Sklar, Andrew Gentilin, Bianca McLean, Omar I Hajjaj, Mali Worme, Spencer Lalonde, Raumil Patel, Yulia Lin, Jeannie Callum, Stephanie Poon
Introduction Iron deficiency anaemia (IDA) is common in patients with heart failure (HF) and is associated with advanced HF and increased mortality. Intravenous iron supplementation increases exercise tolerance, improves quality of life, and decreases symptoms among patients with HF with reduced ejection fraction (HFrEF) and iron deficiency. Despite this, many patients are not screened or treated for
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Initiative to improve handover notes in a tertiary psychiatric hospital BMJ Open Qual. Pub Date : 2024-02-01 Jiangbo Ying, Melvyn Weibin Zhang, Giles Ming Yee Tan, Lambert Low, Tina Fang
Clinical handover is an important process in hospital settings, but it is often carried out inadequately, posing potentially serious consequences for the patients. This project aimed to increase the effectiveness of handover notes when patients were transferred between a general psychiatric ward and other wards in a tertiary psychiatric hospital. Effective handover notes in this project were defined
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Improving patient safety through mandatory quality improvement (QI) education in a family medicine residency programme BMJ Open Qual. Pub Date : 2024-02-01 Shira Goldstein, Jude K A des Bordes, Samuel Neher, Nahid Rianon
Although the American College of Graduate Medical Education (ACGME) requires that medical trainees acquire competencies in patient safety and quality improvement (QI), no standard curriculum exists. We envisaged that a sustainable QI curriculum would be a pragmatic way to improve residents’ skills and competence in patient safety. Our aim was to develop and evaluate a patient safety-oriented QI curriculum
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Lessons from the COVID-19 pandemic in paediatric post-discharge care BMJ Open Qual. Pub Date : 2024-02-01 Kathryn Mullan, Ngozi Oketah, Nicola Davey
The COVID-19 pandemic dictated rapid reform in outpatient paediatric services. To reduce ward footfall and its associated infection risk, a trainee-led outpatient clinic was established with the aim to provide children with continuity of care following discharge from hospital. The service was created as a safe alternative to the long-standing practice of ward attenders while reducing mounting pressures
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Exploring the palliative care ecosystem in Thailand: a protocol for a scoping review and bibliometric analysis BMJ Open Qual. Pub Date : 2024-02-01 Tharin Phenwan, Kanthee Anantapong, Supakorn Sripaew, Sukrit Vinayavekhin
Introduction Palliative care is an approach that aims to holistically improve the quality of life, care and death of people living with life-limiting conditions as well as their families. In Thailand, palliative care became one of its national strategies as of 2014. However, the access to as well as the quality of palliative care being delivered still varies across the nation, due to multiple factors
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Evaluating the implementation of personalised outcomes forecasts to optimise supervised exercise therapy in patients with intermittent claudication in the Netherlands: a multimethods study BMJ Open Qual. Pub Date : 2024-02-01 Laura H M Marcellis, Anneroos Sinnige, Katrien M Rutgers, Andrew Kittelson, Steffie Spruijt, Joep A W Teijink, Philip J van der Wees, Thomas J Hoogeboom
Background To support the optimisation of supervised exercise therapy (SET) in patients with intermittent claudication, we developed personalised outcomes forecasts (POFs), which visualise estimated walking distance and quality of life for individual patients. The POFs may enable healthcare professionals, such as physical and exercise therapists, to improve shared decision-making and patient outcomes
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Enhancing safety in the ischaemic and haemorrhagic stroke population: exploring the efficacy of self-releasing chair alarm belts BMJ Open Qual. Pub Date : 2024-02-01 Justin Weppner, Alaric Gee, Kevin Mesina
Introduction A quality improvement study evaluated the effectiveness of implementing self-releasing chair alarm belts in an inpatient rehabilitation facility (IRF) for patients who had a stroke. The objective of this study is to assess the effectiveness of self-releasing chair alarms as a chair-level fall preventive tool in patients who had a stroke in the IRF setting. Methods A preintervention and
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Complaint behaviour among healthcare users: self-reported complaint experience and complaint proneness in adult men BMJ Open Qual. Pub Date : 2024-02-01 Søren Birkeland, Marie Bismark, Michael J Barry, Sören Möller
Aims When patients are harmed by, or dissatisfied with, healthcare, only a minority will lodge a complaint or file a claim for compensation. This survey aimed to investigate complaint behaviour and inequalities in complaints using self-reports and hypothetical case vignettes. Methods Cross-sectional, web-based survey among 6755 Danish men aged 45–70 years (response rate=30%). Participants reported
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Quality of locally designed surveys in a quality improvement collaborative: review of survey validity and identification of common errors BMJ Open Qual. Pub Date : 2024-02-01 Julie E Reed, Julie K Johnson, Robert Zanni, Randy Messier, Fadi Asfour, Marjorie M Godfrey
Objective Surveys are a commonly used tool in quality improvement (QI) projects, but little is known about the standards to which they are designed and applied. We aimed to investigate the quality of surveys used within a QI collaborative, and to characterise the common errors made in survey design. Methods Five reviewers (two research methodology and QI, three clinical and QI experts) independently
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Reducing use of seclusion on a male medium secure forensic ward BMJ Open Qual. Pub Date : 2024-02-01 Kathryn Amy Rowsell, Ayodele Akinbola, Mark Hancock, Tsitsi Nyambayo, Zoe Jackson, David Francis Hunt
The reduction of restrictive practices is a priority for mental health inpatient services. Often such practices are considered to increase patients’ feelings of anger, loneliness, hopelessness and vulnerability. Moreover, such approaches are counterintuitive to both recovery-orientated and trauma-informed practice. Our project, based in a male 15-bed secure forensic ward, aimed to reduce the duration
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Comparison of two types of extension tubes for people with Parkinson’s disease in advanced treatment with levodopa–entacapone–carbidopa intestinal gel infusions: a prospective, crossover quality study BMJ Open Qual. Pub Date : 2024-02-01 Trine Hørmann Thomsen, Louise Olsen, Mahsa Javidi, Nikolaj Folke La Cour Karottki, Bo Biering-Sørensen
Background Within Parkinson’s disease (PD) management, a pivotal juncture often arises when individuals with PD (PwP) necessitate advanced therapies to stabilise symptom fluctuations and reduce off-periods, which are intrinsic to living with PD. One such intervention is the infusion of duodenal levodopa–entacapone–carbidopa intestinal gel (LECIG), which confers a more dependable levodopa plasma concentration
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Changing the liver transplant assessment process from inpatient to a day-case and outpatient approach to reduce inpatient bed utlisation BMJ Open Qual. Pub Date : 2024-02-01 Peter Robinson Smith, Annette Richardson, Louise Macdougall, Ellice Cross, Siobhan Davison, Vanessa Knowles
The liver transplant assessment process involves a complex set of tests and clinical reviews to determine suitability for liver transplantation. We had an assessment process involving a 3-day inpatient stay and often experienced difficulties admitting patients to the prebooked bed due to a lack of inpatient bed availability. We aimed to change the process from a 3-day and 2-night inpatient stay to
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Virtual quality improvement collaborative with primary care practices during COVID-19: a case study within a clinically integrated network BMJ Open Qual. Pub Date : 2024-02-01 Catherine L Rohweder, Abigail Morrison, Kathleen Mottus, Alexa Young, Lauren Caton, Ronni Booth, Christine Reed, Christopher M Shea, Angela M Stover
Introduction Quality improvement collaboratives (QICs) are a common approach to facilitate practice change and improve care delivery. Attention to QIC implementation processes and outcomes can inform best practices for designing and delivering collaborative content. In partnership with a clinically integrated network, we evaluated implementation outcomes for a virtual QIC with independent primary care
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Deployment of a human-centred clinical decision support system for pulmonary embolism: evaluation of impact on quality of diagnostic decisions BMJ Open Qual. Pub Date : 2024-02-01 Ghazwan Altabbaa, Ward Flemons, Wrechelle Ocampo, Julie Nathalie Babione, Jamie Kaufman, Sydney Murphy, Nicole Lamont, Jeffrey Schaefer, Alejandra Boscan, Henry T Stelfox, John Conly, William A Ghali
Pulmonary embolism (PE) is a serious condition that presents a diagnostic challenge for which diagnostic errors often happen. The literature suggests that a gap remains between PE diagnostic guidelines and adherence in healthcare practice. While system-level decision support tools exist, the clinical impact of a human-centred design (HCD) approach of PE diagnostic tool design is unknown. Design Before–after