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Wagstaff D, Moonesinghe SR. Publishing quality improvement studies: learning to share and sharing to learn. BJA OPEN 2023; 5:100123. [PMID: 37587994 PMCID: PMC10430837 DOI: 10.1016/j.bjao.2023.100123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 01/03/2023] [Indexed: 08/18/2023]
Abstract
This editorial welcomes the decision of BJA Open to publish quality improvement (QI) studies. It summarises the current problems with conducting, evaluating, and publishing QI studies. It highlights existing guidance for prospective authors to follow regarding the reporting of QI interventions, their context(s), underlying theories, and evaluation. In so doing, we hope to encourage the publication of more QI studies of sufficient quality to facilitate learning or replication elsewhere.
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Affiliation(s)
- Duncan Wagstaff
- Centre for Perioperative Medicine and Division of Surgery and Interventional Science, University College London, London, UK
| | - Suneetha Ramani Moonesinghe
- Department for Targeted Intervention, Division of Surgery and Interventional Science, University College London, London, UK
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Nilsen P, Thor J, Bender M, Leeman J, Andersson-Gäre B, Sevdalis N. Bridging the Silos: A Comparative Analysis of Implementation Science and Improvement Science. FRONTIERS IN HEALTH SERVICES 2022; 1:817750. [PMID: 36926490 PMCID: PMC10012801 DOI: 10.3389/frhs.2021.817750] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 12/17/2021] [Indexed: 11/13/2022]
Abstract
Background Implementation science and improvement science have similar goals of improving health care services for better patient and population outcomes, yet historically there has been limited exchange between the two fields. Implementation science was born out of the recognition that research findings and effective practices should be more systematically disseminated and applied in various settings to achieve improved health and welfare of populations. Improvement science has grown out of the wider quality improvement movement, but a fundamental difference between quality improvement and improvement science is that the former generates knowledge for local improvement, whereas the latter is aimed at producing generalizable scientific knowledge. Objectives The first objective of this paper is to characterise and contrast implementation science and improvement science. The second objective, building on the first, is to highlight aspects of improvement science that potentially could inform implementation science and vice versa. Methods We used a critical literature review approach. Search methods included systematic literature searches in PubMed, CINAHL, and PsycINFO until October 2021; reviewing references in identified articles and books; and the authors' own cross-disciplinary knowledge of key literature. Findings The comparative analysis of the fields of implementation science and improvement science centred on six categories: (1) influences; (2) ontology, epistemology and methodology; (3) identified problem; (4) potential solutions; (5) analytical tools; and (6) knowledge production and use. The two fields have different origins and draw mostly on different sources of knowledge, but they have a shared goal of using scientific methods to understand and explain how health care services can be improved for their users. Both describe problems in terms of a gap or chasm between current and optimal care delivery and consider similar strategies to address the problems. Both apply a range of analytical tools to analyse problems and facilitate appropriate solutions. Conclusions Implementation science and improvement science have similar endpoints but different starting points and academic perspectives. To bridge the silos between the fields, increased collaboration between implementation and improvement scholars will help to clarify the differences and connections between the science and practice of improvement, to expand scientific application of quality improvement tools, to further address contextual influences on implementation and improvement efforts, and to share and use theory to support strategy development, delivery and evaluation.
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Affiliation(s)
- Per Nilsen
- Division of Society and Health, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Johan Thor
- Jönköping University, Jönköping Academy for Improvement of Health and Welfare, Jönköping, Sweden
| | - Miriam Bender
- Sue and Bill Gross School of Nursing, University of California, Irvine, Irvine, CA, United States
| | - Jennifer Leeman
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Boel Andersson-Gäre
- Jönköping University, Jönköping Academy for Improvement of Health and Welfare, Jönköping, Sweden
| | - Nick Sevdalis
- Health Service & Population Research Department, Centre for Implementation Science, King's College London, London, United Kingdom
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Duhn L, Sears K. The dual responsibility 'to work', and 'to improve it': The necessity of preparing nursing students as quality improvement leaders. NURSE EDUCATION TODAY 2021; 106:105065. [PMID: 34340193 DOI: 10.1016/j.nedt.2021.105065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 06/21/2021] [Accepted: 07/15/2021] [Indexed: 06/13/2023]
Affiliation(s)
- Lenora Duhn
- School of Nursing, Queen's University, Canada.
| | - Kim Sears
- School of Nursing, Queen's University, Canada
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Ali U, Tsang M, Campbell F, Matava C, Igbeyi B, Balakrishnan S, Shackell K, Kotzer G, Mc Donnell C. Reducing postoperative pain in children undergoing strabismus surgery: From bundle implementation to clinical decision support tools. Paediatr Anaesth 2020; 30:415-423. [PMID: 31889371 DOI: 10.1111/pan.13811] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 12/13/2019] [Accepted: 12/23/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Postoperative pain is a significant cause of morbidity in pediatric anesthesia, which can result in delayed discharge and unplanned hospital admission. Children undergoing strabismus surgery are known to be a particularly high-risk group for postoperative pain. AIM The aim of this project was to reduce the incidence of moderate to severe postoperative pain by 25% over a period of 12 months in children undergoing strabismus surgery. METHODS This was a multidisciplinary quality improvement project using the Institute for Healthcare Improvement model for improvement and iterative Plan-Do-Study-Act cycles. Baseline data from one hundred patients were collected retrospectively from patient records. Subsequently, iterative interventions introduced comprised: a perioperative bundle (comprising preoperative acetaminophen, intraoperative dexamethasone and ketorolac, a long-acting opioid, and two anti-emetics), email reminders, dissemination of results at departmental rounds, and an intraoperative clinical decision aide. Postoperative pain data were collected as an outcome measure, and length of stay in PACU was monitored as a balancing measure. Statistical process control charts were constructed to monitor bundle compliance and incidence of postoperative pain in the postanesthesia care unit. RESULTS Postoperative pain and bundle compliance data were collected for 1127 children in total. Baseline mean monthly incidence of moderate to severe postoperative pain was 47.3%. By the conclusion of this project, the incidence of postoperative pain decreased to 21%. Concurrently, mean bundle compliance increased to 78.7%. Mean length of PACU stay for baseline audit patients was 72.5 min compared with 70 min for patients after the introduction of the strabismus macro (November 2018-April 2019, n 91) (mean difference, 2.5; 95% CI, -3.86 to 8.86; P = .439). CONCLUSION Through the implementation and adoption of an evidence-based bundle of care, we successfully decreased the incidence of moderate to severe postoperative pain for children undergoing strabismus repair. We demonstrated that combining nudge theory with QI methodology can be an effective means of delivering positive results in quality improvement projects.
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Affiliation(s)
- Usman Ali
- Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Maisie Tsang
- Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.,Department of Anesthesiology & Pain Medicine, University of Toronto, Toronto, ON, Canada
| | - Fiona Campbell
- Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.,Department of Anesthesiology & Pain Medicine, University of Toronto, Toronto, ON, Canada
| | - Clyde Matava
- Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.,Department of Anesthesiology & Pain Medicine, University of Toronto, Toronto, ON, Canada
| | - Brenda Igbeyi
- Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Sindu Balakrishnan
- Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.,Department of Anesthesiology, Hamad Medical Corporation, Hamad, Qatar
| | - Kelly Shackell
- Post Anesthesia Care Unit, The Hospital for Sick Children, Toronto, ON, Canada
| | - Gloria Kotzer
- Post Anesthesia Care Unit, The Hospital for Sick Children, Toronto, ON, Canada
| | - Conor Mc Donnell
- Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.,Department of Anesthesiology & Pain Medicine, University of Toronto, Toronto, ON, Canada
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Bashford T, Vercueil A. Anaesthetic research in low- and middle-income countries. Anaesthesia 2018; 74:143-146. [PMID: 30525200 PMCID: PMC6587512 DOI: 10.1111/anae.14518] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2018] [Indexed: 12/15/2022]
Affiliation(s)
- T Bashford
- National Institute for Health Research Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, UK
| | - A Vercueil
- Departments of Intensive Care Medicine and Anaesthesia, King's College Hospital NHS Trust, London, UK
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Whyte S. Audit and feedback: to tell or not to tell? That is not the question. Can J Anaesth 2018; 65:1175-1179. [PMID: 30136094 DOI: 10.1007/s12630-018-1206-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 07/24/2018] [Indexed: 11/29/2022] Open
Affiliation(s)
- Simon Whyte
- Department of Anesthesia, British Columbia's Children's Hospital, University of British Columbia, Vancouver, BC, Canada.
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Levett DZH, Grocott MPW. Tricks of the trade: delivering reliable healthcare. Anaesthesia 2018; 73:671-674. [PMID: 29582415 DOI: 10.1111/anae.14242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- D Z H Levett
- Anaesthesia and Critical Care Research Group, Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust and University of Southampton, Southampton, UK
| | - M P W Grocott
- Anaesthesia and Critical Care Research Group, Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust and University of Southampton, Southampton, UK
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Bashford T, Clarkson PJ, Menon DK, Hutchinson PJA. Unpicking the Gordian knot: a systems approach to traumatic brain injury care in low-income and middle-income countries. BMJ Glob Health 2018; 3:e000768. [PMID: 29607105 PMCID: PMC5873538 DOI: 10.1136/bmjgh-2018-000768] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Revised: 03/06/2018] [Accepted: 03/11/2018] [Indexed: 11/25/2022] Open
Affiliation(s)
- Tom Bashford
- NIHR Global Health Research Group for Neurotrauma, University of Cambridge, Cambridge, UK.,Engineering Design Centre, Department of Engineering, University of Cambridge, Cambridge, UK.,Division of Anaesthesia, Department of Medicine, University of Cambridge, Cambridge, UK
| | - P John Clarkson
- NIHR Global Health Research Group for Neurotrauma, University of Cambridge, Cambridge, UK.,Engineering Design Centre, Department of Engineering, University of Cambridge, Cambridge, UK
| | - David K Menon
- NIHR Global Health Research Group for Neurotrauma, University of Cambridge, Cambridge, UK.,Division of Anaesthesia, Department of Medicine, University of Cambridge, Cambridge, UK
| | - Peter J A Hutchinson
- NIHR Global Health Research Group for Neurotrauma, University of Cambridge, Cambridge, UK.,Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
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