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Schechter SB, Bowles A, Ding L, Nkoy F, Tieder J, Lion KC, Meyer D, Kaiser SV. Hospital-Based Pediatric Quality Improvement Interventions and Health Disparities: A Scoping Review of the Literature. Pediatrics 2024; 153:e2022061176. [PMID: 38666310 DOI: 10.1542/peds.2022-061176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/13/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Quality improvement (QI) has the potential to reduce health disparities through multiple mechanisms, including by standardizing care and addressing social barriers to health. National organizations require that hospital systems integrate equity into quality efforts, but effective approaches remain unclear. We aimed to examine the association of hospital-based pediatric QI interventions and racial and ethnic, language, and socioeconomic disparities in health outcomes. METHODS Quantitative studies from January 1, 2000 to December 11, 2023 reporting the effects of pediatric hospital-based QI were selected from PubMed and Embase. Studies were excluded if outcomes were not stratified by race and ethnicity, language, or socioeconomic status. Studies were reviewed in duplicate for inclusion and by 1 author for data extraction. RESULTS A total of 22 studies were included. Most studies (n = 19, 86%) revealed preexisting disparities, and 68% of those (n = 13) found disparities reductions post-intervention. Studies with disparity-focused objectives or interventions more commonly found reduced disparities than studies of general QI (85% vs 33%). Hospital-based process standardization was associated with reduced disparities in provider practices. Most interventions associated with reduced disparities in patient-facing outcomes involved community/ambulatory partnership. Limitations included potential exclusion of relevant studies, topic heterogenity, and risk of bias. CONCLUSIONS Although the authors of few published hospital-based QI initiatives assessed their equity effect, intentionally designed QI studies were associated with reduced disparities. Interventions focused on care standardization may reduce disparities in care quality, although multilevel interventions are likely needed to affect the health care structures that influence more significant patient outcomes.
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Affiliation(s)
| | - Adria Bowles
- University of California, San Francisco, San Francisco, California
| | - Lucky Ding
- University of California, San Francisco, San Francisco, California
| | - Flory Nkoy
- University of Utah, Salt Lake City, Utah
| | - Joel Tieder
- University of Washington, Seattle, Washington
| | | | - Dodi Meyer
- Columbia University Irving Medical Center, New York, New York
| | - Sunitha V Kaiser
- University of California, San Francisco, San Francisco, California
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Chaudhry AS, Inata Y, Nakagami-Yamaguchi E. Quality analysis of the clinical laboratory literature and its effectiveness on clinical quality improvement: a systematic review. J Clin Biochem Nutr 2023; 73:108-115. [PMID: 37700849 PMCID: PMC10493209 DOI: 10.3164/jcbn.23-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 04/29/2023] [Indexed: 09/14/2023] Open
Abstract
Quality improvement in clinical laboratories is crucial to ensure accurate and reliable test results. With increasing awareness of the potential adverse effects of errors in laboratory practice on patient outcomes, the need for continual improvement of laboratory services cannot be overemphasized. A literature search was conducted on PubMed and a web of science core collection between October and February 2021 to evaluate the scientific literature quality of clinical laboratory quality improvement; only peer-reviewed articles written in English that met quality improvement criteria were included. A structured template was used to extract data, and the papers were rated on a scale of 0-16 using the Quality Improvement Minimum Quality Criteria Set (QI-MQCS). Out of 776 studies, 726 were evaluated for clinical laboratory literature quality analysis. Studies were analyzed according to the quality improvement and control methods and interventions, such as training, education, task force, and observation. Results showed that the average score of QI-MQCS for quality improvement papers from 1981-2000 was 2.5, while from 2001-2020, it was 6.8, indicating continuous high-quality improvement in the clinical laboratory sector. However, there is still room to establish a proper system to judge the quality of clinical laboratory literature and improve accreditation programs within the sector.
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Affiliation(s)
- Ahmed Shabbir Chaudhry
- Department of Medical Quality and Safety Science, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan
| | - Yu Inata
- Department of Medical Quality and Safety Science, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan
- Department of Intensive Care Medicine, Osaka Women’s and Children’s Hospital, 840 Murodo-cho, Izumi, Osaka 594-1101, Japan
| | - Etsuko Nakagami-Yamaguchi
- Department of Medical Quality and Safety Science, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan
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Reifferscheid L, Kiely MS, Lin MSN, Libon J, Kennedy M, MacDonald SE. Effectiveness of hospital-based strategies for improving childhood immunization coverage: A systematic review. Vaccine 2023; 41:5233-5244. [PMID: 37500415 DOI: 10.1016/j.vaccine.2023.07.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 07/17/2023] [Indexed: 07/29/2023]
Abstract
BACKGROUND Hospital settings represent an opportunity to offer and/or promote childhood vaccination. The purpose of the systematic review was to assess the effectiveness of different hospital-based strategies for improving childhood vaccination coverage. METHODS A systematic search of multiple bibliographic databases, thesis databases, and relevant websites was conducted to identify peer-reviewed articles published up to September 20, 2021. Articles were included if they evaluated the impact of a hospital (inpatient or emergency department)-based intervention on childhood vaccination coverage, were published in English or French, and were conducted in high-income countries. High quality studies were included in a narrative synthesis. RESULTS We included 25 high quality studies out of 7,845 unique citations. Studies focused on routine, outbreak, and influenza vaccines, and interventions included opportunistic vaccination (i.e. vaccination during hospital visit) (n = 7), patient education (n = 2), community connection (n = 2), patient reminders (n = 2), and opportunistic vaccination combined with patient education and/or reminders (n = 12). Opportunistic vaccination interventions were generally successful at improving vaccine coverage, though results ranged from no impact to vaccinating 71 % of eligible children with routine vaccines and 9-61 % of eligible children with influenza vaccines. Interventions that aimed to increase vaccination after hospital discharge (community connection, patient education, reminders) were less successful. CONCLUSIONS Some interventions that provide vaccination to children accessing hospitals improved vaccine coverage; however, the baseline coverage level of the population, as well as implementation strategies used impact success. There is limited evidence that interventions promoting vaccination after hospital discharge are more successful if they are tailored to the individual.
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Affiliation(s)
| | - Marilou S Kiely
- Institut National de Santé Publique du Québec, Québec City, QC, Canada; Faculty of Medicine, Department of Social and Preventive Medicine, Québec City, QC, Canada; Centre de recherche du CHU de Québec, Québec City, QC, Canada
| | | | - Jackie Libon
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Megan Kennedy
- John W. Scott Health Sciences Library, University of Alberta, Edmonton, AB, Canada
| | - Shannon E MacDonald
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada; School of Public Health, University of Alberta, Edmonton, AB, Canada.
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Ma F, Shi A, Bian L, Li M, Li M, Xu B. Effect of a BSHP process on clinical work ability of nurses in a children's cardiac intensive care unit. Front Pediatr 2023; 11:1143855. [PMID: 37303756 PMCID: PMC10250624 DOI: 10.3389/fped.2023.1143855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 05/02/2023] [Indexed: 06/13/2023] Open
Abstract
Background Nurse shift change is the key step to ensuring the integrity, dynamics, and continuity of clinical nursing in intensive care units. Objectives To evaluate the effect of a bedside shift handover process (BSHP) on the clinical work ability of first-line clinical nurses in a children's cardiac intensive care unit (CICU). Methods This quasi-experimental study was performed on the first-line clinical nurses working in a pediatric CICU at Children's Hospital of Nanjing Medical University between July and December, 2018. Participants were trained by the BSHP. This article is based on the STROBE checklist. Results A total of 41 nurses were trained, with 34 women. The nurses in the intensive care unit showed significantly improved clinical work ability, including the ability to assess illness/find problems, master professional knowledge, standardized hands-on ability, ability to express communication, strain handling capacity, and humanistic care and accomplishment (all P < 0.05), after training. Conclusion BSHP might improve the clinical work ability for pediatric CICU nurses through a standardization shift handover. The traditional oral shift change in CICU can easily cause an information distortion, and it is difficult or even impossible to arouse the nurses' enthusiasm. This study suggested that BSHP might be an alternative shift change process for pediatric CICU nurses.
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Quality improvement interventions to prevent unplanned extubations in pediatric critical care: a systematic review. Syst Rev 2022; 11:259. [PMID: 36461126 PMCID: PMC9717500 DOI: 10.1186/s13643-022-02119-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 11/03/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND An unplanned extubation is the uncontrolled and accidental removal of a breathing tube and is an important quality indicator in pediatric critical care. The objective of this review was to comprehensively synthesize literature published on quality improvement (QI) practices implemented to reduce the rate of unplanned extubations in critically ill children. METHODS We included original, primary research on quality improvement interventions to reduce the rate of unplanned extubations in pediatric critical care. A search was conducted in MEDLINE (Ovid), Embase, and CINAHL from inception through April 29, 2021. Two reviewers independently screened citations in duplicate using pre-determined eligibility criteria. Data from included studies were abstracted using a tool created by the authors, and QI interventions were categorized using the Behavior Change Wheel. Vote counting based on the direct of effect was used to describe the effectiveness of quality improvement interventions. Study quality was assessed using the Quality Improvement Minimum Quality Criteria Set (QI-MQCS). Results were presented as descriptive statistics and narrative syntheses. RESULTS Thirteen studies were included in the final review. Eleven described primary QI projects; two were sustainability studies that followed up on previously described QI interventions. Under half of the included studies were rated as high-quality. The median number of QI interventions described by each study was 5 [IQR 4-5], with a focus on guidelines, environmental restructuring, education, training, and communication. Ten studies reported decreased unplanned extubation rates after the QI intervention; of these, seven had statistically significant reductions. Both sustainability studies observed increased rates that were not statistically significant. CONCLUSIONS This review provides a comprehensive synthesis of QI interventions to reduce unplanned extubation. With only half the studies achieving a high-quality rating, there is room for improvement when conducting and reporting research in this area. Findings from this review can be used to support clinical recommendations to prevent unplanned extubations, and support patient safety in pediatric critical care. SYSTEMATIC REVIEW REGISTRATION This review was registered on PROSPERO (CRD42021252233) prior to data extraction.
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Dewan M, Wolfe H, Stalets EL. Relentless Improvement: Overcoming the "Active Resisters and Organizational Constipators" to Drive Change. Pediatr Crit Care Med 2021; 22:842-844. [PMID: 34473128 PMCID: PMC8425596 DOI: 10.1097/pcc.0000000000002779] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Maya Dewan
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio
- Division of Critical Care Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- Division of Biomedical Informatics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Heather Wolfe
- Department of Anesthesia and Critical Care, The Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Erika L. Stalets
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio
- Division of Critical Care Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
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Affiliation(s)
- Thomas Bartman
- Division of Neonatology, Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH
| | - Richard J Brilli
- John F. Wolfe Endowed Chair in Medical Leadership and Pediatric Quality and Safety; Division of Critical Care Medicine, Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH
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