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Sosa MA, Garg N, St Onge J, Issenberg B, Diaz Y. A graduate medical education (GME) quality improvement curriculum leads to improved knowledge and participation in high quality improvement projects by trainees. Int J Med Inform 2024; 187:105444. [PMID: 38608423 DOI: 10.1016/j.ijmedinf.2024.105444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 03/28/2024] [Accepted: 04/01/2024] [Indexed: 04/14/2024]
Abstract
BACKGROUND There is increased awareness about the need for quality improvement (QI) education for trainees within clinical training programs. However, formal integration of a QI curriculum into graduate medical education (GME) remains a work-in-progress. We describe the creation and implementation of a novel, virtual QI curriculum complemented by virtual-based workshops. OBJECTIVE To determine the impact of a GME QI curriculum on 1) trainee QI knowledge; 2) Quality of QI projects. METHODS The GME Quality Improvement curriculum was transitioned to an optional formal curriculum in 2020. It is led by three faculty with expertise in QI training and education. The team developed four, web-based learning modules that focused on fundamental QI concepts. These modules are completed monthly and are paired with virtual workshops that facilitate applying learned QI concepts to project development. We evaluated the effectiveness of the curriculum by assessing participants' performance on knowledge-based quizzes before and after each online module. We used IBM SPSS (version 28), to conduct a two-sided paired samples t-test, comparing each post-session test scores with their corresponding pre-session scores. The alpha, or statistical threshold significance threshold, was 0.05. Additionally, two independent judges with expertise in QI evaluated the quality of the projects presented at the annual QI showcase using a standardized scoring rubric. The poster evaluation forms included 8 questions, rated on a scale from 1 to 5. Projects were graded into 4 quartiles (poor, fair, good, excellent). RESULTS In the knowledge assessment quiz, the difference between the mean pre- and post-session quiz scores was statistically significant (p < 0.01). The average score of the quality of the projects presented at the annual showcase was 31, in the fourth quartile which was graded as "excellent" quality. CONCLUSION A GME-led QI curriculum was effective in improving knowledge of QI concepts and producing high-quality scholarly projects.
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Affiliation(s)
- Marie Anne Sosa
- Division of Nephrology and Hypertension, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA.
| | - Neeta Garg
- Harbor-UCLA Medical Center, Santa Monica, CA, USA
| | - Joan St Onge
- Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Barry Issenberg
- Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Yvonne Diaz
- Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
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Kao LS. Towards a learning trauma system: Aligning quality improvement and research strategies. Injury 2024; 55:111515. [PMID: 38575395 DOI: 10.1016/j.injury.2024.111515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Affiliation(s)
- Lillian S Kao
- Department of Surgery, Center for Translational Injury Research, Institute for Clinical Research and Learning Health Care, McGovern Medical School at UTHealth Houston, United States.
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Heathcote C, Walton J, Kellett S, Millings A, Simmonds-Buckley M, Wright A. A feasibility and pilot additive randomised control trial of attachment security priming during behavioural activation. Behav Cogn Psychother 2024; 52:301-316. [PMID: 37933537 DOI: 10.1017/s1352465823000504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2023]
Abstract
BACKGROUND There is some initial evidence that attachment security priming may be useful for promoting engagement in therapy and improving clinical outcomes. AIMS This study sought to assess whether outcomes for behavioural activation delivered in routine care could be enhanced via the addition of attachment security priming. METHOD This was a pragmatic two-arm feasibility and pilot additive randomised control trial. Participants were recruited with depression deemed suitable for a behavioural activation intervention at Step 2 of a Talking Therapies for Anxiety and Depression service. Ten psychological wellbeing practitioners were trained in implementing attachment security priming. Study participants were randomised to either behavioural activation (BA) or BA plus an attachment prime. The diagrammatic prime was integrated into the depression workbook. Feasibility outcomes were training satisfaction, recruitment, willingness to participate and study attrition rates. Pilot outcomes were comparisons of clinical outcomes, attendance, drop-out and stepping-up rates. RESULTS All practitioners recruited to the study, and training satisfaction was high. Of the 39 patients that were assessed for eligibility, 24 were randomised (61.53%) and there were no study drop-outs. No significant differences were found between the arms with regards to drop-out, attendance, stepping-up or clinical outcomes. CONCLUSIONS Further controlled research regarding the utility of attachment security priming is warranted in larger studies that utilise manipulation checks and monitor intervention adherence.
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Affiliation(s)
| | - James Walton
- Tees, Esk and Wear Valleys NHS Foundation Trust, UK
| | - Stephen Kellett
- Rotherham, Doncaster and South Humber NHS Foundation Trust and University of Sheffield, UK
| | | | | | - Andy Wright
- Tees, Esk and Wear Valleys NHS Foundation Trust, UK
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Baandrup L, Dons AM, Bartholdy KV, Holm KO, Hageman I. Changing prescribing practice for rapid tranquillization-a quality improvement project based on the Plan-Do-Study-Act method. Soc Psychiatry Psychiatr Epidemiol 2024; 59:781-788. [PMID: 36943451 PMCID: PMC10029773 DOI: 10.1007/s00127-023-02461-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 03/08/2023] [Indexed: 03/23/2023]
Abstract
PURPOSE It is unclear how the evidence from clinical trials best translates into complex clinical settings. The aim of this quality improvement (QI) project was to change prescribing practice for rapid tranquillization in inpatient mental health care services examining the effectiveness of the Plan-Do-Study-Act (PDSA) method. METHODS A prospective QI project was conducted to ensure that intramuscular (IM) diazepam was substituted with IM lorazepam for benzodiazepine rapid tranquillization in inpatient mental health care. We monitored the prescription and administration of medication for rapid tranquillization before (N = 371), during (N = 1130) and after (N = 364) the QI intervention. Seven iterative PDSA cycles with a multiple-component intervention approach were conducted to gradually turn the prescribing practice in the desired direction. Simultaneously, a standard monitoring regimen was introduced to ensure patient safety. RESULTS Lorazepam administrations gradually replaced diazepam during the intervention period which was sustained post-intervention where lorazepam comprised 96% of benzodiazepine administrations for rapid tranquillization. The mean dose of benzodiazepine administered remained stable from pre (14.40 mg diazepam equivalents) to post (14.61 mg) intervention phase. Close to full compliance (> 80%) with vital signs monitoring was achieved by the end of the observation period. CONCLUSION It was possible to increase the quality of treatment of acute agitation in a large inpatient mental health care setting using a stepwise approach based on iterative PDSA cycles and continuous data feedback. This approach might be valuable in other prescribing practice scenarios with feedback from local stakeholders and opinion leaders.
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Affiliation(s)
- Lone Baandrup
- The Mental Health Services of the Capital Region in Denmark, Copenhagen University Hospital, Copenhagen, Denmark.
- Mental Health Centre Copenhagen, Tuborgvej 235, 2400, Copenhagen NV, Denmark.
| | - Anne Mette Dons
- The Mental Health Services of the Capital Region in Denmark, Copenhagen University Hospital, Copenhagen, Denmark
| | - Katja Vu Bartholdy
- The Mental Health Services of the Capital Region in Denmark, Copenhagen University Hospital, Copenhagen, Denmark
| | - Katrine Overballe Holm
- The Mental Health Services of the Capital Region in Denmark, Copenhagen University Hospital, Copenhagen, Denmark
| | - Ida Hageman
- The Mental Health Services of the Capital Region in Denmark, Copenhagen University Hospital, Copenhagen, Denmark
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Buchberger W, Schmied M, Schomaker M, Del Rio A, Siebert U. Implementation of a comprehensive clinical risk management system in a university hospital. ZEITSCHRIFT FUR EVIDENZ, FORTBILDUNG UND QUALITAT IM GESUNDHEITSWESEN 2024; 184:18-25. [PMID: 38199940 DOI: 10.1016/j.zefq.2023.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 11/20/2023] [Accepted: 11/22/2023] [Indexed: 01/12/2024]
Abstract
BACKGROUND Adverse events during hospital treatment are common and can lead to serious harm. This study reports the implementation of a comprehensive clinical risk management system in a university hospital and assesses the impact of clinical risk management on patient harms. METHODS The clinical risk management system was rolled out over a period of eight years and consisted of a training of interdisciplinary risk management teams, external and internal risk audits, and the implementation of a critical incident reporting system (CIRS). The risks identified during the audits were analyzed according to the type, severity, and implementation of preventive measures. Other key figures of the risk management system were obtained from the annual risk reports. The number of liability cases was used as primary outcome measurement. RESULTS Of the 1,104 risks identified during the risk audits, 56.2% were related to organization, 21.3% to documentation, 15.3% to treatment, and 7.2% to patient information and consent. The highest proportion of serious risks was found in the category organization (22.7%), the lowest in the category documentation (13.6%). Critical incident reporting identified between 241 and 370 critical incidents per year, for which in 79.5% to 83% preventive measures were implemented within twelve months. The frequency of incident reports per department correlated with the number of active risk managers and risk team meetings. Compared with the years prior to the introduction of the clinical risk management system, an average annual reduction of harms by 60.1% (95% CI: 57.1; 63.1) was observed two years after the implementation was completed. On average, the rate of harms dropped by 5% per year for each 10% increase in roll-out of the clinical risk management system (incidence rate ratio: 0.95; 95% CI: 0.93; 0.97) . CONCLUSION The results of this project demonstrate the effectiveness of clinical risk management in detecting treatment-related risks and in reducing harm to patients.
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Affiliation(s)
- Wolfgang Buchberger
- UMIT TIROL- University for Health Sciences and Technology, Institute of Public Health, Medical Decision Making and HTA, Hall in Tirol, Austria.
| | - Marten Schmied
- UMIT TIROL- University for Health Sciences and Technology, Institute of Nursing Science, Hall in Tirol, Austria
| | - Michael Schomaker
- Ludwig-Maximilians-Universität München, Department of Statistics, Munich, Germany; University of Cape Town, Centre of Infectious Disease Epidemiology and Research, Cape Town, South Africa
| | - Anca Del Rio
- Strategy and Global Development Advisor, EIT Health Germany-Switzerland, Munich, Germany
| | - Uwe Siebert
- UMIT TIROL- University for Health Sciences and Technology, Institute of Public Health, Medical Decision Making and HTA, Hall in Tirol, Austria; Harvard T.H. Chan School of Public Health, Center for Health Decision Science and Departments of Epidemiology and Health Policy & Management, Boston, MA, USA; Massachusetts General Hospital, Harvard Medical School, Institute for Technology Assessment and Department of Radiology, Boston, MA, USA
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Liberati EG, Martin GP, Lamé G, Waring J, Tarrant C, Willars J, Dixon-Woods M. What can Safety Cases offer for patient safety? A multisite case study. BMJ Qual Saf 2024; 33:156-165. [PMID: 37734957 PMCID: PMC10894827 DOI: 10.1136/bmjqs-2023-016042] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 08/15/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND The Safety Case is a regulatory technique that requires organisations to demonstrate to regulators that they have systematically identified hazards in their systems and reduced risks to being as low as reasonably practicable. It is used in several high-risk sectors, but only in a very limited way in healthcare. We examined the first documented attempt to apply the Safety Case methodology to clinical pathways. METHODS Data are drawn from a mixed-methods evaluation of the Safer Clinical Systems programme. The development of a Safety Case for a defined clinical pathway was a centrepiece of the programme. We base our analysis on 143 interviews covering all aspects of the programme and on analysis of 13 Safety Cases produced by clinical teams. RESULTS The principles behind a proactive, systematic approach to identifying and controlling risk that could be curated in a single document were broadly welcomed by participants, but was not straightforward to deliver. Compiling Safety Cases helped teams to identify safety hazards in clinical pathways, some of which had been previously occluded. However, the work of compiling Safety Cases was demanding of scarce skill and resource. Not all problems identified through proactive methods were tractable to the efforts of front-line staff. Some persistent hazards, originating from institutional and organisational vulnerabilities, appeared also to be out of the scope of control of even the board level of organisations. A particular dilemma for organisational senior leadership was whether to prioritise fixing the risks proactively identified in Safety Cases over other pressing issues, including those that had already resulted in harm. CONCLUSIONS The Safety Case approach was recognised by those involved in the Safer Clinical Systems programme as having potential value. However, it is also fraught with challenge, highlighting the limitations of efforts to transfer safety management practices to healthcare from other sectors.
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Affiliation(s)
- Elisa Giulia Liberati
- THIS Institute (The Healthcare Improvement Studies Institute), Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Graham P Martin
- THIS Institute (The Healthcare Improvement Studies Institute), Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Guillaume Lamé
- THIS Institute (The Healthcare Improvement Studies Institute), Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Laboratoire Genie Industriel, CentraleSupélec, Paris Saclay University, Gif-sur-Yvette, France
| | - Justin Waring
- Health Services Management Centre, University of Birmingham, Birmingham, UK
| | - Carolyn Tarrant
- Department of Population Health Sciences, University of Leicester, Leicester, UK
| | - Janet Willars
- Department of Population Health Sciences, University of Leicester, Leicester, UK
| | - Mary Dixon-Woods
- THIS Institute (The Healthcare Improvement Studies Institute), Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
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McGowan J, Attal B, Kuhn I, Hinton L, Draycott T, Martin GP, Dixon-Woods M. Quality and reporting of large-scale improvement programmes: a review of maternity initiatives in the English NHS, 2010-2023. BMJ Qual Saf 2024:bmjqs-2023-016606. [PMID: 38050180 DOI: 10.1136/bmjqs-2023-016606] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 11/13/2023] [Indexed: 12/06/2023]
Abstract
BACKGROUND Large-scale improvement programmes are a frequent response to quality and safety problems in health systems globally, but have mixed impact. The extent to which they meet criteria for programme quality, particularly in relation to transparency of reporting and evaluation, is unclear. AIM To identify large-scale improvement programmes focused on intrapartum care implemented in English National Health Service maternity services in the period 2010-2023, and to conduct a structured quality assessment. METHODS We drew on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidance to inform the design and reporting of our study. We identified relevant programmes using multiple search strategies of grey literature, research databases and other sources. Programmes that met a prespecified definition of improvement programme, that focused on intrapartum care and that had a retrievable evaluation report were subject to structured assessment using selected features of programme quality. RESULTS We identified 1434 records via databases and other sources. 14 major initiatives in English maternity services could not be quality assessed due to lack of a retrievable evaluation report. Quality assessment of the 15 improvement programmes meeting our criteria for assessment found highly variable quality and reporting. Programme specification was variable and mostly low quality. Only eight reported the evidence base for their interventions. Description of implementation support was poor and none reported customisation for challenged services. None reported reduction of inequalities as an explicit goal. Only seven made use of explicit patient and public involvement practices, and only six explicitly used published theories/models/frameworks to guide implementation. Programmes varied in their reporting of the planning, scope and design of evaluation, with weak designs evident. CONCLUSIONS Poor transparency of reporting and weak or absent evaluation undermine large-scale improvement programmes by limiting learning and accountability. This review indicates important targets for improving quality in large-scale programmes.
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Affiliation(s)
- James McGowan
- The Healthcare Improvement Studies Institute (THIS Institute), Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Bothaina Attal
- The Healthcare Improvement Studies Institute (THIS Institute), Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Isla Kuhn
- The Healthcare Improvement Studies Institute (THIS Institute), Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Lisa Hinton
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Tim Draycott
- Department of Women's Health, North Bristol NHS Trust, Westbury on Trym, Bristol, UK
| | - Graham P Martin
- The Healthcare Improvement Studies Institute (THIS Institute), Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Mary Dixon-Woods
- The Healthcare Improvement Studies Institute (THIS Institute), Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
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Verma AA, Trbovich P, Mamdani M, Shojania KG. Grand rounds in methodology: key considerations for implementing machine learning solutions in quality improvement initiatives. BMJ Qual Saf 2024; 33:121-131. [PMID: 38050138 DOI: 10.1136/bmjqs-2022-015713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 11/04/2023] [Indexed: 12/06/2023]
Abstract
Machine learning (ML) solutions are increasingly entering healthcare. They are complex, sociotechnical systems that include data inputs, ML models, technical infrastructure and human interactions. They have promise for improving care across a wide range of clinical applications but if poorly implemented, they may disrupt clinical workflows, exacerbate inequities in care and harm patients. Many aspects of ML solutions are similar to other digital technologies, which have well-established approaches to implementation. However, ML applications present distinct implementation challenges, given that their predictions are often complex and difficult to understand, they can be influenced by biases in the data sets used to develop them, and their impacts on human behaviour are poorly understood. This manuscript summarises the current state of knowledge about implementing ML solutions in clinical care and offers practical guidance for implementation. We propose three overarching questions for potential users to consider when deploying ML solutions in clinical care: (1) Is a clinical or operational problem likely to be addressed by an ML solution? (2) How can an ML solution be evaluated to determine its readiness for deployment? (3) How can an ML solution be deployed and maintained optimally? The Quality Improvement community has an essential role to play in ensuring that ML solutions are translated into clinical practice safely, effectively, and ethically.
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Affiliation(s)
- Amol A Verma
- Unity Health Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
- Medicine, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
| | - Patricia Trbovich
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Centre for Quality Improvement and Patient Safety, Department of Medicine, University of Toronto, Toronto, ON, Canada
- North York General Hospital, Toronto, ON, Canada
| | - Muhammad Mamdani
- Unity Health Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Medicine, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
| | - Kaveh G Shojania
- Medicine, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
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Crosby A, Jennings JK, Mills AT, Silcock J, Bourne RS. Economic evaluations of adult critical care pharmacy services: a scoping review. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2023; 31:574-584. [PMID: 37607337 DOI: 10.1093/ijpp/riad049] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 07/05/2023] [Indexed: 08/24/2023]
Abstract
OBJECTIVES To summarise the extent and type of evidence available regarding economic evaluations of adult critical care pharmacy services in the context of UK practice. METHODS A literature search was conducted in eight electronic databases and hand searching of full-text reference lists. Of 2409 journal articles initially identified, 38 were included in the final review. Independent literature review was undertaken by two investigators in a two-step process against the inclusion and exclusion criteria; title and abstract screening were followed by full-text screening. Included studies were taken from high-income economy countries that contained economic data evaluating any key aspect of adult critical care pharmacy services. Grey literature and studies that could not be translated into the English language were excluded. RESULTS The majority were before-and-after studies (18, 47%) or other observational studies (17, 45%), and conducted in North America (25, 66%). None of the included studies were undertaken in the UK. Seven studies (18%) included cost-benefit analysis; all demonstrated positive cost-benefit values for clinical pharmacist activities. CONCLUSIONS Further high-quality primary research focussing on the economic evaluation of UK adult critical care pharmacy services is needed, before undertaking a future systematic review. There is an indication of a cost-benefit value for critical care pharmacist activities. The lack of UK-based economic evaluations is a limitation to further development and standardisation of critical care pharmacy services nationally.
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Affiliation(s)
- Alex Crosby
- Department of Pharmacy, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Jennifer K Jennings
- Department of Pharmacy, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Anna T Mills
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Jonathan Silcock
- Faculty of Life Sciences, School of Pharmacy and Medical Sciences, University of Bradford, Bradford, UK
| | - Richard S Bourne
- Department of Pharmacy, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
- Division of Pharmacy and Optometry, School of Health Sciences, University of Manchester, Manchester, UK
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Bos M, Schouten J, De Bot C, Vermeulen H, Hulscher M. A hidden gem in multidisciplinary antimicrobial stewardship: a systematic review on bedside nurses' activities in daily practice regarding antibiotic use. JAC Antimicrob Resist 2023; 5:dlad123. [PMID: 38021036 PMCID: PMC10667038 DOI: 10.1093/jacamr/dlad123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 11/02/2023] [Indexed: 12/01/2023] Open
Abstract
Background Antimicrobial stewardship (AMS), the set of actions to ensure antibiotics are used appropriately, is increasingly targeted at all those involved in the antimicrobial pathway, including nurses. Several healthcare organizations have issued position statements on how bedside nurses can be involved in AMS. However, it remains unclear how nurses, in reality, contribute to appropriate antibiotic use. Objectives To systematically search the literature to describe the activities bedside nurses perform regarding antibiotic use in daily clinical practice, in relation to the activities proposed by the aforementioned position statements. Methods We searched MEDLINE, Embase, CINAHL and grey literature until March 2021. Studies were included if they described activities regarding antibiotic use performed by bedside nurses. Methodological rigour was assessed by applying the Mixed Method Appraisal Tool. Results A total of 118 studies were included. The majority of the proposed nurses' activities were found in daily practice, categorized into assessment of clinical status, collection of specimens, management of antimicrobial medication, prompting review and educating patient and relatives. Nurses may take the lead in these clinical processes and are communicators in all aspects of the antimicrobial pathway. Patient advocacy appears to be a strong driver of bedside nurses' activities. Conclusions Nurses' activities are already integrated in the day-to-day nursing practice and are grounded in the essence of nursing, being a patient advocate and showing nursing leadership in safeguarding the antimicrobial treatment process. An essential element of the nursing role is communication with other stakeholders in the patient-centred antimicrobial pathway. Educating, engaging and empowering nurses in this already integrated role, could lead to a solid, impactful nursing contribution to AMS.
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Affiliation(s)
- Maria Bos
- School of Social Work and Health, Avans University of Applied Sciences, ’s Hertogenbosch, The Netherlands
- Scientific Center for Quality of Healthcare (IQ Healthcare), Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jeroen Schouten
- Scientific Center for Quality of Healthcare (IQ Healthcare), Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Intensive Care Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Cindy De Bot
- School of Social Work and Health, Avans University of Applied Sciences, ’s Hertogenbosch, The Netherlands
| | - Hester Vermeulen
- Scientific Center for Quality of Healthcare (IQ Healthcare), Radboud University Medical Center, Nijmegen, The Netherlands
- School of Health, HAN University of Applied Sciences, Nijmegen, The Netherlands
| | - Marlies Hulscher
- Scientific Center for Quality of Healthcare (IQ Healthcare), Radboud University Medical Center, Nijmegen, The Netherlands
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11
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Rajaee AN, Olson DW, Freelove D, Velupillai N, Buro K, Sondekoppam RV, Özelsel TJP. Comparison of the Quality of Recovery-15 score in patients undergoing oncoplastic breast-conserving surgery under monitored anesthesia care versus general anesthesia: a prospective quality improvement study. Can J Anaesth 2023; 70:1928-1938. [PMID: 37749365 DOI: 10.1007/s12630-023-02567-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 04/14/2023] [Accepted: 04/28/2023] [Indexed: 09/27/2023] Open
Abstract
PURPOSE Whether changing the institutional practice from general anesthesia (GA) to monitored anesthesia care (MAC) affects postoperative quality of recovery for oncoplastic breast-conserving surgery (BCS) is currently unknown. We designed this quasi-experimental study to evaluate a quality improvement (QI) initiative instituted in Edmonton, AB, Canada. METHODS We chose a prospective controlled cohort study design for this QI study, where patients underwent oncoplastic BCS under MAC in one hospital and BCS under GA at another hospital (control). A total of 125 patients undergoing surgery between May 2021 and February 2022 were enrolled. Exclusion criteria were male sex, total mastectomy, or age under 18. All other patients were included. The primary outcome was the change in Quality of Recovery-15 score at 24 hr compared with a preoperative baseline. Secondary outcomes included intra- and postoperative time profiles, perioperative analgesic and antiemetic use and length of hospital stay. Statistical analysis included a propensity score analysis to account for confounding variables. RESULTS Sixty-four patients received GA and 61 MAC. No enrolled patients were lost to follow up but two were excluded secondarily. No patients receiving MAC needed conversion to GA or unplanned airway management. Monitored anesthesia care was associated with superior outcomes for the primary outcome (β/SE[β], 3.31; 99.5% confidence interval, 0.45 to 6.17; P = 0.001) and most secondary outcomes, when accounting for confounding factors. CONCLUSIONS A care transformation initiative for patients undergoing oncoplastic BCS under MAC was associated with a higher quality recovery profile and shorter length of stay without any increase in perioperative or postoperative adverse events.
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Affiliation(s)
- Azadeh N Rajaee
- Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - David W Olson
- Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | | | - Nirudika Velupillai
- Department of Mathematics and Statistics, MacEwan University, Edmonton, AB, Canada
| | - Karen Buro
- Department of Mathematics and Statistics, MacEwan University, Edmonton, AB, Canada
| | - Rakesh V Sondekoppam
- Department of Anesthesia, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Timur J-P Özelsel
- Department of Anesthesiology & Pain Medicine, University of Alberta, 2-150 Clinical Sciences Building, 8440 112 Street NW, Edmonton, AB, T6G 2B7, Canada.
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12
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Weigl M, Heinrich M, Rivas J, Bergmann F, Kurz M, Silbereisen C, Dieterich HJ, Kleine B, Riek S, Olivieri M, Hoffmann F, Lieftüchter V. Teamwork and mental workload in postsurgical pediatric patient handovers: Prospective effect evaluation of an improvement intervention for OR-PICU patient transitions. Eur J Pediatr 2023; 182:5637-5647. [PMID: 37819421 PMCID: PMC10746584 DOI: 10.1007/s00431-023-05241-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 09/22/2023] [Accepted: 09/25/2023] [Indexed: 10/13/2023]
Abstract
Postsurgical handover of pediatric patients from operating rooms (OR) to pediatric intensive care units (PICU) is a critical step. This transition is susceptible to errors and inefficiencies particularly if poor multidisciplinary teamwork occurs. Despite wide adoption of standardized handover interventions, comprehensive investigations into joint effects for patient care and provider outcomes are scarce. We aimed to improve OR-PICU handovers quality and sought to evaluate the intervention with particular attention to patient care effects and provider outcomes. A prospective, before-after-study design with an interrupted-series and a multi-source, mixed-methods evaluation approach was established. Drawing upon a participative plan-do-study-act approach, a standardized, checklist-based handover process was designed and implemented. For effect assessments, we observed OR-PICU handovers on site (pre implementation: n = 31, post: n = 30), respectively, with standardized expert observation and provider self-report tools (n = 111, n = 110). Setting was a tertiary Pediatric University Hospital. Supplementary qualitative, semi-structured interviews were conducted, and a general inductive content analysis approach was used to identify key facilitators and barriers on implementation. Improvement efforts focused on stepwise implementation of (1) standardized handover process and (2) a checklist for multi-professional OR-PICU handover communication. We observed significant increases in team and patient setup (pre: 79.3%, post: 98.6%, p < .01), enhanced team engagement (pre: 50%, post: 81.7%, p < .01), and comprehensive information transfer by the anesthesia sub-team (pre: 78.6%, post: 87.3%, p < .01). Expert-rated teamwork outcomes were consistently higher, yet self-reported teamwork did not change over time. Provider perceived stress and disruptions did not change, mental workload tended to decrease over time (pre: M = 3.2, post: 2.9, p = .08). Comprehensiveness of post-operative patient information reported by PICU physician increased significantly: pre: 65.9%, post: 76.2%, p < .05. After implementation, providers acknowledged the importance of standardized handover practices and associated benefits for facilitation of information transfer and comprehensiveness. Among reported barriers were obstacles during implementation as well as insufficient consideration of professionals' individual workflow after surgery. CONCLUSION A multidisciplinary intervention for postsurgical pediatric patient handovers was associated with improved expert-rated teamwork and fewer omissions of key patient information over time. Inconsistent results were obtained for provider-rated mental workload and teamwork outcomes. The findings contribute to a better understanding concerning the interplay of teamwork and provider cognitions in the course of establishing safe patient transitions in pediatric care. WHAT IS KNOWN • Transfer of critically ill children conveys significant challenges for interprofessional communication and teamwork. Prospective research into interventions for safe and efficient handover practices of OR PICU patient transitions is necessary. • Checklists are assumed to facilitate cognitive load among providers in acute clinical environments. WHAT IS NEW • A standardized, checklist-based handover intervention was associated with improvements in team set-up and information transfer. Provider outcomes such as mental workload and stress did not change over time. • The combination of teamwork and provider assessments allows a more nuanced understanding of implementation barriers and sustainable effects in course of OR-PICU handover interventions.
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Affiliation(s)
- Matthias Weigl
- Institute for Patient Safety, University Hospital, Bonn, 53127, Germany.
- Institute and Clinic for Occupational, Social and Environmental Medicine, LMU University Hospital, LMU Munich, Munich, Germany.
| | - Martina Heinrich
- Department of Pediatric Surgery, Dr. von Hauner Children's Hospital, LMU University Hospital, LMU Munich, Munich, Germany
| | - Julia Rivas
- Institute and Clinic for Occupational, Social and Environmental Medicine, LMU University Hospital, LMU Munich, Munich, Germany
| | - Florian Bergmann
- Department of Pediatric Surgery, Dr. von Hauner Children's Hospital, LMU University Hospital, LMU Munich, Munich, Germany
| | - Matthias Kurz
- Department of Anesthesiology, LMU University Hospital Munich, LMU Munich, Munich, Germany
| | - Clemens Silbereisen
- Department of Anesthesiology, LMU University Hospital Munich, LMU Munich, Munich, Germany
| | - Hans-Juergen Dieterich
- Department of Anesthesiology, LMU University Hospital Munich, LMU Munich, Munich, Germany
| | - Beate Kleine
- Department of Pediatrics, Dr. von Hauner Children's Hospital, LMU University Hospital, LMU Munich, Munich, Germany
| | - Susanne Riek
- Department of Pediatrics, Dr. von Hauner Children's Hospital, LMU University Hospital, LMU Munich, Munich, Germany
| | - Martin Olivieri
- Department of Pediatrics, Dr. von Hauner Children's Hospital, LMU University Hospital, LMU Munich, Munich, Germany
| | - Florian Hoffmann
- Department of Pediatrics, Dr. von Hauner Children's Hospital, LMU University Hospital, LMU Munich, Munich, Germany
| | - Victoria Lieftüchter
- Department of Pediatrics, Dr. von Hauner Children's Hospital, LMU University Hospital, LMU Munich, Munich, Germany
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Thusini S, Soukup T, Chua KC, Henderson C. How is return on investment from quality improvement programmes conceptualised by mental healthcare leaders and why: a qualitative study. BMC Health Serv Res 2023; 23:1009. [PMID: 37726753 PMCID: PMC10510269 DOI: 10.1186/s12913-023-09911-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 08/13/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND Return on Investment (ROI), whereby the ratio of costs to benefits is assessed, is encouraged in-order to justify the value of Quality Improvement (QI) programmes. We previously performed a literature review to develop a ROI conceptual framework for QI programmes. We concluded that, QI-ROI is conceptualised as any monetary and non-monetary benefit. In the current study, we explored if this finding is shared by mental healthcare leaders. We also investigated the stability of this conceptualisation against influencing factors and potential for disinvestment. METHODS We performed qualitative interviews with leaders in an NHS mental health organisation. There were 16 participants: nine board members and seven senior leaders. The interviews were held online via Microsoft Teams and lasted an hour on average. We performed deductive-inductive analysis to seek data from our initial ROI framework and any new data. RESULTS We found that in mental healthcare, QI-ROI is also conceptualised as any valued monetary and non-monetary benefits. There was a strong emphasis on benefits to external partners and a de-emphasis of benefit monetisation. This conceptualisation was influenced by the 1) perceived mandates to improve quality and manage scarce resources, 2) expectations from QI, 3) health and social care values, 4) ambiguity over expectations, and 5) uncertainty over outcomes. Uncertainty, ambiguity, and potential for disinvestment posed a threat to the stability of this conceptualisation but did not ultimately change it. Health and social care values supported maintaining the QI-ROI as any benefit, with a focus on patients and staff outcomes. Socio-political desires to improve quality were strong drivers for QI investment. CONCLUSION Mental healthcare leaders primarily conceptualise QI-ROI as any valued benefit. The inclusion of externalised outcomes which are hard to attribute may be challenging. However, mental healthcare services do collaborate with external partners. The de-emphases of benefit monetisation may also be controversial due to the need for financial accountability. Mental healthcare leaders recognise the importance of efficiency savings. However, they raised concerns over the legitimacy and utility of traditional ROI as a tool for assessing QI value. Further research is needed to bring more clarity on these aspects of the QI-ROI concept.
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Lennox L, Antonacci G, Harris M, Reed J. Unpacking the 'process of sustaining'-identifying threats to sustainability and the strategies used to address them: a longitudinal multiple case study. Implement Sci Commun 2023; 4:68. [PMID: 37337274 DOI: 10.1186/s43058-023-00445-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 05/25/2023] [Indexed: 06/21/2023] Open
Abstract
BACKGROUND Although sustainability remains a recognised challenge for Quality Improvement (QI) initiatives, most available research continues to investigate sustainability at the end of implementation. As a result, the learning and continuous adjustments that shape sustainability outcomes are lost. With little understanding of the actions and processes that influence sustainability within QI initiatives, there is limited practical guidance and direction on how to enhance the sustainability of QI initiatives. This study aims to unpack the 'process of sustaining', by exploring threats to sustainability encountered throughout the implementation of QI Initiatives and identifying strategies used by QI teams to address these threats over time. METHODS A longitudinal multiple case study design was employed to follow 4 QI initiatives over a 3-year period. A standardised sustainability tool was used quarterly to collect perceptions of sustainability threats and actions throughout implementation. Interviews (n=38), observations (32.5 h), documentary analysis, and a focus group (n=10) were conducted to enable a greater understanding of how the process of sustaining is supported in practice. Data were analysed using the Consolidated Framework for Sustainability (CFS) to conduct thematic analysis. RESULTS Analysis identified five common threats to sustainability: workforce stability, improvement timelines, organisational priorities, capacity for improvement, and stakeholder support. Each of these threats impacted multiple sustainability constructs demonstrating the complexity of the issues encountered. In response to threats, 12 strategies to support the process of sustaining were identified under three themes: engagement (five strategies that promoted the development of relationships), integration (three strategies that supported initiatives to become embedded within local systems), and adaptation (four strategies that enhanced understanding of, and response to, emergent conditions and contextual needs). CONCLUSIONS Sustaining improvements from QI initiatives requires continuous investment in relationships, resilience to integrate improvements in local systems, and flexibility to understand emergent conditions. Findings provide practitioners, funders, and researchers with a better understanding of, and preparation for, the threats associated with sustaining improvements from QI initiatives and offer insight into specific actions that can be taken to mitigate these risks. This learning can be used to inform future initiative design and support, to optimise the sustainability of healthcare improvements. TRIAL REGISTRATION Not applicable.
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Affiliation(s)
- Laura Lennox
- National Institute of Health Research (NIHR) Applied Research Collaboration (ARC) for Northwest London, 369 Fulham Road, London, SW10 9NH, UK.
- Department of Primary Care and Public Health, Imperial College London, Charing Cross Campus, The Reynolds Building, St Dunstan's Road, London, W6 8RP, UK.
| | - Grazia Antonacci
- National Institute of Health Research (NIHR) Applied Research Collaboration (ARC) for Northwest London, 369 Fulham Road, London, SW10 9NH, UK
- Department of Primary Care and Public Health, Imperial College London, Charing Cross Campus, The Reynolds Building, St Dunstan's Road, London, W6 8RP, UK
- Business School, Centre for Health Economics and Policy Innovation (CHEPI), Imperial College London, South Kensington Campus, Exhibition Rd, London, SW7 2AZ, UK
| | - Matthew Harris
- National Institute of Health Research (NIHR) Applied Research Collaboration (ARC) for Northwest London, 369 Fulham Road, London, SW10 9NH, UK
- Department of Primary Care and Public Health, Imperial College London, Charing Cross Campus, The Reynolds Building, St Dunstan's Road, London, W6 8RP, UK
| | - Julie Reed
- Julie Reed Consultancy Ltd, 27 Molasses House, London, UK
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Fournie M, Sibbald SL, Harris SB. Exploring quality improvement for diabetes care in First Nations communities in Canada: a multiple case study. BMC Health Serv Res 2023; 23:462. [PMID: 37161499 PMCID: PMC10170692 DOI: 10.1186/s12913-023-09442-3] [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: 01/21/2022] [Accepted: 04/24/2023] [Indexed: 05/11/2023] Open
Abstract
BACKGROUND Indigenous peoples in Canada experience higher rates of diabetes and worse outcomes than non-Indigenous populations in Canada. Strategies are needed to address underlying health inequities and improve access to quality diabetes care. As part of the national FORGE AHEAD Research Program, this study explores two primary healthcare teams' quality improvement (QI) process of developing and implementing strategies to improve the quality of diabetes care in First Nations communities in Canada. METHODS This study utilized a community-based participatory and qualitative case study methodology. Multiple qualitative data sources were analyzed to understand: (1) how knowledge and information was used to inform the teams' QI process; (2) how the process was influenced by the context of primary care services within communities; and (3) the factors that supported or hindered their QI process. RESULTS The findings of this study demonstrate how teams drew upon multiple sources of knowledge and information to inform their QI work, the importance of strengthening relationships and building relationships with the community, the influence of organizational support and capacity, and the key factors that facilitated QI efforts. CONCLUSIONS This study contributes to the ongoing calls for research in understanding the process and factors affecting the implementation of QI strategies, particularly within Indigenous communities. The knowledge generated may help inform community action and the future development, implementation and scale-up of QI programs in Indigenous communities in Canada and globally.
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Affiliation(s)
| | - Shannon L Sibbald
- Faculty of Health Sciences, Western University, London, ON, Canada
- The Schulich Interfaculty Program in Public Health, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
- Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Stewart B Harris
- Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
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Larson BA, Tsikhutsu I, Bii M, Halim N, Agaba P, Sugut W, Muli J, Sawe F. The effects of revised peer-counselor support on the PMTCT cascade of care: results from a cluster-randomized trial in Kenya (the EMMA study). BMC Infect Dis 2023; 23:257. [PMID: 37098468 PMCID: PMC10127503 DOI: 10.1186/s12879-023-08246-4] [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: 01/17/2023] [Accepted: 04/12/2023] [Indexed: 04/27/2023] Open
Abstract
BACKGROUND This study evaluated the effect of revisions to existing peer-counselor services, called Mentor Mothers (MM), at maternal and child health clinics on medication adherence for women living with HIV (WLWH) in Kenya and on early infant HIV testing. METHODS The Enhanced Mentor Mother Program study was a 12-site, two-arm cluster-randomized trial enrolling pregnant WLWH from March 2017 to June 2018 (with data collection through September 2020). Six clinics were randomized to continued MM-supported standard care (SC). Six clinics were randomized to the intervention arm (INT = SC plus revised MM services to include more one-on-one interactions). Primary outcomes for mothers were defined as: (PO1) the proportion of days covered (PDC) with antiretroviral therapy (ART) ≥ 0.90 during the last 24-weeks of pregnancy; and (PO2) ≥ 0.90 PDC during the first 24-weeks postpartum. Secondary outcomes were infant HIV testing according to national guidelines (at 6, 24, and 48 weeks). Crude and adjusted risk differences between study arms are reported. RESULTS We enrolled 363 pregnant WLHV. After excluding known transfers and subjects with incomplete data extraction, data were analyzed for 309 WLWH (151 SC, 158 INT). A small share achieved high PDC during the prenatal and postnatal periods (0.33 SC/0.24 INT achieved PO1; 0.30 SC/0.31 INT achieved PO2; crude or adjusted risk differences were not statistically significant). In addition, ~ 75% in both study arms completed viral load testing during year two after enrollment, with > 90% suppressed in both arms. For infants, ≥ 90% in both arms had at least one HIV test through study follow up (76 weeks) but testing on schedule according to PMTCT guidelines was uncommon. CONCLUSIONS While national guidelines in Kenya recommended that all HIV-infected pregnant women take a daily antiretroviral regimen for life following a HIV diagnosis, results presented here indicate that a minor share achieved high medication coverage during the prenatal and postnatal periods analyzed. In addition, adjustments to Mentor-Mother services showed no improvement in study outcomes. The lack of effect for this behavioral intervention is relatively consistent with the existing literature to improve mother-infant outcomes along the PMTCT care cascade. CLINICAL TRIAL NUMBER NCT02848235. Date of first trial registration 28/07/2016.
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Affiliation(s)
- Bruce A Larson
- Department of Global Health, Boston University School of Public Health, 801 Massachusetts Avenue, Boston, MA, 02118, USA.
| | - Isaac Tsikhutsu
- Kenya Medical Research Institute, Kericho, Kenya/U.S. Army Medical Research Directorate-Africa, Nairobi, Kenya
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
- HJF Medical Research International, Kericho, Kenya
| | - Margaret Bii
- Kenya Medical Research Institute, Kericho, Kenya/U.S. Army Medical Research Directorate-Africa, Nairobi, Kenya
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
- HJF Medical Research International, Kericho, Kenya
| | - Nafisa Halim
- Department of Global Health, Boston University School of Public Health, 801 Massachusetts Avenue, Boston, MA, 02118, USA
| | - Patricia Agaba
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - William Sugut
- Kenya Medical Research Institute, Kericho, Kenya/U.S. Army Medical Research Directorate-Africa, Nairobi, Kenya
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
- HJF Medical Research International, Kericho, Kenya
| | - Jane Muli
- Kenya Medical Research Institute, Kericho, Kenya/U.S. Army Medical Research Directorate-Africa, Nairobi, Kenya
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
- HJF Medical Research International, Kericho, Kenya
| | - Fredrick Sawe
- Kenya Medical Research Institute, Kericho, Kenya/U.S. Army Medical Research Directorate-Africa, Nairobi, Kenya
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
- HJF Medical Research International, Kericho, Kenya
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Wallin P, Petersson C, Josefsson KA, Nordin A. Enhancing staff capacity to support children with intellectual disability receiving residential services: A realist evaluation of an improvement program. JOURNAL OF POLICY AND PRACTICE IN INTELLECTUAL DISABILITIES 2023. [DOI: 10.1111/jppi.12453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2023]
Affiliation(s)
- Pontus Wallin
- Jönköping Academy for Improvement of Health and Welfare, School of Health and Welfare Jönköping University Jönköping Sweden
| | - Christina Petersson
- Center for Learning and Innovation in Health Care School of Health and Welfare, Jönköping University Jönköping Sweden
| | - Kristina Areskoug Josefsson
- Jönköping Academy for Improvement of Health and Welfare, School of Health and Welfare Jönköping University Jönköping Sweden
- Department of Behavioral Science, Faculty of Health Science Oslo Metropolitan University Oslo Norway
- Department of Health Sciences University West Trollhättan Sweden
| | - Annika Nordin
- Jönköping Academy for Improvement of Health and Welfare, School of Health and Welfare Jönköping University Jönköping Sweden
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Nguyen V, Kertesz M, Davidson J, Humphreys C, Laslett AM. Programme responses for men who perpetrate intimate partner violence in the context of alcohol or other drugs: a scoping review. ADVANCES IN DUAL DIAGNOSIS 2023. [DOI: 10.1108/add-07-2022-0021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Purpose
Substance use plays a significant role in the perpetration of much intimate partner violence (IPV). However, responses to these two issues are rarely integrated. Single focus programme responses can lead to poor outcomes for men as well as their families experiencing these intersecting issues. This scoping paper aims to establish the current state of knowledge on contextual factors influencing the development and implementation of combined programmes.
Design/methodology/approach
Four electronic databases were systematically searched in May 2021 and December 2021. Twenty-one peer-reviewed studies reporting on ten programmes were included.
Findings
This scoping review revealed that combined programme responses are an underdeveloped area of research and evaluation. The limited evidence base indicated systemic barriers hindering services’ capacity to expand this field of work, affecting implementation and outcomes. Support is required from the wider service systems to intervene in men’s perpetration of IPV in the context of substance use.
Practical implications
Findings in this scoping review demonstrate the importance of fostering a coordinated and collective response to IPV in the context of substance use. Combined programmes have the potential to reduce siloed practices, enabling more holistic responses for men with intersecting issues. However, researchers and policymakers must also address contextual issues hindering or enabling combined programmes’ implementation and development.
Originality/value
Mapping the evidence based on combined programmes provides direction for further development and research to expand this field of inquiry.
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Marang-van de Mheen PJ, Woodcock T. Grand rounds in methodology: four critical decision points in statistical process control evaluations of quality improvement initiatives. BMJ Qual Saf 2023; 32:47-54. [PMID: 36109158 DOI: 10.1136/bmjqs-2022-014870] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 08/02/2022] [Indexed: 12/27/2022]
Abstract
Quality improvement (QI) projects often employ statistical process control (SPC) charts to monitor process or outcome measures as part of ongoing feedback, to inform successive Plan-Do-Study-Act cycles and refine the intervention (formative evaluation). SPC charts can also be used to draw inferences on effectiveness and generalisability of improvement efforts (summative evaluation), but only if appropriately designed and meeting specific methodological requirements for generalisability. Inadequate design decreases the validity of results, which not only reduces the chance of publication but could also result in patient harm and wasted resources if incorrect conclusions are drawn. This paper aims to bring together much of what has been written in various tutorials, to suggest a process for using SPC in QI projects. We highlight four critical decision points that are often missed, how these are inter-related and how they affect the inferences that can be drawn regarding effectiveness of the intervention: (1) the need for a stable baseline to enable drawing inferences on effectiveness; (2) choice of outcome measures to assess effectiveness, safety and intervention fidelity; (3) design features to improve the quality of QI projects; (4) choice of SPC analysis aligned with the type of outcome, and reporting on the potential influence of other interventions or secular trends.These decision points should be explicitly reported for readers to interpret and judge the results, and can be seen as supplementing the Standards for Quality Improvement Reporting Excellence guidelines. Thinking in advance about both formative and summative evaluation will inform more deliberate choices and strengthen the evidence produced by QI projects.
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Affiliation(s)
- Perla J Marang-van de Mheen
- Department of Biomedical Data Sciences, Medical Decision Making, J10-S, Leiden University Medical Center, Leiden, The Netherlands
| | - Thomas Woodcock
- National Institute for Health Research Applied Research Collaboration Northwest London, Imperial College London, London, UK
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Chen LP, Gerber DM, Coller RJ. Admitting what is needed: How the health system and society can reduce hospitalizations for children with medical complexity. J Hosp Med 2023; 18:90-94. [PMID: 35996947 PMCID: PMC9817383 DOI: 10.1002/jhm.12948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 08/04/2022] [Accepted: 08/09/2022] [Indexed: 01/11/2023]
Affiliation(s)
- Laura P. Chen
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health
| | - Danielle M. Gerber
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health
| | - Ryan J. Coller
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health
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Harding KE, Camden C, Lewis AK, Perreault K, Taylor NF. Service redesign interventions to reduce waiting time for paediatric rehabilitation and therapy services: A systematic review of the literature. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:2057-2070. [PMID: 35716009 PMCID: PMC10084082 DOI: 10.1111/hsc.13866] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 04/06/2022] [Accepted: 05/28/2022] [Indexed: 06/15/2023]
Abstract
Despite well-documented benefits of rehabilitation and therapy services for children with disabilities, long waiting lists to access these services are common. There is a growing body of evidence, primarily from mixed or adult services, demonstrating that waiting times can be reduced through strategies that target wasteful processes and support services to keep up with demand. However, providers of rehabilitation and therapy services for children face additional complexities related to the long-term nature of many developmental conditions and the need to consider timing of interventions with developmental milestones and education transition points. This review aimed to synthesise available evidence on service redesign strategies in reducing waiting time for paediatric therapy services. We conducted a systematic review of studies conducted in outpatient paediatric rehabilitation or therapy settings, including physical and mental health services, evaluating a service redesign intervention and presenting comparative data on time to access care. Two reviewers independently applied inclusion criteria, assessed risk of bias and extracted data. Findings were analysed descriptively and the certainty of evidence was synthesised according to criteria for health service research. From 1934 studies identified, 33 met the criteria for inclusion. Interventions were categorised as rapid response strategies, process efficiency interventions or substitution strategies (using alternative providers in place of medical specialists). Reductions in waiting time were reported in 30 studies. Evidence is limited by study designs with high risk of bias, but this is mitigated by consistency of findings and large effect sizes. There is moderate-certainty evidence that service redesign strategies similar to those used in adult populations can be applied in paediatric rehabilitation and therapy settings to reduce waiting time.
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Affiliation(s)
- Katherine E. Harding
- La Trobe University, School of Allied HealthHuman Services and SportMelbourneVictoriaAustralia
- Eastern Health Allied Health Clinical Research OfficeBox HillVictoriaAustralia
| | - Chantal Camden
- Sherbrooke University, School of RehabilitationSherbrookeQuébecCanada
| | - Annie K. Lewis
- La Trobe University, School of Allied HealthHuman Services and SportMelbourneVictoriaAustralia
- Eastern Health Allied Health Clinical Research OfficeBox HillVictoriaAustralia
| | - Kadija Perreault
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Centre intégré universitaire de santé et de services sociaux de la Capitale‐NationaleQuébec CityQuébecCanada
- Department of Rehabilitation, Faculty of MedicineUniversité LavalQuébec CityQuébecCanada
| | - Nicholas F. Taylor
- La Trobe University, School of Allied HealthHuman Services and SportMelbourneVictoriaAustralia
- Eastern Health Allied Health Clinical Research OfficeBox HillVictoriaAustralia
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de los Reyes S, Al-Khaled D, Brito K, Kholmatov M, Farley B, Kuriloff M, Stamos G, Victorson D, Plunkett B. AWHONN postpartum discharge education: patient knowledge and sustainability. BMJ Open Qual 2022; 11:bmjoq-2021-001528. [DOI: 10.1136/bmjoq-2021-001528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 09/16/2022] [Indexed: 11/06/2022] Open
Abstract
ObjectiveThe objective is to evaluate whether the implementation of the Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN) postpartum discharge educational initiative is associated with improved patient knowledge of warning signs of severe maternal morbidity (SMM) and if the initiative is self-sustaining.DesignA pre–post design was used to evaluate patient knowledge of warning signs of SMM (Plan–Do–Study–Act, PDSA cycle 1) and if the quality improvement initiative was self-sustaining (PDSA cycle 2). Patient understanding of warning signs of SMM prior to initiation of the AWHONN education (Usual Discharge) was compared with understanding of those who were discharged after implementation (POST-BIRTH discharge). The initiative was designed to be self-sustaining. The POST-BIRTH flyer describes nine warning signs of SMM. Eligible participants were English-speaking patients discharged with a live newborn who were able to be contacted within 2 weeks. Participants completed a telephone administered nine-item survey to assess knowledge of SMM. The primary outcome was the percentage of correct answers. To evaluate sustainability, whether the POST-BIRTH fliers and discharge checklist were still being used at 19 months postinitiative was planned.ResultsFor PDSA cycle 1, in the Usual Discharge group, 347 patients were discharged, 164 (44.7%) were eligible and 151 (92.1%) completed the survey. In the POST-BIRTH discharge group, 268 patients were discharged, 199 (74.3%) were eligible and 183 (92.0%) completed the survey. Compared with the Usual Discharge group, the POST-BIRTH group had significantly more correct responses (30% vs 60%, p<0.001). In PDSA cycle 2, POST-BIRTH flyers were still being used universally on one of the two floors from which postpartum patients are discharged, but not the other.ConclusionThe implementation of an educational initiative for postpartum patients is associated with improved knowledge of warning signs of SMM. The use of the education was self-sustaining on one discharge floor but not the other.
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Høyland SA, Holte KA, Islam K, Øygaarden O, Kjerstad E, Høyland SA, Waernes HR, Gürgen M, Conde KB, Hovland KS, Rødseth E, Carayon P, Fallon M, Ivins N, Bradbury S, Husebø SIE, Harding KG, Ternowitz T. A cross-sector systematic review and synthesis of knowledge on telemedicine interventions in chronic wound management-Implications from a system perspective. Int Wound J 2022; 20:1712-1724. [PMID: 36261052 PMCID: PMC10088836 DOI: 10.1111/iwj.13986] [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: 07/04/2022] [Revised: 09/09/2022] [Accepted: 10/09/2022] [Indexed: 11/29/2022] Open
Abstract
Based on initially identified needs for further telemedicine (TM) and chronic wound management research, the objective of this article is twofold: to conduct a systematic review of existing knowledge on TM interventions in chronic wound management-including barriers and opportunities-across the specialist and primary care sectors, and to incorporate the review findings into a system framework that can be further developed and validated through empirical data. We conclude that there is a pressing need for broader and more comprehensive empirical explorations into quality improvement and integration of TM in chronic wound management, including using system frameworks that can capture cross-sector system perspectives and associated implications. Of practical consideration, we suggest that the design and execution of TM improvement interventions and associated research projects should be conducted in close cooperation with managers and practitioners knowledgeable about barriers and opportunities that can influence the implementation of important interventions within chronic wound management.
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Affiliation(s)
- Sindre Aske Høyland
- Division for Health and Social Sciences, NORCE Norwegian Research Centre, Stavanger, Norway
| | - Kari Anne Holte
- Division for Health and Social Sciences, NORCE Norwegian Research Centre, Stavanger, Norway
| | - Kamrul Islam
- Division for Health and Social Sciences, NORCE Norwegian Research Centre, Stavanger, Norway
| | - Olaug Øygaarden
- Division for Health and Social Sciences, NORCE Norwegian Research Centre, Stavanger, Norway
| | - Egil Kjerstad
- Division for Health and Social Sciences, NORCE Norwegian Research Centre, Stavanger, Norway
| | | | | | - Marcus Gürgen
- Department for Dermatology, Stavanger University Hospital, Stavanger, Norway
| | | | | | - Eirin Rødseth
- Department for Personal E-Health, Norwegian Centre for E-health Research, Tromsø, Norway
| | - Pascale Carayon
- Department for Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | | | - Nicola Ivins
- Welsh Wound Innovation Centre WWIC, Ynysmaerdy, Wales
| | | | | | - Keith G Harding
- School of Medicine, Cardiff University, Cardiff, UK.,Skin Research Institute of Singapore (SRIS), Novena, Singapore
| | - Thomas Ternowitz
- Department for Dermatology, Stavanger University Hospital, Stavanger, Norway
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Jesus TS, Stern BZ, Struhar J, Deutsch A, Heinemann AW. The use of patient experience feedback in rehabilitation quality improvement and codesign activities: Scoping review of the literature. Clin Rehabil 2022; 37:261-276. [DOI: 10.1177/02692155221126690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective To characterize the literature, reported enablers, and gaps on the use of patient experience feedback for person-centered rehabilitation quality improvement and codesign activities. Design Scoping Review. Data sources Scientific databases (PubMed, CINAHL, Rehabdata, Scopus, Web of Science, ProQuest), website searches (e.g. Beryl Institute), snowballing, and key-informant recommendations. Methods Two independent reviewers performed title and abstract screenings and full-text reviews. Eligibility focused on English-language, peer-reviewed (all time) and gray literature (last five years) that used patient experience feedback in rehabilitation improvement activities. The aims, settings, methods, findings, implications, and reported limitations were extracted, followed by content analyses identifying reported enablers and gaps. Results Among the 901 unique references and 52 full texts reviewed, ten were included: four used patient experience surveys for improving patient experiences; six used codesign methodologies to engage patient feedback in service improvement activities. Implementation enablers included securing managerial support, having a structured methodology and facilitator, using efficient processes, engaging staff experiences, and using appreciative inquiry. Reported study gaps included limited follow-up, low sample sizes, analytical limitations, lack of reported limitations, or narrow range of perspectives (e.g. not from people with severe impairments). Conclusion Few examples of the use of patient experience feedback in quality improvement or codesign activities were found in the rehabilitation literature. Patient experience improvement activities relied exclusively on retrospective survey data, which were not combined with often more actionable forms (e.g. qualitative, real time) of patient experience feedback. Further research might consider design of activities that collect and use patient experience feedback for rehabilitation service improvements.
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Affiliation(s)
- TS Jesus
- Center for Education in Health Sciences, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - BZ Stern
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - J Struhar
- Nerve, Muscle + Bone Innovation Center & Oncology Innovation Center, Shirley Ryan AbilityLab, Chicago, IL, USA
| | - A Deutsch
- Center for Rehabilitation Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL, USA
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- RTI International, Chicago, IL, USA
| | - AW Heinemann
- Center for Rehabilitation Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL, USA
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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25
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Hu ZJ, Fusch G, Hu C, Wang JY, Munroe M, el Helou S, Thabane L. Methodologic attributes of quality improvement studies in neonatology: a systematic survey. BMJ Open Qual 2022. [PMCID: PMC9445793 DOI: 10.1136/bmjoq-2022-001898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Introduction Quality improvement (QI) is a growing field of inquiry in healthcare, including neonatology. However, there is limited information on the study setting, and the methodologic approaches used to develop, implement and evaluate QI interventions in neonatology studies. In this study, we describe these intervention characteristics and approaches. Methods Articles were taken from a previous publication. There, we searched MEDLINE for publications of QI studies from 2016 to 16 April 2020. We retrieved all relevant full-text publications and sampled 100 of these articles for data abstraction, stratified by the year of publication. For each QI study, we described several methodological characteristics that included: the clinical topic of QI, setting, whether the study was multicentre, stakeholder engagement, root cause analysis and related problem identification methods, implementation techniques for QI interventions, types of outcomes and statistical analysis methods used. Results We assessed 100 studies; most were conducted in the USA (56%). Academic settings and multicentre settings comprised 44% and 24% of studies, respectively. Most studies reported stakeholder engagement (81%), but infrequently reported engagement with leadership (32%) and caregivers (10%). Frequently used techniques for implementing interventions include provider education (82%), formal QI methods (42%) and audit, feedback and benchmarking (40%). Both patient-important clinical outcomes (78%) and process outcomes (89%) were frequently reported. P values were frequently reported (80%), but other statistical techniques were infrequently used. Conclusion QI studies in neonatology use diverse multicomponent interventions. Reporting of these methodologic details can be useful in designing, implementing and evaluating QI studies in clinical practice.
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Affiliation(s)
- Zheng Jing Hu
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Gerhard Fusch
- Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Catherine Hu
- Bachelor of Arts and Science, McMaster University, Hamilton, Ontario, Canada
| | - Jie Yi Wang
- Bachelor of Medical Sciences, University of Western Ontario, North York, Ontario, Canada
| | - Maleeka Munroe
- Global Health, McMaster University, Hamilton, Ontario, Canada
| | - Salhab el Helou
- Department of Health Research Methods, Evidence and Impact, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence and Impact, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
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Vindrola-Padros C, Ledger J, Barbosa EC, Fulop NJ. The Implementation of Improvement Interventions for "Low Performing" and "High Performing" Organisations in Health, Education and Local Government: A Phased Literature Review. Int J Health Policy Manag 2022; 11:874-882. [PMID: 33160292 PMCID: PMC9808185 DOI: 10.34172/ijhpm.2020.197] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 10/04/2020] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND There is limited understanding about whether and how improvement interventions are effective in supporting failing healthcare organisations and improving the quality of care in high-performing organisations. The aim of this review was to examine the underlying concepts guiding the design of interventions aimed at low and high performing healthcare organisations, processes of implementation, unintended consequences, and their impact on costs and quality of care. The review includes articles in the healthcare sector and other sectors such as education and local government. METHODS We carried out a phased rapid systematic review of the literature. Phase one was used to develop a theoretical framework of organisational failure and turnaround, and the types of interventions implemented to improve quality. The framework was used to inform phase 2, which was targeted and focused on organisational failure and turnaround in healthcare, education and local government settings. We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement to guide the reporting of the methods and findings and the Mixed Methods Appraisal Tool (MMAT) as a quality assessment tool. The review protocol was registered with PROSPERO (CRD: 42019131024). RESULTS Failure is frequently defined as the inability of organisations to meet pre-established performance standards and turnaround as a linear process. Improvement interventions are designed accordingly and are focused on the organisation, with limited system-level thinking. Successful interventions included restructuring senior leadership teams, inspections, and organisational restructuring by external organisations. Limited attention was paid to the potential negative consequences of the interventions and their costs. CONCLUSION Dominant definitions of success/failure and turnaround have led to the reduced scope of improvement interventions, the linear perception of turnaround, and lack of consideration of organisations within the wider system in which they operate. Future areas of research include an analysis of the costs of delivering these interventions in relation to their impact on quality of care.
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Affiliation(s)
| | - Jean Ledger
- Department of Applied Health Research, University College London, London, UK
| | | | - Naomi J. Fulop
- Department of Applied Health Research, University College London, London, UK
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27
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Using a Plastic Drape to Reduce Hypothermia in Premature Neonates During Peripherally Inserted Central Catheter Placement. Adv Neonatal Care 2022; 22:193-202. [PMID: 34138792 DOI: 10.1097/anc.0000000000000906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Premature neonates require assisted heating devices for thermoregulation in the neonatal intensive care unit (NICU). Traditional use of a cloth blanket and cloth towels during peripherally inserted central catheter (PICC) placement may hinder heat transfer from the assisted heating mechanisms, increasing the risk for neonatal hypothermia. PURPOSE This quality improvement project's goal was to reduce the hypothermia rate in very low birth-weight (VLBW) neonates by replacing cloth blanket/towels with a plastic drape during PICC placement. METHODS The FOCUS-PDSA method was used to implement the intervention (plastic drape) over 3 months, during 58 PICC procedures in a level 3 NICU. A pre-/posttest design was used to evaluate the impact of the intervention on hypothermia rates compared with a baseline cloth group and a concurrent cloth cohort. RESULTS After the 3-month implementation period, the hypothermia rate for the intervention group was lower than that for the baseline cloth group (5.2% and 11.3%, respectively), but this difference was not statistically significant. Post-PICC hypothermia rates were significantly lower for the intervention group than for the concurrent cloth cohort (P = .004). IMPLICATIONS FOR PRACTICE Preliminary evidence demonstrated the plastic drape reduced the hypothermia rate in the NICU for VLBW neonates during PICC placement compared with cloth blanket/towels. A plastic drape shows promise in improving nursing practice by providing improved thermoregulation for premature neonates during PICC placement. IMPLICATIONS FOR RESEARCH Further research is recommended to replicate findings with larger samples of PICC insertions, using a plastic drape in the operating room and other NICU procedures.
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Morishima T, Okawa S, Koyama S, Nakata K, Tabuchi T, Miyashiro I. Between-hospital variations in 3-year survival among patients with newly diagnosed gastric, colorectal, and lung cancer. Sci Rep 2022; 12:7134. [PMID: 35505084 PMCID: PMC9065118 DOI: 10.1038/s41598-022-11225-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 04/20/2022] [Indexed: 11/30/2022] Open
Abstract
Due to increases in cancer survivability, quality assessments of cancer care must include long-term outcomes. This multicenter retrospective cohort study evaluated between-hospital variations in the 3-year survival rates of patients with gastric, colorectal, and lung cancer irrespective of treatment modality. We linked cancer registry data and administrative data from patients aged 18–99 years who were diagnosed with gastric, colorectal, or lung cancer between 2013 and 2015 in Osaka Prefecture, Japan. The 3-year survival rates were adjusted for potential prognostic factors using multilevel logistic regression models. Between-hospital variations were visually evaluated using funnel plots. We analyzed 10,296 gastric cancer patients from 30 hospitals, 9276 colorectal cancer patients from 30 hospitals, and 7978 lung cancer patients from 28 hospitals. The 3-year survival rate was 70.2%, 75.2%, and 45.0% for gastric, colorectal, and lung cancer, respectively. In the funnel plots, the adjusted survival rates of gastric and colorectal cancer for all hospitals lay between the lower and upper control limits of two standard deviations of the average survival rates. However, the adjusted survival rates of lung cancer for four hospitals lay below the lower limit while that for two hospitals lay above the upper limit. Older age, men, advanced cancer stage, comorbidities, functional disability, emergency admission, current/ex-smokers, and underweight were independently associated with poorer survival. In conclusion, there were between-hospital variations in 3-year survival for lung cancer even after adjusting for case mix. Quality improvement initiatives may be needed to raise the consistency of care.
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Affiliation(s)
- Toshitaka Morishima
- Cancer Control Center, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka, 541-8567, Japan.
| | - Sumiyo Okawa
- Cancer Control Center, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka, 541-8567, Japan
| | - Shihoko Koyama
- Cancer Control Center, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka, 541-8567, Japan
| | - Kayo Nakata
- Cancer Control Center, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka, 541-8567, Japan
| | - Takahiro Tabuchi
- Cancer Control Center, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka, 541-8567, Japan
| | - Isao Miyashiro
- Cancer Control Center, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka, 541-8567, Japan
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Brunton L, Sammut-Powell C, Birleson E, Boaden R, Knowles SE, McQuaker C, Cross S, Greaves N, Paroutoglou K, Alzouabi O, Patel HC, Suman A, Kawafi K, Parry-Jones AR. Scale-up of ABC care bundle for intracerebral haemorrhage across two hyperacute stroke units in one region in England: a mixed methods evaluation of a quality improvement project. BMJ Open Qual 2022; 11:bmjoq-2021-001601. [PMID: 35428671 PMCID: PMC9014063 DOI: 10.1136/bmjoq-2021-001601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 03/17/2022] [Indexed: 12/03/2022] Open
Abstract
Background Intracerebral haemorrhage (ICH) accounts for 10%–15% of strokes in the UK, but is responsible for half of all annual global stroke deaths. The ABC bundle for ICH was developed and implemented at Salford Royal Hospital, and was associated with a 44% reduction in 30-day case fatality. Implementation of the bundle was scaled out to the other hyperacute stroke units (HASUs) in the region from April 2017. A mixed methods evaluation was conducted alongside to investigate factors influencing implementation of the bundle across new settings, in order to provide lessons for future spread. Methods A harmonised quality improvement registry at each HASU captured consecutive patients with spontaneous ICH from October 2016 to March 2018 to capture process and outcome measures for preimplementation (October 2016 to March 2017) and implementation (April 2017 to March 2018) time periods. Statistical analyses were performed to determine differences in process measures and outcomes before and during implementation. Multiple qualitative methods (interviews, non-participant observation and project document analysis) captured how the bundle was implemented across the HASUs. Results HASU1 significantly reduced median anticoagulant reversal door-to-needle time from 132 min (IQR: 117–342) preimplementation to 76 min (64–113.5) after implementation and intensive blood pressure lowering door to target time from 345 min (204–866) preimplementation to 84 min (60–117) after implementation. No statistically significant improvements in process targets were observed at HASU2. No significant change was seen in 30-day mortality at either HASU. Qualitative evaluation identified the importance of facilitation during implementation and identified how contextual changes over time impacted on implementation. This identified the need for continued implementation support. Conclusion The findings show how the ABC bundle can be successfully implemented into new settings and how challenges can impede implementation. Findings have been used to develop an implementation strategy to support future roll out of the bundle outside the region.
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Affiliation(s)
- Lisa Brunton
- Division of Population Health, Health Services Research and Primary Care, The University of Manchester, Manchester, UK
| | - Camilla Sammut-Powell
- Division of Informatics, Imaging and Data Sciences, The University of Manchester, Manchester, UK
| | - Emily Birleson
- Stroke Department, Pennine Acute Hospitals NHS Trust, Manchester, UK
| | - Ruth Boaden
- Alliance Manchester Business School, The University of Manchester, Manchester, UK
| | - Sarah E Knowles
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Clare McQuaker
- Stroke Department, Stockport NHS Foundation Trust, Stockport, UK
| | - Stephen Cross
- Stroke Department, Stockport NHS Foundation Trust, Stockport, UK
| | - Natalie Greaves
- Stroke Department, Pennine Acute Hospitals NHS Trust, Manchester, UK
| | | | - Omran Alzouabi
- Stroke Department, Pennine Acute Hospitals NHS Trust, Manchester, UK
| | - Hiren C Patel
- Neurosurgical Department, Salford Royal NHS Foundation Trust, Salford, UK
| | - Appukuttan Suman
- Stroke Department, Stockport NHS Foundation Trust, Stockport, UK
| | - Khalil Kawafi
- Stroke Department, Pennine Acute Hospitals NHS Trust, Manchester, UK
| | - Adrian R Parry-Jones
- Division of Cardiovascular Sciences, The University of Manchester, Manchester, UK
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30
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Tabb KM, Bentley B, Pineros Leano M, Simonovich SD, Nidey N, Ross K, Huang WHD, Huang H. Home Visiting as an Equitable Intervention for Perinatal Depression: A Scoping Review. Front Psychiatry 2022; 13:826673. [PMID: 35370817 PMCID: PMC8971366 DOI: 10.3389/fpsyt.2022.826673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 02/11/2022] [Indexed: 12/03/2022] Open
Abstract
Objective Maternal mental health disorders are a leading complication of childbirth. While few systems are adequately able to identify and treat depression, people experiencing perinatal depression may benefit from the intervention of home visiting. The intent of home visiting interventions is to alleviate stressors of parenthood for people facing additional risk factors. The aim of this scoping review is to investigate the effect of home visiting on perinatal depression grounded in published studies. Methods We conducted a scoping review of the existing literature of studies relevant to perinatal depression and home visiting. We entered keywords in five search databases: MEDLINE, PsycInfo, CINAHL, Social Work Abstracts, and Google Scholar. All relevant literature published between January 1999-December 2019 was reviewed. Duplicates, books, and errata were excluded from the study. As a scoping review, we included all studies published in English describing the inclusion of maternal depression in home visits. We hypothesize birthing people with perinatal depression will benefit from home visiting interventions. Results The results from the scoping review and describe the use of home visiting to improve perinatal mental health. An initial 12,652 records were identified in the search. After duplicates were removed, the titles of 2,140 articles were assessed for applicability, however 29 identified for full-text eligibility and were included in this analysis. The majority of the studies included in this review were quantitative (n = 23), followed by qualitative (n = 3), and mixed methods (n = 3). Nearly all studies (n = 28) using validated instruments such as the Edinburgh Postnatal Depression Scale to determine depressive symptoms. Discussion This review offers preliminary qualitative insights on the efficacy of home visiting for administrating perinatal depression care. Studies show that home visiting programs can provide treatment for perinatal depression and reduce the effects of depression for birthing people. Our review suggests that the efficacy of home visiting programs beginning in the postpartum period are less predictable than prenatal home visiting intervention among various populations, including people experiencing both high-risk and low-risk situations.
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Affiliation(s)
- Karen M. Tabb
- School of Social Work, University of Illinois at Urbana-Champaign, Champaign, IL, United States
| | - Brandie Bentley
- School of Social Work, University of Illinois at Urbana-Champaign, Champaign, IL, United States
| | | | | | - Nichole Nidey
- Cincinnati Children's Hospital Medical Center, Division of Biostatistics and Epidemiology, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Kate Ross
- School of Social Work, University of Illinois at Urbana-Champaign, Champaign, IL, United States
| | - Wen-hao David Huang
- School of Social Work, University of Illinois at Urbana-Champaign, Champaign, IL, United States
| | - Hsiang Huang
- Cambridge Health Alliance (CHA), Cambridge, MA, United States
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31
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What Should Be the Topics of a Prospective Study on Ovarian Masses in Children?—Results of a Multicenter Retrospective Study and a Scoping Literature Review. Curr Oncol 2022; 29:1488-1500. [PMID: 35323325 PMCID: PMC8946882 DOI: 10.3390/curroncol29030125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 02/19/2022] [Accepted: 02/25/2022] [Indexed: 11/17/2022] Open
Abstract
Purpose: to determine management problems of ovarian masses in girls in order to form a baseline for prospective randomized studies of the established topics and quality improvement of our management. Materials and Methods: We performed a national analysis of clinical aspects of ovarian masses in girls operated on in Poland, analyzed retrospectively medical files of all consecutive patients aged 0–18 who underwent surgeries for ovarian lesions between 2012 and 2017 at 17 pediatric surgical departments and complemented the analysis with a scoping review of a recent primary research related to ovarian masses in children. Results: The study group comprised 595 patients. Forty-four (7.39%) girls were diagnosed with malignant tumors. The overall preservation rate was 64.54%. The analysis revealed that positive tumor markers (OR = 10.3), lesions larger than 6 cm (OR = 4.17) and solid mass on ultrasound examination (OR = 5.34) are interdependent variables differentiating malignant tumors from non-malignant lesions (X42 = 79.1; p = 0.00000). Our scoping review revealed 10 major branches of research within the topic of ovarian masses in pediatric population. Conclusions: We have developed an overview of the field with the emphasis on the local environment. Our next step is a multi-institutional prospective study of a quality improvement project implementation based on the obtained knowledge.
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Rosário M, Fonseca AC. Incorporating Quality Improvement Projects Into Stroke Care and Research. Stroke 2022; 53:e118-e121. [PMID: 35135324 DOI: 10.1161/strokeaha.121.038204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Madalena Rosário
- Department of Neurology, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal (M.R., A.C.F.)
| | - Ana Catarina Fonseca
- Department of Neurology, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal (M.R., A.C.F.).,Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal (A.C.F.)
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Brown A, Grierson L. Two sides of the same coin: Quality improvement and program evaluation in health professions education. J Eval Clin Pract 2022; 28:3-9. [PMID: 34291535 DOI: 10.1111/jep.13598] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 06/29/2021] [Accepted: 06/30/2021] [Indexed: 11/29/2022]
Abstract
Health professions education is in constant pursuit of new ways of teaching and assessment in order to improve the training of healthcare professionals. Educators are often challenged with designing, implementing, and evaluating programs in the context of their professional practice, particularly those in response to dynamic and emerging social needs. This article explores the synergies and intersections of two approaches-quality improvement and program evaluation-and the potential utility of their combinations within our field to design, evaluate, and most importantly, improve educational programming. We argue that the inclusion of established quality improvement frameworks within program evaluation provides a proven mechanism for driving change, can optimize programming within the multi-contextual education systems, and, ultimately, that these two approaches are complementary to one another. These combinations hold great promise for optimizing programming in alignment with social missions, where it has been difficult for institutions worldwide to generate and capture evidence of social accountability.
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Affiliation(s)
- Allison Brown
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Lawrence Grierson
- Department of Family Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada.,McMaster Education Research, Innovation, and Theory (MERIT), McMaster University, Hamilton, Ontario, Canada
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Reen G, Page B, Oikonomou E. Working as an embedded researcher in a healthcare setting: A practical guide for current or prospective embedded researchers. J Eval Clin Pract 2022; 28:93-98. [PMID: 34121278 DOI: 10.1111/jep.13593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 05/19/2021] [Accepted: 05/25/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Gurpreet Reen
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Bethan Page
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Eirini Oikonomou
- Department of Experimental Psychology, University of Oxford, Oxford, UK
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Moffatt S, Garry C, McCann H, Teeling SP, Ward M, McNamara M. The Use of Lean Six Sigma Methodology in the Reduction of Patient Length of Stay Following Anterior Cruciate Ligament Reconstruction Surgery. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:1588. [PMID: 35162610 PMCID: PMC8835068 DOI: 10.3390/ijerph19031588] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 01/27/2022] [Accepted: 01/28/2022] [Indexed: 02/04/2023]
Abstract
Background: The purpose of this study was to reduce the length of stay of anterior cruciate ligament reconstruction patients within a private hospital in Ireland, reducing any non-value-added activity in the patient pathway, with the goal of increasing patient flow, bed capacity, and revenue generation within the hospital system, while maintaining patient satisfaction. Methods: We used a pre-/post-intervention design and Lean Six Sigma methods and tools to assess and improve the current process. Results: A reduction in inpatient length of stay by 57%, and a reduction in identified non-value-added activity by 88%, resulted in a new day-case surgery pathway for anterior cruciate ligament reconstruction patients. The pathway evidenced no re-admissions and demonstrated patient satisfaction. Conclusion: Six months post-project commencement, we had successfully achieved our goals of reducing our anterior cruciate ligament reconstruction patient's length of stay. This study contributes to the growing body of published evidence which shows that adopting a Lean Six Sigma approach can be successfully employed to optimise care and surgical pathways in healthcare.
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Affiliation(s)
- Sinead Moffatt
- Beacon Hospital, Beacon Court, Bracken Rd, Sandyford Business Park, Sandyford, Dublin 18, D18 AK68 Dublin, Ireland; (C.G.); (H.M.)
| | - Catherine Garry
- Beacon Hospital, Beacon Court, Bracken Rd, Sandyford Business Park, Sandyford, Dublin 18, D18 AK68 Dublin, Ireland; (C.G.); (H.M.)
| | - Hannah McCann
- Beacon Hospital, Beacon Court, Bracken Rd, Sandyford Business Park, Sandyford, Dublin 18, D18 AK68 Dublin, Ireland; (C.G.); (H.M.)
| | - Sean Paul Teeling
- UCD Centre for Interdisciplinary Research, Education & Innovation in Health Systems, School of Nursing, Midwifery & Health Systems UCD Health Sciences Centre, D04 V1W8 Dublin, Ireland; (S.P.T.); (M.M.)
- Centre for Person-Centred Practice Research Division of Nursing, School of Health Sciences, Queen Margaret University, Queen Margaret University Drive, Musselburgh EH21 6UU, UK
| | - Marie Ward
- Centre for Innovative Human Systems, School of Psychology, Trinity College, The University of Dublin, Dublin 2, D02 PN40 Dublin, Ireland;
| | - Martin McNamara
- UCD Centre for Interdisciplinary Research, Education & Innovation in Health Systems, School of Nursing, Midwifery & Health Systems UCD Health Sciences Centre, D04 V1W8 Dublin, Ireland; (S.P.T.); (M.M.)
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Ranji SR, Thomas EJ. Research to improve diagnosis: time to study the real world. BMJ Qual Saf 2022; 31:255-258. [PMID: 34987085 DOI: 10.1136/bmjqs-2021-014071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2021] [Indexed: 11/04/2022]
Affiliation(s)
- Sumant R Ranji
- Medicine, University of California, San Francisco, California, USA
| | - Eric J Thomas
- Internal Medicine, University of Texas John P and Katherine G McGovern Medical School, Houston, Texas, USA
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Lima de Andrade LE, Saturno-Hernández PJ, Mendes de Melo LO, da Silva Gama ZA. Improvements in Patient Safety Structures and Culture following Implementation of a National Public Program: An Observational Study in Three Brazilian Hospitals. PORTUGUESE JOURNAL OF PUBLIC HEALTH 2022. [DOI: 10.1159/000525147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
<b><i>Objective:</i></b> The aim of this study was to observe and describe the changes in the structures for patient safety (PS) and PS culture (PSC) at the level of health facilities, following the implementation of the National Patient Safety Program (NPSP). <b><i>Methods:</i></b> An observational, longitudinal, and descriptive study including follow-up of changes in structure and activities for PS and assessments of PSC before and 15 months after the NPSP enforcement. Three Brazilian hospitals with different management logistics participated in the study (federal public, state public, and private). PSC was measured using the AHRQ’s instrument, adapted and validated for the Brazilian context (Hospital Survey on Patient Safety Culture [HSOPSC]). Changes in structure and activities to improve PS were mapped against the NPSP objectives. Changes in PSC were assessed by the hospital and discussed considering a change theory based on the literature. <b><i>Results:</i></b> Structural changes occurred in all hospitals but at a different pace and extension. A PS unit, adoption of some PS protocols, and training on PS occurred in the three hospitals. PSC significantly improved in all facilities. Public hospitals had the worst baseline PSC but showed greater improvements. The state hospital presented few structural changes and soon had the lowest ratings of PSC. <b><i>Conclusions:</i></b> This study demonstrates that external regulatory initiatives can trigger, even if unevenly, actions promoting PS and relevant internal structural changes, which in turn seem to increase awareness and improvement in PSC.
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Marques Cavalcante-Santos L, Carvalho Silvestre C, Andrade Macêdo L, Mônica Machado Pimentel D, Dias de Oliveira-Filho A, Manias E, Pereira de Lyra D. Written communication about the use of medications in medical records in a Brazilian hospital. Int J Clin Pract 2021; 75:e14990. [PMID: 34710266 DOI: 10.1111/ijcp.14990] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 09/23/2021] [Accepted: 10/27/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Effective communication regarding the use of medications in hospital environments is a process that contributes to patient safety. Despite its importance, written communication about the medication use process in medical records remains insufficiently investigated. AIM To describe the documentation in medical records regarding the medication use process by pharmacists, physicians and nurses on admission, during the hospital stay, and at hospital discharge. METHOD A retrospective cross-sectional chart review study was carried out in medical records of patients admitted to a teaching hospital in Northeast Brazil. The study considered all patients admitted between December 2016 and February 2017, aged 18 or older and hospitalised for at least 48 hours. Clinical notes made by pharmacists, physicians and nurses were examined at three transition points of care. Data were collected using a questionnaire relating to the use of medications prior to hospital admission, changes in the prescribed medications during the hospital stay and discharge, as well as prescription non-conformities. Communication failures between the three healthcare professional groups were analysed and classified. The study was authorised by the Hospital's Board of Directors and approved by the Research Ethics Committee of the Federal University of Sergipe. RESULTS This study included 202 medical records of patients with a mean age of 51.48 (SD 6.42, range: 19-97) years. There was no record of a patient or relative interview on allergies and adverse drug reactions in 54 (26.8%) physician notes, 44 (21.9%) nursing notes, and 9 (25.0%) pharmacist notes. Moreover, 1,588 changes in prescriptions were identified during data collection, and 1,198 (75.4%) of these were unjustified. CONCLUSION Medication-related information in medical records was incomplete and inconsistent in the clinical notes of the three studied professions, especially in pharmacists' documentation. Future studies should focus on investigating the consequences of interprofessional communication in patient care.
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Affiliation(s)
- Lincoln Marques Cavalcante-Santos
- Department of Pharmaceutical Sciences, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo (USP), Ribeirão Preto, São Paulo, Brazil
| | - Carina Carvalho Silvestre
- Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Department of Pharmacy, Federal University of Sergipe, São Cristóvão, Brazil
- Department of Pharmacy, Life Sciences Institute, Federal University of Juiz de Fora, Minas Gerais, Brazil
| | - Luana Andrade Macêdo
- Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Department of Pharmacy, Federal University of Sergipe, São Cristóvão, Brazil
| | | | | | - Elizabeth Manias
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Burwood, Victoria, Australia
| | - Divaldo Pereira de Lyra
- Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Department of Pharmacy, Federal University of Sergipe, São Cristóvão, Brazil
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Philip J, Le B, Pasanen L, Rosens E, Wong A, Mendis R, Boughey M, Coperchini M, Moran J, Hynson J, Weil J, Rosenthal M. Palliative Care Clinical Trials: Building Capability and Capacity. J Palliat Med 2021; 25:421-427. [PMID: 34788568 DOI: 10.1089/jpm.2021.0314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Clinical trials are a key component of expanding the evidence base in palliative care. A key strategic objective of the Victorian Comprehensive Cancer Centre (VCCC), a multisite cancer center alliance, was to increase palliative care clinical trial expertise. The palliative care services within the VCCC alliance presented substantial trial development opportunities with large number of patients and established relationships, but few trial-active centers. Objectives: To establish a multi-site "Building Capability in Palliative Care Clinical Trials" program as a service development, and to assess the strategies, activities, and the outcomes resulting from this program. Methods: A series of strategies and activities were developed linked to the key program objectives of increasing the number of clinical sites and skilled clinicians conducting clinical trials, increasing the number of trials available and patients participating, broadening research opportunities in palliative care, and establishing the program sustainability. Results: In the two years of implementation, the program resulted in the establishment and conduct of several Phase 4 postmarketing pharmacovigilance studies, nine Phase 2 and 3 trials across five palliative care services, and a Phase 1 clinical trial. During the program, 150 patients were recruited to clinical trials, and 258 prospective pharmacovigilance monitoring cases were recorded. Five investigator-initiated trials were developed by clinical trial fellows and achieved competitive (n = 3) or commercial (n = 2) funding. Clinicians reported that undertaking clinical trials had increased attention to the evidence base of care provision, and increased service research activity more broadly. Long-term sustainability remains a challenge, particularly in the context of the COVID-19 pandemic. Conclusions: Clinical trials in palliative care services are feasible, acceptable, and result in increased attention to the evidence base of care. The strategies detailing the framework, activities, and outcomes have been collated to facilitate implementation of clinical trials in other sites and with other trial-naive disciplinary groups.
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Affiliation(s)
- Jennifer Philip
- Department of Medicine, University of Melbourne, Fitzroy, Australia.,Departments of Palliative Care and Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia.,Departments of Palliative Care and Medical Oncology, Melbourne Health, Victorian Comprehensive Cancer Centre, Parkville, Australia.,Department of Palliative Care, St Vincent's Hospital Melbourne, Fitzroy, Australia
| | - Brian Le
- Departments of Palliative Care and Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia.,Departments of Palliative Care and Medical Oncology, Melbourne Health, Victorian Comprehensive Cancer Centre, Parkville, Australia
| | - Leeanne Pasanen
- Department of Palliative Care, St Vincent's Hospital Melbourne, Fitzroy, Australia
| | - Evelien Rosens
- Departments of Palliative Care and Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia.,Victorian Comprehensive Cancer Centre, Australia
| | - Aaron Wong
- Departments of Palliative Care and Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia.,Departments of Palliative Care and Medical Oncology, Melbourne Health, Victorian Comprehensive Cancer Centre, Parkville, Australia.,Palliative Care Service, Austin Health, Heidelberg, Australia
| | - Ruwani Mendis
- Palliative Care Service, Western Health, Footscray, Australia
| | - Mark Boughey
- Department of Palliative Care, St Vincent's Hospital Melbourne, Fitzroy, Australia
| | | | - Juli Moran
- Palliative Care Service, Austin Health, Heidelberg, Australia
| | - Jenny Hynson
- Palliative Care Service, Royal Children's Hospital, Melbourne, Australia
| | - Jenny Weil
- Department of Palliative Care, St Vincent's Hospital Melbourne, Fitzroy, Australia
| | - Mark Rosenthal
- Departments of Palliative Care and Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia.,Departments of Palliative Care and Medical Oncology, Melbourne Health, Victorian Comprehensive Cancer Centre, Parkville, Australia
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Dempsey A, Robinson C, Moffatt N, Hennessy T, Bradshaw A, Teeling SP, Ward M, McNamara M. Lean Six Sigma Redesign of a Process for Healthcare Mandatory Education in Basic Life Support-A Pilot Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:11653. [PMID: 34770166 PMCID: PMC8583709 DOI: 10.3390/ijerph182111653] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 11/03/2021] [Accepted: 11/04/2021] [Indexed: 12/19/2022]
Abstract
Healthcare staff are required to undertake mandatory training programs to ensure they maintain key clinical competencies. This study was conducted in a private hospital in Ireland, where the processes for accessing mandatory training were found to be highly complex and non-user friendly, resulting in missed training opportunities, specific training license expiration, and underutilized training slots which resulted in lost time for both the trainers and trainees. A pilot study was undertaken to review the process for accessing mandatory training with a focus on the mandatory training program of Basic Life Support (BLS). This was chosen due to its importance in patient resuscitation and its requirement in the hospital achieving Joint Commission International (JCI) accreditation. A pre- and post-team-based intervention design was used with Lean Six Sigma (LSS) methodology employed to redesign the process of booking, scheduling, and delivery of BLS training leading to staff individual BLS certification for a period of two years. The redesign of the BLS training program resulted in a new blended delivery method, and the initiation of a pilot project led to a 50% increase in the volume of BLS classes and a time saving of 154 h 30 min for staff and 48 h 14 min for BLS instructors. The success of the BLS process access pilot has functioned as a platform for the redesign of other mandatory education programs and will be of interest to hospitals with mandatory training requirements that are already facing healthcare challenges and demands on staff time.
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Affiliation(s)
- Anne Dempsey
- Beacon Hospital, Sandyford, D18 AK68 Dublin, Ireland; (C.R.); (N.M.); (T.H.); (A.B.)
| | - Ciara Robinson
- Beacon Hospital, Sandyford, D18 AK68 Dublin, Ireland; (C.R.); (N.M.); (T.H.); (A.B.)
| | - Niamh Moffatt
- Beacon Hospital, Sandyford, D18 AK68 Dublin, Ireland; (C.R.); (N.M.); (T.H.); (A.B.)
| | - Therese Hennessy
- Beacon Hospital, Sandyford, D18 AK68 Dublin, Ireland; (C.R.); (N.M.); (T.H.); (A.B.)
| | - Annmarie Bradshaw
- Beacon Hospital, Sandyford, D18 AK68 Dublin, Ireland; (C.R.); (N.M.); (T.H.); (A.B.)
| | - Sean Paul Teeling
- UCD Centre for Interdisciplinary Research, Education & Innovation in Health Systems, School of Nursing, Midwifery & Health Systems, University College Dublin, D04 V1W8 Dublin, Ireland; (S.P.T.); (M.M.)
- Centre for Person-Centred Practice Research Division of Nursing, School of Health Sciences, Queen Margaret University Drive, Queen Margaret University, Musselburgh EH21 6UU, UK
| | - Marie Ward
- Centre for Innovative Human Systems, School of Psychology, Trinity College, The University of Dublin, D02 PN40 Dublin, Ireland;
| | - Martin McNamara
- UCD Centre for Interdisciplinary Research, Education & Innovation in Health Systems, School of Nursing, Midwifery & Health Systems, University College Dublin, D04 V1W8 Dublin, Ireland; (S.P.T.); (M.M.)
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Cho J, Shin S, Jeong Y, Lee E, Ahn S, Won S, Lee E. Healthcare Quality Improvement Analytics: An Example Using Computerized Provider Order Entry. Healthcare (Basel) 2021; 9:1187. [PMID: 34574961 PMCID: PMC8471240 DOI: 10.3390/healthcare9091187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 09/02/2021] [Accepted: 09/07/2021] [Indexed: 11/16/2022] Open
Abstract
Evaluation of sustainability after quality improvement (QI) projects in healthcare settings is an essential part of monitoring and future QI planning. With limitations in adopting quasi-experimental study design in real-world practice, healthcare professionals find it challenging to present the sustained effect of QI changes effectively. To provide quantitative methodological approaches for demonstrating the sustainability of QI projects for healthcare professionals, we conducted data analyses based on a QI project to improve the computerized provider order entry system to reduce patients' dosing frequencies in Korea. Data were collected for 5 years: 24-month pre-intervention, 12-month intervention, and 24-month post-intervention. Then, analytic approaches including control chart, Analysis of Variance (ANOVA), and segmented regression were performed. The control chart intuitively displayed how the outcomes changed over the entire period, and ANOVA was used to test whether the outcomes differed between groups. Last, segmented regression analysis was conducted to evaluate longitudinal effects of interventions over time. We found that the impact of QI projects in healthcare settings should be initiated following the Plan-Do-Study-Act cycle and evaluated long-term effects while widening the scope of QI evaluation with sustainability. This study can serve as a guide for healthcare professionals to use a number of statistical methodologies in their QI evaluations.
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Affiliation(s)
- Jungwon Cho
- Department of Pharmacy, Seoul National University Bundang Hospital, Seongnam-si 13620, Korea; (J.C.); (S.S.); (Y.J.); (E.L.)
- Research Institute of Pharmaceutical Sciences & College of Pharmacy, Seoul National University, Seoul 08826, Korea
| | - Sangmi Shin
- Department of Pharmacy, Seoul National University Bundang Hospital, Seongnam-si 13620, Korea; (J.C.); (S.S.); (Y.J.); (E.L.)
| | - Youngmi Jeong
- Department of Pharmacy, Seoul National University Bundang Hospital, Seongnam-si 13620, Korea; (J.C.); (S.S.); (Y.J.); (E.L.)
| | - Eunsook Lee
- Department of Pharmacy, Seoul National University Bundang Hospital, Seongnam-si 13620, Korea; (J.C.); (S.S.); (Y.J.); (E.L.)
| | - Soyeon Ahn
- Medical Research Collaborating Center, Seoul National University Bundang Hospital, Seongnam-si 13620, Korea;
| | - Seunghyun Won
- Medical Research Collaborating Center, Seoul National University Bundang Hospital, Seongnam-si 13620, Korea;
| | - Euni Lee
- Department of Pharmacy, Seoul National University Bundang Hospital, Seongnam-si 13620, Korea; (J.C.); (S.S.); (Y.J.); (E.L.)
- Research Institute of Pharmaceutical Sciences & College of Pharmacy, Seoul National University, Seoul 08826, Korea
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Lee KS, Yordanov S, Stubbs D, Edlmann E, Joannides A, Davies B. Integrated care pathways in neurosurgery: A systematic review. PLoS One 2021; 16:e0255628. [PMID: 34339465 PMCID: PMC8328336 DOI: 10.1371/journal.pone.0255628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 07/20/2021] [Indexed: 11/27/2022] Open
Abstract
Introduction Integrated care pathways (ICPs) are a pre-defined framework of evidence based, multidisciplinary practice for specific patients. They have the potential to enhance continuity of care, patient safety, patient satisfaction, efficiency gains, teamwork and staff education. In order to inform the development of neurosurgical ICPs in the future, we performed a systematic review to aggregate examples of neurosurgical ICP, to consider their impact and design features that may be associated with their success. Methods Electronic databases MEDLINE, EMBASE, and CENTRAL were searched for relevant literature published from date of inception to July 2020. Primary studies reporting details of neurosurgical ICPs, across all pathologies and age groups were eligible for inclusion. Patient outcomes in each case were also recorded. Results Twenty-four studies were included in our final dataset, from the United States, United Kingdom, Italy, China, Korea, France, Netherlands and Switzerland, and a number of sub-specialties. 3 for cerebrospinal fluid diversion, 1 functional, 2 neurovascular, 1 neuro-oncology, 2 paediatric, 2 skull base, 10 spine, 1 for trauma, 2 miscellaneous (other craniotomies). All were single centre studies with no regional or national examples. Thirteen were cohort studies while 11 were case series which lacked a control group. Effectiveness was typically evaluated using hospital or professional performance metrics, such as length of stay (n = 11, 45.8%) or adverse events (n = 17, 70.8%) including readmission, surgical complications and mortality. Patient reported outcomes, including satisfaction, were evaluated infrequently (n = 3, 12.5%). All studies reported a positive impact. No study reported how the design of the ICP was informed by published literature or other methods Conclusions ICPs have been successfully developed across numerous neurosurgical sub-specialities. However, there is often a lack of clarity over their design and weaknesses in their evaluation, including an underrepresentation of the patient’s perspective.
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Affiliation(s)
- Keng Siang Lee
- Bristol Medical School, Faculty of Health Sciences, University of Bristol, Bristol, United Kingdom
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
- * E-mail: (KSL); (BD)
| | - Stefan Yordanov
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
| | - Daniel Stubbs
- Division of Anaesthesia, Department of Medicine, Addenbrooke’s Hospital, University of Cambridge, Cambridge, United Kingdom
| | - Ellie Edlmann
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
| | - Alexis Joannides
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
| | - Benjamin Davies
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
- * E-mail: (KSL); (BD)
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Willett J, Barclay M, Mukoro F, Sweeney G. Telling the story of complex change: an Impact Framework for the real world. Int J Qual Health Care 2021; 33:6294829. [PMID: 34100552 PMCID: PMC8253549 DOI: 10.1093/intqhc/mzab090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 04/20/2021] [Accepted: 06/03/2021] [Indexed: 12/26/2022] Open
Abstract
Background In the National Health Service (NHS) in England, traditional approaches to evidencing impact and value have an important role to play but are unlikely to demonstrate the full value of national quality improvement programmes and large-scale change initiatives in health and care. This type of work almost always takes place in complex and complicated settings, in that it involves multiple players, numerous interventions and a host of other confounding factors. Improvement work is usually emergent, with cause and effect only understood in hindsight; challenges around contribution and attribution can lead the key players to question how they can be certain that the described or observed changes are due to their intervention and would not have happened without them. In this complex environment, there is a risk of oversimplifying the observed impact and focusing instead on those things that are easier to measure, missing that which is important but more difficult to evidence. Methods Between 2016 and 2019, an action-orientated approach, drawing on realist and development evaluation approaches, was taken to designing and testing the Impact Framework. First, we undertook a pragmatic review of tools and approaches used by others to capture and demonstrate their impact both within and outside the health and care environment. Following the identification and review of these tools and approaches, and in consultation with national improvement teams in England about their evaluation challenges and aspirations, we developed a set of underpinning principles to inform the design and build of the framework. The principles were informed and finessed following conversations with improvement teams and programme leads in NHS England with respect to the challenges that they were facing and their aspirations in terms of demonstrating their impact and learning as they worked. Results The ‘Impact Framework’ described in this article offers a practical approach to capturing the impact of improvement work at any scale, taking account of unintended outcomes, considering attribution and contribution, and using a narrative approach to uncover the difference made by improvement initiatives in rich detail. In this article, we describe how the Impact Framework has been used with one of NHS England’s national programmes, Time for Care, which was delivered between 2016 and 2020. Conclusions The Impact Framework continues to be used, developed and further tested by national improvement programmes being delivered by NHS England and NHS Improvement and is updated regularly. The framework has been developed to be accessible to frontline teams and is supported by a set of resources to help improvement teams and individuals to use by themselves (https://www.england.nhs.uk/sustainableimprovement/impact-framework/).
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Affiliation(s)
- Jo Willett
- Improvement Science and Capability Building, NHS England and NHS Improvement, Cheylesmore House, Quinton Road, Coventry CV1 2WT, UK
| | - Michelle Barclay
- Improvement Science and Capability Building, NHS England and NHS Improvement, Cheylesmore House, Quinton Road, Coventry CV1 2WT, UK
| | - Felix Mukoro
- Improvement Science and Capability Building, NHS England and NHS Improvement, Cheylesmore House, Quinton Road, Coventry CV1 2WT, UK
| | - Grace Sweeney
- Improvement Science and Capability Building, NHS England and NHS Improvement, Cheylesmore House, Quinton Road, Coventry CV1 2WT, UK
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Szelest I, Harries B, Motluk L, Harries J. How prescribing available pharmacotherapies for alcohol use disorder can impact the healthcare system: A retrospective quality improvement study. Healthc Manage Forum 2021; 34:283-290. [PMID: 34247530 DOI: 10.1177/08404704211027183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Alcohol use disorder is a multifactorial undertreated chronic disorder influenced by genetic, psychological, and environmental factors. Numerous pharmacotherapies are available and effective but are underutilized in healthcare. The purpose of this retrospective quality improvement study is to determine the impact of education sessions on the availability and efficacy of medications (focusing on Naltrexone) to treat alcohol use disorder in the healthcare system. Control charts were implemented to monitor the system change in two comparable urban areas. Dispensing rates increased at three points after a series of presentations. The first increase from baseline was 2.47 times, the second 3.7, and the third 4.81. Coinciding with these, weekly visits to the emergency department also decreased by 35% and stabilized at a 15% reduction. It was also observed that alcohol use disorder hospital admission rates decreased by 21%, but bounced back once the education sessions ended. Combined with counselling, pharmacotherapies can be effective in combating alcohol use disorder, while potentially reducing demands on the healthcare system.
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Affiliation(s)
- Izabela Szelest
- The Canadian Alcohol Use Disorder Society, Penticton, British Columbia, Canada.,Care.Transformed Consulting, Vancouver, British Columbia, Canada
| | - Bruce Harries
- The Canadian Alcohol Use Disorder Society, Penticton, British Columbia, Canada.,Improvement Associates Ltd., Edmonton, Alberta, Canada
| | - Lori Motluk
- The Canadian Alcohol Use Disorder Society, Penticton, British Columbia, Canada
| | - Jeff Harries
- The Canadian Alcohol Use Disorder Society, Penticton, British Columbia, Canada.,Interior Health Authority, Penticton, British Columbia, Canada
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Tume L, Vollam S. What is in the journal? Nurs Crit Care 2021; 26:219-221. [PMID: 34189803 DOI: 10.1111/nicc.12672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 05/31/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Lyvonne Tume
- School of Health & Society, University of Salford, manchester, UK
| | - Sarah Vollam
- Kadoorie Centre for Critical Care Research and Education, University of Oxford, UK
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de Cerqueira BGT, da Silva EP, Gama ZADS. Improvement of quality of care for gestational syphilis in the municipality of Rio de Janeiro. Rev Saude Publica 2021; 55:34. [PMID: 34133619 PMCID: PMC8225322 DOI: 10.11606/s1518-8787.2021055002534] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 08/11/2020] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To analyze the effect of a multifaceted intervention in the care of pregnant women with syphilis in primary health care. METHODS This is a quality improvement project performed in 26 basic care units in the municipality of Rio de Janeiro, between January and December 2017. It has a quasi-experimental mixed design, with previous, later and time series analyses. We evaluated the care provided to all pregnant women with syphilis whose prenatal care that ended during the studied period, using ten quality criteria and one indicator. The intervention was multifaceted, covering permanent education, improvement of records and information systems, audit and feedback, patient education, organizational changes and work processes. We estimated absolute and relative improvements of the criteria and their statistical significance (α = 5%). The facilitators and hinders of the intervention were analyzed according to the Model for Understanding Success in Quality. RESULTS After the intervention, there was a total absolute improvement of 6.7% (64.4% versus 71.0%) and relative of 28.8% (p > 0.05). Eight of the ten quality criteria had an improvement, which was significant in four of them (p < 0.05). The monthly indicator of adequate treatment also improved (p < 0.05), but maintained low performance throughout the project. The increase in the compliance of the treatment scheme with the protocol (91.4% versus 99.1%) positively stood out, but the main opportunities for improvement were testing (42.8% versus 48.5%) and treatment of sexual partnerships (42.8% versus 44.2%). Regulatory pressures to improve the monthly indicator and the political-economic crisis experienced by the municipality modulated the effect of the intervention. CONCLUSION The project was useful to identify priorities and guide interventions to improve the quality of care for syphilis, although there is still ample room for improvement. The identified problems, as well as the contextual modulators of the effect, should be considered in future interventions.
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Affiliation(s)
- Brena Gabriella Tostes de Cerqueira
- Universidade Federal do Rio Grande do NorteCentro de Ciências da SaúdePrograma de Pós-Graduação em Gestão da Qualidade em Serviços de SaúdeNatalRNBrasilUniversidade Federal do Rio Grande do Norte. Centro de Ciências da Saúde. Programa de Pós-Graduação em Gestão da Qualidade em Serviços de Saúde. Natal, RN, Brasil
| | - Eliane Pereira da Silva
- Universidade Federal do Rio Grande do NorteCentro de Ciências da SaúdeDepartamento de Medicina ClínicaNatalRNBrasilUniversidade Federal do Rio Grande do Norte. Centro de Ciências da Saúde. Departamento de Medicina Clínica. Natal, RN, Brasil
| | - Zenewton André da Silva Gama
- Universidade Federal do Rio Grande do NorteCentro de Ciências da SaúdeDepartamento de Saúde ColetivaNatalRNBrasilUniversidade Federal do Rio Grande do Norte. Centro de Ciências da Saúde. Departamento de Saúde Coletiva. Natal, RN, Brasil
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Hu ZJ, Fusch G, Hu C, Wang JY, El Helou Z, Hassan MT, Mbuagbaw L, El Helou S, Thabane L. Completeness of reporting of quality improvement studies in neonatology is inadequate: a systematic literature survey. BMJ Open Qual 2021; 10:bmjoq-2020-001273. [PMID: 34127453 PMCID: PMC8204179 DOI: 10.1136/bmjoq-2020-001273] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 06/02/2021] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION Quality improvement (QI) is a growing field of inquiry in healthcare, but the reporting quality of QI studies in neonatology remains unclear. We conducted a systematic survey of the literature to assess the reporting quality of QI studies and factors associated with reporting quality. METHODS We searched Medline for publications of QI studies from 2016 to 16 April 2020. Pairs of reviewers independently screened citations and assessed reporting quality using a 31-item modified Standards for Quality Improvement Reporting Excellence, 2nd edition (SQUIRE 2.0) checklist. We reported the number (percentage) of studies that reported each item and their corresponding 95% CIs. We used Poisson regression to explore factors associated with reporting quality, namely, journal endorsement of SQUIRE 2.0, declaration of funding sources, year of publication and number of authors. The results were reported as incidence rate ratio (IRR) and 95% CI. RESULTS Of 1921 citations, 336 were eligible; among them, we randomly selected 100 articles to assess reporting quality. The mean (standard deviation) number of SQUIRE 2.0 items adhered to was 22.0 (4.5). Percentage of articles reporting each item varied from 26% to 100%. Journal endorsement of SQUIRE 2.0 (IRR=1.11, 95% CI 1.02 to 1.21, p=0.015), declaration of funding sources and increasing number of authors were significantly associated with better reporting. CONCLUSIONS Reporting quality of QI studies in neonatology is inadequate. Endorsing the SQUIRE 2.0 guideline is a step that journals can implement to enhance the completeness of reporting.
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Affiliation(s)
- Zheng Jing Hu
- Department of Health Research Methods Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Gerhard Fusch
- Division of Neonatology, Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Catherine Hu
- Bachelor of Arts and Science, McMaster University, Hamilton, Ontario, Canada
| | - Jie Yi Wang
- Bachelor of Medical Sciences, Schulich School of Medicine & Dentistry, University of Western Ontario, London, Ontario, Canada
| | - Zoe El Helou
- Bachelor of Health Sciences, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Muhammad Taaha Hassan
- Bachelor of Health Sciences, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Lawrence Mbuagbaw
- Department of Health Research Methods Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Salhab El Helou
- Division of Neonatology, Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Lehana Thabane
- Department of Health Research Methods Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
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Ogrinc G. Measuring and publishing quality improvement. Reg Anesth Pain Med 2021; 46:643-649. [PMID: 34031218 DOI: 10.1136/rapm-2020-102201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 03/06/2021] [Accepted: 03/07/2021] [Indexed: 12/17/2022]
Abstract
Misalignment of measures, measurement and analysis with the goals and methods of quality improvement efforts in healthcare may create confusion and decrease effectiveness. In healthcare, measurement is used for accountability, research, and quality improvement, so distinguishing between these is an important first step. Using a case vignette, this paper focuses on using measurement for improvement to gain insight into the dynamic nature of healthcare systems and to assess the impact of interventions. This involves an understanding of the variation in the data over time. Statistical process control (SPC) charting is an effective and powerful analysis tool for this. SPC provides ongoing assessment of system functioning and enables an improvement team to assess the impact of its own interventions and external forces on the system. Once improvement work is completed, the Standards for Quality Improvement Reporting Excellence (SQUIRE) guidelines is a valuable tool to describe the rationale, context, and study of the interventions. SQUIRE can be used to plan improvement work as well as structure a manuscript for publication in peer-reviewed journals.
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Affiliation(s)
- Greg Ogrinc
- American Board of Medical Specialties, Chicago, Illinois, USA .,Medicine, University of Illinois at Chicago College of Medicine, Chicago, Illinois, USA
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van der Scheer JW, Woodward M, Ansari A, Draycott T, Winter C, Martin G, Kuberska K, Richards N, Kern R, Dixon-Woods M. How to specify healthcare process improvements collaboratively using rapid, remote consensus-building: a framework and a case study of its application. BMC Med Res Methodol 2021; 21:103. [PMID: 33975550 PMCID: PMC8111055 DOI: 10.1186/s12874-021-01288-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 04/21/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Practical methods for facilitating process improvement are needed to support high quality, safe care. How best to specify (identify and define) process improvements - the changes that need to be made in a healthcare process - remains a key question. Methods for doing so collaboratively, rapidly and remotely offer much potential, but are under-developed. We propose an approach for engaging diverse stakeholders remotely in a consensus-building exercise to help specify improvements in a healthcare process, and we illustrate the approach in a case study. METHODS Organised in a five-step framework, our proposed approach is informed by a participatory ethos, crowdsourcing and consensus-building methods: (1) define scope and objective of the process improvement; (2) produce a draft or prototype of the proposed process improvement specification; (3) identify participant recruitment strategy; (4) design and conduct a remote consensus-building exercise; (5) produce a final specification of the process improvement in light of learning from the exercise. We tested the approach in a case study that sought to specify process improvements for the management of obstetric emergencies during the COVID-19 pandemic. We used a brief video showing a process for managing a post-partum haemorrhage in women with COVID-19 to elicit recommendations on how the process could be improved. Two Delphi rounds were then conducted to reach consensus. RESULTS We gathered views from 105 participants, with a background in maternity care (n = 36), infection prevention and control (n = 17), or human factors (n = 52). The participants initially generated 818 recommendations for how to improve the process illustrated in the video, which we synthesised into a set of 22 recommendations. The consensus-building exercise yielded a final set of 16 recommendations. These were used to inform the specification of process improvements for managing the obstetric emergency and develop supporting resources, including an updated video. CONCLUSIONS The proposed methodological approach enabled the expertise and ingenuity of diverse stakeholders to be captured and mobilised to specify process improvements in an area of pressing service need. This approach has the potential to address current challenges in process improvement, but will require further evaluation.
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Affiliation(s)
- Jan W van der Scheer
- THIS Institute (The Healthcare Improvement Studies Institute), Department of Public Health and Primary Care, University of Cambridge, Cambridge Biomedical Campus, Clifford Allbutt Building, Cambridge, CB2 0AH, UK.
| | - Matthew Woodward
- THIS Institute (The Healthcare Improvement Studies Institute), Department of Public Health and Primary Care, University of Cambridge, Cambridge Biomedical Campus, Clifford Allbutt Building, Cambridge, CB2 0AH, UK
| | - Akbar Ansari
- THIS Institute (The Healthcare Improvement Studies Institute), Department of Public Health and Primary Care, University of Cambridge, Cambridge Biomedical Campus, Clifford Allbutt Building, Cambridge, CB2 0AH, UK
| | - Tim Draycott
- Department of Translational Health Services, University of Bristol, Bristol, UK
- PROMPT Maternity Foundation, Women and Children's Health, North Bristol NHS Trust, Westbury on Trym, UK
| | - Cathy Winter
- PROMPT Maternity Foundation, Women and Children's Health, North Bristol NHS Trust, Westbury on Trym, UK
| | - Graham Martin
- THIS Institute (The Healthcare Improvement Studies Institute), Department of Public Health and Primary Care, University of Cambridge, Cambridge Biomedical Campus, Clifford Allbutt Building, Cambridge, CB2 0AH, UK
| | - Karolina Kuberska
- THIS Institute (The Healthcare Improvement Studies Institute), Department of Public Health and Primary Care, University of Cambridge, Cambridge Biomedical Campus, Clifford Allbutt Building, Cambridge, CB2 0AH, UK
| | - Natalie Richards
- THIS Institute (The Healthcare Improvement Studies Institute), Department of Public Health and Primary Care, University of Cambridge, Cambridge Biomedical Campus, Clifford Allbutt Building, Cambridge, CB2 0AH, UK
| | - Ruth Kern
- THIS Institute (The Healthcare Improvement Studies Institute), Department of Public Health and Primary Care, University of Cambridge, Cambridge Biomedical Campus, Clifford Allbutt Building, Cambridge, CB2 0AH, UK
| | - Mary Dixon-Woods
- THIS Institute (The Healthcare Improvement Studies Institute), Department of Public Health and Primary Care, University of Cambridge, Cambridge Biomedical Campus, Clifford Allbutt Building, Cambridge, CB2 0AH, UK
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Implementation effect of institutional policy of EGD observation time on neoplasm detection. Gastrointest Endosc 2021; 93:1152-1159. [PMID: 32916166 DOI: 10.1016/j.gie.2020.09.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 09/02/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS The observation time in EGD is associated with detection rate of premalignant or neoplastic lesions in the upper GI (UGI) tract. The aim of this study was to evaluate an institutional policy of EGD observation time on the detection rate of UGI neoplasms. METHODS From July 2017 to March 2019, all endoscopists were requested to comply with our institutional policy of spending more than 3 minutes of observation time in every screening EGD. Observation time was defined as the time from when the endoscope reached the duodenum to when it was withdrawn. We obtained a neoplasm detection rate (NDR) during this period and compared it with that of a baseline period from 2009 to 2015. RESULTS During the study period, 30,506 EGDs were performed. Mean subject age was 49.9 ± 10.5 years, and 56.5% were men. All endoscopists achieved an average EGD observation time of more than 3 minutes during this period. Mean observation time was 3:35 ± 0:50, which was significantly longer than the baseline (2:38 ± 0:21, P < .001). NDR was .33%, which was higher than the baseline (.23%, P < .001). Even after adjusting for subjects' age and gender, smoking history, and endoscopists' biopsy sampling rate, prolonged EGD observation time of more than 3 minutes increased the NDR of UGI neoplasms (odds ratio, 1.51; 95% confidence interval, 1.21-1.75). CONCLUSIONS This study provides evidence that implementing a protocol of a prolonged observation time could increase NDR. Observation time should be an important quality indicator of the EGD examination.
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