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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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2
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Reed JE, Johnson JK, Zanni R, Messier R, Asfour F, Godfrey MM. Quality of locally designed surveys in a quality improvement collaborative: review of survey validity and identification of common errors. BMJ Open Qual 2024; 13:e002387. [PMID: 38365431 PMCID: PMC10875491 DOI: 10.1136/bmjoq-2023-002387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 01/09/2024] [Indexed: 02/18/2024] Open
Abstract
OBJECTIVE Surveys are a commonly used tool in quality improvement (QI) projects, but little is known about the standards to which they are designed and applied. We aimed to investigate the quality of surveys used within a QI collaborative, and to characterise the common errors made in survey design. METHODS Five reviewers (two research methodology and QI, three clinical and QI experts) independently assessed 20 surveys, comprising 250 survey items, that were developed in a North American cystic fibrosis lung transplant transition collaborative. Content Validity Index (CVI) scores were calculated for each survey. Reviewer consensus discussions decided an overall quality assessment for each survey and survey item (analysed using descriptive statistics) and explored the rationale for scoring (using qualitative thematic analysis). RESULTS 3/20 surveys scored as high quality (CVI >80%). 19% (n=47) of survey items were recommended by the reviewers, with 35% (n=87) requiring improvements, and 46% (n=116) not recommended. Quality assessment criteria were agreed upon. Types of common errors identified included the ethics and appropriateness of questions and survey format; usefulness of survey items to inform learning or lead to action, and methodological issues with survey questions, survey response options; and overall survey design. CONCLUSION Survey development is a task that requires careful consideration, time and expertise. QI teams should consider whether a survey is the most appropriate form for capturing information during the improvement process. There is a need to educate and support QI teams to adhere to good practice and avoid common errors, thereby increasing the value of surveys for evaluation and QI. The methodology, quality assessment criteria and common errors described in this paper can provide a useful resource for this purpose.
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Affiliation(s)
- Julie E Reed
- Julie Reed Consultancy Ltd, London, UK
- Halmstad University School of Health and Welfare, Halmstad, Sweden
| | - Julie K Johnson
- Northwestern Quality Improvement, Research, and Education in Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Robert Zanni
- Robert Wood Johnson Barnabas Health Medical Group, Monmouth Medical Center, Long Branch, New Jersey, USA
| | - Randy Messier
- University of New Hampshire, Durham, New Hampshire, USA
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How Well Is Surgical Improvement Being Conducted? Evaluation of 50 Local Surgery-Related Improvement Efforts. J Am Coll Surg 2022; 235:573-580. [DOI: 10.1097/xcs.0000000000000341] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ko CY, Shah T, Nelson H, Nathens AB. Developing the American College of Surgeons Quality Improvement Framework to Evaluate Local Surgical Improvement Efforts. JAMA Surg 2022; 157:737-739. [PMID: 35704310 PMCID: PMC9201737 DOI: 10.1001/jamasurg.2022.1826] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Clifford Y Ko
- Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, Illinois.,Department of Surgery, University of California, Los Angeles, Los Angeles
| | - Tejen Shah
- Department of Surgery, The Ohio State University, Columbus
| | - Heidi Nelson
- Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, Illinois
| | - Avery B Nathens
- Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, Illinois.,Department of Surgery, University of Toronto, Toronto, Ontario, Canada
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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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Cerulus M, Bossuyt I, Vanderhaeghen B. An integrative literature review of the implementation of advance care planning in hospital settings. J Clin Nurs 2021; 30:3099-3110. [PMID: 34010482 DOI: 10.1111/jocn.15835] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 04/09/2021] [Accepted: 04/14/2021] [Indexed: 11/27/2022]
Abstract
AIMS AND OBJECTIVES To identify and synthesise existing literature about action research in the implementation of advance care planning in a hospital setting. BACKGROUND Despite the proven added value of advance care planning, there is a lack of wide integration of this concept. There are several obstacles known for the implementation but it remains unclear how these can be overcome. Action research is described in the literature as a plausible way to overcome obstacles to the implementation of quality enhancing projects. DESIGN An integrative literature review was conducted using the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) and reported in accordance with the PRISMA statement. METHODS We searched databases MEDLINE, EMBASE, CINAHL and Web of Science to identify executed action research for the implementation of advance care planning programs within a hospital setting, from January 2005 until November 2019. Studies were assessed for comprehensiveness and were supplemented by studies in reference lists of included articles. A quality appraisal and a thematic synthesis were performed on all included studies. RESULTS Five studies met inclusion criteria. Interventions focused on both nurses, physicians and hospitalised patients. Interventions targeted three different themes: identifying at-risk patients, adapting documentation to the local context and using communication improvement tools. CONCLUSIONS A Supportive and Palliative Care Indicators Tool is proposed to identify patients in need of advance care planning to work more efficiently. Furthermore, adapting documentation and instruments to a specific care context are shown to make advance care planning more effective. Communication challenges can be addressed by promoting communication skills and increase stakeholder self-confidence.
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Fernández-Méndez R, Rastall RJ, Sage WA, Oberg I, Bullen G, Charge AL, Crofton A, Santarius T, Watts C, Price SJ, Brodbelt A, Joannides AJ. Quality improvement of neuro-oncology services: integrating the routine collection of patient-reported, health-related quality-of-life measures. Neurooncol Pract 2019; 6:226-236. [PMID: 31385996 PMCID: PMC6656295 DOI: 10.1093/nop/npy040] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Brain cancer has a strong impact on health-related quality of life (HRQoL), and its evaluation in clinical practice can improve the quality of care provided. The aim of this project was to integrate routine collection of HRQoL information from patients with brain tumor or metastasis in 2 specialized United Kingdom tertiary centers, and to evaluate the implementation process. METHODS Since October 2016, routine collection of electronic self-reported HRQoL information has been progressively embedded in the participating centers using standard questionnaires. During the first year, the project was implemented, and the process evaluated, through regular cycles of process evaluation followed by an action plan, monitoring of questionnaire completion rates, and assessment of patient views. RESULTS Main challenges encountered included reluctance to change usual practice and limited resources. Key measures for success included strong leadership of senior staff, involvement of stakeholders in project design and evaluation, and continuous strategic support to professionals. Final project workflow included 6 process steps, 1 decision step, and 4 outputs. Questionnaires were mostly self-completed (75.1%), and completion took 6-9 minutes. Most patients agreed that the questionnaire items were easy to understand (97.0%), important for them (93.0%), and helped them think what they wanted to discuss in their clinical consultation (75.4%). CONCLUSIONS Integrating HRQoL information as a routine part of clinical assessments has the potential to enhance individually tailored patient care in our institutions. Challenges involved in innovations of this nature can be overcome through a systematic approach involving strong leadership, wide stakeholder engagement, and strategic planning.
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Affiliation(s)
| | | | - William A Sage
- Department of Clinical Neurosciences, University of Cambridge, UK
| | - Ingela Oberg
- Neurosurgery Department, Cambridge University Hospitals NHS Trust, Addenbrookes Hospital, UK
| | - Gemma Bullen
- Neurosurgery Department, Cambridge University Hospitals NHS Trust, Addenbrookes Hospital, UK
| | - Amy Louise Charge
- Neurosurgery Department, Cambridge University Hospitals NHS Trust, Addenbrookes Hospital, UK
| | - Anna Crofton
- Neurosurgery Department, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Thomas Santarius
- Department of Clinical Neurosciences, University of Cambridge, UK
- Neurosurgery Department, Cambridge University Hospitals NHS Trust, Addenbrookes Hospital, UK
| | - Colin Watts
- Department of Clinical Neurosciences, University of Cambridge, UK
- Neurosurgery Department, Cambridge University Hospitals NHS Trust, Addenbrookes Hospital, UK
| | - Stephen J Price
- Department of Clinical Neurosciences, University of Cambridge, UK
- Neurosurgery Department, Cambridge University Hospitals NHS Trust, Addenbrookes Hospital, UK
| | - Andrew Brodbelt
- Neurosurgery Department, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Alexis J Joannides
- Department of Clinical Neurosciences, University of Cambridge, UK
- Neurosurgery Department, Cambridge University Hospitals NHS Trust, Addenbrookes Hospital, UK
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Malterud K, Aamland A, Iden KR. Small-scale implementation with pragmatic process evaluation: a model developed in primary health care. BMC FAMILY PRACTICE 2018; 19:93. [PMID: 29929482 PMCID: PMC6014026 DOI: 10.1186/s12875-018-0778-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 05/25/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND Research often fails to impose substantial shifts in clinical practice. Evidence-based health care requires implementation of documented interventions, with implementation research as a science-informed strategy to identify core experiences from the process and share preconditions for achievement. Evidence developed in hospital contexts is often neither relevant nor feasible for primary care. Different evidence types may constitute a point of departure, stretching and testing the transferability of the intervention by piloting it in primary care. Comprehensive descriptions of aims, context and procedures can be a more useful outcome than traditional effect studies. MAIN TEXT We present a model for small-scale implementation of relevant research evidence, monitored by pragmatic evaluation. The model, which is applicable in primary care, is supported by Weiner's theory about organizational readiness for change and consists of four steps: 1) recognize the problem - identify a workable intervention, 2) assess the context - prepare for inception, 3) pilot the intervention on site, and 4) upscale and accomplish the intervention. The process is evaluated by exploring selected relevant aspects of experiences and outcomes from the first to the last step. Process evaluation is a logical precondition for outcome evaluation - attempting to assess either the efficacy or the effectiveness of a "black box" intervention makes no sense. We argue why evidence beyond effect studies and evaluation beyond randomized controlled trials may be adequate for science-informed evaluation of a small-scale implementation project such as is often conducted by primary health care practitioners. The model is illustrated by an ongoing project, in which a strategy for upgrading the management of depression in nursing homes in Norway is currently being implemented. CONCLUSIONS A flexible and manageable approach is suggested, in which the inevitable unpredictability of clinical practice is incorporated. Finding the appropriate middle ground between rigour and flexibility, some compromises must be made. Our model recognizes the skills of practical knowing as something other than traditional medical research, while maintaining academic values such as systematic and transparent reflection, using adequate tools. Considering the purpose and context of our model, we argue that these priorities, emphasizing relevance and feasibility, are strengths, not limitations.
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Affiliation(s)
- Kirsti Malterud
- Research Unit for General Practice, Uni Research Health, Uni Research, Kalfarveien 31, N-5018 Bergen, Norway
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Aase Aamland
- Research Unit for General Practice, Uni Research Health, Uni Research, Kalfarveien 31, N-5018 Bergen, Norway
| | - Kristina Riis Iden
- Research Unit for General Practice, Uni Research Health, Uni Research, Kalfarveien 31, N-5018 Bergen, Norway
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Karlsson Lind L, von Euler M, Korkmaz S, Schenck-Gustafsson K. Sex differences in drugs: the development of a comprehensive knowledge base to improve gender awareness prescribing. Biol Sex Differ 2017; 8:32. [PMID: 29065918 PMCID: PMC5655861 DOI: 10.1186/s13293-017-0155-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 10/09/2017] [Indexed: 02/12/2023] Open
Affiliation(s)
- Linnéa Karlsson Lind
- Department of E-health and Strategic IT, Health and Medical Care Administration, Stockholm County Council, Box 17533, 118 91, Stockholm, Sweden. .,Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.
| | - Mia von Euler
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.,Department of Clinical Pharmacology, Karolinska University Hospital, Stockholm, Sweden.,Department of Medicine, Division of Clinical Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Seher Korkmaz
- Department of Medicine, Division of Clinical Pharmacology, Karolinska Institutet, Stockholm, Sweden.,Department of Health Care Development, Health and Medical Care Administration, Stockholm County Council, Stockholm, Sweden
| | - Karin Schenck-Gustafsson
- Department of Medicine, Centre for Gender Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Medicine, Cardiac Unit, Karolinska University Hospital, Stockholm, Sweden
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Smith I. Operationalising the Lean principles in maternity service design using 3P methodology. BMJ QUALITY IMPROVEMENT REPORTS 2016; 5:bmjquality_uu208920.w5761. [PMID: 27933146 PMCID: PMC5128763 DOI: 10.1136/bmjquality.u208920.w5761] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 10/18/2016] [Indexed: 11/26/2022]
Abstract
The last half century has seen significant changes to Maternity services in England. Though rates of maternal and infant mortality have fallen to very low levels, this has been achieved largely through hospital admission. It has been argued that maternity services may have become over-medicalised and service users have expressed a preference for more personalised care. NHS England's national strategy sets out a vision for a modern maternity service that continues to deliver safe care whilst also adopting the principles of personalisation. Therefore, there is a need to develop maternity services that balance safety with personal choice. To address this challenge, a maternity unit in North East England considered improving their service through refurbishment or building new facilities. Using a design process known as the production preparation process (or 3P), the Lean principles of understanding user value, mapping value-streams, creating flow, developing pull processes and continuous improvement were applied to the design of a new maternity department. Multiple stakeholders were engaged in the design through participation in a time-out (3P) workshop in which an innovative pathway and facility for maternity services were co-designed. The team created a hybrid model that they described as “wrap around care” in which the Lean concept of pull was applied to create a service and facility design in which expectant mothers were put at the centre of care with clinicians, skills, equipment and supplies drawn towards them in line with acuity changes as needed. Applying the Lean principles using the 3P method helped stakeholders to create an innovative design in line with the aspirations and objectives of the National Maternity Review. The case provides a practical example of stakeholders applying the Lean principles to maternity services and demonstrates the potential applicability of the Lean 3P approach to design healthcare services in line with policy requirements.
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O'Rourke HM, Fraser KD. How Quality Improvement Practice Evidence Can Advance the Knowledge Base. J Healthc Qual 2016; 38:264-74. [DOI: 10.1097/jhq.0000000000000067] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Smith I. The Participative Design of an Endoscopy Facility using Lean 3P. BMJ QUALITY IMPROVEMENT REPORTS 2016; 5:bmjquality_uu208920.w3611. [PMID: 27493744 PMCID: PMC4949607 DOI: 10.1136/bmjquality.u208920.w3611] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Revised: 01/29/2016] [Indexed: 11/09/2022]
Abstract
In the UK, bowel cancer is the second largest cancer killer. Diagnosing people earlier can save lives but demand for endoscopies is increasing and this can put pressure on waiting times. To address this challenge, an endoscopy unit in North East England decided to improve their facilities to increase capacity and create environments that improve the experience of users. This presented a significant opportunity for step change improvement but also a problem in terms of creating designs that meet user requirements whilst addressing structural or space constraints. The Lean design process known as ‘3P' (standing for the production preparation process) was utilised as a participative design strategy to engage stakeholders in the design of the new department. This involved a time-out workshop (or 3P event) in which Lean and participative design tools were utilised to create an innovative design based on ‘point of delivery' (POD) principles. The team created a design that demonstrated an increase in treatment room capacity by 25% and bed capacity by 70% whilst reducing travel distance for patients by 25.8% and staff by 27.1%. This was achieved with an increase in available space of only 13%. The Lean 3P method provided a structured approach for corporate and clinical staff to work together with patient representatives as cross-functional teams. This participative approach facilitated communication and learning between stakeholders about care processes and personal preferences. Lean 3P therefore appears to be a promising approach to improving the healthcare facilities design process to meet user requirements.
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Abstract
Purpose
– The quality improvement in colonoscopy study was a region wide service improvement study to improve adenoma detection rate at colonoscopy by implementing evidence into routine colonoscopy practice. Implementing evidence into clinical practice can be challenging. The purpose of this paper is to perform a qualitative interview study to evaluate factors that influenced implementation within the study.
Design/methodology/approach
– Semi-structured interviews were conducted with staff in endoscopy units taking part in the quality improvement in colonoscopy study, after study completion. Units and interviewees were purposefully sampled to ensure a range of experiences was represented. Interviews were conducted with 11 participants.
Findings
– Key themes influencing uptake of the quality improvement in colonoscopy evidence bundle included time, study promotion, training, engagement, positive outcomes and modifications. Areas within themes were increased awareness of quality in colonoscopy (QIC), emphasis on withdrawal time and empowerment of endoscopy nurses to encourage the use of quality measures were positive outcomes of the study. The simple, visible study posters were reported as useful in aiding study promotion. Feedback sessions improved engagement. Challenges included difficulty arranging set-up meetings and engaging certain speciality groups.
Originality/value
– This evaluation suggests that methods to implement evidence into clinical practice should include identification and empowerment of team members who can positively influence engagement, simple, visible reminders and feedback. Emphasis on timing of meetings and strategies to engage speciality groups should also be given consideration. Qualitative evaluations can provide important insights into why quality improvement initiatives are successful or not, across different sites.
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Ritchie MJ, Kirchner JE, Parker LE, Curran GM, Fortney JC, Pitcock JA, Bonner LM, Kilbourne AM. Evaluation of an implementation facilitation strategy for settings that experience significant implementation barriers. Implement Sci 2015. [PMCID: PMC4551776 DOI: 10.1186/1748-5908-10-s1-a46] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
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Brooks P, Spillane JJ, Dick K, Stuart-Shor E. Developing a strategy to identify and treat older patients with postoperative delirium. AORN J 2014; 99:257-73; quiz 274-6. [PMID: 24472589 DOI: 10.1016/j.aorn.2013.12.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2013] [Revised: 07/16/2013] [Accepted: 12/17/2013] [Indexed: 12/27/2022]
Abstract
Postoperative delirium is one of the most common adverse outcomes in elderly patients undergoing surgery and is associated with increased morbidity, length of stay, and patient care costs. The purpose of this quality improvement project was to evaluate the effectiveness of a multicomponent strategy to identify and treat general surgical patients 65 years of age or older at risk for and who develop postoperative delirium at Cape Cod Hospital, a community hospital in southern New England. We evaluated 96 patients using the Mini-Cog assessment tool preoperatively and the Confusion Assessment Method (CAM) delirium screening tool or CAM-Intensive Care Unit (CAM-ICU) assessment tool postoperatively. Patients who tested positive during preoperative assessment underwent a postoperative delirium management protocol. We summarized data using descriptive statistics. The results showed an association between compliance and outcomes. High compliance with implementation of CAM and CAM-ICU assessment tools resulted in increased identification of postoperative delirium in the older surgical population. The use of screening tools helped facilitate early identification of postoperative delirium in elderly surgical patients.
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Hills DJ, Joyce CM, Humphreys JS. Workplace aggression prevention and minimisation in Australian clinical medical practice settings - a national study. AUST HEALTH REV 2014; 37:607-13. [PMID: 24120266 DOI: 10.1071/ah13149] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Accepted: 08/02/2013] [Indexed: 11/23/2022]
Abstract
INTRODUCTION This report describes the extent to which 12 workplace aggression prevention and minimisation actions have been implemented in Australian clinical medical practice settings. METHODS Using a cross-sectional, self-report survey conducted as part of a national longitudinal study of the Australian medical workforce, differences in the proportions of medical clinicians reporting the implementation of 12 aggression prevention and minimisation actions in their main workplace were determined. RESULTS Only one-third of aggression prevention and minimisation actions achieved point-prevalence rates of greater than 60%, including aggression policies and protocols (65.7%) and incident reporting systems (68.2%). Overall, lower point-prevalence rates were detected for general practitioners and specialists compared with hospital non-specialists and specialists in training, largely reflecting those for doctors mainly working in private rooms compared with public hospitals. Key environmental interventions had relatively low point-prevalence overall, including duress alarms and optimised clinician escape in consulting and treatment areas, and after-hours and off-site safety strategies. CONCLUSIONS More widespread adoption of aggression prevention and minimisation measures in medical practice settings is required. Specific legislative and accreditation provisions and funding support may provide the necessary impetus for reform. Further studies can enhance the evidence base on the most effective approaches to the prevention and minimisation of workplace aggression in medical practice settings.
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Affiliation(s)
- Danny J Hills
- Department of Epidemiology and Preventive Medicine, Level 6, Alfred Centre, 99 Commercial Road, Melbourne, Vic. 3004, Australia.
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Murphy C, Fader M, Prieto J. Interventions to minimise the initial use of indwelling urinary catheters in acute care: a systematic review. Int J Nurs Stud 2013; 51:4-13. [PMID: 23332716 DOI: 10.1016/j.ijnurstu.2012.12.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2012] [Revised: 12/13/2012] [Accepted: 12/13/2012] [Indexed: 12/17/2022]
Abstract
BACKGROUND Indwelling urinary catheters (IUC) are the primary cause of urinary tract infection in acute care. Current research aimed at reducing the use of IUCs in acute care has focused on the prompt removal of catheters already placed. This paper evaluates attempts to minimise the initial placement of IUCs. OBJECTIVES To evaluate systematically the evidence of the effectiveness of interventions to minimise the initial placement of IUCs in adults in acute care. DESIGN Studies incorporating an intervention to reduce the initial placement of IUCs in an acute care environment in patients aged 18 and over that reported on the incidence of IUC placement were included in the review. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist has been used as a tool to guide the structure of the review. DATA SOURCES MEDLINE, CINAHL, EMBASE, National Health Service Centre for Review and Dissemination and Cochrane Library. REVIEW METHODS A systematic review to identify and synthesise research reporting on the impact on interventions to minimise the use of IUCs in acute care published up to July 2011. RESULTS 2689 studies were scanned for eligibility. Only eight studies were found that reported any change (increase or decrease) in the level of initial placement of IUCs as a result of an intervention in acute care. Of the eight, six had an uncontrolled before-after design. Seven demonstrated a reduction in the initial use of IUCs post-intervention. There was insufficient evidence to support or rule out the effectiveness of interventions due to the small number of studies, limitations in study design and variation in clinical environments. Notably, each study listed the indications considered to be acceptable uses of an IUC and there was substantial variation between the lists of indications. CONCLUSIONS More work is needed to establish when the initial placement of an IUC is appropriate in order to better understand when IUCs are overused and inform the development of methodologically robust research on the potential of interventions to minimise the initial placement of IUCs.
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Affiliation(s)
- Catherine Murphy
- Faculty of Health Sciences, University of Southampton, United Kingdom.
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Russell NCC, Wallace LM, Ketley D. Evaluation and measurement for improvement in service-level quality improvement initiatives. Health Serv Manage Res 2011; 24:182-9. [DOI: 10.1258/hsmr.2011.011010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The National Health Service (NHS) in England, as with other health services worldwide, currently faces the need to reduce costs and to improve the quality of patient care. Evidence gathered through effective and appropriate measurement and evaluation, is essential to achieving this. Through interviews with service improvement managers and analysis of comments in a seminar of NHS staff involved in health service improvement, we found a lack of understanding regarding the definition and methodology of both measurement and evaluation, which decreases the likelihood that NHS staff will be competent to commission or provide these skills. In addition, we highlight the importance of managers assessing their organizations' ‘readiness’ to undergo change before embarking on a quality improvement (QI) initiative, to ensure that the initiative's impact can be adequately judged. We provide definitions of measurement for improvement and of evaluation, and propose a comparative framework from which to gauge an appropriate approach. Examples of two large-scale QI initiatives are also given, along with descriptions of some of their problems and solutions, to illustrate the use of the framework. We recommend that health service managers use the framework to determine the most appropriate approach to evaluation and measurement for improvement for their context, to ensure that their decisions are evidence based.
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Affiliation(s)
- Nicholas C C Russell
- Applied Research Centre in Health and Lifestyle Interventions, Faculty of Health and Life Sciences, Coventry University, Coventry, UK
- NHS Institute for Innovation and Improvement, University of Warwick Campus, Coventry, UK
| | - Louise M Wallace
- Applied Research Centre in Health and Lifestyle Interventions, Faculty of Health and Life Sciences, Coventry University, Coventry, UK
| | - Diane Ketley
- NHS Institute for Innovation and Improvement, University of Warwick Campus, Coventry, UK
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Sonneveld RE, Wensing M, Bronkhorst EM, Truin GJ, Brands WG. The estimation of patients' views on organizational aspects of a general dental practice by general dental practitioners: a survey study. BMC Health Serv Res 2011; 11:263. [PMID: 21989235 PMCID: PMC3204231 DOI: 10.1186/1472-6963-11-263] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2011] [Accepted: 10/11/2011] [Indexed: 11/21/2022] Open
Abstract
Background Considering the changes in dental healthcare, such as the increasing assertiveness of patients, the introduction of new dental professionals, and regulated competition, it becomes more important that general dental practitioners (GDPs) take patients' views into account. The aim of the study was to compare patients' views on organizational aspects of general dental practices with those of GDPs and with GDPs' estimation of patients' views. Methods In a survey study, patients and GDPs provided their views on organizational aspects of a general dental practice. In a second, separate survey, GDPs were invited to estimate patients' views on 22 organizational aspects of a general dental practice. Results For 4 of the 22 aspects, patients and GDPs had the same views, and GDPs estimated patients' views reasonably well: 'Dutch-speaking GDP', 'guarantee on treatment', 'treatment by the same GDP', and 'reminder of routine oral examination'. For 2 aspects ('quality assessment' and 'accessibility for disabled patients') patients and GDPs had the same standards, although the GDPs underestimated the patients' standards. Patients had higher standards than GDPs for 7 aspects and lower standards than GDPs for 8 aspects. Conclusion On most aspects GDPs and patient have different views, except for social desirable aspects. Given the increasing assertiveness of patients, it is startling the GDP's estimated only half of the patients' views correctly. The findings of the study can assist GDPs in adapting their organizational services to better meet the preferences of their patients and to improve the communication towards patients.
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Affiliation(s)
- Rutger E Sonneveld
- Department of Preventive and Restorative Dentistry, Radboud University Nijmegen Medical Centre, Philips van Leijdenlaan 25, 6525 EX Nijmegen, the Netherlands.
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Harvey G, Fitzgerald L, Fielden S, McBride A, Waterman H, Bamford D, Kislov R, Boaden R. The NIHR Collaborations for Leadership in Applied Health Research and Care (CLAHRC) for Greater Manchester: combining empirical, theoretical and experiential evidence to design and evaluate a large-scale implementation strategy. Implement Sci 2011; 6:96. [PMID: 21861886 PMCID: PMC3170237 DOI: 10.1186/1748-5908-6-96] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2011] [Accepted: 08/23/2011] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND In response to policy recommendations, nine National Institute for Health Research (NIHR) Collaborations for Leadership in Applied Health Research and Care (CLAHRCs) were established in England in 2008, aiming to create closer working between the health service and higher education and narrow the gap between research and its implementation in practice. The Greater Manchester (GM) CLAHRC is a partnership between the University of Manchester and twenty National Health Service (NHS) trusts, with a five-year mission to improve healthcare and reduce health inequalities for people with cardiovascular conditions. This paper outlines the GM CLAHRC approach to designing and evaluating a large-scale, evidence- and theory-informed, context-sensitive implementation programme. DISCUSSION The paper makes a case for embedding evaluation within the design of the implementation strategy. Empirical, theoretical, and experiential evidence relating to implementation science and methods has been synthesised to formulate eight core principles of the GM CLAHRC implementation strategy, recognising the multi-faceted nature of evidence, the complexity of the implementation process, and the corresponding need to apply approaches that are situationally relevant, responsive, flexible, and collaborative. In turn, these core principles inform the selection of four interrelated building blocks upon which the GM CLAHRC approach to implementation is founded. These determine the organizational processes, structures, and roles utilised by specific GM CLAHRC implementation projects, as well as the approach to researching implementation, and comprise: the Promoting Action on Research Implementation in Health Services (PARIHS) framework; a modified version of the Model for Improvement; multiprofessional teams with designated roles to lead, facilitate, and support the implementation process; and embedded evaluation and learning. SUMMARY Designing and evaluating a large-scale implementation strategy that can cope with and respond to the local complexities of implementing research evidence into practice is itself complex and challenging. We present an argument for adopting an integrative, co-production approach to planning and evaluating the implementation of research into practice, drawing on an eclectic range of evidence sources.
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Affiliation(s)
- Gill Harvey
- Manchester Business School, University of Manchester, Booth Street West, Manchester, M15 6PB, UK
| | - Louise Fitzgerald
- Manchester Business School, University of Manchester, Booth Street West, Manchester, M15 6PB, UK
| | - Sandra Fielden
- Manchester Business School, University of Manchester, Booth Street West, Manchester, M15 6PB, UK
| | - Anne McBride
- Manchester Business School, University of Manchester, Booth Street West, Manchester, M15 6PB, UK
| | - Heather Waterman
- School of Nursing, Midwifery and Social Work, University of Manchester
| | - David Bamford
- Manchester Business School, University of Manchester, Booth Street West, Manchester, M15 6PB, UK
| | - Roman Kislov
- Manchester Business School, University of Manchester, Booth Street West, Manchester, M15 6PB, UK
| | - Ruth Boaden
- Manchester Business School, University of Manchester, Booth Street West, Manchester, M15 6PB, UK
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Svoronos T, Mate KS. Evaluating large-scale health programmes at a district level in resource-limited countries. Bull World Health Organ 2011; 89:831-7. [PMID: 22084529 DOI: 10.2471/blt.11.088138] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2011] [Revised: 06/27/2011] [Accepted: 07/03/2011] [Indexed: 11/27/2022] Open
Abstract
Recent experience in evaluating large-scale global health programmes has highlighted the need to consider contextual differences between sites implementing the same intervention. Traditional randomized controlled trials are ill-suited for this purpose, as they are designed to identify whether an intervention works, not how, when and why it works. In this paper we review several evaluation designs that attempt to account for contextual factors that contribute to intervention effectiveness. Using these designs as a base, we propose a set of principles that may help to capture information on context. Finally, we propose a tool, called a driver diagram, traditionally used in implementation that would allow evaluators to systematically monitor changing dynamics in project implementation and identify contextual variation across sites. We describe an implementation-related example from South Africa to underline the strengths of the tool. If used across multiple sites and multiple projects, the resulting driver diagrams could be pooled together to form a generalized theory for how, when and why a widely-used intervention works. Mechanisms similar to the driver diagram are urgently needed to complement existing evaluations of large-scale implementation efforts.
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Affiliation(s)
- Theodore Svoronos
- Institute for Healthcare Improvement, 20 University Road, Cambridge, MA 02138, United States of America.
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Translating knowledge on best practice into improving quality of RRT care: a systematic review of implementation strategies. Kidney Int 2011; 80:1021-34. [PMID: 21775971 DOI: 10.1038/ki.2011.222] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Recent studies showed wide variation in the extent to which guidelines and other types of best practice have been implemented as part of routine health care. This is also true for the delivery of renal replacement therapy (RRT) for ESRD patients. Increasing uptake of best practice within such complex care systems requires an understanding of implementation strategies and specific quality improvement (QI) techniques. Therefore, we systematically reviewed over 5000 titles published since 1990 and included papers describing planned attempts to accelerate uptake of best RRT practice into daily care. This resulted in a list of 93 QI initiatives, categorized in order to expedite shared learning. The majority of the initiatives were executed within the domains of vascular access, nutrition, and anemia management. Strategies oriented at patients were most common and many initiatives pre-defined an improvement target before starting implementation. Of the 93 initiatives, 22 were sufficiently robust methodologically to be analyzed in more detail. Our results tend to support previous findings that multifaceted strategies are more effective than single strategies. Improving our understanding of how to successfully implement best practice can inform system-level change and is the only way to close the gap between knowledge on what works and the actual care delivered to ESRD patients. Research into implementation, using specific QI techniques, should therefore be given priority in future.
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Lynch J, Goodhart F, Saunders Y, O'Connor SJ. Screening for psychological distress in patients with lung cancer: results of a clinical audit evaluating the use of the patient Distress Thermometer. Support Care Cancer 2010; 19:193-202. [PMID: 20069436 PMCID: PMC3016098 DOI: 10.1007/s00520-009-0799-8] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2009] [Accepted: 12/07/2009] [Indexed: 01/09/2023]
Abstract
PURPOSE Patients with lung cancer frequently suffer psychological distress and guidelines in the United Kingdom recommend screening of all cancer patients for this problem. The audit investigated use of the Distress Thermometer in terms of staff adherence to locally developed guidelines, patient willingness to use the tool, its impact on referral rates to clinical psychology services and concordance between the tool and the clinical assessment. METHOD Use of the Distress Thermometer was audited over a 3-month period in one lung cancer outpatient clinic. Referrals to clinical psychology services in response to clearly delineated referral indicators were assessed. Patient-reported outcomes were compared with practitioner assessment of need during clinical consultations to see whether the tool was measuring distress effectively. RESULTS Thirty three of 34 patients used the Distress Thermometer during the audit period. Ten reported distress levels above 4 in the emotional or family problems domains. On ten occasions, the clinical interview identified problems not elicited by the Distress Thermometer. Guidelines were adhered to by staff, and patients were offered information about local support services and referral to clinical psychology services where indicated. Whilst all patients were happy to receive written information about further sources of support, none wanted to be referred to psychological services at that time. CONCLUSIONS The Distress Thermometer is acceptable to patients with lung cancer in outpatient settings but it did not increase referrals for psychological support. Staff found it to be a useful tool in opening up communication about patient issues although it should not replace a comprehensive clinical interview.
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Affiliation(s)
- Johanna Lynch
- The Hillingdon Hospital, Pield Heath Road, Uxbridge UB8 3NN, UK.
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Bowman CC, Sobo EJ, Asch SM, Gifford AL. Measuring persistence of implementation: QUERI Series. Implement Sci 2008; 3:21. [PMID: 18430200 PMCID: PMC2390585 DOI: 10.1186/1748-5908-3-21] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2006] [Accepted: 04/22/2008] [Indexed: 11/10/2022] Open
Abstract
As more quality improvement programs are implemented to achieve gains in performance, the need to evaluate their lasting effects has become increasingly evident. However, such long-term follow-up evaluations are scarce in healthcare implementation science, being largely relegated to the "need for further research" section of most project write-ups. This article explores the variety of conceptualizations of implementation sustainability, as well as behavioral and organizational factors that influence the maintenance of gains. It highlights the finer points of design considerations and draws on our own experiences with measuring sustainability, framed within the rich theoretical and empirical contributions of others. In addition, recommendations are made for designing sustainability analyses. This article is one in a Series of articles documenting implementation science frameworks and approaches developed by the U.S. Department of Veterans Affairs Quality Enhancement Research Initiative (QUERI).
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Affiliation(s)
- Candice C Bowman
- Health Services Research & Development, VA San Diego Healthcare System, San Diego, California, USA
| | - Elisa J Sobo
- Department of Anthropology, San Diego State University, San Diego, California, USA
| | - Steven M Asch
- Center for the Study of Healthcare Provider Behavior, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Allen L Gifford
- Center for Health Quality, Outcomes, and Economic Research, VA New England Healthcare System, Bedford, Massachusetts, USA
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Abstract
This article assesses the extent to which a team using quality improvement methods could improve the timeliness of the flow of admitted patients through the emergency department in one hospital. Using a structured approach, a multidisciplinary team redesigned the processes for admitting patients from the emergency department to the inpatient unit. Indicators of capacity limitations in the inpatient environment were also identified as triggers for a tiered institutional response to capacity constraints. Three time intervals in the admission process were identified for measuring performance, with comparisons to the same months of the previous year to determine significance. Significant reductions in the median minutes for a majority of the time intervals studied were achieved during the 6-month study period. The data from the study suggest that improvements in patient progression through an emergency department can be achieved with quality improvement methods. Success factors for this and other improvement strategies are discussed.
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Eliasson M, Bastholm P, Forsberg P, Henriksson K, Jacobson L, Nilsson A, Gustafsson LL. Janus computerised prescribing system provides pharmacological knowledge at point of care - design, development and proof of concept. Eur J Clin Pharmacol 2006; 62:251-8. [PMID: 16552505 DOI: 10.1007/s00228-006-0114-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2005] [Accepted: 02/08/2006] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To develop and verify proof of concept for a user-defined prescribing system with decision support based on one single database consisting of several pharmacological sources. METHODS A multidisciplinary working group within the framework of a two-phase project developed the tool. A small-scale pilot study for proof of concept was carried out in an outpatient neurological polyclinic where four experienced physicians used the tool in patient care on a daily basis. RESULTS Automatically generated functions, such as recommended drugs, alerts for interactions, alerts for drug therapy during pregnancy and breast-feeding and a search tool for adverse drug effects, were quickly adopted into the daily outpatient working regime. Functions such as treatment strategies and a link to a producer independent website were less frequently used but still rated as useful and educational. CONCLUSION Searches for information that can be concentrated in one system saves time. Alerts inevitably draw physicians' attention to the information. Instant availability to drug recommendations in a computerised prescribing system such as Janus should increase adherence to recommendations, but this needs to be evaluated systematically. Small-scale pilot studies such as the one reported here have been shown to be invaluable in providing the theoretical basis for implementation of the system and for gaining an understanding of the complex change processes involved. Small-scale projects can therefore provided a base for further development and broader implementation of pharmacological tools and services.
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Affiliation(s)
- Marie Eliasson
- Department of Drug Management and Informatics, Stockholm Health Region, Sweden.
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Davidoff F, Batalden P. Toward stronger evidence on quality improvement. Draft publication guidelines: the beginning of a consensus project. Qual Saf Health Care 2006; 14:319-25. [PMID: 16195563 PMCID: PMC1744070 DOI: 10.1136/qshc.2005.014787] [Citation(s) in RCA: 144] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
In contrast with the primary goals of science, which are to discover and disseminate new knowledge, the primary goal of improvement is to change performance. Unfortunately, scholarly accounts of the methods, experiences, and results of most medical quality improvement work are not published, either in print or electronic form. In our view this failure to publish is a serious deficiency: it limits the available evidence on efficacy, prevents critical scrutiny, deprives staff of the opportunity and incentive to clarify thinking, slows dissemination of established improvements, inhibits discovery of innovations, and compromises the ethical obligation to return valuable information to the public.The reasons for this failure are many: competing service responsibilities of and lack of academic rewards for improvement staff; editors' and peer reviewers' unfamiliarity with improvement goals and methods; and lack of publication guidelines that are appropriate for rigorous, scholarly improvement work. We propose here a draft set of guidelines designed to help with writing, reviewing, editing, interpreting, and using such reports. We envisage this draft as the starting point for collaborative development of more definitive guidelines. We suggest that medical quality improvement will not reach its full potential unless accurate and transparent reports of improvement work are published frequently and widely.
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Affiliation(s)
- F Davidoff
- Institute for Healthcare Improvement, 143 Garden Street, Wethersfield, CT 06109, USA.
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Goyder EC, Blank L, Ellis E, Furber A, Peters J, Sartain K, Massey C. Reducing inequalities in access to health care: developing a toolkit through action research. Qual Saf Health Care 2006; 14:336-9. [PMID: 16195566 PMCID: PMC1744068 DOI: 10.1136/qshc.2005.013821] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PROBLEM Healthcare organisations are expected both to monitor inequalities in access to health services and also to act to improve access and increase equity in service provision. DESIGN Locally developed action research projects with an explicit objective of reducing inequalities in access. SETTING Eight different health care services in the Yorkshire and Humber region, including community based palliative care, general practice asthma care, hospital based cardiology clinics, and termination of pregnancy services. KEY MEASURES FOR IMPROVEMENT Changes in service provision, increasing attendance rates in targeted groups. STRATEGIES FOR CHANGE Local teams identified the population concerned and appropriate interventions using both published and grey literature. Where change to service provision was achieved, local data were collected to monitor the impact of service change. EFFECTS OF CHANGE A number of evidence based changes to service provision were proposed and implemented with variable success. Service uptake increased in some of the targeted populations. LESSONS LEARNT Interventions to improve access must be sensitive to local settings and need both practical and managerial support to succeed. It is particularly difficult to improve access effectively if services are already struggling to meet current demand. Key elements for successful interventions included effective local leadership, identification of an intervention which is both evidence based and locally practicable, and identification of additional resources to support increased activity. A "toolkit" has been developed to support the identification and implementation of appropriate changes.
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Affiliation(s)
- E C Goyder
- ScHARR, University of Sheffield, Sheffield, UK.
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Hughes R, Higginson I. Discussion of quality and audit in health. JOURNAL OF HEALTH & SOCIAL POLICY 2006; 22:29-38. [PMID: 17135107 DOI: 10.1300/j045v22n01_03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Attaining quality health care has long been a social policy priority for countries internationally. This discussion considers issues important to understanding quality, and audit implementation in particular. The paper covers, first, the principles and practice of audit and, second, broader implementation issues, which together point to the further development of quality initiatives in health in the United Kingdom health care context. To close, the future of audit as a means of improving health care is elaborated.
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Affiliation(s)
- Rhidian Hughes
- Centre for Health and Social Care, School for Policy Studies, University of Bristol, Bristol, United Kingdom.
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Cleary M, Freeman A, Sharrock L. The development, implementation, and evaluation of a clinical leadership program for mental health nurses. Issues Ment Health Nurs 2005; 26:827-42. [PMID: 16203638 DOI: 10.1080/01612840500184277] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
A structured clinical leadership program was developed to assist nurses working in a metropolitan mental health service to develop and consolidate clinical leadership skills. The Nurses' Self-Concept Questionnaire (NSCO) was used to elicit responses from participants prior to commencement of the leadership program and again at completion. Findings indicate that the program was considered useful and its benefits were carried over into the workplace via the sharing of information. The self-directed nature of this program was found to be an effective way for clinical nurses to undertake continued professional development within the exigencies of clinical practice.
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Affiliation(s)
- Michelle Cleary
- Central Sydney Area Mental Health Service, New South, Wales, Australia.
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Garner P, Meremikwu M, Volmink J, Xu Q, Smith H. Putting evidence into practice: how middle and low income countries "get it together". BMJ 2004; 329:1036-9. [PMID: 15514355 PMCID: PMC524565 DOI: 10.1136/bmj.329.7473.1036] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The scarcity of resources in poorer countries means that ensuring health care is evidence based is particularly important. A group of workers active in the field describe their experiences of trying to do just that
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Affiliation(s)
- Paul Garner
- International Health Research Group, Liverpool School of Tropical Medicine, Liverpool L3 5QA.
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Premji SS, McNeil DA, Scotland J. Regional neonatal oral feeding protocol: changing the ethos of feeding preterm infants. J Perinat Neonatal Nurs 2004; 18:371-84. [PMID: 15646307 DOI: 10.1097/00005237-200410000-00008] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The Calgary Health Region Neonatal Oral Feeding Protocol is the culminating work of a broad range of healthcare professionals, including staff nurses, nurse practitioners, nurse educators, nurse managers, dietitians, lactation consultants, clinical nurse specialists, and occupational therapists. The protocol represents a synthesis of research evidence and expert opinion pertaining to the introduction and management of oral milk feedings for high-risk infants in the neonatal intensive care unit. This evidence-based neonatal oral feeding protocol is presented to share knowledge and skill required to create positive feeding experiences while assisting high-risk infants to achieve full oral feedings. Goals of this project include promoting consistent neonatal nursing feeding practices and changing the ethos in relation to feeding interactions between caregiver and infant in the neonatal intensive care unit. This culture change will assist nurses to identify what is unique about their professional practice, which is of particular importance given the skill mix resulting from hospital understaffing and a growing nursing workforce shortage.
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