Implementation and Promotion of Quality Control Circle: A Starter for Quality Improvement in Chinese Hospitals

Quality Control Circle Practices to Reduce Specimen Rejection Rates

Background

Quality assurance in laboratory testing significantly impacts patient care. The pre-analytical phase is particularly error-prone, contributing to around 70% of laboratory errors. High specimen rejection rates can delay diagnosis and treatment, cause patient discomfort, and increase healthcare costs. Quality Control Circles (QCC) have been introduced to medical institutions to improve process efficiency and reduce errors. This study aims to evaluate the effectiveness of QCC practices in reducing specimen rejection rates in a hospital clinical laboratory.

Methods

A QCC initiative was implemented in the clinical laboratory from July 2021 to August 2022. The QCC comprised members from the clinical laboratory, nursing department, and administration. The initiative followed the PDCA (Plan-Do-Check-Act) cycle and involved multiple quality control methods, including flowchart analysis, Pareto analysis, and Fishbone diagrams. The effectiveness of the initiative was evaluated using statistical analyses of specimen rejection rates before and after implementation.

Results

The QCC initiative led to a significant reduction in specimen rejection rates. The monthly specimen rejection rate decreased from an average of 1.13% before the intervention to 0.27% after the intervention. The most significant factors contributing to specimen rejection were identified as lack of sample collection information and blood clotting. Targeted interventions, such as appointing specimen collection liaisons, establishing a quality control team, and providing training on blood collection procedures, were implemented. These measures resulted in a notable decrease in the proportion of rejected specimens due to the identified factors.

Conclusion

The implementation of QCC practices effectively reduced specimen rejection rates in the hospital laboratory. The study highlights the importance of systematic quality control methods and targeted interventions in improving laboratory processes. The success of the QCC initiative demonstrates its potential for broader application in other healthcare settings to enhance quality and efficiency.

Analysis and visualization of the research progress on surgical smoke

BACKGROUND

With the advancement of medical technology, tools such as electrosurgical equipment, laser knives, and ultrasonic scalpels have made modern medical procedures more convenient and effective. However, the generation of surgical smoke during these procedures poses significant health risks to medical personnel. Despite this, only a few studies have examined the literature systematically in this area. By analyzing bibliometric data on surgical smoke, we can gain insights into current research hotspots and forecast future trends.

METHODS

This study included literature related to surgical smoke from the Web of Science and China National Knowledge Infrastructure (CNKI) databases, covering the period from 2000 to 2024. We used VOSviewer, CiteSpace, and BioBERT to visualize research trends and hotspots.

RESULTS

In the early stages of research, the focus was mainly on the composition, generation mechanisms, and susceptible populations related to surgical smoke. In recent years, with the development of laparoscopic surgery and the global COVID-19 pandemic, research interests have shifted towards occupational protection of healthcare workers and public health. Currently, the research in this field primarily explores the promoting effects of surgical smoke on conditions such as inflammation and tumors, as well as occupational protection and health education for healthcare workers. Disease research focuses heavily on Smoke Inhalation Injury, Infections, Neoplasms, Postoperative Complications, and Inflammation.

CONCLUSION

We explored future research directions in the field of surgical smoke using VOSviewer, CiteSpace, and BioBERT. Our findings indicate that current research focuses on investigating the promoting effects of surgical smoke on conditions such as inflammation and tumors, as well as on occupational protection and health education for healthcare workers. We summarized existing preventive measures, aiming to facilitate further research advancements and the translation of research outcomes into clinical results. These efforts provide new insights for advancing research in occupational protection of healthcare workers.

Continuous quality improvement project to reduce the downtime of medical linear accelerators: A case study at Zhejiang Cancer Hospital

Objective

To analyse and continually improve existing issues in the quality improvement process of medical linear accelerators (LINACs) and enhance the quality control management of LINACs.

Methods

Data were collected from eight LINACs (sourced from three manufacturers) at Zhejiang Cancer Hospital using Excel diaries between January 2019 and December 2020. The data description and analysis were performed using the analytic hierarchy process, SPSSAU and Excel software, and mean-time-to-repair (MTTR)/mean-time-between-failure (MTBF) metrics. Continuous quality improvement was executed using the quality control circle (QCC) quality management method.

Results

After quality improvement, the risk frequency of 'LINAC down' events decreased by 43.63% and downtime was reduced by 40.45%. The weight of downtime risk improved by 73.69%. The MTTR recovery value increased by 31.90%, and MTBF reliability increased by 2.97 h. The simulation results demonstrated that the proposed quality improvement measures could effectively decrease the frequency and duration of downtimes, consequently extending the normal operational time of LINACs.

Conclusion

Transitioning from instant repair to preventative maintenance can enhance the operational efficiency of equipment and yield economic benefits for hospitals. The QCC method and the event risk evaluation model are effective in reducing the downtime of LINACs and improving their quality control management.

Application of quality control circle in the management of early ambulation after cesarean section: An observational study

BACKGROUND

The quality control circle (QCC) model has achieved good results in clinical applications in many hospitals in China and has gained popularity. This study aims to explore the application of QCC activities on early ambulation after cesarean section.

METHODS

A QCC management group was established following standardized methods and techniques. The theme of the group was identified as "to enhance the implementation rate of the patient early ambulation after the cesarean section" through a matrix graph. The early ambulation rates after surgery of patients who received cesarean section were compared before and after QCC managements.

RESULTS

Our data suggested that the early ambulation rates after cesarean section increased from 37.5% to 81.25% after applying QCC management. The biggest factor influencing the ambulation activities 24 ± 4 hours after the surgery was patients and family members do not cooperate. In addition, outstanding improvements in terms of nurses' sense of responsibility and self-confidence, communication and teamwork capacity in the problem-solving process were observed after the establishment of QCC.

CONCLUSION

The application of QCC management had not only increase the early ambulation rates after cesarean section but also improved the quality of nursery care in general.

Application of Multidimensional Quality Management Tools in the Management of Medical Adverse Events

Purpose

This study aims to investigate the impact of multidimensional quality management tools in establishing a medical adverse event management system, with the aim of continuously improving medical quality and safety while ensuring patient well-being.

Methods

This study introduces risk management theories, such as the "Gray Rhino Theory", and employs quality management tools like the Plan-Do-Check-Act (PDCA) cycle, Quality Control Circle (QCC), and Root Cause Analysis (RCA), to provide relevant quality management education and training to employees. This approach facilitates the establishment of a medical adverse event management system that encourages reporting and fosters a blame-free reporting culture, while simultaneously implementing quality management across the entire process. The regular utilization of the QCC facilitates ongoing quality improvement. Furthermore, for sentinel events and patient harm incidents with educational values, the study employs the Incident Decision Tree (IDT) to determine appropriate actions. Additionally, the hospital initiates RCA for system-wide improvements, focusing on areas such as management, institutional processes, and environmental aspects. Moreover, an internal medical quality improvement case competition is organized, with outstanding cases being selected to participate in the multidimensional quality management competition organized by the National Quality Management Alliance.

Results

The study reveals a significant improvement in employees' awareness of adverse events, the percentage of employees reporting adverse events increased significantly from 39.15% in 2019 to 49.77% in 2022, P=0.002. Furthermore, the adverse event reporting rate has risen significantly from 2.78% (2019) to 5.96% (2022), P=0.002. Additionally, each department has been able to utilize QCC or RCA tools for quality improvement, thereby further reinforcing the development of a patient safety culture.

Conclusion

Multidimensional quality management tools play a crucial role in establishing a hospital's adverse event management system, promoting continuous improvement in medical quality, ensuring patient safety, and effectively implementing a culture of patient safety.

A quality control circle process to improve enteral nutrition feeding support in discharged patients with colorectal cancer

Correct usage and maintenance of the enteral nutrition feeding pump system is always a challenge in nutrition support for patients with colorectal cancer (CRC). However, there are few studies on the sustained accuracy improvement of the enteral nutrition feeding system in discharged CRC patients. Here, we established a seven-month quality control circle (QCC) activity with the theme of improving the performance of home enteral feeding pumps (EFP) and examined the effect of QCC activity on the nutritional state and quality of life in discharged CRC patients. We enrolled 100 discharged CRC patients treated with home enteral nutrition from Zhejiang Cancer Hospital between March 2020 and December 2021. The patients were randomly split into two research groups: one participated in the QCC activity (n = 50) and the other did not (n = 50). QCC analysis indicated that the top 3 causes of EFP inaccurate usage are the simple and boring contents of training, various types of pumps, no examination rules, and lack of management. Furthermore, both intra- and inter-group comparisons showed that QCC significantly improved the patients' pass rate of nutrition pump operation from 52 to 70% after 1-month of activity, which gradually improved and got the highest (90%) after 3 months (p < 0.05). Interestingly, the established QCC activity significantly increased the patient-generated subjective global assessment (PG-SGA) and Barthel index (BI) scores, body fat mass (BFM) and superior longitudinal muscle (SLM) by intra- and inter-group comparisons. In this study, we clarified the main causes of inaccurate EFP usage and established a QCC process to improve the pass rate of EFP usage. It finally leads to the improvement of nutritional state and quality of life in CRC patients.

Effect of Quality Control Circle Activity Nursing Combined with Respiratory Function Exercise Nursing on Patients with Esophageal Cancer

Objective. To explore the effect of quality control circle activity nursing combined with respiratory function exercise nursing on esophageal cancer patients’ immune function and nutritional status. Methods. The clinical case data of 119 esophageal cancer patients admitted to our hospital were selected as the research objects from May 2019 to July 2021. They were divided into the quality control circle activity care group (QCCAC) (9 cases dropped due to incomplete case data, n= 50) and respiratory function exercise care group (10 cases dropped due to incomplete case data, n=50) by the random number table method, the respiratory function exercise care group was treated with respiratory function exercise care, while the QCCAC group was treated with QCCAC. Changes in lung function, immune function, and nutritional status before and after nursing were compared in the two groups of patients. Results. Before nursing, there was no significant difference in pulmonary function indexes, immune function indexes, and the level of nutritional status indicators between the two groups ( $P>0.05$ ). After nursing, the finger pulse oxygen saturation, vital capacity (VC), respiratory rate, forced vital capacity (FVC), deep inspiratory volume (IC), and maximum ventilation (MVV) of the QCCAC improved, and the QCCAC group was significantly higher than the respiratory function exercise care group ( $P<0.05$ ). After nursing, the QCCAC’s CD3+, CD4+, IgG, IgM, and IgA levels increased, and the QCCAC group was significantly higher than the respiratory function exercise care group. The CD8+ level decreased, and the QCCAC was lower than the respiratory function exercise care group ( $P<0.05$ ). After continuous nursing, the QCCAC’s D-lactic acid, DAO, FFMI, Hb, ALB, PA, and other nutritional evaluation indexes all increased, and the QCCAC was significantly higher than the respiratory function exercise care group ( $P<0.05$ ). Conclusion. Quality control circle activity nursing combined with respiratory function exercise nursing can effectively improve the immune function, respiratory function, and nutritional status of esophageal cancer patients.

Adjusting Quality Control Chart Limits for WBC, RBC, Hb, and PLT Counts to Reduce Daily Control Risks in Hospital Laboratory

BACKGROUND

To continuously improve medical quality and provide clinicians with more accurate blood test reports, this study collected blood quality control data in 2017 from a medical examination laboratory in a teaching level hospital located in Taoyuan City, Taiwan.

MATERIAL AND METHODS

The quality control data were arranged and analyzed from daily complete blood count (CBC), including white blood cells (WBC), red blood cells (RBC), hemoglobin (Hb), and platelets (PLT) recorded by a laboratory blood analyzer. Using the empirical Bayesian method, we estimated the variation of concentrations of the last and current batches to establish a novel control chart with adjusted upper and lower limits for the current batch, and then compared results with the traditional Shewhart method. The average run length (ARL) and sensitivity of the empirical Bayesian method were explored.

RESULTS

The study found that ARL showed a qualified capability for the four blood routine tests when using the empirical Bayesian method. Compared to the Levey-Jennings control chart, the novel control chart presents an alert earlier when a deviation occurs and shows a fake alert later when there is no deviation.

CONCLUSION

The parallel tests showed that the longer the time is, the better the test's proficiency. We concluded that the empirical Bayesian method could be applied effectively to improve the capability of daily control in CBC laboratory tests.