International Journal for Quality in Health Care最新文献

Background: This study aimed to systematically evaluate apps with temporomandibular disorder (TMD) self-management content available in Australia for quality, clinical safety, self-management support functions, and contributors to app development.

Methods: A systematic search of the App Store (iOS) and Google Play (Android) was conducted on 18 April 2023 (and updated 26 July 2023) to identify apps that had TMD self-management content. Two raters independently assessed app quality, clinical safety, self-management support, and contributors to app development for the involvement of people living with TMD and clinicians. Quality was evaluated using the Mobile App Rating Scale (MARS) for engagement, functionality, aesthetics, and information quality scored using a 5-point Likert scale. App clinical safety was assessed using MARS functionality (item 6) and information quality items for accuracy/relevance (item 15), scope (item 16), and visual information accuracy/clarity (item 17) (scored on a Likert scale), and the M-Health Index and Navigation Database framework questions: does the app provide any warning for use? Does the app have a crisis management feature? Can the app cause harm? (scored yes/no). Self-management support was evaluated using the Self-Management Support (SMS-14) checklist (scored yes/no). Included apps, app store descriptions and linked websites were qualitatively evaluated to determine the contributors to app development.

Results: Seven apps with TMD self-management content were available in Australia. Overall, the included apps were of acceptable quality (mean=3.25/5) but scored poorly for engagement (2.71/5) and information (2.92/5). Clinical safety limitations identified were the inability to identify and/or direct users to support services in a crisis and inconsistent TMD information. One app (Do I Grind or Snore) was deemed potentially harmful as sleep sounds suggestive of obstructive sleep apnoea were interpreted as snoring by the app. Overall, the inclusion of self-management support functions was variable (range 1-9; mean=4.71/14), with pain/TMD education (71%) and self-monitoring (71%) the most common. Only one app had development input from a person with lived experience of TMD.

Conclusion: The quality and self-management support of apps with TMD self-management content is variable. TMD apps with activating self-management strategies and higher engagement scores are more likely to be effective. Concerningly, one app was found to be potentially harmful, and overall apps lacked user safeguards. Only one app involved a person with TMD in its development, and the authors recommend using co-design in future TMD app development to improve app quality, clinical safety and impact.

Background Care in the dying phase is often suboptimal in hospitals outside specialised palliative care. Studies of the implementation of recommendations for care in the dying phase are rare. Medical records can provide information in this regard. Methods Retrospective medical record analysis of n=400 patients who died on six intensive care units and four general wards of two German medical centres. To evaluate the care in the dying phase, we descriptively analysed 37 variables reflecting recommendations of the German Palliative Care Guideline. To identify factors associated with important aspects of care, seven of these variables were determined as appropriate for multiple logistic regression. Results In 299/400 (74.8%) patients, recognition of the dying phase was documented. Patients with ability to communicate were informed about the impending death in 46/121 (38.0%) and informal caregivers in 282/390 (72.3%). Patients' wishes regarding care were documented in 33/122 (27.1%). Monitoring was rarely stopped before death, with significantly lower percentages on intensive care units: e.g. vital signs in 30% (14.9% in intensive care units vs. 52.9% in general wards; confidence interval [28.4; 47.6]). Validated symptom assessment tools were used in 272/400 (68.0%), mainly for pain (66.3%). Logistic regression analysis identified setting (intensive care units vs. general ward), recognition of the dying phase, patient age, communication ability, and malignant neoplasm as factors significantly associated with aspects of care. Conclusion The dying phase was not consistently documented, many presumably non-beneficial interventions continued until death, systematic symptom assessment beyond pain was lacking, and communication with patients and informal caregivers was poorly documented. Findings suggest a need for setting-specific strengthening of healthcare professionals in these settings.

Background: Intra- and postoperative adverse events are devastating to patients and costly for healthcare systems. In 2008, the World Health Organization Surgical Safety Checklist was introduced to minimise morbidity and mortality and to enhance team performance. It consists of three parts whereof the third part, the sign-out at the end of surgery, is generally performed poorly. Addressing intraoperative adverse events and discussion of the consecutive postoperative management should take place during this often-omitted sign-out. To address this issue, a national, multicentre quality improvement project (CIBOSurg - ClassIntra® for Better Outcomes in Surgery) is currently being conducted in Switzerland. This project evaluates the effectiveness and implementation of systematic recording of intraoperative adverse events using ClassIntra® (a generic classification system for intraoperative adverse events) and an interdisciplinary discussion during the sign-outThe current study, conducted in the pre-implementation phase of CIBOSurg, aims to assess existing practices and determinants concerning the future implementation of systematic recording of intraoperative adverse events, perceptions surrounding ClassIntra®, and its implementation during sign-out.

Methods: A qualitative context analysis was conducted across eight hospitals in Switzerland and one in the Netherlands. Nearly 100 semi-structured interviews were conducted with interdisciplinary staff from different surgical disciplines. Data were analysed using rapid analysis and concept-structuring qualitative content analysis guided by the Consolidated Framework for Implementation Research and the Expert Recommendations for Implementing Change.

Results: Findings indicate that the sign-out is not yet implemented consistently at every participating hospital. Currently, intraoperative adverse events are not being systematically recorded and discussed, despite recognition of their importance. Most interviewees considered the application and implementation of ClassIntra® to be feasible and were convinced that a systematic recording of intraoperative adverse events and interdisciplinary discussion amongst the operative team during sign-out is particularly useful for learning and postoperative patient care. Several barriers and facilitators to the successful recording and discussion of intraoperative adverse events were identified.

Conclusion: The study results provide important information about current practices, while also generating insights on how to better discuss and systematically record intraoperative adverse events and improve sign-out performance. Future implementation of ClassIntra® is generally perceived positively. The findings address a critical gap in surgical safety practice and provide a basis for developing multifaceted implementation strategies.

Background: Interprofessional team-based care has been known to aid in better patient-focused care and outcomes. However, the same concept in the space of bone marrow transplant (BMT) especially in this part of the world is currently elusive. This single-center experience from a BMT unit of India depicts the effectiveness of interdisciplinary care.

Methods: An interdisciplinary team was built, and experts from different medical and allied specialties were onboarded along with establishment of state-of-the-art laboratories. Conceptualization of an integrative approach and development of HemeTEAM India began in 2020, and implementation in 2021. The evaluation of outcomes was performed on 31 December 2020 and on 31 July 2024 to compare the differences in outcomes after implementation of HemeTEAM India.

Results: A total of 550 transplants were conducted before 2021. From 2021 to 2024, 500 more transplants were done. The day 100 mortality, hospital acquired infection rate, and antibiotic stewardship reduced by ∼70% after 2021. The uptake of genomics-based testing increased to 95%, with genetically informed treatment in 65%. The average length of hospital stay reduced from 21 to 19 days and intensive care unit stay from 7 to 3 days. The net profit increased from 12% to 16%, with a cost benefit of ∼$10 000 to the patient.

Conclusion: This is a single-center experience, depicting the effect of an integrative team base approach in a BMT unit providing holistic interdisciplinary care in India. This is the largest and the first of its kind hematology team in the country and South East Asia, where all aspects for a hematology/transplant patient are available in a single consultation.

Background Increasing the use of independent providers has been proposed as a solution to the long waiting times at public hospitals generated by the post-pandemic backlog for elective care. However, the profit-maximising aims of some independent providers may risk cost-cutting behaviours and reduced care quality. Empirical evidence on the extent to which these concerns are borne out in practice is sparse. We aim to examine the quality of acute hospital care provided by the public and independent hospital sectors in England and explore the drivers of variation in quality. Methods We construct a unique dataset collating publicly available Care Quality Commission (CQC) quality ratings of independent and public acute hospitals as of December 2022 and 2020. We link these to regional deprivation indices, population estimates, average household disposable incomes, and Referral To Treatment data. We first categorise providers into NHS and Independent hospitals to analyse the association of ownership with quality ratings. To analyse ownership further, we then sub-categorise independent hospitals further and consider whether the organisation provides NHS commissioned care. Thus, hospitals were categorised into seven mutually exclusive categories: NHS provider, commissioned charity, commissioned brand, commissioned independent other, not-commissioned charity, not-commissioned brand, and not-commissioned independent other. We use linear and ordered logistic regression models to assess the association of ownership with quality ratings. In supplementary analysis, we examine consistency over time by comparing the effects on 2022 ratings and 2020 ratings. Results Of the 283 NHS hospitals, 47.3% (N=134) were rated 'Good', and 41.0% (N=116) were rated as 'Requires Improvement.' Of the 453 independent hospitals, 82.3% (N=373) were rated 'Good', and 9.5% (N=43) were rated as 'Requires Improvement.' On average, independent hospitals had 0.205 (SE=0.0581) higher category quality ratings than NHS providers. All types of NHS-commissioned independent sector hospitals had higher average quality ratings than NHS hospitals, as did non-commissioned branded hospitals. Quality ratings were negatively related to the number of different services provided, suggesting specialisation is associated with higher quality. Conclusion We find higher quality ratings for independent providers providing NHS funded care, branded providers, and providers with a narrower range of services. We find no evidence to suggest that outsourced patients will experience lower quality care, although cream-skimming could still be detrimental for NHS services if they are left with a more complex case mix. Overall, our results taken together suggest the increasing number of NHS patients treated in the independent sector do not experience a worse quality of care, especially if providers specialise in a limited number of services.

Background: Despite the importance of hospital accreditation, its sustainability is jeopardized. This is due to the disparity between the rapid changes in the health sector and the accreditation standards that remain unchanged. This study aims to examine what improvements are important in enhancing the sustainability of the hospital accreditation model in Saudi Arabia.

Methods: All quality managers in accredited Saudi Arabian hospitals were invited to participate in a cross-sectional questionnaire-based study in July-August 2022. A structured questionnaire was developed, tested, piloted, and factorially validated using exploratory factor analysis. On a 5-point Likert scale, respondents were asked to rate the importance of recommended changes that are proposed to enhance the sustainability of accreditation policies, standards development, evaluation methods, and the evaluation team. The importance of the recommendations, according to the respondents, was described using the relative importance index, while multivariate linear regression was used to analyse the association with independent variables.

Results: A total of 158 valid questionnaires (64% response rate) were included in the analysis. On average, participants had 6.9 (SD 2.1) years of experience in quality management. The overall mean importance attached to improving standards development, accreditation policies, evaluation team, and evaluation methods were 3.55, 3.43, 3.41, and 3.21, on a 5-point scale, respectively. Shifting the focus of accreditation standards from structure and compliance to outcomes and improvement (mean importance = 4.47), updating standards periodically to reflect current best practices and research (mean importance = 4.41), and integrating consumer perspectives in all aspects of accreditation (mean importance = 4.37) were the most important perceived recommendations. Multivariate regression analysis yielded that managers with more years of experience had significantly higher mean scores on the importance of improving accreditation policies (β = 0.120, P = .037), standards development (β = 0.246, P < .001), evaluation methods (β = 0.268, P < .001), and the evaluation team (β = 0.369, P < .001).

Conclusions: Improving accreditation policies, standards development, evaluation methods, and the evaluation team are important in enhancing the sustainability of hospital accreditation programmes. This study offers insights to assist policymakers and other stakeholders in redesigning traditional accreditation models to make them more sustainable and that can supplement other performance improvement tools in improving the quality of healthcare services.

Background: Medication safety remains a global concern, with governments and organisations striving to mitigate preventable patient harm across healthcare systems. Look-alike, Sound -alike medications incidents and the safety culture are widely acknowledged as a contributor to medication errors, particularly within the high-risk perioperative environment. The Medication Safety Culture Indicator Matrix is a novel tool developed by the Canadian Institute for Safe Medication Practices to assess the maturity of the medication safety culture. This study aims to delineate Look-Alike Sound-Alike (LASA) medication incidents reported in the pharmacy and perioperative settings of an Australian hospital and assess the maturity of the medication safety culture.

Methods: The study setting is within a large regional hospital in Australia, servicing both adult and paediatric populations. Medication incidents from 1st April 2018 to 1st April 2023 were retrospectively gathered from the Clinical Incident Management System, Riskman®. Data and statistical analyses were carried out using Microsoft Excel®. The necessary approvals were secured from the Heath Service Human Research and Ethics Committee.

Results: During the five-year period, a total of 246 (4.1%) of the 6,002 medication incidents within the health service were identified as meeting the inclusion criteria. Of the 246 medication incidents, 63.0% were identified from the Pharmacy Department, while 22.0% and 15.0% were from the Post Anaesthetic Care Unit and Anaesthetics Department respectively. The most frequently reported incident classification in both the Anaesthetics Department and Post Anaesthetic Care Unit was 'incorrect dose', followed by 'incorrect medication'. Throughout the five-year period, 46 (18.7%) of the 246 medication incidents were attributed to Look-Alike, Sound -Alike sources of error, predominantly identified in the Pharmacy Department (73.9%), followed by the Anaesthetics Department (17.4%) and the Post Anaesthetic Care Unit (8.7%). High-risk medications were most frequently reported to the Anaesthetics Department. Packaging (packaging alone, naming and packaging and syringe swaps) was determined to be a contributing factor in 30 (65.2%) of the 46 LASA medication incidents. Medication Safety Culture Indicator Matrix assessment revealed a reactive medication safety culture. Additionally, the medication incident report documentation was found to be mostly complete or semi-complete.

Conclusion: Our analysis delineated medication incidents occurring across the entire medication management cycle and identified incidents related to LASA medications as a contributor to medication incidents across these clinical settings. This novel medication safety culture tool assessment highlighted opportunities for improvement with clinical incident documentation.

Introduction: Enhancing patient safety and minimizing medical errors are crucial in healthcare. While root cause analysis (RCA) is commonly used to investigate adverse events, its lack of human factor integration limits its effectiveness. The Human Factors Analysis and Classification System (HFACS), adapted from aviation to healthcare, systematically identifies human and organizational factors. However, the integration of HFACS into RCA and the impact of HFACS-RCA implementation remain underexplored. Therefore, this study aims to provide a practical case of HFACS integration into RCA and explore the effects of HFACS-RCA implementation.

Methods: This study integrates HFACS into the RCA process at a medical center in Taiwan, examining an incident involving unsterilized instruments distributed from the Central Sterile Supply Room (CSR) to the Intensive Care Unit (ICU). This study employed a before-and-after study design to examine the impact of the HFACS-RCA intervention. The primary outcome measures were the changes in scores across the eight dimensions of the Taiwan Patient Safety Culture Survey (TPSC) before and after the intervention.

Results: A 1-year follow-up of the CSR case showed no similar incidents. HFACS-RCA significantly improved TPSC scores in unit safety climate (P = .05), feelings toward management (P = .05), and job satisfaction (P = 0.05), while the other dimensions showed no significant changes.

Conclusion: HFACS-RCA application offers a comprehensive framework for identifying and mitigating factors contributing to medical errors, improving patient safety, and setting a precedent for future healthcare safety management research and practice.