Journal of Healthcare Quality Research最新文献

Background: DC cardioversion (DCCV), when performed early, effectively restores sinus rhythm in patients with atrial fibrillation (AF). This audit aimed to evaluate the outcomes of patients undergoing DCCV at our institution and assess the factors predicting restoration of sinus rhythm.

Methods: This retrospective audit included patients who underwent elective DCCV in 2021 at our hospital. We excluded patients where data was incomplete. Data was collected from the electronic case records of the patients.

Results: Two hundred forty-three patients (mean age 67.5±11.7 years, 67.1% male) were included in the analysis. The median delay from DCCV decision was 265 (108-826) days. Patients who were initially managed with rate control (158 (65%) patients) had longer DCCV wait times compared to those where DCCV was considered as the first line treatment (308 vs. 114 days, p<0.001). DCCV was immediately successful in 232 (93.1%) patients, with 226 (91.5%) maintaining sinus rhythm at discharge, 120 (48.6%) at 6 months and 98 (39.7%) at one year. Fewer shocks predicted sinus rhythm maintenance at discharge, 6 months, and one year (p<0.001). Amiodarone continued post-DCCV also predicted maintenance of sinus rhythm at one year (p=0.01). No significant differences were found in demographics, risk factors, DCCV delay, or LA size between those who maintained sinus rhythm and those who reverted to AF.

Conclusion: At our institution, most patients experienced significant delays before elective cardioversion. Decision to perform DCCV should be taken early and not after an initial trial of rate control. In our patients, amiodarone helped maintain sinus rhythm after successful DCCV.

Background and objective: Float nurses are frequently assigned to unfamiliar settings where they must perform a wide range of tasks, often without prior orientation, specific training, or knowledge of local protocols and equipment. Given the widespread use of floating as a staffing strategy, it is essential to allocate resources that support their integration while prioritising patient safety. This study aimed to develop a self-administered Integration Checklist for float nurses, highlighting key aspects to address before delivering direct patient care.

Materials and methods: A three-phase approach was employed, integrating brainstorming sessions with nurses and patient safety experts alongside a literature review: (A) identification of key barriers encountered by float nurses; (B) critical analysis of literature-based solutions; and (C) development of the Integration Checklist.

Results: After identifying core challenges and reviewing solutions at the institutional-level, a practical Integration Checklist was created using a reverse approach to conventional orientation programmes. The tool comprised three sections: administrative, unit-specific, and patient care. Each section included targeted questions to ensure that float nurses were aware of the critical information relevant to each area before delivering care.

Conclusions: The implementation of a Safety Integration Checklist for float nurses has the potential to enhance the onboarding process into new units by optimising transition time, increasing professional confidence, and reducing staff-related stress. However, further research is needed to assess its practical value and effectiveness in improving both patient and staff outcomes across diverse clinical settings.

Introduction and objective: To determine the impact of a home-based occupational therapy and nursing program, on autonomy in activities of daily living, quality of life, and falls in people with chronic diseases and complex needs.

Material and methods: A pre-post quasi-experimental quantitative study with a consecutive sample based on the usual clinical practice of home care teams. The Barthel Index, Lawton & Brody Scale, Short Falls Efficacy Scale, Life Space Assessment, Quality of Life Index, and falls in the last two months were assessed. A paired sample pre-post hypothesis contrast analysis was performed, stratified by sex and care profile.

Results: A total of 115 participants were recruited, of whom 8 were dropouts. The program showed statistically significant improvement in all indicators. Notably, the Barthel Index increased by 10,0 (IC 95%: 8.2; 11.8) (p≤0.001), reducing the level of dependency from severe to moderate. The Lawton & Brody scale increased by 0.6 (IC 95%: 0.4; 0.8) globally, and the percentage of participants with at least one fall in the past two months decreased from 40.4% to 2.0%.

Conclusions: The intervention performed by the occupational therapist is key in the promotion of autonomy, falls prevention and quality of life. It is a value to be taken into account in the configuration of home care teams in primary care.

Background: Burnout and promoting physician well-being have become priorities for healthcare institutions. Obstetrics and Gynecology teams are susceptible to stress due to work demands and limited resources. Organizational interventions are increasingly recognized as crucial to mitigating burnout and improving professional well-being.

Aims: To assess the impact of an organizational-level intervention designed to reduce burnout and emotional distress, and improve well-being and quality of life among faculty members and residents of an Obstetrics/Gynecology team.

Methods: A structured organizational intervention was implemented in the Obstetrics/Gynecology Academic Unit A, Universidad de la República, in Uruguay. The effectiveness was assessed using validated psychometric instruments, Maslach Burnout Inventory - Human Services Survey, Oldenburg Burnout Inventory, PROMIS Global Health Scale, World Health Organization Anxiety and Depression Scale (WHO-5). Statistical analyses included Wilcoxon signed-rank tests and effect size calculations.

Results: Of the 76 invited participants, 61 completed baseline assessments, and 30 completed follow-up assessments. Significant improvements were observed in burnout, emotional well-being with effect sizes ranged from large to very large (0.50-0.74). The prevalence of burnout decreased from 63.3% to 40.0% (p=0.039), and high-risk emotional distress (WHO-5 <50 points) decreased from 53.3% to 26.7% (p=0.039).

Conclusions: A structured organizational-level intervention effectively reduced burnout and improved well-being among faculty and obstetrics and gynecology residents. These findings are consistent with previous research indicating that organizational interventions produce considerable benefits at work. Further studies with larger samples are needed to confirm long-term efficacy and generalizability to other health care settings.