BMJ Open Quality最新文献

Purpose: The Facial Clinimetric Evaluation Scale (FaCE) and the Facial Disability Index (FDI) are essential tools for assessing the quality of life (QoL) in patients with peripheral facial palsy (PFP). This study aims to translate, adapt and validate the FaCE and FDI scales to ensure cultural relevance and psychometric validity for Chinese patients with PFP.

Methods: Following the International Society for Pharmacoeconomics and Outcomes Research guidelines, the FaCE and FDI scales were translated and culturally adapted for Chinese use (including forward and back translation). From January to August 2024, 150 Chinese PFP patients and 50 age/gender-matched healthy controls in Sichuan Province were enrolled to evaluate psychometric properties. Statistical analyses included Cronbach's α (internal consistency), two-way random-effects intraclass correlation coefficient (test-retest reliability, 2-week follow-up), exploratory factor analysis (EFA, principal component analysis/varimax rotation, Kaiser-Meyer-Olkin/Bartlett's test; construct validity), Content Validity Index (CVI), Pearson correlations (convergent/discriminant validity VS 36-Item Short Form Health Survey (SF-36)), Mann-Whitney U test (group differences) and standardised response means (SRM)/Cohen's d (responsiveness).

Results: The Cronbach's α for the FaCE scale was 0.835, and for the FDI scale, it was 0.895, indicating good internal consistency. Factor analysis revealed six dimensions for the FaCE scale, while the FDI scale was confirmed to have a two-dimensional structure. Additionally, significant correlations were found between the relevant dimensions of the FaCE and FDI scales and the SF-36, supporting their convergent validity. The Mann-Whitney U test indicated significant differences in initial questionnaire responses between the experimental and control groups (p<0.01). Responsiveness analysis demonstrated that the FaCE scale effectively captured changes in patient status.

Conclusions: This study validates the effectiveness and reliability of the Chinese-version FaCE and FDI in patients with PFP, providing robust evidence for their use as assessment tools for QoL in this population.

Contrast-enhanced MRI is essential for the evaluation and characterisation of indeterminate liver and pancreatic lesions. Conventional volumetric 3D T1-weighted sequences, such as the volumetric interpolated breath-hold examination (VIBE), play a key role in dynamic contrast-enhanced imaging of these organs. However, these sequences typically require a sustained breath-hold of 18-22 s to achieve optimal image quality. This requirement poses significant challenges for elderly or critically ill patients, often leading to suboptimal images, reduced diagnostic image quality, scan cancellations or conversion to non-contrast studies.This quality improvement project at a radiology department in a tertiary care hospital spanned 18 months and employed two plan-do-study-act (PDSA) cycles. At baseline, the existing dynamic VIBE sequence was optimised to the shortest feasible breath-hold duration of 12-17 s. While this modification improved image quality for patients capable of brief breath-hold, it remained inadequate for those unable to comply with breath-hold instructions. Consequently, the golden-angle radial sparse parallel VIBE (GRASP VIBE) sequence was applied. This technique enabled free-breathing imaging and retrospective reconstruction of multiple contrast-enhanced phases, offering a viable solution for patients with limited or no breath-hold capacity. In the first PDSA cycle, a trial of GRASP VIBE on patients with breath-hold difficulties demonstrated its feasibility and improved diagnostic value, leading to its broader implementation over 6 months. The second PDSA cycle expanded GRASP VIBE usage to all patients with breath-hold limitations, including those requiring liver-specific contrast agents (gadoxetate disodium) that necessitate prolonged imaging times.The implementation yielded a 42% reduction in suboptimal images, 75% decrease in scan cancellations and 90% drop in omission of contrast media administration. GRASP VIBE improved diagnostic image quality, minimised breathing artefacts and increased departmental efficiency.This initiative demonstrates GRASP VIBE as an effective solution for breath-hold challenges encountered in MRI liver and pancreas scans.

Background: A wide variety of performance indicators/metrics are used to measure the performance of healthcare systems and to promote quality improvement (QI). We sought to identify indicators relevant to QI and organisational development (OD) within primary care/general practices and to evaluate the evidence for their use in QI and OD interventions in UK general practice and primary care.

Methods: We used a framework based on UK National Health Service primary care documents to structure the review. Separate literature searches were performed in four databases to identify relevant reviews and primary studies. Studies were included if (1) the main focus was a metric or indicator that fell within the review framework or (2) they reported an OD or QI initiative or intervention in UK primary care that used one or more of the previously identified metrics or indicators. We mapped studies in group 1 against our framework domains. We performed a narrative synthesis of studies in group 2, again organised by the overall framework.

Results: We included 28 studies, 24 (11 reviews and 13 international primary studies) for metrics or indicators and 4 for initiatives or interventions. The number of individual indicators or groups of indicators in group 1 studies ranged from 1 to 773. Three of the four UK QI/OD studies focused on initial access to general practice services; the other dealt with a programme to encourage self-care for long-term conditions. Mapping of the group 1 studies identified potentially relevant indicators across all domains but the process was methodologically challenging.

Conclusions: Although numerous potential indicators exist, they tend to be poorly defined and lack examples of their use in practice. Further work is needed to identify and evaluate candidate indicators.

Background: Medication reconciliation is a critical process for ensuring patient safety by preventing medication errors, especially at hospital admission. Despite its importance, compliance with this process in our internal medicine ward was alarmingly low, with an initial baseline of only 4% compliance in January 2019. This prompted the initiation of a quality improvement (QI) project aimed at improving adherence to the medication reconciliation process.

Methods: A team-based approach was implemented, including junior doctors, nurses, pharmacists and the hospital's information technology team. The plan-do-study-act (PDSA) methodology was used to design, test and implement interventions. Key interventions included educational sessions for junior doctors, integration of pharmacy systems for easy access, daily reminders via a WhatsApp group, and reinforcement of the process by senior residents. Data collection was standardised, tracking patient demographics, reconciliation times and team responsibilities. Compliance was monitored over a 4-month intervention period.

Results: At the start of the intervention, medication reconciliation compliance was at 4%. Initial progress was slow, requiring frequent reminders and educational sessions. However, by the end of the first month, compliance had reached 77%, and by the end of the 4-month period, it improved to 96%, surpassing the target of 90%. This improvement was sustained with a compliance rate above 90% for 6 months following the intervention.

Conclusions: The use of the PDSA methodology significantly improved medication reconciliation compliance, achieving a 96% adherence rate. Engaging healthcare staff through education, clear communication and a team-based approach was key to overcoming barriers and ensuring sustainable improvements. This model can be applied to other QI projects aimed at enhancing patient safety and reducing preventable harm.

Recovery in postoperative patients involves multiple domains including physical, physiological, psychological, social and economic aspects. Immediate postoperative physiotherapy (PT) is crucial for promoting early recovery and reducing hospital stay, particularly after common general surgeries like laparoscopic appendectomy, laparoscopic cholecystectomy and hernia repair. Despite its benefits, there is often a gap in the optimal delivery of PT services, as observed at Hazm Mebaireek General Hospital, where only 10.4% of postoperative patients were referred to PT. The project aimed to improve the Six-Minute Walk Test (6MWT) distance from 250 m to 350 m and the incentive spirometry inspiration volume (ISIV) from 927 mL/s to 1200 mL/s in acute care surgery (ACS) postoperative patients over a 12-week period. This was to be achieved by increasing the percentage of immediate postoperative PT referrals from 10% to 50% through multiple Plan-Do-Study-Act cycles. The project involved a multidisciplinary team of ACS surgeons, physiotherapists and inpatient nurses. The interventions included educational workshops, daily reminders and personalised reminders to on-call surgeons. Process, outcome and balancing measures were tracked to evaluate the effectiveness of the interventions. The percentage of immediate postoperative referrals to PT increased from 10% to 67.7%, surpassing the target. The average 6MWT distance improved from 247.17 m to 390.86 m, and the average ISIV increased from 927 mL/s to 1198 mL/s. There were no reported increases in fall incidents or pain following PT, indicating that the interventions improved care quality without compromising patient safety. The project successfully enhanced postoperative recovery through increased PT referrals, demonstrating the effectiveness of targeted educational interventions and systematic reminders. These findings suggest that simple, targeted interventions can significantly improve postoperative care. Future steps include institutionalising the successful strategies, expanding them to other departments and exploring broader applications to ensure sustainability and scalability.

Objective: Colorectal cancer (CRC) screening is critical for early detection and prevention. A prior analysis at our urban primary care clinic revealed a CRC screening completion rate of 62% in patients who had visited our clinic in the first half of 2023. Identified barriers for lower-than-national-average CRC screening rate included limited awareness and understanding among both providers and patients regarding CRC screening options and processes, particularly Cologuard. To address these gaps effectively, we implemented a series of targeted interventions aimed at increasing Cologuard utilisation.

Methods: Using an iterative plan-do-study-act model, interventions were implemented from January to September 2024 among average-risk patients aged 45-75 years who presented to primary care visits. Interventions focused on (1) biweekly, small-group provider education sessions with daily reminders, (2) bilingual patient-facing educational materials, posters and instructional videos and (3) electronic medical record portal outreach. The primary outcome was Cologuard completion rate among CRC-screening eligible patients. Process measures were Cologuard order rates and kit return rates, and the secondary outcome was the overall CRC screening completion rates.

Results: A total of 2171 CRC-screening eligible patients visited during the intervention period, and a total of 399 Cologuard orders were placed, with 235 completed kits returned. Cologuard completion rates improved from a preintervention median of 7.38%-10.00%. Median order rates rose from 14.59% to 18.71%, and overall CRC screening rates increased from 68.6% to 72.2%. Direct patient messaging had the most immediate impact, with 7.2% responses by recipients, resulting in 16 screenings and a transient peak of 20.71% in monthly Cologuard completion.

Discussion: This project demonstrates that practical, multifaceted, low-cost strategies of provider-focused education and patient-directed digital outreach can significantly improve Cologuard usage, ultimately leading to an increase in CRC screening completion rates. Sustained reinforcement and improvement in kit return will be a key to future improvements.

Background: The criticality of compassion in healthcare is recogniszed by governments, healthcare organisations, providers, researchers and most importantly patients. There have been calls for the development and evaluation of tools for the routine measurement of compassion, as compassion has been found to be a critical predictor of quality care. However, there has been a paucity of validated and reliable psychometrics to assess this construct.

Objective: We assessed the reliability, factor structure and validity of the Sinclair Compassion Questionnaire-Short Form (SCQ-SF).

Methods: The SCQ-SF was embedded in a large administration survey (N=2236) aimed at assessing Canadians in facility-based continuing care contexts. Reliability analysis and confirmatory factor analysis (CFA) were conducted on the SCQ-SF data.

Results: Data from 2236 residents were analysed. Cronbach's alpha (α =0.91) indicated that the SCQ-Short had excellent reliability. CFA indicated a well-fitting unidimensional model of compassion. The standardised factor loadings for the 5-items ranged between 0.76 and 0.87. Global indicators of fit were largely excellent (root-mean-squared residuals = 0.06, comparative fit index <0.99, standardised root-mean squared residual = 0.01, χ2 =35.66, p<0.001).

Conclusion: The SCQ-SF is a short psychometric tool, with excellent internal consistency, strong factor loadings and good fit. The SCQ-SF is suitable for use by clinicians, researchers and health system analysts.

Introduction: Prostate cancer is a leading cause of cancer-related deaths among men in the USA. Prostate-specific antigen (PSA) testing for screening remains controversial, with shared decision-making (SDM) recommended by professional guidelines to discuss screening's risks, benefits and uncertainties. Despite these recommendations, SDM is underused, with only 10% of men receiving comprehensive SDM. This quality improvement project aimed to improve SDM documentation and the implementation of PSA screening in an urban safety-net, resident-led primary care clinic.

Methods: We implemented a continuity clinic note template with a specific SDM 'dot phrase' to improve the documentation and execution of SDM conversations. Our primary aim was to increase SDM documentation for prostate cancer screening, with a secondary aim to improve follow-up on abnormal PSA values. The intervention included men aged 55-69 years. Preintervention, residents were educated on SDM and PSA screening. Postintervention, patient charts were reviewed for documentation rates and screening outcomes. Feedback was collected during dedicated sessions. Finally, comparative statistics were conducted between baseline preintervention and eligible postintervention cohorts.

Results: SDM documentation improved significantly from 7.1% preintervention to 37.2% postintervention (p<0.001). PSA screening rates increased from 31.5% to 37.8% (p=0.155), though not significantly. Notably, 49.3% of patients declined PSA testing post-SDM, and 68.5% of previously screened patients were up to date with PSA testing. Residents reported challenges with SDM implementation, including time constraints and patient acuity.

Conclusion: Templated notes and dot phrases significantly improved SDM documentation, both compared with our clinic baseline rates and compared with recent reported national rates, overall enhancing standardised preventive care in primary care. Although PSA screening rates improved, challenges such as time limitations and patient no-shows impacted the intervention's effectiveness. Future cycles will address these barriers to improve outcomes further.

Background: Healthcare systems face excessive pressure on sustainability due to financial, social and environmental concerns. Video visits offer an appreciated alternative for routine in-person visits in surgical subspecialties, with the potential to lower costs among hospitals and patients and carbon footprint. However, a comprehensive understanding of patients' and companions' costs to attend an outpatient clinic visit remains understudied. The study aims to provide insight into direct and indirect patient costs of a tertiary surgical outpatient clinic visit.

Methods: A cross-sectional survey study was conducted among adult patients scheduled for a tertiary outpatient surgery clinic visit from September 2020 to September 2021. The cost of a surgical visit was assessed using a study-specific questionnaire. Visit costs between subspecialties and visit modalities were compared with generalised linear modelling.

Results: Of the 961 included surgical patients (866 in-person and 95 video visits), those who received a video visit experienced a substantial halving of visit-related costs (€67 vs €172; β=-103.65, p<0.001) and reduction in costs with increasing age (β=-1.52, p=<0.001), attributable to decreased absenteeism from work for patients and companions, and the absence of travel expenses.

Conclusion: Direct and indirect costs among patients and relatives for a visit to a tertiary surgical outpatient clinic are high. Reporting previously neglected, yet significant costs, including those borne by companions, could enhance awareness among clinicians and policymakers regarding the financial and societal impact of offering certain visit modalities and may influence the shared decision-making process.

Objectives: To identify and prioritise technical and non-technical procedures that should be integrated into a simulation-based training curriculum in anaesthesiology using the Delphi method.

Study design: A needs assessment using a three-round Delphi process was completed among leaders in anaesthesiologists across medical colleges in our country. The responders were mostly alumni of our institution and their colleagues. Delphi round 1 identified technical and non-technical skills after brainstorming sessions with experts in the field. Round 2 involved collecting data through questionnaires about the technical skills best suited for simulation-based training and topics of importance using Copenhagen Academy for Medical Education and Simulation-Needs Assessment Formula (CAMES NAF) score. Round 3 included final elimination and reprioritisation. The topics were narrowed down by steering research members based on data saturation in the open-ended questions (qualitative), as well as statistical data (CAMES-NAF) for the quantitative questions.

Results: In Delphi round 1, we identified 22 technical skills, 10 non-technical skills and 21 scenarios. Response rates in the Delphi round 2 averaged to 85.5% and responses were prioritised using CAMES NAF score. Open-ended questions reached data saturation for non-technical skills and scenarios. In round 3, we were able to narrow it down to 10 technical skills, 5 non-technical skills and 8 scenarios after elimination and reprioritisation.

Conclusions: We identified and prioritised 8 scenarios, 10 technical skills and 5 non-technical skills in anaesthesiology that are suitable for simulation and may be used as a guide for developing simulation-based curriculum in anaesthesiology.