BMJ Open Quality最新文献

Background: 'Safe surgery saves lives' initiative by the WHO consists of measures focussed on improving surgical safety. Healthcare institutions across the globe are encouraged to identify the lacunae in surgical safety and adopt these initiatives to suit the local practices and traditions.

Methods: A few never events and near misses prompted our institution to create a surgical care safety bundle to improve perioperative patient safety. The surgical care bundle focused on improving the usage of surgical safety checklist (SSCL), surgical consents, surgical site marking (SSM) and sponge count in a phased manner. Baseline audits were conducted for each of the above components at different time points and measures were introduced to improve compliance.

Results: The baseline usage of SSCL in 2010 was 65% that improved to 70% in 2014, 86% in 2016 and 97% in 2019. The availability of general surgical consents improved from 56% in 2010 to 70% in 2015. With the introduction of specialised surgical consents in 2019, the compliance improved significantly to 99%. SSM was added to the project in 2017, improved from baseline 74% to 95% in 2019 and continues to remain above 90%. Sponge count documentation has been below 80% in 2010 and was implemented as a part of the safe surgery protocol in 2019 after which compliance significantly improved and stayed above 90%. Good compliance with the usage of checklists and improved the safety culture was demonstrated by increased reporting of near miss events. Never events have not occurred after introduction of all components of surgical safety in 2019.

Conclusion: Phased implementation of surgical care safety bundles, audits and reaudits, repeated educational measures and a slow yet steady process of interventions has markedly improved the safety culture and surgical safety in a larger teaching hospital of a developing country.

Background: Implementing structured safety interventions in intensive care units (ICUs) remains challenging due to patient complexity, staff turnover and dynamic workflows. This study evaluates the longitudinal impact of a multidisciplinary safety improvement programme in a high-acuity ICU.

Methods: A 2-year prospective evaluation was conducted in a 12-bed academic ICU in Milan, Italy. The Hospital Survey on Patient Safety Culture was administered to all ICU professionals (physicians, nurses, physiotherapists) in December 2022 and repeated in December 2024. Interventions included staff training, enhanced event reporting systems, regular morbidity and mortality conferences and a multidisciplinary safety team. Responses were analysed descriptively, including subgroup analysis by professional category and staff turnover.

Results: A total of 86 staff completed the 2022 survey, and 66 completed the 2024 survey, with 56 participating in both. Over the 2 years, perceptions of teamwork (68%-81%), communication openness (47%-60%) and comfort in reporting errors (38%-55%) showed substantial improvement. The proportion of staff who perceived management support for safety increased from 70%-80%. Staff hired after 2022 reported more favourable safety perceptions than continuing staff, particularly in communication and reporting domains.

Conclusions: Structured, multidisciplinary interventions led to measurable improvements in ICU safety culture. However, persistent interprofessional differences and under-reporting of adverse events highlight the need for targeted strategies. Safety culture transformation requires sustained leadership, continuous onboarding and system-focused feedback mechanisms to ensure long-term impact.

Background: The Peripheral Arterial Disease Quality Improvement Programme (PAD QIP) was a quality improvement (QI) collaborative between 11 English vascular surgery centres from May 2020 to May 2022, aiming to expedite treatment for PAD. This qualitative study explored beliefs about the PAD QIP and barriers and facilitators to implementation of changes in vascular surgery.

Methods: Sixteen semi-structured interviews were conducted with clinicians from the vascular centres that participated in the PAD QIP and were analysed using framework analysis, based on the five broad domains within the Consolidated Framework for Implementation Research.

Results: Five themes captured the main factors that affected the implementation of changes in the pathway of patients with chronic limb-threatening ischaemia: the programme, the benefit for patients, the role of the team, the resources and organisational processes, and the polarising effect of COVID-19. Regarding the programme, participants stated that the concrete timeframes, external performance monitoring, peer comparison and the programme's national reach helped them obtain resources to implement changes. Learning from and sharing experiences with others was also useful. Accurate performance data were considered essential for leveraging resources, but data entry was onerous and required dedicated staff. The view that the programme was beneficial for patients, the support of a team of healthcare professionals and organisational support in the form of resources were important requirements for implementation, while the COVID-19 pandemic also played a crucial role as a contextual factor beyond the control of the participants. The main factors that differed between high-implementation and low-implementation centres were team beliefs, team structure, team compatibility, networks/communication, resources, implementation climate, relative priority and evidence strength.

Conclusions: This QI collaborative facilitated the implementation of changes according to participants, while team and organisational support was crucial.

Objectives: Hospital food influences experiences and outcomes of care, and optimising nutrition for hospitalised children is universally recognised as important for recovery. While several barriers to oral food intake have been identified, interventions to address them are limited. Our aim was to implement and evaluate a proof-of-concept (PoC) trial of a Food on Demand Delivery Service app in a specialist paediatric hospital.

Design: PoC trial and evaluation.

Setting: Specialist children's hospital.

Participants: 101 families completed baseline measures; 26 families completed measures during the PoC trial, 18 parents and 11 ward-based staff participated in interviews, and four ward-based staff and four catering staff took part in focus groups.

Intervention: Following adaptations to an existing web-based Food on Demand Delivery Service app, a PoC trial was undertaken on six inpatient wards during a 4-week period. Data were collected before and following implementation, using quantitative (surveys) and qualitative (focus groups and individual interviews) approaches.

Results: The Food on Demand Delivery Service was positively evaluated by all stakeholder groups. Challenges were identified, particularly by catering staff in relation to communication and logistics, but overall findings supported upscaling to a hospital-wide roll-out.

Conclusion: The Food on Demand Delivery Service offers potential for addressing barriers to oral intake for hospitalised children. Challenges will need to be addressed prior to scaling up the project for a hospital-wide roll-out, and several recommendations came from the trial. However, the benefits for children, families and staff were evident and supported further work to enable the Food on Demand Delivery Service to be introduced across the hospital.

Introduction: Treatment of moderate to severe psoriasis typically requires the use of multiple systemic therapies over a patient's lifetime. The efficacy and safety of systemic treatments are typically evaluated in clinical trials; however, patient registries are increasingly used to monitor long-term outcomes of systemic therapies for psoriasis in real-world settings. Psoriasis registries also generate important real-world evidence about psoriasis treatment that may facilitate a greater understanding of outcomes outside of a controlled clinical trial setting. This study thus characterises the design and measures used in real-world studies of psoriasis treatment from patient registries and assesses its use in informing clinical guidelines and reimbursement decisions.

Methods and analysis: A systematic literature review was conducted to identify real-world observational studies that used psoriasis registry data. PubMed and Embase were searched for English-language studies published between January 2018 and January 2023. To assess how real-world studies, clinical guidelines, and reimbursement and coverage reports have informed practice, treatment, and reimbursement guidelines, a narrative review of recommendations was conducted. All results were screened by two independent reviewers (LP and TAS) using prespecified inclusion and exclusion criteria. Outcomes of interest were extracted into Excel, with all conflicts resolved through discussion/consensus. Tables displayed outcomes and research topics first by year, then by registry.

Prospero registration number: CRD42023402431.

Background: Music can enhance exercise performance, but its potential has not been well explored in pulmonary rehabilitation (PR). The aim was to explore the current music-related behaviours among PR service users with chronic respiratory diseases (CRDs) to inform future PR service interventions and explore the potential for music to facilitate exercise adherence in this context.

Methods: The cross-sectional survey was distributed among PR attendees at the University Hospitals of Leicester (UHL) NHS Trust in the United Kingdom, between November 2023 and August 2024. Participants completed a 25-item survey exploring (i) relevant technology ownership and music-related behaviours, (ii) preferred music genres and songs and (iii) anticipated benefits/concerns of exercising to music. Quantitative data were analysed descriptively. Free-text data were analysed using qualitative counting.

Results: We surveyed 109 people living with CRDs (51% male, 56% aged ≥70 year, 76% chronic obstructive pulmonary disease, 82% owned a smartphone). More than half had no prior experience of exercising to music (n=59, 54%). Despite this, almost half of participants listened to music at least once/day (n=54, 49%), primarily via the radio (n=83, 76%) and/or online music platforms (n=76, 70%). Pop (n=39, 36%) and Country (n=38, 35%) were the most popular music genres listened to, with the majority listening to music without headphones (n=64, 59%). The main concern about wearing headphones while exercising was that it might reduce their awareness of the surroundings (n=67, 61%). The perceived benefits of listening to music during exercise were to boost their mood (n=39, 36%) or help maintain their walking pace (n=19, 17%).

Conclusion: There is potential to use music as a tool to support exercise in PR. However, lack of prior experience exercising to music, diverse music preferences, safety considerations and the need to increase knowledge of the potential benefits of exercising to music are key challenges. These findings may help future PR services to implement music into their programmes and develop personalised music-based interventions to optimise exercise performance.

Sepsis resulting from bloodstream infection is a medical emergency, especially in immunocompromised haematology patients. Identification of causative pathogens through blood cultures is crucial for delivering effective antibiotics promptly.Adequate blood culture volumes (BCV) are crucial for detecting bloodstream infections. Guidelines recommend 8-10 mL per blood culture bottle, yet achieving these volumes remains challenging. In our haematology wards, baseline mean BCV was suboptimal at 4.5 mL. This quality improvement project aimed to optimise BCVs to recommended levels within 6 months at a Singapore tertiary hospital's Department of Haematology.We implemented a multistakeholder quality improvement across three haematology wards from January 2023 to January 2025. Three Plan-Do-Study-Act cycles were executed from July 2024: (1) staff education and stakeholder engagement, (2) equipment and process enhancement and (3) validation of BCV measurements through comparison of an automated BCV measurement system (BD EpiCenter BACTEC Microbiology Data Management System) against manual bottle weighing.Postintervention data demonstrated clear statistical signals of improvements in BCV through both EpiCenter automated system and manual bottle weighing. Manual validation in selected wards demonstrated achievement of target volumes. Importantly, this validation process revealed potential limitations of automated measurement systems in our specialised clinical setting. Overall, our results demonstrate that a well-coordinated, multidisciplinary approach combining staff education and engagement, improved equipment and BCV measurement process can successfully achieve recommended BCV in our complex haematology settings.

Background: Increasing evidence supports early extubation in liver transplant (LT) recipients and the early recovery after surgery for LT guideline strongly recommends considering early extubation. Usual care at our institution involves admitting all LT recipients to the intensive care unit (ICU), sedated, mechanically ventilated and extubated during daytime hours. This quality improvement project aimed to identify and extubate suitable LT recipients within 4 hours postoperatively.

Methods: Baseline data were collected from all LT recipients between October 2018 and September 2020, the control group. An early extubation pathway was implemented in October 2020, and prospective data were collected from October 2020 to September 2022 and used as the intervention group. Primary outcome was extubation within 4 hours after LT. Secondary outcomes included the duration of mechanical ventilation, ICU length of stay (LOS) and hospital LOS.

Main results: During the study period, 342 LT procedures were performed, of which 339 patients were included in the study. Of LT recipients who met criteria for early extubation, the rate of extubation within 4 hours postoperatively increased from 23% (14/60) in the control group to 65% (62/96) in the intervention group (p<0.001). In adjusted models, the pathway was associated with an increased proportion of patients extubated within 4 hours (OR=6.74, 95% CI 3.04 to 14.92, p<0.001) and reduction in duration of mechanical ventilation (HR=1.95, 95% CI 1.37 to 2.79, p<0.001), ICU LOS (HR=1.42, 95% CI 1.02 to 1.99, p=0.04) and hospital LOS (HR=1.60, 95% CI 1.14 to 2.26, p=0.007).

Conclusions: An early extubation pathway for LT recipients reduced duration of mechanical ventilation, ICU LOS and hospital LOS.

Background: Central line-associated bloodstream infection (CLABSI) is a major contributor to morbidity and mortality among neonates admitted to the neonatal intensive care unit (NICU). Point-of-care quality improvement (POCQI) methods can reduce the rate of CLABSI by improving compliance with the care bundle.

Methods: A quality improvement study comprising three phases was planned in the NICU of a tertiary care hospital in western India to assess the impact of the central line care bundle. Baseline data were collected for 8 weeks to find the incidence of CLABSI. An aim statement was made and a team formed. A root cause analysis was conducted to identify the factors contributing to the high rate of CLABSI. Various changed ideas were tested in plan-do-study-act cycles and monitored with process indicators. Ideas were adopted or adapted based on their impact. Compliance with insertion and maintenance bundles was used as a process indicator, while the CLABSI rate served as an outcome indicator.

Results: CLABSI rate reduced from 66/1000 catheter days (May 2023) to 18/1000 catheter days (95% CI 0.14 to 0.79; p value 0.012) during the study. Insertion bundle compliance increased to 85% during the intervention phase and 70% during the sustainability phase. Maintenance bundle compliance was 45% and 35% during the intervention and sustainability phases, respectively.

Conclusion: POCQI methods can help increase bundle care compliance in the NICU and reduce CLABSI rates in low- and middle-income country settings.